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Guidelines for sinkhole and subsidence rehabilitation based on generic geological models of a dolomite environment on the East Rand, South Africa

NASA Astrophysics Data System (ADS)

Kleinhans, Ilse; Van Rooy, J. Louis

2016-05-01

A sound understanding of the various factors influencing and associated with the formation of sinkholes or subsidences on dolomite land is essential for the selection of appropriate rehabilitation methods. The investigation and rehabilitation of numerous sinkholes and subsidences located on dolomite in the East Rand of South Africa, created an opportunity to develop a broad based understanding of different karst environments, their susceptibility to sinkhole and subsidence formation and best practice rehabilitation methods. This paper is based on the guidelines developed whereby the geological model of the sinkhole or subsidence is used to recommend an appropriate rehabilitation method. Nine typical geological models with recommended rehabilitation methods are presented in this paper.
How does sagittal imbalance affect the appropriateness of surgical indications and selection of procedure in the treatment of degenerative scoliosis? Findings from the RAND/UCLA Appropriate Use Criteria study.

PubMed

Daubs, Michael D; Brara, Harsimran S; Raaen, Laura B; Chen, Peggy Guey-Chi; Anderson, Ashaunta T; Asch, Steven M; Nuckols, Teryl K

2018-05-01

Degenerative lumbar scoliosis (DLS) is often associated with sagittal imbalance, which may affect patients' health outcomes before and after surgery. The appropriateness of surgery and preferred operative approaches has not been examined in detail for patients with DLS and sagittal imbalance. The goals of this article were to describe what is currently known about the relationship between sagittal imbalance and health outcomes among patients with DLS and to determine how indications for surgery in patients with DLS differ when sagittal imbalance is present. This study included a literature review and an expert panel using the RAND/University of California at Los Angeles (UCLA) Appropriateness Method. To develop appropriate use criteria for DLS, researchers at the RAND Corporation recently employed the RAND/UCLA Appropriateness Method, which involves a systematic review of the literature and multidisciplinary expert panel process. Experts reviewed a synopsis of published literature and rated the appropriateness of five common operative approaches for 260 different clinical scenarios. In the present work, we updated the literature review and compared panelists' ratings in scenarios where imbalance was present versus absent. This work was funded by the Collaborative Spine Research Foundation, a group of surgical specialty societies and device manufacturers. On the basis of 13 eligible studies that examined sagittal imbalance and outcomes in patients with DLS, imbalance was associated with worse functional status in the absence of surgery and worse symptoms and complications postoperatively. Panelists' ratings demonstrated a consistent pattern across the diverse clinical scenarios. In general, when imbalance was present, surgery was more likely to be appropriate or necessary, including in some situations where surgery would otherwise be inappropriate. For patients with moderate to severe symptoms and imbalance, a deformity correction procedure was usually appropriate and frequently necessary, except in some patients with severe risk factors for complications. Conversely, procedures that did not correct imbalance, when present, were usually inappropriate. Clinical experts agreed that sagittal imbalance is a major factor affecting both when surgery is appropriate and which type of procedure is preferred among patients with DLS. Copyright © 2018 Elsevier Inc. All rights reserved.
Developing a policy guidance for financing dental care in Iran using the RAND Appropriateness Method.

PubMed

Jadidfard, M P; Yazdani, S; Khoshnevisan, M H

2013-12-01

This study aimed to provide recommendations on health care financing with special emphasis on dental care. The RAND Appropriateness Method was employed to obtain the collective opinion of a multidisciplinary panel of experts on a set of recommendation statements regarding Iranian dental care financing. An initial set of recommendations were identified from a literature review. Panel members, selected purposively and by peer nomination, each rated the appropriateness and necessity of the recommendations in a structured process of two rounds. Each recommendation was classified as inappropriate, uncertain, appropriate but not necessary, or appropriate and necessary according to the median rating score and the level of disagreement among the panellists. Of 28 initial recommendations, 25 were agreed on as appropriate, of which 22 were considered as necessary. Altogether, these recommendations provide a holistic picture of an oral health system's financing in three domains: revenue collection, pooling of revenues and purchasing of dental services. The policy guidance recommendations are intended to provide the Iranian oral health authorities with an evidence-base for financing dental care. The recommendations may be transferrable, at least in part, particularly to developing countries with similar hybrid health system structures. Finally, the method used to develop the recommendations can serve as a model for use elsewhere.
Identification of an updated set of prescribing-safety indicators for GPs

PubMed Central

Spencer, Rachel; Bell, Brian; Avery, Anthony J; Gookey, Gill; Campbell, Stephen M

2014-01-01

Background Medication error is an important contributor to patient morbidity and mortality and is associated with inadequate patient safety measures. However, prescribing-safety tools specifically designed for use in general practice are lacking. Aim To identify and update a set of prescribing-safety indicators for assessing the safety of prescribing in general practice, and to estimate the risk of harm to patients associated with each indicator. Design and setting RAND/UCLA consensus development of indicators in UK general practice. Method Prescribing indicators were identified from a systematic review and previous consensus exercise. The RAND Appropriateness Method was used to further identify and develop the indicators with an electronic-Delphi method used to rate the risk associated with them. Twelve GPs from all the countries of the UK participated in the RAND exercise, with 11 GPs rating risk using the electronic-Delphi approach. Results Fifty-six prescribing-safety indicators were considered appropriate for inclusion (overall panel median rating of 7–9, with agreement). These indicators cover hazardous prescribing across a range of therapeutic indications, hazardous drug–drug combinations and inadequate laboratory test monitoring. Twenty-three (41%) of these indicators were considered high risk or extreme risk by 80% or more of the participants. Conclusion This study identified a set of 56 indicators that were considered, by a panel of GPs, to be appropriate for assessing the safety of GP prescribing. Twenty-three of these indicators were considered to be associated with high or extreme risk to patients and should be the focus of efforts to improve patient safety. PMID:24686882
Development and validation of Australian aphasia rehabilitation best practice statements using the RAND/UCLA appropriateness method.

PubMed

Power, Emma; Thomas, Emma; Worrall, Linda; Rose, Miranda; Togher, Leanne; Nickels, Lyndsey; Hersh, Deborah; Godecke, Erin; O'Halloran, Robyn; Lamont, Sue; O'Connor, Claire; Clarke, Kim

2015-07-02

To develop and validate a national set of best practice statements for use in post-stroke aphasia rehabilitation. Literature review and statement validation using the RAND/UCLA Appropriateness Method (RAM). A national Community of Practice of over 250 speech pathologists, researchers, consumers and policymakers developed a framework consisting of eight areas of care in aphasia rehabilitation. This framework provided the structure for the development of a care pathway containing aphasia rehabilitation best practice statements. Nine speech pathologists with expertise in aphasia rehabilitation participated in two rounds of RAND/UCLA appropriateness ratings of the statements. Panellists consisted of researchers, service managers, clinicians and policymakers. Statements that achieved a high level of agreement and an overall median score of 7-9 on a nine-point scale were rated as 'appropriate'. 74 best practice statements were extracted from the literature and rated across eight areas of care (eg, receiving the right referrals, providing intervention). At the end of Round 1, 71 of the 74 statements were rated as appropriate, no statements were rated as inappropriate, and three statements were rated as uncertain. All 74 statements were then rated again in the face-to-face second round. 16 statements were added through splitting existing items or adding new statements. Seven statements were deleted leaving 83 statements. Agreement was reached for 82 of the final 83 statements. This national set of 82 best practice statements across eight care areas for the rehabilitation of people with aphasia is the first to be validated by an expert panel. These statements form a crucial component of the Australian Aphasia Rehabilitation Pathway (AARP) (http://www.aphasiapathway.com.au) and provide the basis for more consistent implementation of evidence-based practice in stroke rehabilitation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Development and validation of Australian aphasia rehabilitation best practice statements using the RAND/UCLA appropriateness method

PubMed Central

Power, Emma; Thomas, Emma; Worrall, Linda; Rose, Miranda; Togher, Leanne; Nickels, Lyndsey; Hersh, Deborah; Godecke, Erin; O'Halloran, Robyn; Lamont, Sue; O'Connor, Claire; Clarke, Kim

2015-01-01

Objectives To develop and validate a national set of best practice statements for use in post-stroke aphasia rehabilitation. Design Literature review and statement validation using the RAND/UCLA Appropriateness Method (RAM). Participants A national Community of Practice of over 250 speech pathologists, researchers, consumers and policymakers developed a framework consisting of eight areas of care in aphasia rehabilitation. This framework provided the structure for the development of a care pathway containing aphasia rehabilitation best practice statements. Nine speech pathologists with expertise in aphasia rehabilitation participated in two rounds of RAND/UCLA appropriateness ratings of the statements. Panellists consisted of researchers, service managers, clinicians and policymakers. Main outcome measures Statements that achieved a high level of agreement and an overall median score of 7–9 on a nine-point scale were rated as ‘appropriate’. Results 74 best practice statements were extracted from the literature and rated across eight areas of care (eg, receiving the right referrals, providing intervention). At the end of Round 1, 71 of the 74 statements were rated as appropriate, no statements were rated as inappropriate, and three statements were rated as uncertain. All 74 statements were then rated again in the face-to-face second round. 16 statements were added through splitting existing items or adding new statements. Seven statements were deleted leaving 83 statements. Agreement was reached for 82 of the final 83 statements. Conclusions This national set of 82 best practice statements across eight care areas for the rehabilitation of people with aphasia is the first to be validated by an expert panel. These statements form a crucial component of the Australian Aphasia Rehabilitation Pathway (AARP) (http://www.aphasiapathway.com.au) and provide the basis for more consistent implementation of evidence-based practice in stroke rehabilitation. PMID:26137883
Appropriate customization of radiation therapy for stage II and III rectal cancer: Executive summary of an ASTRO Clinical Practice Statement using the RAND/UCLA Appropriateness Method.

PubMed

Goodman, Karyn A; Patton, Caroline E; Fisher, George A; Hoffe, Sarah E; Haddock, Michael G; Parikh, Parag J; Kim, John; Baxter, Nancy N; Czito, Brian G; Hong, Theodore S; Herman, Joseph M; Crane, Christopher H; Hoffman, Karen E

2016-01-01

To summarize results of a Clinical Practice Statement on radiation therapy for stage II-III rectal cancer, which addressed appropriate customization of (neo)adjuvant radiation therapy and use of non-surgical therapy for patients who are inoperable or refuse abdominoperineal resection. The RAND/University of California, Los Angeles, Appropriateness Method was applied to combine current evidence with multidisciplinary expert opinion. A systematic literature review was conducted and used by the expert panel to rate appropriateness of radiation therapy options for different clinical scenarios. Treatments were categorized by median rating as Appropriate, May Be Appropriate, or Rarely Appropriate. In the neoadjuvant setting, chemoradiation was rated Appropriate and the ratings indicated short-course radiation therapy, chemotherapy alone, and no neoadjuvant therapy are potential options in selected patients. However, neoadjuvant endorectal brachytherapy was rated Rarely Appropriate. For adjuvant therapy, chemoradiation (plus ≥4 months of chemotherapy) was rated Appropriate and chemotherapy alone May Be Appropriate for most scenarios. For medically inoperable patients, definitive external beam radiation therapy and chemotherapy alone were rated May Be Appropriate, whereas endorectal brachytherapy and chemoradiation plus endorectal brachytherapy were possible approaches for some scenarios. The last option, definitive chemoradiation, was rated Appropriate to May Be Appropriate based on performance status. Finally, for patients with low-lying tumors refusing abdominoperineal resection, definitive chemoradiation alone, chemoradiation plus endorectal brachytherapy, and chemoradiation plus external beam radiation therapy were all rated Appropriate. This Clinical Practice Statement demonstrated the central role of radiation therapy in stage II-III rectal cancer management and evaluated ways to better individualize its use in the neoadjuvant, adjuvant, and definitive settings. Ongoing trials may clarify areas of continuing uncertainty and allow further customization. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
Validation of prescribing appropriateness criteria for older Australians using the RAND/UCLA appropriateness method

PubMed Central

Basger, Benjamin Joseph; Chen, Timothy Frank; Moles, Rebekah Jane

2012-01-01

Objective To further develop and validate previously published national prescribing appropriateness criteria to assist in identifying drug-related problems (DRPs) for commonly occurring medications and medical conditions in older (≥65 years old) Australians. Design RAND/UCLA appropriateness method. Participants A panel of medication management experts were identified consisting of geriatricians/pharmacologists, clinical pharmacists and disease management advisors to organisations that produce Australian evidence-based therapeutic publications. This resulted in a round-one panel of 15 members, and a round-two panel of 12 members. Main outcome measure Agreement on all criteria. Results Forty-eight prescribing criteria were rated. In the first rating round via email, there was disagreement regarding 17 of the criteria according to median panel ratings. During a face-to-face second round meeting, discussion resulted in retention of 25 criteria after amendments, agreement for 14 criteria with no changes required and deletion of 9 criteria. Two new criteria were added, resulting in a final validated list of 41 prescribing appropriateness criteria. Agreement after round two was reached for all 41 criteria, measured by median panel ratings and the amount of dispersion of panel ratings, based on the interpercentile range. Conclusions A set of 41 Australian prescribing appropriateness criteria were validated by an expert panel. Use of these criteria, together with clinical judgement and other medication review processes such as patient interview, is intended to assist in improving patient care by efficiently detecting potential DRPs related to commonly occurring medicines and medical conditions in older Australians. These criteria may also contribute to the medication management education of healthcare professionals. PMID:22983875
The IRYSS-COPD appropriateness study: objectives, methodology, and description of the prospective cohort

PubMed Central

2011-01-01

Background Patients with chronic obstructive pulmonary disease (COPD) often experience exacerbations of the disease that require hospitalization. Current guidelines offer little guidance for identifying patients whose clinical situation is appropriate for admission to the hospital, and properly developed and validated severity scores for COPD exacerbations are lacking. To address these important gaps in clinical care, we created the IRYSS-COPD Appropriateness Study. Methods/Design The RAND/UCLA Appropriateness Methodology was used to identify appropriate and inappropriate scenarios for hospital admission for patients experiencing COPD exacerbations. These scenarios were then applied to a prospective cohort of patients attending the emergency departments (ED) of 16 participating hospitals. Information was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up after admission or discharge home. While complete data were generally available at the time of ED admission, data were often missing at the time of decision making. Predefined assumptions were used to impute much of the missing data. Discussion The IRYSS-COPD Appropriateness Study will validate the appropriateness criteria developed by the RAND/UCLA Appropriateness Methodology and thus better delineate the requirements for admission or discharge of patients experiencing exacerbations of COPD. The study will also provide a better understanding of the determinants of outcomes of COPD exacerbations, and evaluate the equity and variability in access and outcomes in these patients. PMID:22115318
Appropriate Use of Drug Testing in Clinical Addiction Medicine.

PubMed

Jarvis, Margaret; Williams, Jessica; Hurford, Matthew; Lindsay, Dawn; Lincoln, Piper; Giles, Leila; Luongo, Peter; Safarian, Taleen

: Biological drug testing is a tool that provides information about an individual's recent substance use. Like any tool, its value depends on using it correctly; that is, on selecting the right test for the right person at the right time. This document is intended to clarify appropriate clinical use of drug testing in addiction medicine and aid providers in their decisions about drug testing for the identification, diagnosis, treatment, and recovery of patients with, or at risk for, addiction. The RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) process for combining scientific evidence with the collective judgment of experts was used to identify appropriate clinical practices and highlight areas where research is needed. Although consensus panels and expert groups have offered guidance on the use of drug testing for patients with addiction, very few addressed considerations for patients across settings and in different levels of care. This document will focus primarily on patients in addiction treatment and recovery, where drug testing is used to assess patients for a substance use disorder, monitor the effectiveness of a treatment plan, and support recovery. Inasmuch as the scope includes the recognition of addiction, which often occurs in general healthcare settings, selected special populations at risk for addiction visiting these settings are briefly included.
Fracture healing: a consensus report from the International Osteoporosis Foundation Fracture Working Group.

PubMed

Silverman, S L; Kupperman, E S; Bukata, S V

2016-07-01

We used the RAND UCLA appropriateness method to decide appropriateness of use of osteoporosis medication after incident fracture and potential for fracture healing and make suggestions for trial design for clinical and preclinical research. To develop appropriateness criteria to assist in the use and study of osteoporosis medications in patients with recent fracture and in the potential use of osteoporosis medications to enhance delayed fracture healing. To promote further research by suggesting preclinical and clinical trial design for studies where fracture healing is the endpoint. RAND/UCLA appropriateness method (RUAM). A panel of experts, both members and non-members of the International Osteoporosis Foundation Fracture Working Group, were identified consisting of geriatricians, rheumatologists, orthopedists, endocrinologists, and internists. This resulted in a round 1 panel of 15 panelists, round 2 panel of 15 members, and a round 3 panel of 14 members. Agreement on statements and scenarios using RUAM. Three rounds of voting by panelists took place. Agreement in a third round was reached for 111 statements and scenarios, measured by median panel ratings and the amount of dispersion of panel ratings, based on the interpercentile range. An expert panel validated a set of statements and scenarios about the use of osteoporosis medications after incident fracture and use of these medications to enhance delayed fracture healing and made recommendations for study designs to investigate the effect of osteoporosis medications on fracture healing. The result of this exercise is intended to assist in improving patient care by identifying the appropriateness of use of osteoporosis medications after fracture and in fracture healing and to make suggestions for further preclinical and clinical research.
Theory and Methods for Supporting High Level Military Decisionmaking

DTIC Science & Technology

2007-01-01

the possible effects of operations. Our definition goes beyond that used by statisticians, i.e., that deep uncertainty exists when one does not know...example, (1) suppress 1 The literature on decisionmaking and decisionmaking theory is voluminous. An earlier RAND study led by one of the authors (Davis...path on the right side, building a rolling plan with appropriate tactical options. However, insert a process of creative critical review,
ACR Appropriateness Criteria® Chronic Ankle Pain.

PubMed

Chang, Eric Y; Tadros, Anthony S; Amini, Behrang; Bell, Angela M; Bernard, Stephanie A; Fox, Michael G; Gorbachova, Tetyana; Ha, Alice S; Lee, Kenneth S; Metter, Darlene F; Mooar, Pekka A; Shah, Nehal A; Singer, Adam D; Smith, Stacy E; Taljanovic, Mihra S; Thiele, Ralf; Kransdorf, Mark J

2018-05-01

Chronic ankle pain is a common clinical problem whose cause is often elucidated by imaging. The ACR Appropriateness Criteria for chronic ankle pain define best practices of image ordering. Clinical scenarios are followed by the imaging choices and their appropriateness. The information is in ordered tables with an accompanying narrative explanation to guide physicians to order the right test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.
ACR Appropriateness Criteria® Chronic Hip Pain.

PubMed

Mintz, Douglas N; Roberts, Catherine C; Bencardino, Jenny T; Baccei, Steven J; Caird, Michelle S; Cassidy, R Carter; Chang, Eric Y; Fox, Michael G; Gyftopoulos, Soterios; Kransdorf, Mark J; Metter, Darlene F; Morrison, William B; Rosenberg, Zehava S; Shah, Nehal A; Small, Kirstin M; Subhas, Naveen; Tambar, Siddharth; Towers, Jeffrey D; Yu, Joseph S; Weissman, Barbara N

2017-05-01

Chronic hip pain is a common clinical problem whose cause is often elucidated by imaging. The ACR Appropriateness Criteria for chronic hip pain define best practices of image ordering. Clinical scenarios are followed by the imaging choices and their appropriateness. The information is in ordered tables with an accompanying narrative explanation to guide physicians to order the right test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Portfolio-Analysis Methods for Assessing Capability Options

DTIC Science & Technology

2008-01-01

available from www.rand.org as a public service of the RAND Corporation. 6Jump down to document THE ARTS CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY AND...knowledge; (4) time; (5) the psychological context resulting from other contemporary events; (6) the format of presen- tation (briefing, discussion...TERRORISM AND HOMELAND SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research organization
Organizing complexity: the hopeful dreams and harsh realities of interdisciplinary collaboration at the rand corporation in the early cold war.

PubMed

Bessner, Daniel

2015-01-01

Historians argue that in the early Cold War an interdisciplinary research culture defined the RAND Corporation. However, a significant epistemological gap divided the members of RAND's Social Science Division (SSD) from the rest of the organization. While the social scientists used qualitative methods, most RAND researchers embraced quantified approaches and derided the social sciences as unscientific. This encouraged RAND's social scientists to develop a political-military simulation that embraced everything-politics, culture, and psychology-that RAND's other analysts largely ignored. Yet the fact that the SSD embraced gaming, a heuristic practiced throughout RAND, suggests that the political simulation was nonetheless inspired by social scientists' engagement with their colleagues. This indicates that the concept of interdisciplinarity should move beyond its implication of collaboration to incorporate instances in which research agendas are defined against but also shaped by colleagues in other disciplines. Such a rethinking of the term may make it possible to trace how varieties of interdisciplinary interaction historically informed knowledge production. © 2014 Wiley Periodicals, Inc.
Development of a model for integrated care at the end of life in advanced dementia: A whole systems UK-wide approach

PubMed Central

Jones, Louise; Candy, Bridget; Davis, Sarah; Elliott, Margaret; Gola, Anna; Harrington, Jane; Kupeli, Nuriye; Lord, Kathryn; Moore, Kirsten; Scott, Sharon; Vickerstaff, Victoria; Omar, Rumana Z; King, Michael; Leavey, Gerard; Nazareth, Irwin; Sampson, Elizabeth L

2015-01-01

Background: The prevalence of dementia is rising worldwide and many people will die with the disease. Symptoms towards the end of life may be inadequately managed and informal and professional carers poorly supported. There are few evidence-based interventions to improve end-of-life care in advanced dementia. Aim: To develop an integrated, whole systems, evidence-based intervention that is pragmatic and feasible to improve end-of-life care for people with advanced dementia and support those close to them. Design: A realist-based approach in which qualitative and quantitative data assisted the development of statements. These were incorporated into the RAND/UCLA appropriateness method to achieve consensus on intervention components. Components were mapped to underlying theory of whole systems change and the intervention described in a detailed manual. Setting/participants: Data were collected from people with dementia, carers and health and social care professionals in England, from expert opinion and existing literature. Professional stakeholders in all four countries of the United Kingdom contributed to the RAND/UCLA appropriateness method process. Results: A total of 29 statements were agreed and mapped to individual, group, organisational and economic/political levels of healthcare systems. The resulting main intervention components are as follows: (1) influencing local service organisation through facilitation of integrated multi-disciplinary care, (2) providing training and support for formal and informal carers and (3) influencing local healthcare commissioning and priorities of service providers. Conclusion: Use of in-depth data, consensus methods and theoretical understanding of the intervention components produced an evidence-based intervention for further testing in end-of-life care in advanced dementia. PMID:26354388
ACR Appropriateness Criteria® Headache-Child.

PubMed

Hayes, Laura L; Palasis, Susan; Bartel, Twyla B; Booth, Timothy N; Iyer, Ramesh S; Jones, Jeremy Y; Kadom, Nadja; Milla, Sarah S; Myseros, John S; Pakalnis, Ann; Partap, Sonia; Robertson, Richard L; Ryan, Maura E; Saigal, Gaurav; Soares, Bruno P; Tekes, Aylin; Karmazyn, Boaz K

2018-05-01

Headaches in children are not uncommon and have various causes. Proper neuroimaging of these children is very specific to the headache type. Care must be taken to choose and perform the most appropriate initial imaging examination in order to maximize the ability to properly determine the cause with minimum risk to the child. This evidence-based report discusses the different headache types in children and provides appropriate guidelines for imaging these children. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Evaluating Questionnaires Used to Assess Self-Reported Physical Activity and Psychosocial Outcomes Among Survivors of Adolescent and Young Adult Cancer: A Cognitive Interview Study.

PubMed

Wurz, Amanda; Brunet, Jennifer

2017-09-01

Physical activity is increasingly being studied as a way to improve psychosocial outcomes (e.g., quality of life, self-efficacy, physical self-perceptions, self-esteem, body image, posttraumatic growth) among survivors of adolescent and young adult (AYA) cancer. Assessing levels of and associations between self-reported physical activity and psychosocial outcomes requires clear, appropriate, and relevant questionnaires. To explore how survivors of AYA cancer interpreted and responded to the following eight published questionnaires: Leisure Time Exercise Questionnaire, Exercise Self-Efficacy Scale, Physical Self-Description Questionnaire, Rosenberg Global Self-Esteem Scale, Multidimensional Body-Self Relations Questionnaire, Posttraumatic Growth Inventory, Functional Assessment of Cancer Therapy-General (FACT-G), RAND 36-Item Health Survey 1.0 (RAND-36), cognitive interviews were conducted with three men and four women age 18-36 years who were diagnosed with cancer at age 16-35 years. Initially, the first seven questionnaires listed above were assessed. Summaries of the interviews were prepared and compared across participants. Potential concerns were identified with the FACT-G; thus, a second interview was conducted with participants to explore the clarity, appropriateness, and relevance of the RAND-36. Concerns identified for the FACT-G related mostly to the lack of relevance of items pertaining to cancer-specific aspects of quality of life given that participants were posttreatment. No or few concerns related to comprehension and/or structure/logic were identified for the other questionnaires. In general, the questionnaires assessed were clear, appropriate, and relevant. Participants' feedback suggested they could be used to assess self-reported physical activity and varied psychosocial outcomes in studies with survivors of AYA cancer, either with or without slight modifications.
A simulation based approach to optimize inventory replenishment with RAND algorithm: An extended study of corrected demand using Holt's method for textile industry

NASA Astrophysics Data System (ADS)

Morshed, Mohammad Sarwar; Kamal, Mostafa Mashnoon; Khan, Somaiya Islam

2016-07-01

Inventory has been a major concern in supply chain and numerous researches have been done lately on inventory control which brought forth a number of methods that efficiently manage inventory and related overheads by reducing cost of replenishment. This research is aimed towards providing a better replenishment policy in case of multi-product, single supplier situations for chemical raw materials of textile industries in Bangladesh. It is assumed that industries currently pursue individual replenishment system. The purpose is to find out the optimum ideal cycle time and individual replenishment cycle time of each product for replenishment that will cause lowest annual holding and ordering cost, and also find the optimum ordering quantity. In this paper indirect grouping strategy has been used. It is suggested that indirect grouping Strategy outperforms direct grouping strategy when major cost is high. An algorithm by Kaspi and Rosenblatt (1991) called RAND is exercised for its simplicity and ease of application. RAND provides an ideal cycle time (T) for replenishment and integer multiplier (ki) for individual items. Thus the replenishment cycle time for each product is found as T×ki. Firstly, based on data, a comparison between currently prevailing (individual) process and RAND is provided that uses the actual demands which presents 49% improvement in total cost of replenishment. Secondly, discrepancies in demand is corrected by using Holt's method. However, demands can only be forecasted one or two months into the future because of the demand pattern of the industry under consideration. Evidently, application of RAND with corrected demand display even greater improvement. The results of this study demonstrates that cost of replenishment can be significantly reduced by applying RAND algorithm and exponential smoothing models.

A protocol for a scoping and qualitative study to identify and evaluate indications for damage control surgery and damage control interventions in civilian trauma patients

PubMed Central

Roberts, Derek J; Zygun, David A; Kirkpatrick, Andrew W; Ball, Chad G; Faris, Peter D; Bobrovitz, Niklas; Robertson, Helen Lee; Stelfox, H Thomas

2014-01-01

Introduction Initial abbreviated surgery with planned reoperation (damage control surgery) is frequently used for major trauma patients to rapidly control haemorrhage while limiting surgical stress. Although damage control surgery may decrease mortality risk among the severely injured, it may also be associated with several complications when inappropriately applied. We seek to scope the literature on trauma damage control surgery, identify its proposed indications, map and clarify their definitions, and examine the content and evidence on which they are based. We also seek to generate a comprehensive list of unique indications to inform an appropriateness rating process. Methods and analysis We will search 11 electronic bibliographic databases, included article bibliographies and grey literature sources for citations involving civilian trauma patients that proposed one or more indications for damage control surgery or a damage control intervention. Indications will be classified into a predefined conceptual framework and categorised and described using qualitative content analysis. Constant comparative methodology will be used to create, modify and test codes describing principal findings or injuries (eg, bilobar liver injury) and associated decision variables (eg, coagulopathy) that comprise the reported indications. After a unique list of codes have been developed, we will use the organisational system recommended by the RAND/University of California, Los Angeles (RAND-UCLA) Appropriateness Rating Method to group principal findings or injuries into chapters (subdivided by associated decision variables) according to broader clinical findings encountered during surgical practice (eg, major liver injury). Ethics and dissemination This study will constitute the first step in a multistep research programme aimed at developing appropriate, evidence-informed indications for damage control in civilian trauma patients. With use of an integrated knowledge translation intervention that includes collaboration with surgical practice leaders, this research may allow for development of indications that are more likely to be relevant to and used by surgeons. Ethics approval is not required for this study. PMID:25001397
Testing an Adapted Modified Delphi Method: Synthesizing Multiple Stakeholder Ratings of Health Care Service Effectiveness.

PubMed

Escaron, Anne L; Chang Weir, Rosy; Stanton, Petra; Vangala, Sitaram; Grogan, Tristan R; Clarke, Robin M

2016-03-01

The Affordable Care Act incentivizes health systems for better meeting patient needs, but often guidance about patient preferences for particular health services is limited. All too often vulnerable patient populations are excluded from these decision-making settings. A community-based participatory approach harnesses the in-depth knowledge of those experiencing barriers to health care. We made three modifications to the RAND-UCLA appropriateness method, a modified Delphi approach, involving patients, adding an advisory council group to characterize existing knowledge in this little studied area, and using effectiveness rather than "appropriateness" as the basis for rating. As a proof of concept, we tested this method by examining the broadly delivered but understudied nonmedical services that community health centers provide. This method created discrete, new knowledge about these services by defining 6 categories and 112 unique services and by prioritizing among these services based on effectiveness using a 9-point scale. Consistent with the appropriateness method, we found statistical convergence of ratings among the panelists. Challenges include time commitment and adherence to a clear definition of effectiveness of services. This diverse stakeholder engagement method efficiently addresses gaps in knowledge about the effectiveness of health care services to inform population health management. © 2015 Society for Public Health Education.
A Flexible and Integrated System for the Remote Acquisition of Neuropsychological Data in Stroke Research

PubMed Central

Durisko, Corrine; McCue, Michael; Doyle, Patrick J.; Dickey, Michael Walsh

2016-01-01

Abstract Background: Neuropsychological testing is a central aspect of stroke research because it provides critical information about the cognitive-behavioral status of stroke survivors, as well as the diagnosis and treatment of stroke-related disorders. Standard neuropsychological methods rely upon face-to-face interactions between a patient and researcher, which creates geographic and logistical barriers that impede research progress and treatment advances. Introduction: To overcome these barriers, we created a flexible and integrated system for the remote acquisition of neuropsychological data (RAND). The system we developed has a secure architecture that permits collaborative videoconferencing. The system supports shared audiovisual feeds that can provide continuous virtual interaction between a participant and researcher throughout a testing session. Shared presentation and computing controls can be used to deliver auditory and visual test items adapted from standard face-to-face materials or execute computer-based assessments. Spoken and manual responses can be acquired, and the components of the session can be recorded for offline data analysis. Materials and Methods: To evaluate its feasibility, our RAND system was used to administer a speech-language test battery to 16 stroke survivors with a variety of communication, sensory, and motor impairments. The sessions were initiated virtually without prior face-to-face instruction in the RAND technology or test battery. Results: Neuropsychological data were successfully acquired from all participants, including those with limited technology experience, and those with a communication, sensory, or motor impairment. Furthermore, participants indicated a high level of satisfaction with the RAND system and the remote assessment that it permits. Conclusions: The results indicate the feasibility of using the RAND system for virtual home-based neuropsychological assessment without prior face-to-face contact between a participant and researcher. Because our RAND system architecture uses off-the-shelf technology and software, it can be duplicated without specialized expertise or equipment. In sum, our RAND system offers a readily available and promising alternative to face-to-face neuropsychological assessment in stroke research. PMID:27214198
The Foundations of Operational Resilience Assessing the Ability to Operate in an Anti-Access/Area Denial (A2/AD) Environment: The Analytical Framework, Lexicon, and Characteristics of the Operational Resilience Analysis Model (ORAM)

DTIC Science & Technology

2016-07-07

engineering (CCE) methods, such as aggregate crater fill and laying replacement concrete. [RAND] • Level 2: CCE plus the use of folded fiberglass ( FFM ...or aluminum mats (e.g., AM-2). [RAND] • Level 3: CCE, FFMs , and Critical Runway Assessment and Repair (CRATR) teams. [RAND] Recovery. In air...CSG carrier strike group CTA central terminal area DCA defensive counterair DoD U.S. Department of Defense FFM folded fiber mats FOB forward
Paying for War: Funding U.S. Military Operations Since 2001

DTIC Science & Technology

2011-08-01

of the RAND Corporation. CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE INFRASTRUCTURE AND...Requests and Appropriations, Less Defense Health .......................................................37 3.5. Difference between Investment...chapter concludes the dissertation with some policy recommendations directed towards the executive and legislative branches designed to moderate budgetary
ACR Appropriateness Criteria® Colorectal Cancer Screening.

PubMed

Moreno, Courtney; Kim, David H; Bartel, Twyla B; Cash, Brooks D; Chang, Kevin J; Feig, Barry W; Fowler, Kathryn J; Garcia, Evelyn M; Kambadakone, Avinash R; Lambert, Drew L; Levy, Angela D; Marin, Daniele; Peterson, Christine M; Scheirey, Christopher D; Smith, Martin P; Weinstein, Stefanie; Carucci, Laura R

2018-05-01

This review summarizes the relevant literature regarding colorectal screening with imaging. For individuals at average or moderate risk for colorectal cancer, CT colonography is usually appropriate for colorectal cancer screening. After positive results on a fecal occult blood test or immunohistochemical test, CT colonography is usually appropriate for colorectal cancer detection. For individuals at high risk for colorectal cancer (eg, hereditary nonpolyposis colorectal cancer, ulcerative colitis, or Crohn colitis), optical colonoscopy is preferred because of its ability to obtain biopsies to detect dysplasia. After incomplete colonoscopy, CT colonography is usually appropriate for colorectal cancer screening for individuals at average, moderate, or high risk. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Attitude orientation control for a spinning satellite

NASA Astrophysics Data System (ADS)

Frost, Gerald

The Department of the Air Force, Headquarters Space Systems Division, and the National Aeronautics and Space Administration (NASA) are currently involved in litigation with Hughes Aircraft Company over the alledged infringement of the 'Williams patent,' which describes a method for attitude control of a spin-stabilized vehicle. Summarized here is pre-1960 RAND work on this subject and information obtained from RAND personnel knowledgeable on this subject. It was concluded that there is no RAND documentation that directly parallels the 'Williams patent' concept. Also, the TIROS II magnetic torque attitude control method is reviewed. The TIROS II meteorological satellite, launched on November 23, 1960, incorporated a magnetic actuation system for spin axis orientation control. The activation system was ground controlled to orient the satellite spin axis to obtain the desired pointing direction for optical and infrared sensor subsystems.
Economic Implications of Changes in Financing Medical Education. The Rand Paper Series P-5150.

ERIC Educational Resources Information Center

Koehler, John E.; Williams, Albert P., Jr.

To increase the supply of doctors, the government has become directly involved in physician education. Of the $673 million appropriated for health manpower programs in 1972, 55% was for medical schools. Legislation to date has emphasized expansion of medical education output in the aggregate, but increasing attention has been directed to the…
Reliability of clinical guideline development using mail-only versus in-person expert panels.

PubMed

Washington, Donna L; Bernstein, Steven J; Kahan, James P; Leape, Lucian L; Kamberg, Caren J; Shekelle, Paul G

2003-12-01

Clinical practice guidelines quickly become outdated. One reason they might not be updated as often as needed is the expense of collecting expert judgment regarding the evidence. The RAND-UCLA Appropriateness Method is one commonly used method for collecting expert opinion. We tested whether a less expensive, mail-only process could substitute for the standard in-person process normally used. We performed a 4-way replication of the appropriateness panel process for coronary revascularization and hysterectomy, conducting 3 panels using the conventional in-person method and 1 panel entirely by mail. All indications were classified as inappropriate or not (to evaluate overuse), and coronary revascularization indications were classified as necessary or not (to evaluate underuse). Kappa statistics were calculated for the comparison in ratings from the 2 methods. Agreement beyond chance between the 2 panel methods ranged from moderate to substantial. The kappa statistic to detect overuse was 0.57 for coronary revascularization and 0.70 for hysterectomy. The kappa statistic to detect coronary revascularization underuse was 0.76. There were no cases in which coronary revascularization was considered inappropriate by 1 method, but necessary or appropriate by the other. Three of 636 (0.5%) hysterectomy cases were categorized as inappropriate by 1 method but appropriate by the other. The reproducibility of the overuse and underuse assessments from the mail-only compared with the conventional in-person conduct of expert panels in this application was similar to the underlying reproducibility of the process. This suggests a potential role for updating guidelines using an expert judgment process conducted entirely through the mail.
Middle Miocene Displacement Along the Rand Detachment Fault, Rand Mountains

NASA Astrophysics Data System (ADS)

Shulaker, D. Z.; Grove, M. J.

2015-12-01

Laramide flat-slab subduction extinguished Sierra Nevada pluton emplacement in southern California by ca. 85 Ma as trench-derived sediments were underthrust and accreted beneath arc basement. These relationships are well illustrated in the Rand Mountains, situated just south of the Garlock fault in the northwestern Mojave Desert. Here, accreted rocks within the Rand Mountains are referred to as Rand Schist. The Rand Detachment fault juxtaposes Rand Schist beneath 87 Ma Sierran granitoids. New zircon (U-Th)/He age results from schist and basement juxtaposed across the Rand Detachment fault are 15 ± 3 Ma and 30 ± 5 Ma, respectively. When considered within the context of previously reported thermochronology from the Rand Mountains, our data shows that the Rand Detachment fault in the Rand Mountains is a middle Miocene fault that facilitated extension of the northwest Mojave Desert. This timing is in temporal and spatial agreement with regional extension throughout the Mojave triggered by northern migration of the slab window after collision of the Mendocino Triple Junction with the southern California margin. Further evidence of slab-window-related magmatism in the easternmost Rand Mountains is provided by the 19 Ma Yellow Aster pluton and 19 Ma rhyolite porphyry. It is possible that Miocene extension re-activated an older structure within the Rand Mountains. For example, a similar low-angle fault juxtaposing schist and basement present in the San Emigdio Mountains is believed to have accommodated large scale Late Cretaceous displacement, exhuming Rand Schist and overlying deepest Sierran basement to shallow crustal levels by 77 Ma [1]. However, 68-72 Ma phengite cooling ages and other thermochronology from the Rand Mountains indicates that any pre-Miocene extension in this area must postdate that in the San Emigdio Mountains. [1] Chapman et al., 2012. Geosphere, 8, 314-341.
Review and Evaluation of the VA Enrollee Health Care Projection Model

DTIC Science & Technology

2008-01-01

prohibited. RAND PDFs are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research ...Visit RAND at www.rand.org Explore the RAND Center for Military Health Policy Research View document details For More Information This PDF document was...SUBSTANCE ABUSE TERRORISM AND HOMELAND SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research
Improving Army Basic Research: Report of an Expert Panel on the Future of Army Laboratories

DTIC Science & Technology

2012-01-01

commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under...complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND documents to a non-RAND website is prohibited. RAND...Inspired senior scientists and technologists with vision will be essential in research as well as in the design , development, evaluation, and
Assessing the Cost-Effectiveness of Modernizing the KC-10 to Meet Global Air Traffic Management Mandates

DTIC Science & Technology

2009-01-01

representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND PDFs to a non-RAND Web site is...duplicated for commercial purposes. Unauthorized posting of RAND documents to a non-RAND Web site is prohibited. RAND documents are protected under...Employment; Manpower, Personnel, and Train- ing; Resource Management; and Strategy and Doctrine. Additional information about PAF is available on our Web
Reflecting Warfighter Needs in Air Force Programs: Prototype Analysis

DTIC Science & Technology

2010-01-01

representation of RAND intellectual property is provided for non -commercial use only. Unauthorized posting of RAND PDFs to a non -RAND Web site is prohibited...duplicated for commercial purposes. Unauthorized posting of RAND documents to a non -RAND website is prohibited. RAND documents are protected under...Secretary of Defense for Acqui- sition, Technology, and Logistics (USD/AT&L). Step One is to sharpen understanding of the mission area and its seams
Development of Hospital-Based Guidelines for Skeletal Survey in Young Children With Bruises

PubMed Central

Fakeye, Oludolapo; Mondestin, Valerie; Rubin, David M.; Localio, Russell; Feudtner, Chris

2015-01-01

OBJECTIVE: To develop guidelines for performing an initial skeletal survey (SS) for children <24 months of age presenting with bruising in the hospital setting, combining available evidence with expert opinion. METHODS: Applying the Rand/UCLA Appropriateness Method, a multispecialty panel of 10 experts relied on evidence from the literature and their own clinical expertise in rating the appropriateness of performing SS for 198 clinical scenarios characterizing children <24 months old with bruising. After a moderated discussion of initial ratings, the scenarios were revised. Panelists re-rated SS appropriateness for 219 revised scenarios. For the 136 clinical scenarios in which SS was deemed appropriate, the panel finally assessed the necessity of SS. RESULTS: Panelists agreed that SS is “appropriate” for 62% (136/219) of scenarios, and “inappropriate” for children ≥12 months old with nonpatterned bruising on bony prominences. Panelists agreed that SS is “necessary” for 95% (129/136) of the appropriate scenarios. SS was deemed necessary for infants <6 months old regardless of bruise location, with rare exceptions, but the necessity of SS in older children depends on bruise location. According to the panelists, bruising on the cheek, eye area, ear, neck, upper arm, upper leg, hand, foot, torso, buttock, or genital area necessitates SS in children <12 months. CONCLUSIONS: The appropriateness and necessity of SS in children presenting for care to the hospital setting with bruising, as determined by a diverse panel of experts, depends on age of the child and location of bruising. PMID:25601982
A Systematic Process to Facilitate Evidence-Informed Decisionmaking Regarding Program Expansion. The RAND Toolkit, Volume 3

DTIC Science & Technology

2014-01-01

provided for non - commercial use only. Unauthorized posting of RAND electronic documents to a non -RAND website is prohibited. RAND electronic documents...documents to a non -RAND website is prohibited. RAND documents are protected under copyright law. Permission is given to duplicate this document for...the DoD-wide decisionmaking board to focus their review efforts on larger programs or those that function in multiple branches of service, as well as
Diagnostic triage and the role of natriuretic peptide testing and echocardiography for suspected heart failure: an appropriateness ratings evaluation by UK GPs

PubMed Central

Campbell, Stephen M; Fuat, Ahmet; Summerton, Nick; Lancaster, Neil; Hobbs, FD Richard

2011-01-01

Background Some UK GPs are acquiring access to natriuretic peptide (NP) testing or echocardiography as diagnostic tests for heart failure. This study developed appropriateness ratings for the diagnostic application of these tests in routine general practice. Aim To develop appropriateness ratings for the diagnostic application of NP testing or echocardiography for heart failure in general practice. Design and setting An appropriateness ratings evaluation in UK general practice. Method Four presenting symptoms (cough, bilateral ankle swelling, dyspnoea, fatigue), three levels of risk of cardiovascular disease (low, intermediate, high), and dichotomous categorisations of cardiovascular/chest examination and electrocardiogram result, were used to create 540 appropriateness scenarios for patients in whom NP testing or echocardiography might be considered. These were rated by a 10-person expert panel, consisting of GPs and GPs with specialist interests in cardiology, in a two-round RAND Appropriateness Method. Results Onward referral for NP testing or echocardiography was rated as an appropriate next step in 217 (40.2%) of the 540 scenarios; in 194 (35.9%) it was rated inappropriate. The ratings also show where NP testing or echocardiography were ranked as equivalent next steps and when one test was seen as the more appropriate than the other. Conclusion NP testing should be the routine test for suspected heart failure where referral for diagnostic testing is considered appropriate. An abnormal electrocardiogram status makes referral to echocardiography an accompanying, or more appropriate, next step alongside NP testing, especially in the presence of dyspnoea. Abnormal NP testing should subsequently be followed up with referral for echocardiography. PMID:21722451
ACR Appropriateness Criteria® Abdominal Aortic Aneurysm: Interventional Planning and Follow-Up.

PubMed

Francois, Christopher J; Skulborstad, Erik P; Majdalany, Bill S; Chandra, Ankur; Collins, Jeremy D; Farsad, Khashayar; Gerhard-Herman, Marie D; Gornik, Heather L; Kendi, A Tuba; Khaja, Minhajuddin S; Lee, Margaret H; Sutphin, Patrick D; Kapoor, Baljendra S; Kalva, Sanjeeva P

2018-05-01

Abdominal aortic aneurysms (AAAs) are a relatively common vascular problem that can be treated with either open, surgical repair or endovascular aortic aneurysm repair (EVAR). Both approaches to AAA repair require dedicated preoperative imaging to minimize adverse outcomes. After EVAR, cross-sectional imaging has an integral role in confirming the successful treatment of the AAA and early detection of complications related to EVAR. CT angiography is the primary imaging modality for both preoperative planning and follow-up after repair. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Promoting International Energy Security. Volume 3: Sea-Lanes to Asia

DTIC Science & Technology

2012-01-01

commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under...copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use . For...trademark. © Copyright 2012 RAND Corporation Permission is given to duplicate this document for personal use only, as long as it is unaltered and
Leveraging Observations of Security Force Assistance in Afghanistan for Global Operations

DTIC Science & Technology

2013-01-01

commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under...copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use . For...contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of

Assessment of Beddown Alternatives for the F-35

DTIC Science & Technology

2013-01-01

For More Information Visit RAND at www.rand.org Explore the RAND Corporation View document details Support RAND Purchase this document Browse Reports...copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information ...HOMELAND SECURITY Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to
Assessment of the Content, Design, and Dissemination of the Real Warriors Campaign

DTIC Science & Technology

2012-01-01

by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non...commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under...copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For
Developing Headquarters Guidance for Army Installation Sustainability Plans in 2007

DTIC Science & Technology

2009-01-01

Make a charitable contribution Support RAND This PDF document was made available from www.rand.org as a public service of the RAND Corporation . Jump...down to document The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the...6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) RAND Corporation ,1776 Main
Managing Technological Change: The Process is Key

DTIC Science & Technology

1989-01-01

research results. The RAND Note reports other outputs of sponsored research for general distri- bution. Publications of The RAND Corporation do not...necessarily reflect the opinions or policies of the sponsors of RAND research. Published by The RAND Corporation 1700 Main Street, P.O. Box 2138, Santa...Procedures in Office Settings: Influences and Outcomes, The RAND Corporation , R-3077-NSF/IRIS, October 1987. Bikson, T.K., C. Stasz, and D. A. Mankin, Computer
Supporting Air and Space Expeditionary Forces: Analysis of Combat Support Basing Options

DTIC Science & Technology

2004-01-01

Brooke et al., 2003. 13 For more information on Set Covering models, see Daskin , 1995. Analysis Methodology 43 Transportation Model. A detailed...This PDF document was made available from www.rand.org as a public service of the RAND Corporation. 6Jump down to document Visit RAND at...www.rand.org Explore RAND Project AIR FORCE View document details This document and trademark(s) contained herein are protected by law as indicated in a
Early history and reactivation of the rand thrust, southern California

NASA Astrophysics Data System (ADS)

Postlethwaite, Clay E.; Jacobson, Carl E.

The Rand thrust of the Rand Mountains in the northwestern Mojave Desert separates an upper plate of quartz monzonite and quartzofeldspathic to amphibolitic gneiss from a lower plate of metagraywacke and mafic schist (Rand Schist). The Rand thrust is considered part of the regionally extensive Vincent/Chocolate Mountain thrust system, which is commonly believed to represent a Late Cretaceous subduction zone. The initial direction of dip and sense of movement along the Vincent/Chocolate Mountain thrust are controversial. Microfabrics of mylonites and quartzites from the Rand Mountains were analyzed in an attempt to determine transport direction for this region, but the results are ambiguous. In addition, the southwestern portion of the Rand thrust was found to have been reactivated as a low-angle normal fault after subduction. Reactivation might have occurred shortly after subduction, in which case it could account for the preservation of high-pressure mineral assemblages in the Rand Schist, or it could be related to mid-Tertiary extension in the western United States. In either event, the reactivation might be responsible for the complicated nature of the microfabrics. The Rand Schist exhibits an inverted metamorphic zonation. Isograds in the schist are not significantly truncated by the reactivated segment of the Rand thrust. This indicates that other segments of the Vincent/Chocolate Mountain thrust should be re-evaluated for the possibility of late movement, even if they show an apparently undisturbed inverted metamorphic zonation.
Improving Interagency Information Sharing Using Technology Demonstrations: The Legal Basis for Using New Sensor Technologies for Counterdrug Operations Along the U.S. Border

DTIC Science & Technology

2014-01-01

herein are protected by law as indicated in a notice appearing later in this work . This electronic representation of RAND intellectual property is...commercial use. For information on reprint and linking permissions, please see RAND Permissions. Skip all front matter: Jump to Page 16 The RAND Corporation ...from www.rand.org as a public service of the RAND Corporation . CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND HEALTH
RAND's Impact in the Middle East. Corporate Publication

ERIC Educational Resources Information Center

RAND Corporation, 2015

2015-01-01

The RAND Corporation works throughout the Middle East to analyze complex policy problems and help policymakers create enduring solutions. RAND's work in the Middle East focuses on the issues that drive economic development. This brief report provides an overview of RAND's impact in the Middle East in the areas of supporting youth, health and…
Recommendations for the detection and therapeutic management of cognitive impairment in multiple sclerosis.

PubMed

Bensa, C; Bodiguel, E; Brassat, D; Laplaud, D; Magy, L; Ouallet, J-C; Zephir, H; De Seze, J; Blanc, F

2012-11-01

The aim of the Multiple Sclerosis Think Tank (Groupe de réflexion sur la sclérose en plaques [GRESEP]) is to prescribe recommendations following a systematic literature search and using a Rand Corporation and California University (RAND/UCLA) appropriateness derived method, in response to practical questions that are raised in the management of patients with multiple sclerosis (MS). The topics of this working program were chosen because they were not addressed in the French recommendations and because of the few data in the literature that enabled practices to be based on validated data. Following the theme on useful serum testing with suspected multiple sclerosis, the subjects of the present work concern the detection and management of cognitive impairment in the beginning stages of the disease course. Two clinical questions were asked: which complementary exams (besides physical examination and neuropsychological tests) would help in the screening of cognitive impairment at the beginning of the disease? What care management should the person with MS and cognitive impairment be offered (treatments and neurocognitive rehabilitation)? The recommendations are the result of a consensus amongst a working group, a rating group and a reading group comprised of hospital neurologists involved in the management of patients with multiple sclerosis. Each recommendation is presented with the degree of consensus that it was accorded. Copyright © 2012 Elsevier Masson SAS. All rights reserved.
The U.S.-Soviet Strategic Balance in the 1980s: Can We Meet the Challenge,

DTIC Science & Technology

1981-08-01

34 ; ’ 085 The Rand Paper Series Papers are issued by The Rand Corporation as a service to its professional Staff, Theis purpose is to tacilitate the...exchange of ideas among those who share the author’s research interests; Papers are not reports prepared in fulfillment of Rand’s contracts or grants...Views expressed in a Paper are the author’s own, and are not necessarily shared by Rand or its research sponsors. The Rand Corporation Santa Monica
ACR Appropriateness Criteria® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis.

PubMed

Jacobson, Jon A; Roberts, Catherine C; Bencardino, Jenny T; Appel, Marc; Arnold, Erin; Baccei, Steven J; Cassidy, R Carter; Chang, Eric Y; Fox, Michael G; Greenspan, Bennett S; Gyftopoulos, Soterios; Hochman, Mary G; Mintz, Douglas N; Newman, Joel S; Rosenberg, Zehava S; Shah, Nehal A; Small, Kirstin M; Weissman, Barbara N

2017-05-01

Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. This review first discusses the characteristic osseous and soft tissue abnormalities seen with inflammatory arthritis and how they may be imaged. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity as there is significant overlap of imaging findings among the various types of arthritis. This review provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
ACR Appropriateness Criteria® Suspected Liver Metastases.

PubMed

Kaur, Harmeet; Hindman, Nicole M; Al-Refaie, Waddah B; Arif-Tiwari, Hina; Cash, Brooks D; Chernyak, Victoria; Farrell, James; Grajo, Joseph R; Horowitz, Jeanne M; McNamara, Michelle M; Noto, Richard B; Qayyum, Aliya; Lalani, Tasneem; Kamel, Ihab R

2017-05-01

Liver metastases are the most common malignant liver tumors. The accurate and early detection and characterization of liver lesions is the key to successful treatment strategies. Increasingly, surgical resection in combination with chemotherapy is effective in significantly improving survival if all metastases are successfully resected. MRI and multiphase CT are the primary imaging modalities in the assessment of liver metastasis, with the relative preference toward multiphase CT or MRI depending upon the clinical setting (ie, surveillance or presurgical planning). The optimization of imaging parameters is a vital factor in the success of either modality. PET/CT, intraoperative ultrasound are used to supplement CT and MRI. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
The Development of Quality Measures for the Performance and Interpretation of Esophageal Manometry

PubMed Central

Yadlapati, Rena; Gawron, Andrew J.; Keswani, Rajesh N.; Bilimoria, Karl; Castell, Donald O.; Dunbar, Kerry B.; Gyawali, Chandra P.; Jobe, Blair A.; Katz, Philip O.; Katzka, David A.; Lacy, Brian E.; Massey, Benson T.; Richter, Joel E.; Schnoll-Sussman, Felice; Spechler, Stuart J.; Tatum, Roger; Vela, Marcelo F.; Pandolfino, John E.

2016-01-01

Background and Aims Esophageal manometry (EM) is the gold standard for the diagnosis of esophageal motility disorders. Variations in the performance and interpretation of EM result in discrepant diagnoses and unnecessary repeated procedures, and may negatively impact patient outcomes. A method to benchmark the procedural quality of EM is needed. The primary aim of this study was to develop quality measures for performing and interpreting EM. Methods The RAND/University of California, Los Angeles Appropriateness Methodology (RAM) was utilized. Fifteen experts in esophageal manometry were invited to be a part of the panel. Potential quality measures were identified through a literature search and interviews with experts. The expert panel ranked the proposed quality measures for appropriateness via a two-round process on the basis of RAM. Results Fourteen experts participated in all processes. A total of 29 measures were considered; 17 of these measures were ranked as appropriate and related to competency (2), pre-procedure (2), procedure (3) and interpretation (10). The latter 10 were integrated into a single composite measure. Thus, 8 final measures were determined to be appropriate quality measures for EM. Five strong recommendations were also endorsed by the experts, however they were not ranked as appropriate quality measures. Conclusions Eight formally validated quality measures for the performance and interpretation of EM were developed on the basis of RAM. These measures represent key aspects of a high-quality EM study and should be uniformly adopted. Evaluation of these measures in clinical practice is needed to assess their impact on outcomes. PMID:26499925
A RAND Analysis Tool for Intelligence, Surveillance, and Reconnaissance: The Collections Operations Model

DTIC Science & Technology

2008-01-01

appropriate; scan cycle, emission interval, or emission probability; frequency bands; relative angular size of 2 Carl Rhodes, Jeff Hagen, and Mark...choices based on its own perceptions. An agent has autonomy. 2 In this report, “behaviors” are individual scripts , programs, instructions, or decision...relative angular size of main and side lobes (for directional signals); and the effective radiated power of each radiative lobe. With these parameters and
Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine

PubMed Central

Paruthi, Shalini; Brooks, Lee J.; D'Ambrosio, Carolyn; Hall, Wendy A.; Kotagal, Suresh; Lloyd, Robin M.; Malow, Beth A.; Maski, Kiran; Nichols, Cynthia; Quan, Stuart F.; Rosen, Carol L.; Troester, Matthew M.; Wise, Merrill S.

2016-01-01

Sleep is essential for optimal health in children and adolescents. Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine. Citation: Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016;12(6):785–786. PMID:27250809
Intratheater Airlift Functional Solution Analysis (FSA)

DTIC Science & Technology

2011-01-01

law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non ...commercial use only. Unauthorized posting of RAND electronic documents to a non -RAND website is prohibited. RAND electronic documents are protected under...1. REPORT DATE 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Intratheater Airlift Functional Solution
American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.

PubMed

Kampman, Kyle; Jarvis, Margaret

2015-01-01

The Centers for Disease Control have recently described opioid use and resultant deaths as an epidemic. At this point in time, treating this disease well with medication requires skill and time that are not generally available to primary care doctors in most practice models. Suboptimal treatment has likely contributed to expansion of the epidemic and concerns for unethical practices. At the same time, access to competent treatment is profoundly restricted because few physicians are willing and able to provide it. This "Practice Guideline" was developed to assist in the evaluation and treatment of opioid use disorder, and in the hope that, using this tool, more physicians will be able to provide effective treatment. Although there are existing guidelines for the treatment of opioid use disorder, none have included all of the medications used at present for its treatment. Moreover, few of the existing guidelines address the needs of special populations such as pregnant women, individuals with co-occurring psychiatric disorders, individuals with pain, adolescents, or individuals involved in the criminal justice system. This Practice Guideline was developed using the RAND Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Method (RAM) - a process that combines scientific evidence and clinical knowledge to determine the appropriateness of a set of clinical procedures. The RAM is a deliberate approach encompassing review of existing guidelines, literature reviews, appropriateness ratings, necessity reviews, and document development. For this project, American Society of Addiction Medicine selected an independent committee to oversee guideline development and to assist in writing. American Society of Addiction Medicine's Quality Improvement Council oversaw the selection process for the independent development committee. Recommendations included in the guideline encompass a broad range of topics, starting with the initial evaluation of the patient, the selection of medications, the use of all the approved medications for opioid use disorder, combining psychosocial treatment with medications, the treatment of special populations, and the use of naloxone for the treatment of opioid overdose. Topics needing further research were noted.
A Framework to Assess Programs for Building Partnerships

DTIC Science & Technology

2009-01-01

available from www.rand.org as a public service of the RAND Corporation . 6Jump down to document THE ARTS CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY...ABUSE TERRORISM AND HOMELAND SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research...6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Rand Corporation ,1776
ACR Appropriateness Criteria® Urinary Tract Infection-Child.

PubMed

Karmazyn, Boaz K; Alazraki, Adina L; Anupindi, Sudha A; Dempsey, Molly E; Dillman, Jonathan R; Dorfman, Scott R; Garber, Matthew D; Moore, Sheila G; Peters, Craig A; Rice, Henry E; Rigsby, Cynthia K; Safdar, Nabile M; Simoneaux, Stephen F; Trout, Andrew T; Westra, Sjirk J; Wootton-Gorges, Sandra L; Coley, Brian D

2017-05-01

Urinary tract infection (UTI) is common in young children and may cause pyelonephritis and renal scarring. Long-term complications from renal scarring are low. The role of imaging is to evaluate for underlying urologic abnormalities and guide treatment. In neonates there is increased risk for underlying urologic abnormalities. Evaluation for vesicoureteral reflux (VUR) may be appropriate especially in boys because of higher prevalence of VUR and to exclude posterior urethral valve. In children older than 2 months with first episode of uncomplicated UTI, there is no clear benefit of prophylactic antibiotic. Ultrasound is the only study that is usually appropriate. After the age of 6 years, UTIs are infrequent. There is no need for routine imaging as VUR is less common. In children with recurrent or complicated UTI, in addition to ultrasound, imaging of VUR is usually appropriate. Renal cortical scintigraphy may be appropriate in children with VUR, as renal scarring may support surgical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
ACR Appropriateness Criteria® Tinnitus.

PubMed

Kessler, Marcus M; Moussa, Marwan; Bykowski, Julie; Kirsch, Claudia F E; Aulino, Joseph M; Berger, Kevin L; Choudhri, Asim F; Fife, Terry D; Germano, Isabelle M; Kendi, A Tuba; Kim, Jeffrey H; Luttrull, Michael D; Nunez, Diego; Shah, Lubdha M; Sharma, Aseem; Shetty, Vilaas S; Symko, Sophia C; Cornelius, Rebecca S

2017-11-01

Tinnitus is the perception of sound in the absence of an external source. It is a common symptom that can be related to hearing loss and other benign causes. However, tinnitus may be disabling and can be the only symptom in a patient with a central nervous system process disorder. History and physical examination are crucial first steps to determine the need for imaging. CT and MRI are useful in the setting of pulsatile tinnitus to evaluate for an underlying vascular anomaly or abnormality. If there is concomitant asymmetric hearing loss, neurologic deficit, or head trauma, imaging should be guided by those respective ACR Appropriateness Criteria ® documents, rather than the presence of tinnitus. Imaging is not usually appropriate in the evaluation of subjective, nonpulsatile tinnitus that does not localize to one ear. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Role of heterogeneous research and development funds in the productivity of the US manufacturing industry

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

Rhee, C.O.

1987-01-01

This paper investigates, in the framework of firm's optimal behavior, the effect of company-funded and federally-funded RandD on productivity in selected US industries. Especially, the role of federal funding RandD in productivity through direct as well as indirect mechanisms is analyzed. Using different model specification, two types of RandD-federal and company, and data of industry level, no support can be found for the blanket statement that federally-funded RandD (FRD) crowds out or pulls in company-funding RandD in productivity growth. Whether crowding-out or pulling-in is shown to be industry-specific as well as based on FRD's time dimension. Hence, the lag effectmore » of heterogeneous RandD funds on productivity is emphasized. The classification of heterogeneous RandD funds into basic research, applied research, and development is adopted to look at the impact of each on productivity. The model of firm's optimal behavior following such classification demonstrates that federally-funded basic research has a tremendous pulling-in impact on company-funded applied research and development, respectively.« less
Expanding the Use of Time/Frequency Difference of Arrival Geolocation in the Department of Defense

DTIC Science & Technology

2012-01-01

next decade. Military acquisition and research , development, test , and evaluation will likely be the hardest hit by spending cuts (Eaglen and Nguyen...Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under copyright law...Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint
Adding Value to Air Force Management Through Building Partnerships Assessment

DTIC Science & Technology

2010-01-01

information on reprint and linking permissions, please see RAND Permissions. Skip all front matter: Jump to Page 16 The RAND Corporation is a nonprofit...public service of the RAND Corporation . CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE INFRASTRUCTURE AND...5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Rand Corporation ,Project Air Force,PO Box 2138,Santa Monica,CA,90407-2138
Air Power Against Terror: America’s Conduct of Operation Enduring Freedom

DTIC Science & Technology

2005-01-01

Institute View document details For More Information This PDF document was made available from www.rand.org as a public service of the RAND Corporation ...WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the...WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Rand Corporation ,1776 Main Street,PO Box 2138,Santa Monica,CA,90407-2138 8
Reading "The Fountainhead": The Missing Self in Ayn Rand's Ethical Individualism

ERIC Educational Resources Information Center

Fand, Roxanne J.

2009-01-01

Ayn Rand's novel "The Fountainhead" can be a useful text in an undergraduate English class, helping students think through issues of individualism. Rand's own concept of the self, however, ignores its social dimensions. (Contains 7 notes.)
Analysis of the Air Force Logistics Enterprise: Evaluation of Global Repair Network Options for Supporting the C-130

DTIC Science & Technology

2011-01-01

for each of the target shops. The primary maintenance function would be at the flightline to aid sortie generation. However, on observing that...law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non ...commercial use only. Unauthorized posting of RAND electronic documents to a non -RAND website is prohibited. RAND electronic documents are protected under
The National Response System: The Need to Leverage Networks and Knowledge

DTIC Science & Technology

2006-03-01

military organizations engaged a battle against the asymmetric threat of terrorism. In 1996 , John Arquilla and David Ronfeldt coined the use of the term...16 John Arquilla and others, The Advent of Netwar (Santa Monica: RAND, 1996 ), 5, http://www.rand.org/publications/MR/MR789/ [Accessed January 12...Advent of Netwar (Santa Monica: RAND, 1996 ), 82, http://www.rand.org/publications/MR/MR789/. 20 Richard M. Gomez, "Centralized Command - Decentralized
Developing an Assessment Framework for U.S. Air Force Building Partnerships Programs

DTIC Science & Technology

2010-01-01

www.rand.org as a public service of the RAND Corporation . 6Jump down to document THE ARTS CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY AND ENVIRONMENT HEALTH...HOMELAND SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research organization providing objective...NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Rand Corporation
75 FR 82397 - Medicaid Program: Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-30

............ NA........ RAND Schizophrenia 2: ........ Annual assessment of weight/BMI, glycemic control, lipids. 41......... NA........ RAND Schizophrenia B: ........ Proportion of schizophrenia patients with long- term utilization of antipsychotic medications. 42......... NA........ RAND Schizophrenia C...
Reconnaissance In Megacities: Lessons From The Past

DTIC Science & Technology

2016-05-26

Operations: Visualizing the Elephant (Santa Monica: RAND, 2004), ix. 49 prevented a coordinated and decisive response. In Fallujah and Sadr City, air and...Monica: RAND, 2000. ———. Managing Complexity During Military Operations: Visualizing the Elephant . Santa Monica: RAND, 2004. Glenn, Russell W
Locomotor Stability in a Model Swimmer: Coupling Fluid Dynamics, Neurophysiology and Muscle Mechanics

DTIC Science & Technology

2017-07-05

springs which resist deformation. (C) Inset that shows the position of the muscle segments. Cohen, Holmes, Rand, J. Math Biol. 1982 A representative...numbers are the segment number, labeled from head to tail. Cohen, Holmes, Rand, J. Math Biol. 1982 The signals are periodic. Cohen, Holmes, Rand, J... Math Biol. 1982 From head to tail there is a phase lag on each side. Cohen, Holmes, Rand, J. Math Biol. 1982 On a given segment, the signals are in
Hybrid Airships for Lift: A New Lift Paradigm and a Pragmatic Assessment of the Vehicle’s Key Operational Challenges

DTIC Science & Technology

2011-12-01

prepares for storms.” 11 RAND, High Altitude Airships for the Future Force Army, 32. 12 Boyd to author, email, 23 September 2011. 27...2011). High Altitude Airships for the Future Force Army, RAND Technical Report DASW01-01-C-0003. Santa Monica, CA: RAND, 2005. www.rand.org/pubs...beginning to realize the potential capabilities of HA for lift, misinformed opinions on airship challenges continue to plague a rational analysis on
77 FR 6156 - Rand Capital Corporation, et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-07

... venture capital investments in small, early-stage and developing enterprises. Rand's principal objective... Capital Corporation, et al.; Notice of Application February 1, 2012. AGENCY: Securities and Exchange... Act'') granting an exemption from section 13(a) of the Exchange Act. Applicants: Rand Capital...
Correspondence between the RAND-Negative Impact of Asthma on Quality of Life item bank and the Marks Asthma Quality of Life Questionnaire.

PubMed

Edelen, Maria Orlando; Stucky, Brian D; Sherbourne, Cathy; Eberhart, Nicole; Lara, Marielena

2014-05-01

In many research and clinical settings in which patient-reported outcome (PRO) measures are used, it is often desirable to link scores across disparate measures or to use scores from 1 measure to describe scores on a separate measure. However, PRO measures are scored by using a variety of metrics, making such comparisons difficult. The objective of this article was to provide an example of how to transform scores across disparate measures (the Marks Asthma Quality of Life Questionnaire [AQLQ-Marks] and the newly developed RAND-Negative Impact of Asthma on Quality of Life item bank [RAND-IAQL-Bank]) by using an item response theory (IRT)-based linking method. Our sample of adults with asthma (N = 2032) completed 2 measures of asthma-specific quality of life: the AQLQ-Marks and the RAND-IAQL-Bank. We use IRT-based co-calibration of the 2 measures to provide a linkage, or a common metric, between the 2 measures. Co-calibration refers to the process of using IRT to estimate item parameters that describe the responses to the scales' items according to a common metric; in this case, a normal distribution transformed to a T scale with a mean of 50 and an SD of 10. Respondents had an average age of 43 (15), were 60% female, and predominantly non-Hispanic White (56%), with 19% African American, 14% Hispanic, and 11% Asian. Most had at least some college education (83%), and 90% had experienced an asthma attack during the last 12 months. Our results indicate that the AQLQ-Marks and RAND-IAQL-Bank scales measured highly similar constructs and were sufficiently unidimensional for IRT co-calibration. Once linked, scores from the 2 measures were invariant across subgroups. A crosswalk is provided that allows researchers and clinicians using AQLQ-Marks to crosswalk to the RAND-IAQL toolkit. The ability to translate scores from the RAND-IAQL toolkit to other "legacy" (ie, commonly used) measures increases the value of the new toolkit, aids in interpretation, and will hopefully facilitate adoption by asthma researchers and clinicians. More generally, the techniques we illustrate can be applied to other newly developed or existing measures in the PRO research field to obtain crosswalks with widely used traditional legacy instruments. Copyright © 2014 Elsevier HS Journals, Inc. All rights reserved.
ACR Appropriateness Criteria® First Trimester Vaginal Bleeding.

PubMed

Brown, Douglas L; Packard, Ann; Maturen, Katherine E; Deshmukh, Sandeep Prakash; Dudiak, Kika M; Henrichsen, Tara L; Meyer, Benjamin J; Poder, Liina; Sadowski, Elizabeth A; Shipp, Thomas D; Simpson, Lynn; Weber, Therese M; Zelop, Carolyn M; Glanc, Phyllis

2018-05-01

Vaginal bleeding is not uncommon in the first trimester of pregnancy. The majority of such patients will have a normal intrauterine pregnancy (IUP), a nonviable IUP, or an ectopic pregnancy. Ultrasound (US) is the primary imaging modality in evaluation of these patients. US, along with clinical observations and serum human chorionic gonadotropin levels, can usually distinguish these causes. Although it is important to diagnose ectopic pregnancies and nonviable IUPs, one should also guard against injury to normal pregnancies due to inappropriate treatment with methotrexate or surgical intervention. Less common causes of first trimester vaginal bleeding include gestational trophoblastic disease and arteriovenous malformations. Pulsed methods of Doppler US should generally be avoided in the first trimester when there is a normal, or a potentially normal, IUP. Once a normal IUP has been excluded, Doppler US may be useful when other diagnoses such as retained products of conception or arteriovenous malformations are suspected. MRI may occasionally be helpful as a problem-solving tool. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Moscow’s Lessons from the 1982 Lebanon Air War

DTIC Science & Technology

1984-09-01

or else failed to comprehend the tactical lessons suggested by Israeli combat perfbrmance. \\• O UL~Y~ aSCU @ hS~G1~ t,? - IT I , PREFACE The Rand...results of the Lebanese wnr anrd drawi- ag appropriate technical conclusions. They, like ourselves, are awarv~ th.-at thle AlM.VL was a star performer (not...it should be required." Air Power in the Nuclear Age (Chicago: University of Illinois Press, 1983). p 176. 12Maj. Gen. Jasper A. Welch, Jr., USAF
ACR Appropriateness Criteria® Ovarian Cancer Screening.

PubMed

Pandharipande, Pari V; Lowry, Kathryn P; Reinhold, Caroline; Atri, Mostafa; Benson, Carol B; Bhosale, Priyadarshani R; Green, Edward D; Kang, Stella K; Lakhman, Yulia; Maturen, Katherine E; Nicola, Refky; Salazar, Gloria M; Shipp, Thomas D; Simpson, Lynn; Sussman, Betsy L; Uyeda, Jennifer; Wall, Darci J; Whitcomb, Bradford; Zelop, Carolyn M; Glanc, Phyllis

2017-11-01

There has been much interest in the identification of a successful ovarian cancer screening test, in particular, one that can detect ovarian cancer at an early stage and improve survival. We reviewed the currently available data from randomized and observational trials that examine the role of imaging for ovarian cancer screening in average-risk and high-risk women. We found insufficient evidence to recommend ovarian cancer screening, when considering the imaging modality (pelvic ultrasound) and population (average-risk postmenopausal women) for which there is the greatest available published evidence; randomized controlled trials have not demonstrated a mortality benefit in this setting. Screening high-risk women using pelvic ultrasound may be appropriate in some clinical situations; however, related data are limited because large, randomized trials have not been performed in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Air Force Personnel Research: Recommendations for Improved Alignment

DTIC Science & Technology

2014-01-01

Satisfaction in organizational Research,” in David A . Buchanan and Alan Bryman , eds., The SAGE Handbook of Organizational Research Methods, Los Angeles...ElEctronic copiEs of rAnD rEsEArch ArE proviDED for pErsonAl usE; posting to A nonrAnD wEbsitE is prohibitED. this publicAtion is AvAilAblE for...linking or frEE DownloAD At www.rand.org C O R P O R A T I O N Air Force Personnel Research Recommendations for Improved Alignment Carra S. Sims, Chaitra
Prognostication: Do the Services See the Same Future of Warfare?

DTIC Science & Technology

2008-05-01

conduct of war, warfare. 24 Dana Johnson, Scott Pace, C. Bryan Gabbard , Space: Emerging Options for National Power, (RAND, 1998), 10. 25 Creveld, 145...Bryan Gabbard . Space: Emerging Options for National Power, RAND http://www.rand.org/pubs/monograph_reports/MR517/, 1998. (Accessed 5 January 2008
75 FR 20386 - Trane a Subsidiary of Ingersoll Rand Including On-Site Leased Workers From Aerotek, Express...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-19

... Ingersoll Rand Including On-Site Leased Workers From Aerotek, Express Personnel Services, Select Staffing... Ingersoll Rand, including on-site leased workers from Aerotek, Express Personnel Staffing, and Select... from Aerotek, Express Personnel Staffing, Select Staffing, and Mechanical Contractors, Inc., Pueblo...

Sexual Assault and Sexual Harassment in the U.S. Military: Annex to Volume 3. Tabular Results from the 2014 RAND Military Workplace Study for Coast Guard Service Members

DTIC Science & Technology

2015-01-01

SEXUAL ASSAULT AND SEXUAL HARASSMENT IN THE U.S. MILITARY Annex to Volume 3. Tabular Results from the 2014 RAND Military Workplace Study for... Sexual Harassment in the U.S. Military: Top-Line Estimates for Active-Duty Service Members from the 2014 RAND Military Workplace Study • Sexual ...Assault and Sexual Harassment in the U.S. Military: Top-Line Estimates for Active-Duty Coast Guard Members from the 2014 RAND Military Workplace Study vi
Appropriate Use Criteria in Dermatopathology: Initial Recommendations from the American Society of Dermatopathology.

PubMed

Vidal, Claudia I; Armbrect, Eric A; Andea, Aleodor A; Bohlke, Angela K; Comfere, Nneka I; Hughes, Sarah R; Kim, Jinah; Kozel, Jessica A; Lee, Jason B; Linos, Konstantinos; Litzner, Brandon R; Missall, Tricia A; Novoa, Roberto A; Sundram, Uma; Swick, Brian L; Hurley, M Yadira; Alam, Murad; Argenyi, Zsolt; Duncan, Lyn M; Elston, Dirk M; Emanuel, Patrick O; Ferringer, Tammie; Fung, Maxwell A; Hosler, Gregory A; Lazar, Alexander J; Lowe, Lori; Plaza, Jose A; Prieto, Victor G; Robinson, June K; Schaffer, Andras; Subtil, Antonio; Wang, Wei-Lien

2018-04-21

Appropriate use criteria (AUC) provide physicians guidance in test selection, can affect health care delivery, reimbursement policy, and physician decision-making. The American Society of Dermatopathology (ASDP), with input from the American Academy of Dermatology (AAD) and the College of American Pathologists (CAP), sought to develop AUC in dermatopathology. The RAND/UCLA appropriateness methodology, which combines evidence-based medicine, clinical experience and expert judgment, was used to develop AUC in dermatopathology. With the number of ratings predetermined at 3, AUC were developed for 211 clinical scenarios (CS) involving 12 ancillary studies (AS). Consensus was reached for 188 (89%) CS, with 93 (44%) considered "usually appropriate", 52 (25%) "rarely appropriate", and 43 (20%) "uncertain appropriateness". The methodology requires a focus on appropriateness without comparison between tests and irrespective of cost. The ultimate decision of when to order specific test rests with the physician and is one where the expected benefit exceeds the negative consequences. This publication outlines the recommendation of appropriateness - AUC for 12 tests used in dermatopathology. Importantly, these recommendations may change considering new evidence. Results deemed "uncertain appropriateness" and where consensus was not reached may benefit from further research. Copyright © 2018. Published by Elsevier Inc.
A Decision Support Tool for Appropriate Glucose-Lowering Therapy in Patients with Type 2 Diabetes

PubMed Central

Benhamou, Pierre Yves; Charpentier, Guillaume; Consoli, Agostino; Diamant, Michaela; Gallwitz, Baptist; Khunti, Kamlesh; Mathieu, Chantal; Ridderstråle, Martin; Seufert, Jochen; Tack, Cees; Vilsbøll, Tina; Phan, Tra-Mi; Stoevelaar, Herman

2015-01-01

Abstract Background: Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Materials and Methods: Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope®; Novo Nordisk Health Care AG, Zürich, Switzerland). Results: Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process). Conclusions: A novel decision support tool based on the ADA/EASD 2012 position statement and a systematic analysis of expert opinion has been developed to help healthcare professionals to individualize glucose-lowering therapy in daily clinical situations. PMID:25347226
Measuring Melatonin in Humans

PubMed Central

Benloucif, Susan; Burgess, Helen J.; Klerman, Elizabeth B.; Lewy, Alfred J.; Middleton, Benita; Murphy, Patricia J.; Parry, Barbara L.; Revell, Victoria L.

2008-01-01

Study Objectives: To provide guidelines for collecting and analyzing urinary, salivary, and plasma melatonin, thereby assisting clinicians and researchers in determining which method of measuring melatonin is most appropriate for their particular needs and facilitating the comparison of data between laboratories. Methods: A modified RAND process was utilized to derive recommendations for methods of measuring melatonin in humans. Results: Consensus-based guidelines are presented for collecting and analyzing melatonin for studies that are conducted in the natural living environment, the clinical setting, and in-patient research facilities under controlled conditions. Conclusions: The benefits and disadvantages of current methods of collecting and analyzing melatonin are summarized. Although a single method of analysis would be the most effective way to compare studies, limitations of current methods preclude this possibility. Given that the best analysis method for use under multiple conditions is not established, it is recommended to include, in any published report, one of the established low threshold measures of dim light melatonin onset to facilitate comparison between studies. Citation: Benloucif S; Burgess HJ; Klerman EB; Lewy AJ; Middleton B; Murphy PJ; Parry BL; Revell VL. Measuring melatonin in humans. J Clin Sleep Med 2008;4(1):66-69. PMID:18350967
Middle School: Lessons from the Rand Report

ERIC Educational Resources Information Center

Bunting, Carolyn E.

2005-01-01

This article reports on a recent study by the Rand Corporation that concluded that there is cause for middle schools to worry. Commissioned by the Edna McConnell Clark Foundation, one of four major philanthropies supporting the middle school movement, the Rand investigation is clear in its assessment: The American middle school leaves adolescents…
Validation of Portuguese version of Quality of Erection Questionnaire (QEQ) and comparison to International Index of Erectile Function (IIEF) and RAND 36-Item Health Survey

PubMed Central

Reis, Ana Luiza; Reis, Leonardo Oliveira; Saade, Ricardo Destro; Santos, Carlos Alberto; de Lima, Marcelo Lopes; Fregonesi, Adriano

2015-01-01

Purpose To validate the Quality of Erection Questionnaire (QEQ) considering Brazilian social-cultural aspects. Materials and Methods To determine equivalence between the Portuguese and the English QEQ versions, the Portuguese version was back-translated by two professors who are native English speakers. After language equivalence had been determined, urologists considered the QEQ Portuguese version suitable. Men with self-reported erectile dysfunction (ED) and infertile men who had a stable sexual relationship for at least 6 months were invited to answer the QEQ, the International Index of Erectile Function (IIEF) and the RAND 36-Item Health Survey (RAND-36). The questionnaires were presented together and answered without help in a private room. Internal consistency (Cronbach’s α), test-retest reliability (Spearman), convergent validity (Spearman correlation) coefficients and known-groups validity (the ability of the QEQ Portuguese version to differentiate erectile dysfunction severity groups) were assessed. Results We recruited 197 men (167 ED patients and 30 non-ED patients), mean age of 53.3 and median of 55.5 years (23-82 years). The Portuguese version of the QEQ had high internal consistency (Cronbach α=0.93), high stability between test and retest (ICC 0.83, with IC 95%: 0.76-0.88, p<0.001) and Spearman correlation coefficient r=0.82 (p<0.001), which demonstrated the high correlation between the QEQ and IIEF results. The correlations between the QEQ and RAND-36 were significantly low in ED (r=0.20, p=0.01) and non-ED patients (r=0.37, p=0.04). Conclusion The QEQ Portuguese version presented good psychometric properties and high convergent validity in relation to IIEF. The low correlations between the QEQ and the RAND-36, as well as between the IIEF and the RAND-36 indicated IIEF and QEQ specificity, which may have resulted from the patients’ psychological adaptations that minimized the impact of ED on Quality of Life (QoL) and reestablished the well-being feeling. PMID:25928522
Recent Contributions of Information Sciences Research at RAND to Modeling- and Simulation-Based Policy Analysis.

ERIC Educational Resources Information Center

Donohue, G. L.; And Others

This report presents examples of Rand's current research in the information sciences and illustrates the application of information science tools to specific policy studies. The projects discussed depict Rand's success with using corporate seed money to bridge the gap between the research and development of new information science tools and…
Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society

PubMed Central

Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

2015-01-01

Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. SLEEP 2015;38(6):843–844. PMID:26039963
Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society

PubMed Central

Watson, Nathaniel F.; Badr, M. Safwan; Belenky, Gregory; Bliwise, Donald L.; Buxton, Orfeu M.; Buysse, Daniel; Dinges, David F.; Gangwisch, James; Grandner, Michael A.; Kushida, Clete; Malhotra, Raman K.; Martin, Jennifer L.; Patel, Sanjay R.; Quan, Stuart F.; Tasali, Esra

2015-01-01

Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modified RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing the conference proceedings and evidence supporting the final recommendation statement will be published in SLEEP and the Journal of Clinical Sleep Medicine. Citation: Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 2015;11(6):591–592. PMID:25979105
Delphi-RAND consensus of the Spanish Society of Internal Medicine on the controversies in anticoagulant therapy and prophylaxis in medical diseases. INTROMBIN Project (Uncertainty in thromboprophylaxis in internal medicine).

PubMed

Ruiz-Ruiz, F; Medrano, F J; Navarro-Puerto, M A; Rodríguez-Torres, P; Romero-Alonso, A; Santos-Lozano, J M; Alonso-Ortiz Del Rio, C; Varela-Aguilar, J M; Calderón, E J; Marín-León, I

2018-05-21

The aim of this study was to determine the opinion of internists on the management of anticoagulation and thromboembolism prophylaxis in complex clinical scenarios in which the risk-benefit ratio of surgery is narrow and to develop a consensus document on the use of drugs anticoagulant therapy in this patient group. To this end, we identified by consensus the clinical areas of greatest uncertainty, a survey was created with 20 scenarios laid out in 40 clinical questions, and we reviewed the specific literature. The survey was distributed among the internists of the Spanish Society of Internal Medicine (SEMI) and was completed by 290 of its members. The consensus process was implemented by changing the Delphi-RAND appropriateness method in an anonymous, double-round process that enabled an expert panel to identify the areas of agreement and uncertainty. In our case, we also added the survey results to the panel, a methodological innovation that helps provide additional information on the standard clinical practice. The result of the process is a set of 19 recommendations formulated by SEMI experts, which helps establish guidelines for action on anticoagulant therapy in complex scenarios (high risk or active haemorrhage, short life expectancy, coexistence of antiplatelet therapy or comorbidities such as kidney disease and liver disease), which are not uncommon in standard clinical practice. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.
The Global Positioning System: Assessing National Policies,

DTIC Science & Technology

1995-01-01

WASSEM • MONICA PINTO CRITICAL TECHNOLOGIES INSTITUTE RAND The research described in this report was supported by RAND’s Critical...MONICA PINTO Prepared for the Executive Office of the President Office of Science and Technology Policy CRITICAL TECHNOLOGIES INSTITUTE RAND...National Research Council Committee on the Future of the Global Positioning System, Washington, D.C., July 28-30,1994. Barbier, Jacques , and Thierry
Intratheater Airlift Functional Needs Analysis (FNA)

DTIC Science & Technology

2011-01-01

information on reprint and linking permissions, please see RAND Permissions. Skip all front matter: Jump to Page 16 The RAND Corporation is a nonprofit...facing the public and private sectors. All RAND mono- graphs undergo rigorous peer review to ensure high standards for research quality and...personnel. xii Intratheater Airlift Functional Needs Analysis all operating environments. The FNA assesses the ability of current assets to
Assessing Stop-Loss Policy Options through Personnel Flow Modeling

DTIC Science & Technology

2014-01-01

from www.rand.org as a public service of the RAND Corporation. CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND HEALTH...the RAND National Defense Research Institute, a federally funded research and development center sponsored by OSD, the Joint Staff, the Unified...detrimental to cohesion, morale , and other aspects of unit performance. However, the multifaceted challenges of meeting general force needs with
Options for Filling Vacant Officer Positions

DTIC Science & Technology

2010-01-01

from www.rand.org as a public service of the RAND Corporation. CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND HEALTH...of Defense (OSD). The research was conducted in the RAND National Defense Research Institute, a federally funded research and development center...extant Department of Defense (DoD) military manpower policy, and assesses alternative mixes of military manpower against criteria developed to determine
U.S. Security-Related Agreements in Force Since 1955: Introducing a New Database

DTIC Science & Technology

2014-01-01

necessarily reflect the opinions of its research clients and sponsors. Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving...PAF), a division of the RAND Corporation, is the U.S. Air Force’s federally funded research and development center for studies and analyses. PAF...33 Additional Applications of the Treaty and Agreement Database ........................................................... 35 Summary
Instrumentation and Controls Division progress report for the period July 1, 1986 to June 30, 1988

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

Klobe, L.E.

1988-12-01

The Instrumentation and Controls (IandC) Division of Oak Ridge National Laboratory (ORNL) performs basic and applied instrumentation and controls research, development and design engineering, specialized instrument design and fabrication, and maintenance services for instruments, electronics, and computers. The IandC Division is one of the largest RandD organizations of its type among government laboratories, and it exists as the result of an organizational strategy to integrate ORNL's instrumentation and controls-related disciplines into one dedicated functional organization to increase the Laboratory's expertise and capabilities in these rapidly expanding, innovative areas of technology. The Division participates in the programs and projects of ORNLmore » by applying its expertise and capabilities in concert with other divisions to perform basic research and mission-oriented technology development. Many of the Division's RandD tasks that are a part of a larger ORNL program are of sufficient scope that the IandC effort constitutes a separate program element with direct funding and management responsibility within the Division. The activities of IandC include performance of an RandD task in IandC facilities, the participation of from one of many IandC engineers and scientists in a multidisciplinary team working in a specific research area or development project, design and fabrication of a special instrument or instrumentation system, or a few hours of maintenance service. In its support and maintenance work, the role of the IandC Division is to provide a level of expertise appropriate to complete a job successfully at minimum overall cost and time schedule---a role which involves IandC in almost all ORNL activities.« less
Restoring the Power Projection Capabilities of the U.S. Armed Forces

DTIC Science & Technology

2017-02-16

Armed Services on February 16, 2017. For more information on this publication , visit www.rand.org/pubs/testimonies/CT464.html Testimonies RAND...law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is...planning prior to Russia’s attacks on Ukraine did not take account of the need to deter large-scale aggression against the North Atlantic Treaty
Children on the Homefront: The Experiences of Children from Military Families

DTIC Science & Technology

2010-03-01

2010). Children on the homefront : the experience of children from military families. Pediatrics. 25 ( 1 ), 13-25. Department of Defense, Public...around the world . Visit RAND at www.rand.org Explore RAND Testimony View document details For More Information Browse Books & Publications Make a...information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and
The Future of Conventional Arms Control

DTIC Science & Technology

1975-08-01

of ideas among those who share the author’s research interests; Papers are not reports prepared in fulfillment of Rand’s contracts or grants. Views...expressed in a Paper are the author’s own, and are not necessarily shared by Rand or its research sponsors. The Rand Corporation Santa Monica...technology is realizing fundamental changes. In defending the fiscal year 1975 Defense Department research and development budget, Dr. Malcolm Currie
The Federal Role in Terrorism Insurance. Evaluating Alternatives in an Uncertain World

DTIC Science & Technology

2007-01-01

representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND PDFs to a non-RAND Web site is...Swiss Re Life & Health America Inc. Richard Thomas* Senior vice president Chief underwriting officer American International Group Steven Wechsler ...bomb, outdoor anthrax, nuclear bomb Attack scaling S [0.33, 3.0] Postattack government compensation Market retention R [$27.5 billion, $100 billion

Smarter Power, Stronger Partners, Volume 1: Exploiting U.S. Advantages to Prevent Aggression

DTIC Science & Technology

2016-01-01

representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited...or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit...www.rand.org/pubs/permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities
Army Stock Positioning: How Can Distribution Performance Be Improved

DTIC Science & Technology

2017-01-01

Support RAND Make a tax -deductible charitable contribution at www.rand.org/giving/contribute www.rand.org Preface The...the source- preference logic that selects the warehouse for issuing an item to a cus- tomer. Below, we describe the LMP source-preference logic and...the AMC pilot to use it to tailor how warehouses are selected to issue items to customers. AMC Pilot Implementation of LMP Source-Preference
RandAgiamo™, a Pilot Project Increasing Adoptability of Shelter Dogs in the Umbria Region (Italy)

PubMed Central

Menchetti, Laura; Mancini, Stefania; Catalani, Maria Chiara; Boccini, Beatrice; Diverio, Silvana

2015-01-01

Simple Summary In Italy, dog shelters are overcrowded because the rate of dog adoption is lower than that of abandonment. A project called “RandAgiamo” was implemented in a rescue shelter in central Italy. RandAgiamo provides training, socialization and advertising of adult shelter dogs. Official data of the Umbria regional health authorities from the year 2014 showed a higher rate of adoption in shelters involved in the project. RandAgiamo dogs had triple odds of being adopted compared to others housed in shelters of the same province. The increase in adoption rate can be beneficial for both dog welfare and shelter management. Abstract Current Italian legislation does not permit euthanasia of dogs, unless they are ill or dangerous. Despite good intentions and ethical benefits, this “no-kill policy” has caused a progressive overpopulation of dogs in shelters, due to abandonment rates being higher than adoption rates. Shelter overcrowding has negative implications for dog welfare and increases public costs. The aim of this paper is to describe the pilot project “RandAgiamo” implemented in a rescue shelter in the Umbria Region and to evaluate its effectiveness on the rate of dog adoption using official data. RandAgiamo aimed to increase adult shelter dogs’ adoptability by a standard training and socialization programme. It also promoted dogs’ visibility by publicizing them through social media and participation in events. We analysed the official data of the Umbria regional health authorities regarding dog shelters of the Perugia province of the year 2014. In the RandAgiamo shelter, the dog adoption rate was 27.5% higher than that of dogs housed in other shelters located in the same geographical area (p < 0.001). The RandAgiamo project could be beneficial for the dogs’ welfare, owner satisfaction, shelter management, and public perception of shelter dogs. However, staff were required to provide dog training and related activities. PMID:26479385
A label field fusion bayesian model and its penalized maximum rand estimator for image segmentation.

PubMed

Mignotte, Max

2010-06-01

This paper presents a novel segmentation approach based on a Markov random field (MRF) fusion model which aims at combining several segmentation results associated with simpler clustering models in order to achieve a more reliable and accurate segmentation result. The proposed fusion model is derived from the recently introduced probabilistic Rand measure for comparing one segmentation result to one or more manual segmentations of the same image. This non-parametric measure allows us to easily derive an appealing fusion model of label fields, easily expressed as a Gibbs distribution, or as a nonstationary MRF model defined on a complete graph. Concretely, this Gibbs energy model encodes the set of binary constraints, in terms of pairs of pixel labels, provided by each segmentation results to be fused. Combined with a prior distribution, this energy-based Gibbs model also allows for definition of an interesting penalized maximum probabilistic rand estimator with which the fusion of simple, quickly estimated, segmentation results appears as an interesting alternative to complex segmentation models existing in the literature. This fusion framework has been successfully applied on the Berkeley image database. The experiments reported in this paper demonstrate that the proposed method is efficient in terms of visual evaluation and quantitative performance measures and performs well compared to the best existing state-of-the-art segmentation methods recently proposed in the literature.
Mathematics Audit of the DoDEA Schools: 2014-2015

DTIC Science & Technology

2016-01-01

inform instruction ” was a moderate or major focus of their PD during 2014–2015, and 31 percent reported that they had a moderate or high need for...permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the...agencies, and the defense Intelligence Community . For more information on the RAND Forces and Resources Policy Center, see www.rand.org/nsrd/ndri
Byting Back. Regaining Information Superiority Against 21st-Century Insurgents

DTIC Science & Technology

2007-01-01

representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND PDFs to a non-RAND Web site is...thus, denoting safe or unsafe areas for urban combat, ingress/ egress, or convoy operations. It also offers clues as to where insur- gents might plant...on security authorities. Victims may, themselves, be reluctant to come forward if they feel their efforts are futile, or worse, can put them in
Beyond Close Air Support. Forging a New Air-Ground Partnership

DTIC Science & Technology

2005-01-01

15213-1516 RAND URL: http://www.rand.org/ To order RAND documents or to obtain additional information, contact Distribution Services : Telephone: (310) 451...prominence for either partner. It gives the least opportunity for parochial claims and one-sided plead- ing for one’s own service . Its very difficulty...could be a virtue: Once the services have mastered partnership, they can easily revert to sim- pler approaches. Partnership does not, of course, imply
A Program Manager’s Guide for Program Improvement in Ongoing Psychological Health and Traumatic Brain Injury Programs. The RAND Toolkit, Volume 4

DTIC Science & Technology

2014-01-01

Hughes EFX, Boerstler H, O’Connor EJ. “Assessing the Impact of Continuous Quality Improvement/ Total Quality Management : Concept versus...facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity. Gery...RAND Program Manager’s Guide helps managers assess program performance, consider options for improvement, implement solutions, then assess whether the
Supporting the Future Total Force. A Methodology for Evaluating Potential Air National Guard Mission Assignments

DTIC Science & Technology

2007-01-01

force with its primary function —to organize, train, and equip aviation forces primarily for prompt and sustained offen- sive and defensive air...staff. 4 The full warfighter headquarters end-to-end operation was considered in this study to include non -AOC command and control functions performed...representation of RAND intellectual property is provided for non -commercial use only. Unauthorized posting of RAND PDFs to a non -RAND Web site is
Supporting the Future Total Force: A Methodology for Evaluating Potential Air National Guard Mission Assignments

DTIC Science & Technology

2007-01-01

practices. The Air Force continues to strive to align the total force with its primary function —to organize, train, and equip aviation forces primarily for...to include non -AOC command and control functions performed for the COMAFFOR and staff. Potential COMAFFOR Warfighting Operations Support Postures...representation of RAND intellectual property is provided for non -commercial use only. Unauthorized posting of RAND PDFs to a non -RAND Web site is
Making an Impact in the Kurdistan Region--Iraq. Summary of Four Studies to Assess the Present and Future Labor Market, Improve Technical Vocational Education and Training, Reform the Health Sector, and Build Data Collection Capacity. Research Report

ERIC Educational Resources Information Center

Anthony, C. Ross; Constant, Louay; Culbertson, Shelby; Click, Peter; Kumar, Krishna B.; Meili, Robin C.; Moore, Melinda; Shatz, Howard J.; Vernez, Georges

2015-01-01

This executive summary describes key results from four studies carried out by the RAND Corporation as part of Phase II of its work for the Kurdistan Regional Government (KRG). The KRG asked RAND to undertake several studies aimed at improving the economic and social development of the Kurdistan Region--Iraq (KRI). RAND's work is intended to help…
Alternative Measured-Service Rate Structures for Local Telephone Service,

DTIC Science & Technology

1980-06-01

contracts or grants . Views expressed in a Papet are the author’s own, and are not necessarily shared by Rand or its research sponsors. The Rand Corporation...by National Science Foundation, grant DAR 77-16286 to The Rand Corporation. Measuring costs depend strongly on the technology of the telephone network...a Budget Constraint. The Case of the Two-Part Tariff," Review of Economic Studies, July 1974, Vol. 41, pp. 337-345. -28- Oi, W. Y., "A Disneyland
Sexual Assault and Sexual Harassment in the U.S. Military: Highlights from the 2014 RAND Military Workplace Study

DTIC Science & Technology

2015-01-01

assault, sexual harassment , and gender discrimination in the military. The resulting study, the RAND Military Workplace Study (RMWS), invited close to...members are highlighted in this brief. Sexual Assault and Sexual Harassment in the U.S. Military HigHligHts from tHe 2014 rAND militAry WorkplAce stuDy...significantly higher rates than men : 22 percent of women and 7 percent of men experienced sexual harassment in the past year. In addition, we estimate
An Overview and Comparison of Demand Assignment Multiple Access (DAMA) Concepts for Satellite Communications Networks,

DTIC Science & Technology

1996-01-01

helps improve public policy through research and analysis . RAND’s publications do not necessarily reflect the opinions or policies of its research...celebrating 50 years of service to the United States Air Force. Project AIR FORCE began in March 1946 as Project RAND at Douglas Aircraft Company , under...through research and analysis for the public welfare and security of the United States—what is known today as RAND. Contents Preface iii Figures ix
Global Combat Support Basing. Robust Prepositioning Strategies for Air Force War Reserve Material

DTIC Science & Technology

2010-01-01

e.g., WRM assets at b may receive their mainte- nance from a traveling maintenance team based offsite at b’ ). Both the 5 Mark S. Daskin , Lawrence V...This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic...representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND PDFs to a non-RAND Web site is
Analysis and Recommendations on the Company-Grade Officer Shortfall in the Reserve Components of the U.S. Army

DTIC Science & Technology

2011-01-01

available from www.rand.org as a public service of the RAND Corporation. CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND...conducted within the RAND National Defense Research Institute, a federally funded research and development center sponsored by OSD, the Joint Staff, the... develop - ment center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps
RAND’s Role in the Evolution of Balloon and Satellite Observation Systems and Related U.S. Space Technology

DTIC Science & Technology

1988-09-01

committee consisting of the Under Secre- tary of the Air Force, Joseph Charyk; the Deputy Director of Defense Research and Engineering , John H. Rubel...prepared as part of RAND-sponsored research, was originally intended to commemorate the fortieth anniversary of Project RAND (now Project AIR FORCE), a...simple matter either for the authors or for the U.S. government.(/-) Hence, a project begun two years ago to commemorate the fortieth anniversary of Air
ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association.

PubMed

Brindis, Ralph G; Douglas, Pamela S; Hendel, Robert C; Peterson, Eric D; Wolk, Michael J; Allen, Joseph M; Patel, Manesh R; Raskin, Ira E; Hendel, Robert C; Bateman, Timothy M; Cerqueira, Manuel D; Gibbons, Raymond J; Gillam, Linda D; Gillespie, John A; Hendel, Robert C; Iskandrian, Ami E; Jerome, Scott D; Krumholz, Harlan M; Messer, Joseph V; Spertus, John A; Stowers, Stephen A

2005-10-18

Under the auspices of the American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC), an appropriateness review was conducted for radionuclide cardiovascular imaging (RNI), specifically gated single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). The review assessed the risks and benefits of the imaging test for several indications or clinical scenarios and scored them based on a scale of 1 to 9, where the upper range (7 to 9) implies that the test is generally acceptable and is a reasonable approach, and the lower range (1 to 3) implies that the test is generally not acceptable and is not a reasonable approach. The mid range (4 to 6) implies that the test may be generally acceptable and may be a reasonable approach for the indication. The indications for this review were primarily drawn from existing clinical practice guidelines and modified based on discussion by the ACCF Appropriateness Criteria Working Group and the Technical Panel members who rated the indications. The method for this review was based on the RAND/UCLA approach for evaluating appropriateness, which blends scientific evidence and practice experience. A modified Delphi technique was used to obtain first- and second-round ratings of 52 clinical indications. The ratings were done by a Technical Panel with diverse membership, including nuclear cardiologists, referring physicians (including an echocardiographer), health services researchers, and a payer (chief medical officer). These results are expected to have a significant impact on physician decision making and performance, reimbursement policy, and future research directions. Periodic assessment and updating of criteria will be undertaken as needed.
Quality indicators for in-hospital geriatric co-management programmes: a systematic literature review and international Delphi study

PubMed Central

Van Grootven, Bastiaan; McNicoll, Lynn; Mendelson, Daniel A; Friedman, Susan M; Fagard, Katleen; Milisen, Koen; Flamaing, Johan; Deschodt, Mieke

2018-01-01

Objective To find consensus on appropriate and feasible structure, process and outcome indicators for the evaluation of in-hospital geriatric co-management programmes. Design An international two-round Delphi study based on a systematic literature review (searching databases, reference lists, prospective citations and trial registers). Setting Western Europe and the USA. Participants Thirty-three people with at least 2 years of clinical experience in geriatric co-management were recruited. Twenty-eight experts (16 from the USA and 12 from Europe) participated in both Delphi rounds (85% response rate). Measures Participants rated the indicators on a nine-point scale for their (1) appropriateness and (2) feasibility to use the indicator for the evaluation of geriatric co-management programmes. Indicators were considered appropriate and feasible based on a median score of seven or higher. Consensus was based on the level of agreement using the RAND/UCLA Appropriateness Method. Results In the first round containing 37 indicators, there was consensus on 14 indicators. In the second round containing 44 indicators, there was consensus on 31 indicators (structure=8, process=7, outcome=16). Experts indicated that co-management should start within 24 hours of hospital admission using defined criteria for selecting appropriate patients. Programmes should focus on the prevention and management of geriatric syndromes and complications. Key areas for comprehensive geriatric assessment included cognition/delirium, functionality/mobility, falls, pain, medication and pressure ulcers. Key outcomes for evaluating the programme included length of stay, time to surgery and the incidence of complications. Conclusion The indicators can be used to assess the performance of geriatric co-management programmes and identify areas for improvement. Furthermore, the indicators can be used to monitor the implementation and effect of these programmes. PMID:29549210
ACR Appropriateness Criteria® Monitoring Response to Neoadjuvant Systemic Therapy for Breast Cancer.

PubMed

Slanetz, Priscilla J; Moy, Linda; Baron, Paul; diFlorio, Roberta M; Green, Edward D; Heller, Samantha L; Holbrook, Anna I; Lee, Su-Ju; Lewin, Alana A; Lourenco, Ana P; Niell, Bethany; Stuckey, Ashley R; Trikha, Sunita; Vincoff, Nina S; Weinstein, Susan P; Yepes, Monica M; Newell, Mary S

2017-11-01

Patients with locally advanced invasive breast cancers are often treated with neoadjuvant chemotherapy prior to definitive surgical intervention. The primary aims of this approach are to: 1) reduce tumor burden thereby permitting breast conservation rather than mastectomy; 2) promptly treat possible metastatic disease, whether or not it is detectable on preoperative staging; and 3) potentially tailor future chemotherapeutic decisions by monitoring in-vivo tumor response. Accurate radiological assessment permits optimal management and planning in this population. However, assessment of tumor size and response to treatment can vary depending on the modality used, the measurement technique (such as single longest diameter, 3-D measurements, or calculated tumor volume), and varied response of different tumor subtypes to neoadjuvant chemotherapy (such as concentric shrinkage or tumor fragmentation). As discussed in further detail, digital mammography, digital breast tomosynthesis, US and MRI represent the key modalities with potential to help guide patient management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

ACR Appropriateness Criteria® Breast Cancer Screening.

PubMed

Mainiero, Martha B; Moy, Linda; Baron, Paul; Didwania, Aarati D; diFlorio, Roberta M; Green, Edward D; Heller, Samantha L; Holbrook, Anna I; Lee, Su-Ju; Lewin, Alana A; Lourenco, Ana P; Nance, Kara J; Niell, Bethany L; Slanetz, Priscilla J; Stuckey, Ashley R; Vincoff, Nina S; Weinstein, Susan P; Yepes, Monica M; Newell, Mary S

2017-11-01

Breast cancer screening recommendations are based on risk factors. For average-risk women, screening mammography and/or digital breast tomosynthesis is recommended beginning at age 40. Ultrasound (US) may be useful as an adjunct to mammography for incremental cancer detection in women with dense breasts, but the balance between increased cancer detection and the increased risk of a false-positive examination should be considered in the decision. For intermediate-risk women, US or MRI may be indicated as an adjunct to mammography depending upon specific risk factors. For women at high risk due to prior mantle radiation between the ages of 10 to 30, mammography is recommended starting 8 years after radiation therapy but not before age 25. For women with a genetic predisposition, annual screening mammography is recommended beginning 10 years earlier than the affected relative at the time of diagnosis but not before age 30. Annual screening MRI is recommended in high-risk women as an adjunct to mammography. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
ACR Appropriateness Criteria Low Back Pain.

PubMed

Patel, Nandini D; Broderick, Daniel F; Burns, Judah; Deshmukh, Tejaswini K; Fries, Ian Blair; Harvey, H Benjamin; Holly, Langston; Hunt, Christopher H; Jagadeesan, Bharathi D; Kennedy, Tabassum A; O'Toole, John E; Perlmutter, Joel S; Policeni, Bruno; Rosenow, Joshua M; Schroeder, Jason W; Whitehead, Matthew T; Cornelius, Rebecca S; Corey, Amanda S

2016-09-01

Most patients presenting with uncomplicated acute low back pain (LBP) and/or radiculopathy do not require imaging. Imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome, malignancy, fracture, and infection. Many imaging modalities are available to clinicians and radiologists for evaluating LBP. Application of these modalities depends largely on the working diagnosis, the urgency of the clinical problem, and comorbidities of the patient. When there is concern for fracture of the lumbar spine, multidetector CT is recommended. Those deemed to be interventional candidates, with LBP lasting for > 6 weeks having completed conservative management with persistent radiculopathic symptoms, may seek MRI. Patients with severe or progressive neurologic deficit on presentation and red flags should be evaluated with MRI. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.
ACR Appropriateness Criteria Assessment of Fetal Well-Being.

PubMed

Simpson, Lynn; Khati, Nadia J; Deshmukh, Sandeep P; Dudiak, Kika M; Harisinghani, Mukesh G; Henrichsen, Tara L; Meyer, Benjamin J; Nyberg, David A; Poder, Liina; Shipp, Thomas D; Zelop, Carolyn M; Glanc, Phyllis

2016-12-01

Although there is limited evidence that antepartum testing decreases the risk for fetal death in low-risk pregnancies, women with high-risk factors for stillbirth should undergo antenatal fetal surveillance. The strongest evidence supporting antepartum testing pertains to pregnancies complicated by intrauterine fetal growth restriction secondary to uteroplacental insufficiency. The main ultrasound-based modalities to determine fetal health are the biophysical profile, modified biophysical profile, and duplex Doppler velocimetry. In patients at risk for cardiovascular compromise, fetal echocardiography may also be indicated to ensure fetal well-being. Although no single antenatal test has been shown to be superior, all have high negative predictive values. Weekly or twice-weekly fetal testing has become the standard practice in high-risk pregnancies. The timing for the initiation of assessments of fetal well-being should be tailored on the basis of the risk for stillbirth and the likelihood of survival with intervention. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.
11. Historic American Buildings Survey Marvin Rand, Photographer August 1971 ...

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

11. Historic American Buildings Survey Marvin Rand, Photographer August 1971 FIRST FLOOR: MUSIC ROOM (Stained Glass Windows Designed by Shepard) - Villa Montezuma, 1925 K Street, San Diego, San Diego County, CA
Quality of care indicators for the rehabilitation of children with traumatic brain injury.

PubMed

Rivara, Frederick P; Ennis, Stephanie K; Mangione-Smith, Rita; MacKenzie, Ellen J; Jaffe, Kenneth M

2012-03-01

To develop measurement tools for assessing compliance with identifiable processes of inpatient care for children with traumatic brain injury (TBI) that are reliable, valid, and amenable to implementation. Literature review and expert panel using the RAND/UCLA Appropriateness Method and a Delphi technique. Not applicable. Children with TBI. Not applicable. Quality of care indicators. A total of 119 indicators were developed across the domains of general management; family-centered care; cognitive-communication, speech, language, and swallowing impairments; gross and fine motor skill impairments; neuropsychologic, social, and behavioral impairments; school reentry; and community integration. There was a high degree of agreement on these indicators as valid and feasible quality measures for children with TBI. These indicators are an important step toward building a better base of evidence about the effectiveness and efficiency of the components of acute inpatient rehabilitation for pediatric patients with TBI. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
A decision support tool for appropriate glucose-lowering therapy in patients with type 2 diabetes.

PubMed

Ampudia-Blasco, F Javier; Benhamou, Pierre Yves; Charpentier, Guillaume; Consoli, Agostino; Diamant, Michaela; Gallwitz, Baptist; Khunti, Kamlesh; Mathieu, Chantal; Ridderstråle, Martin; Seufert, Jochen; Tack, Cees; Vilsbøll, Tina; Phan, Tra-Mi; Stoevelaar, Herman

2015-03-01

Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope(®); Novo Nordisk Health Care AG, Zürich, Switzerland). Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process). A novel decision support tool based on the ADA/EASD 2012 position statement and a systematic analysis of expert opinion has been developed to help healthcare professionals to individualize glucose-lowering therapy in daily clinical situations.
ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding.

PubMed

Singh-Bhinder, Nimarta; Kim, David H; Holly, Brian P; Johnson, Pamela T; Hanley, Michael; Carucci, Laura R; Cash, Brooks D; Chandra, Ankur; Gage, Kenneth L; Lambert, Drew L; Levy, Angela D; Oliva, Isabel B; Peterson, Christine M; Strax, Richard; Rybicki, Frank J; Dill, Karin E

2017-05-01

Upper gastrointestinal bleeding (UGIB) remains a significant cause of morbidity and mortality with mortality rates as high as 14%. This document addresses the indications for imaging UGIB that is nonvariceal and unrelated to portal hypertension. The four variants are derived with respect to upper endoscopy. For the first three, it is presumed that upper endoscopy has been performed, with three potential initial outcomes: endoscopy reveals arterial bleeding source, endoscopy confirms UGIB without a clear source, and negative endoscopy. The fourth variant, "postsurgical and traumatic causes of UGIB; endoscopy contraindicated" is considered separately because upper endoscopy is not performed. When endoscopy identifies the presence and location of bleeding but bleeding cannot be controlled endoscopically, catheter-based arteriography with treatment is an appropriate next study. CT angiography (CTA) is comparable with angiography as a diagnostic next step. If endoscopy demonstrates a bleed but the endoscopist cannot identify the bleeding source, angiography or CTA can be typically performed and both are considered appropriate. In the event of an obscure UGIB, angiography and CTA have been shown to be equivalent in identifying the bleeding source; CT enterography may be an alternative to CTA to find an intermittent bleeding source. In the postoperative or traumatic setting when endoscopy is contraindicated, primary angiography, CTA, and CT with intravenous contrast are considered appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
5. Historic American Buildings Survey Frances Rand Smith Collection California ...

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

5. Historic American Buildings Survey Frances Rand Smith Collection California Historical Society Original: After 1860's Re-photo: January 1940 FIRST FRAME CHURCH (LEFT) - Mission San Rafael Archangel, San Rafael, Marin County, CA
Of Tanks and Toyotas: An Assessment of Japan’s Defense Industry

DTIC Science & Technology

1993-01-01

AD-A282 389 A RAND NOTE Of Tants and Toyotas An Asmamnt of Jan’s Defense Idustry Arthur Alexander DTIC S ELECTEJUL 2 6 1994 0 G 94-22886 RAND 94 7 21...RAND NOTE N3542-AF Of Tanks and Toyotas : An Assesmen of Japan’s Defense Idus"r Arthur Alexander Prepared for the United States Air Force Accesion For...Japanese dfense expenditures are modest when compared to those of NATO countries such as Italy and France, whose economies are considerably smaller than
10. Historic American Buildings Survey Frances Rand Smith Collection California ...

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

10. Historic American Buildings Survey Frances Rand Smith Collection California Historical Society Original: About 1890 Re-photo: January 1940 SECOND FRAME CHURCH REPLACING MISSION (1890) - Mission San Rafael Archangel, San Rafael, Marin County, CA
Explicit criteria for prioritization of cataract surgery

PubMed Central

Ma Quintana, José; Escobar, Antonio; Bilbao, Amaia

2006-01-01

Background Consensus techniques have been used previously to create explicit criteria to prioritize cataract extraction; however, the appropriateness of the intervention was not included explicitly in previous studies. We developed a prioritization tool for cataract extraction according to the RAND method. Methods Criteria were developed using a modified Delphi panel judgment process. A panel of 11 ophthalmologists was assembled. Ratings were analyzed regarding the level of agreement among panelists. We studied the effect of all variables on the final panel score using general linear and logistic regression models. Priority scoring systems were developed by means of optimal scaling and general linear models. The explicit criteria developed were summarized by means of regression tree analysis. Results Eight variables were considered to create the indications. Of the 310 indications that the panel evaluated, 22.6% were considered high priority, 52.3% intermediate priority, and 25.2% low priority. Agreement was reached for 31.9% of the indications and disagreement for 0.3%. Logistic regression and general linear models showed that the preoperative visual acuity of the cataractous eye, visual function, and anticipated visual acuity postoperatively were the most influential variables. Alternative and simple scoring systems were obtained by optimal scaling and general linear models where the previous variables were also the most important. The decision tree also shows the importance of the previous variables and the appropriateness of the intervention. Conclusion Our results showed acceptable validity as an evaluation and management tool for prioritizing cataract extraction. It also provides easy algorithms for use in clinical practice. PMID:16512893
The Effects of Quality of Care on Costs: A Conceptual Framework

PubMed Central

Nuckols, Teryl K; Escarce, José J; Asch, Steven M

2013-01-01

Context The quality of health care and the financial costs affected by receiving care represent two fundamental dimensions for judging health care performance. No existing conceptual framework appears to have described how quality influences costs. Methods We developed the Quality-Cost Framework, drawing from the work of Donabedian, the RAND/UCLA Appropriateness Method, reports by the Institute of Medicine, and other sources. Findings The Quality-Cost Framework describes how health-related quality of care (aspects of quality that influence health status) affects health care and other costs. Structure influences process, which, in turn, affects proximate and ultimate outcomes. Within structure, subdomains include general structural characteristics, circumstance-specific (e.g., disease-specific) structural characteristics, and quality-improvement systems. Process subdomains include appropriateness of care and medical errors. Proximate outcomes consist of disease progression, disease complications, and care complications. Each of the preceding subdomains influences health care costs. For example, quality improvement systems often create costs associated with monitoring and feedback. Providing appropriate care frequently requires additional physician visits and medications. Care complications may result in costly hospitalizations or procedures. Ultimate outcomes include functional status as well as length and quality of life; the economic value of these outcomes can be measured in terms of health utility or health-status-related costs. We illustrate our framework using examples related to glycemic control for type 2 diabetes mellitus or the appropriateness of care for low back pain. Conclusions The Quality-Cost Framework describes the mechanisms by which health-related quality of care affects health care and health status–related costs. Additional work will need to validate the framework by applying it to multiple clinical conditions. Applicability could be assessed by using the framework to classify the measures of quality and cost reported in published studies. Usefulness could be demonstrated by employing the framework to identify design flaws in published cost analyses, such as omitting the costs attributable to a relevant subdomain of quality. PMID:23758513
Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: an appropriateness ratings evaluation

PubMed Central

Blakeman, Tom; Griffith, Kathryn; Lasserson, Dan; Lopez, Berenice; Tsang, Jung Y; Campbell, Stephen; Tomson, Charles

2016-01-01

Objectives Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. Design An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. Setting Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result. Participants A 10-person panel was purposively sampled with representation from clinical biochemistry, acute and emergency medicine and general practice. General practitioners (GPs) represented typical practice in relation to rural and urban practice, out of hours care, GP commissioning and those interested in reducing the impact of medicalisation and ‘overdiagnosis’. Results There was agreement that delivery of AKI warning stage test results through interruptive methods of communication (ie, telephone) from laboratories to primary care was the appropriate next step for patients with an AKI warning stage 3 test result. In the context of acute illness, waiting up to 72 hours to respond to an AKI warning stage test result was deemed an inappropriate action in 62 out of the 65 (94.5%) cases. There was agreement that a clinician response was required within 6 hours, or less, in 39 out of 40 (97.5%) clinical cases relating AKI warning stage test results in the presence of moderate hyperkalaemia. Conclusions The study has informed national guidance to support a timely and calibrated response to AKI warning stage test results for adults in primary care. Further research is needed to support effective implementation, with a view to examine the effect on health outcomes and costs. PMID:27729353
8. Historic American Buildings Survey Frances Rand Smith Collection California ...

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

8. Historic American Buildings Survey Frances Rand Smith Collection California Historical Society Original: 1870's Re-photo: January, 1940 FIRST FRAME CHURCH (LEFT), OLD MARIN COUNTY COURT HOUSE (CENTER) - Mission San Rafael Archangel, San Rafael, Marin County, CA
Hazardous Waste Cleanup: Curtiss-Wright in Kearny, New Jersey

EPA Pesticide Factsheets

The site is located in Phillipsburg, New Jersey and was operated by Ingersoll Rand Company. Ingersoll Rand began facility construction in 1903 and produced products such as pumps, turbo equipment, air and gas compressors, rock drills, and mining equipment.
15. VIEW OF INGERSOLLRAND AIR COMPRESSOR, 1920 (left) and INGERSOLLRAND ...

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

15. VIEW OF INGERSOLL-RAND AIR COMPRESSOR, 1920 (left) and INGERSOLL-RAND TURBINE GENERATOR UNIT AND FLYWHEEL, patented 1901-1911 (right). - Juniata Shops, Power Plant & Boiler House, East of Fourth Avenue at Second Street, Altoona, Blair County, PA
RandAgiamo™, a Pilot Project Increasing Adoptability of Shelter Dogs in the Umbria Region (Italy).

PubMed

Menchetti, Laura; Mancini, Stefania; Catalani, Maria Chiara; Boccini, Beatrice; Diverio, Silvana

2015-08-14

Current Italian legislation does not permit euthanasia of dogs, unless they are ill or dangerous. Despite good intentions and ethical benefits, this 'no-kill policy' has caused a progressive overpopulation of dogs in shelters, due to abandonment rates being higher than adoption rates. Shelter overcrowding has negative implications for dog welfare and increases public costs. The aim of this paper is to describe the pilot project "RandAgiamo" implemented in a rescue shelter in the Umbria Region and to evaluate its effectiveness on the rate of dog adoption using official data. RandAgiamo aimed to increase adult shelter dogs' adoptability by a standard training and socialization programme. It also promoted dogs' visibility by publicizing them through social media and participation in events. We analysed the official data of the Umbria regional health authorities regarding dog shelters of the Perugia province of the year 2014. In the RandAgiamo shelter, the dog adoption rate was 27.5% higher than that of dogs housed in other shelters located in the same geographical area (P < 0.001). The RandAgiamo project could be beneficial for the dogs' welfare, owner satisfaction, shelter management, and public perception of shelter dogs. However, staff were required to provide dog training and related activities.
Making Strategic Analysis Matter

DTIC Science & Technology

2012-01-01

Bryan Gabbard , Assessing the Tradecraft of Intelligence Analysis, Santa Monica, Calif.: RAND Corporation, TR-293, 2008. 4 See The Commission on the...July 7, 2011: http://www.rand.org/pubs/occasional_papers/OP152.html Treverton, Gregory F., and C. Bryan Gabbard , Assessing the Tradecraft of
ACR Appropriateness Criteria® Stage I Breast Cancer: Initial Workup and Surveillance for Local Recurrence and Distant Metastases in Asymptomatic Women.

PubMed

Moy, Linda; Bailey, Lisa; D'Orsi, Carl; Green, Edward D; Holbrook, Anna I; Lee, Su-Ju; Lourenco, Ana P; Mainiero, Martha B; Sepulveda, Karla A; Slanetz, Priscilla J; Trikha, Sunita; Yepes, Monica M; Newell, Mary S

2017-05-01

Women and health care professionals generally prefer intensive follow-up after a diagnosis of breast cancer. However, there are no survival differences between women who obtain intensive surveillance with imaging and laboratory studies compared with women who only undergo testing because of the development of symptoms or findings on clinical examinations. American Society of Clinical Oncology and National Comprehensive Cancer Network guidelines state that annual mammography is the only imaging examination that should be performed to detect a localized breast recurrence in asymptomatic patients; more imaging may be needed if the patient has locoregional symptoms (eg, palpable abnormality). Women with other risk factors that increase their lifetime risk for breast cancer may warrant evaluation with breast MRI. Furthermore, the quality of life is similar for women who undergo intensive surveillance compared with those who do not. There is little justification for imaging to detect or rule out metastasis in asymptomatic women with newly diagnosed stage I breast cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
[Indications for magnetic resonance imaging for low back pain in adults].

PubMed

Millán Ortuondo, E; Cabrera Zubizarreta, A; Muñiz Saitua, J; Sola Sarabia, C; Zubia Arratibel, J

2014-01-01

Low back pain is a common disorder that generates many medical consultations. Magnetic Resonance Imaging (MRI) is commonly used in the clinical management of some of these patients. However, the cost of inappropriate MRI use is high, so there is a need to develop guidelines to help physicians make correct decisions and optimize available resources. To determine the main clinical indications for MRI scanning in adults with low back pain. The RAND/UCLA appropriateness method was used: After a systematic review (May 2012), a list of the clinical indications for MRI scanning in patients with low back pain was prepared. A multidisciplinary expert panel scored each indication from 1, «totally inappropriate» to 9, «totally appropriate». A first on-line round, an in-person panel meeting, where results of the first round were discussed, and a final second on-line round were arranged. A clinical indication was considered appropriate if the median score was 6.5 or higher, and there was agreement between experts (IPRAS index was used). An MRI test is considered appropriate if cancer, spinal infection or a fracture, even with a negative X-ray test is suspected.; if there is inflammatory back pain; severe/progressive neurological deficit; severe and progressive low back pain; subacute or chronic low back pain with radicular involvement unresponsive to conservative therapy. Clinical indications for a MRI scanning are based on the suspicion of a secondary serious pathology. This methodology helps to set clinical indications for MRI, and may be of great value for both clinicians and health managers. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

ACR Appropriateness Criteria® Multiple Gestations.

PubMed

Glanc, Phyllis; Nyberg, David A; Khati, Nadia J; Deshmukh, Sandeep Prakash; Dudiak, Kika M; Henrichsen, Tara Lynn; Poder, Liina; Shipp, Thomas D; Simpson, Lynn; Weber, Therese M; Zelop, Carolyn M

2017-11-01

Women with twin or higher-order pregnancies will typically have more ultrasound examinations than women with a singleton pregnancy. Most women will have at minimum a first trimester scan, a nuchal translucency evaluation scan, fetal anatomy scan at 18 to 22 weeks, and one or more scans in the third trimester to evaluate growth. Multiple gestations are at higher risk for preterm delivery, congenital anomalies, fetal growth restriction, placenta previa, vasa previa, and velamentous cord insertion. Chorionicity and amnionicity should be determined as early as possible when a twin pregnancy is identified to permit triage of the monochorionic group into a closer surveillance model. Screening for congenital heart disease is warranted in monochorionic twins because they have an increased rate of congenital cardiac anomalies. In addition, monochorionic twins have a higher risk of developing cardiac abnormalities in later gestation related to right ventricular outflow obstruction, in particular the subgroups with twin-twin transfusion syndrome or selective intrauterine growth restriction. Monochorionic twins have unique complications including twin-to-twin transfusion syndrome, twin embolization syndrome, and acardius, or twin-reversed arterial perfusion sequence. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.
The Future Of Sectarian Relations in the Middle East

DTIC Science & Technology

2017-01-01

by demanding remuneration for its forward deployments. Meanwhile, the United States relationship with the United Arab Emirates and Qatar is growing...information on the RAND Intelligence Policy Center, see http://www.rand.org/nsrd/ndri/centers/intel.html or contact the director (contact
New projects developed by COMOTI in gas industry

NASA Astrophysics Data System (ADS)

Nitulescu, Marian; Silivestru, Valentin; Toma, Niculae; Slujitoru, Cristian; Petrescu, Valentin; Leahu, Mihai; Oniga, Ciprian; Ulici, Gheorghe

2015-08-01

The paper aims to present two new projects developed by the Romanian Research and Development Institute for Gas Turbines (COMOTI) in partnership with City University of London and GHH-Rand Germany, in the field of screw compressors/expanders. COMOTI passed, in recent years, from being a GHH-Rand licensed manufacturer for a range of oil-injected screw compressors, of CU type, to a new phase of range diversification, approaching screw compressors with a maximum discharge pressure of 45 bara. So, in cooperation with City University and GHH-Rand we design, manufacture and test, with air, in COMOTI test bench the new type of screw compressor named CHP 220. Also, the cooperation with GHH-Rand has resulted in the design, manufacture and air testing on the test bench, and then gas testing - in a gas compression station - for an electric generator driven by a screw expander. This paper presents how the tests were carried out, the experimental data and the interpretation of results
The African Institutions Initiative: Insights from the First Four Years

ERIC Educational Resources Information Center

Cochrane, Gavin; Robin, Enora; Marjanovic, Sonja; Diepeveen, Stephanie; Hanlin, Rebecca; Kryl, David; Muchova, Lucia; Yaqub, Ohid; Chataway, Joanna

2014-01-01

In 2009, the Wellcome Trust launched a research capacity strengthening programme known as the "African Institutions Initiative" (AII). The AII is innovative in its methods and organization. The Initiative funded networked consortia (7 consortia involving 54 institutions in 18 African countries, and Northern partners). RAND Europe was…
Effects of Stigma and Discrimination Reduction Programs Conducted Under the California Mental Health Services Authority

PubMed Central

Cerully, Jennifer L.; Collins, Rebecca L.; Wong, Eunice C.; Roth, Elizabeth; Marks, Joyce; Yu, Jennifer

2016-01-01

Abstract Describes the methods and results of a RAND evaluation of stigma and discrimination reduction efforts by Runyon Saltzman Einhorn, Inc., involving screenings of a documentary film called “A New State of Mind: Ending the Stigma of Mental Illness.” PMID:28083418
Robust climate policies under uncertainty: a comparison of robust decision making and info-gap methods.

PubMed

Hall, Jim W; Lempert, Robert J; Keller, Klaus; Hackbarth, Andrew; Mijere, Christophe; McInerney, David J

2012-10-01

This study compares two widely used approaches for robustness analysis of decision problems: the info-gap method originally developed by Ben-Haim and the robust decision making (RDM) approach originally developed by Lempert, Popper, and Bankes. The study uses each approach to evaluate alternative paths for climate-altering greenhouse gas emissions given the potential for nonlinear threshold responses in the climate system, significant uncertainty about such a threshold response and a variety of other key parameters, as well as the ability to learn about any threshold responses over time. Info-gap and RDM share many similarities. Both represent uncertainty as sets of multiple plausible futures, and both seek to identify robust strategies whose performance is insensitive to uncertainties. Yet they also exhibit important differences, as they arrange their analyses in different orders, treat losses and gains in different ways, and take different approaches to imprecise probabilistic information. The study finds that the two approaches reach similar but not identical policy recommendations and that their differing attributes raise important questions about their appropriate roles in decision support applications. The comparison not only improves understanding of these specific methods, it also suggests some broader insights into robustness approaches and a framework for comparing them. © 2012 RAND Corporation.
Methods Used to Estimate Achievement Effects in Personalized Learning Schools. Working Paper WR-1061-BMGF

ERIC Educational Resources Information Center

Pane, John F.; Baird, Matthew

2014-01-01

The purpose of this document is to describe the methods RAND used to analyze achievement for 23 personalized learning (PL) schools for the 2012-13 through 2013-14 academic years. This work was performed at the request of the Bill & Melinda Gates Foundation (BMGF), as part of a multi-year evaluation contract. The 23 schools were selected from a…
Engaging Patients and Caregivers Managing Rare Diseases to Improve the Methods of Clinical Guideline Development: A Research Protocol

PubMed Central

Kinnett, Kathi; Grant, Sean; Lucas, Ann; Martin, Ann; Denger, Brian; Peay, Holly; Coulter, Ian; Fink, Arlene

2017-01-01

Background Clinical guidelines provide systematically developed recommendations for deciding on appropriate health care options for specific conditions and clinical circumstances. Up until recently, patients and caregivers have rarely been included in the process of developing care guidelines. Objective This project will develop and test a new online method for including patients and their caregivers in this process using Duchenne muscular dystrophy (DMD) care guidelines as an example. The new method will mirror and complement the RAND/UCLA Appropriateness Method (RAM)—the gold standard approach for conducting clinical expert panels that uses a modified Delphi format. RAM is often used in clinical guideline development to determine care appropriateness and necessity in situations where existing clinical evidence is uncertain, weak, or unavailable. Methods To develop the new method for engaging patients and their caregivers in guideline development, we will first conduct interviews with experts on RAM, guideline development, patient engagement, and patient-centeredness and engage with Duchenne patients and caregivers to identify how RAM should be modified for the purposes of patient engagement and what rating criteria should patients and caregivers use to provide their input during the process of guideline development. Once the new method is piloted, we will test it by conducting two concurrently run patient/caregiver panels that will rate patient-centeredness of a subset of DMD care management recommendations already deemed clinically appropriate and necessary. The ExpertLens™ system—a previously evaluated online modified Delphi system that combines two rounds of rating with a round of feedback and moderated online discussions—will be used to conduct these panels. In addition to developing and testing the new engagement method, we will work with the members of our project’s Advisory Board to generate a list of best practices for enhancing the level of patient and caregiver involvement in the guideline development process. We will solicit input on these best practice from Duchenne patients, caregivers, and clinicians by conducting a series of round-table discussions and making a presentation at an annual conference on Duchenne. Results The study protocol was reviewed by RAND’s Human Subjects Protection Committee, which determined it to be exempt from review. Interviews with RAM experts have been completed. The projected study completion date is May 2020. Conclusions We expect that the new method will make it easier to engage large numbers of patients and caregivers in the process of guideline development in a rigorous and culturally appropriate manner that is consistent with the way clinicians participate in guideline development. Moreover, this project will develop best practices that could help involve patients and caregivers in the clinical guideline development process in other clinical areas, thereby facilitating the work of guideline developers. PMID:28455279
Alternative Models for the ERIC Clearinghouse Network.

ERIC Educational Resources Information Center

Greenwood, P. W.; Weiler, D. M.

The National Center for Educational Communication (NCEC) contracted with Rand to develop a range of potential objectives and structures for the Educational Resources Information Center (ERIC) system that could render it more effective in the future. The Rand study team surveyed the scope and sources of education literature and studied the…
The New DOD Instruction 5000.02: An Analysis of the Efficiencies to be Gained

DTIC Science & Technology

2015-06-01

IT, and Information Systems • Post Implementation Review (PIR) • DOD Enterprise Architecture requirement • Cybersecurity Strategy for all IT... dam /rand/pubs/occasional_papers/2010/RAND_OP3 08.pdf President’s Blue Ribbon Commission on Defense Management. (1986). A quest for excellence, final
Time Critical Targeting Concept of Operations (CONOPS) Interactions

DTIC Science & Technology

2011-05-01

range of topics in force development and employment. Carl has participated in projects examining the interdiction of armoured ground forces , long...Critical Targeting Concept of Operations (CONOPS) Interactions Executive Summary In 2003, RAND Project Air Force examined the...Attack. ____________________ ________________________________________________ Carl Rhodes Project Air Force , RAND Corporation Carl Rhodes is the
Validation in daily clinical situations of Diascope®, a software developed to help healthcare professionals individualize antidiabetic treatment in type 2 diabetes.

PubMed

Ampudia-Blasco, Francisco Javier; García-Soidán, Francisco Javier; Rubio Sánchez, Manuela; Phan, Tra-Mi

2017-03-01

DiaScope ® is a software to help in individualized prescription of antidiabetic treatment in type 2 diabetes. This study assessed its value and acceptability by different professionals. DiaScope ® was developed based on the ADA-EASD 2012 algorithm and on the recommendation of 12 international diabetes experts using the RAND/UCLA appropriateness method. The current study was performed at a single session. In the first phase, 5 clinical scenarios were evaluated, selecting the most appropriated therapeutic option among 4 possibilities (initial test). In a second phase, the same clinical cases were evaluated with DiaScope ® (final test).Opinion surveys on DiaScope ® were also performed (questionnaire). DiaScope ® changed the selected option 1 or more times in 70.5% of cases. Among 275 evaluated questionnaires, 54.0% strongly agree that DiaScope ® allowed finding easily a similar therapeutic scenario to the corresponding patient, and 52.5 among the obtained answers were clinically plausible. Up to 58.3% will recommend it to a colleague. In particular, primary care physicians with >20 years of professional dedication found with DiaScope ® the most appropriate option for a particular situation against specialists or those with less professional dedication (p<.05). DiaScope ® is an easy to use tool for antidiabetic drug prescription that provides plausible solutions and is especially useful for primary care physicians with more years of professional practice. Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.
On using ethical principles of community-engaged research in translational science.

PubMed

Khodyakov, Dmitry; Mikesell, Lisa; Schraiber, Ron; Booth, Marika; Bromley, Elizabeth

2016-05-01

The transfer of new discoveries into both clinical practice and the wider community calls for reliance on interdisciplinary translational teams that include researchers with different areas of expertise, representatives of health care systems and community organizations, and patients. Engaging new stakeholders in research, however, calls for a reconsideration or expansion of the meaning of ethics in translational research. We explored expert opinion on the applicability of ethical principles commonly practiced in community-engaged research (CEnR) to translational research. To do so, we conducted 2 online, modified-Delphi panels with 63 expert stakeholders who iteratively rated and discussed 9 ethical principles commonly used in CEnR in terms of their importance and feasibility for use in translational research. The RAND/UCLA appropriateness method was used to analyze the data and determine agreement and disagreement among participating experts. Both panels agreed that ethical translational research should be "grounded in trust." Although the academic panel endorsed "culturally appropriate" and "forthcoming with community about study risks and benefits," the mixed academic-community panel endorsed "scientifically valid" and "ready to involve community in interpretation and dissemination" as important and feasible principles of ethical translational research. These findings suggest that in addition to protecting human subjects, contemporary translational science models need to account for the interests of, and owe ethical obligations to, members of the investigative team and the community at large. Copyright © 2016 Elsevier Inc. All rights reserved.
Recommendations for the clinical evaluation of agents for treatment of osteoporosis: consensus of an expert panel representing the American Society for Bone and Mineral Research (ASBMR), the International Society for Clinical Densitometry (ISCD), and the National Osteoporosis Foundation (NOF).

PubMed

Silverman, Stuart L; Cummings, Steven R; Watts, Nelson B

2008-01-01

A panel of experts representing ASBMR, NOF, and ISCD reviewed evidence and reached consensus that regulatory approval of treatments for osteoporosis should be based on trials with fracture endpoints, lasting 18-24 mo, and extending treatment to 5 yr; other indications could be approved based on BMD and turnover markers. In response to an FDA request for clinical trial guidance in osteoporosis, an expert panel was convened with representatives from the American Society of Bone and Mineral Research, the International Society of Clinical Densitometry, and the National Osteoporosis Foundation. The panel used a validated evidence-based expert panel process (the Rand Appropriateness Method) to address issues of trial duration, trial design, use of intermediate endpoints as outcomes, and use of placebo-controlled trials in high-risk patients. The panel concluded that placebo-controlled trials with fracture endpoints are appropriate and, with informed consent, are ethical for registration of new compounds. Trials may be 18-24 mo in duration for efficacy, assuming longer duration to 5 yr for safety and demonstration of sustained fracture reduction. Once fracture efficacy has been established for a particular agent, intermediate endpoints (e.g., BMD and bone turnover markers) may be used as outcomes for new indications other than corticosteroid-induced osteoporosis.
Evaluating the BK 21 Program. Research Brief

ERIC Educational Resources Information Center

Seong, Somi; Popper, Steven W.; Goldman, Charles A.; Evans, David K.; Grammich, Clifford A.

2008-01-01

The Brain Korea 21 program (BK21), an effort to improve Korean universities and research, has attracted a great deal of attention in Korea, producing the need to understand how well the program is meeting its goals. RAND developed a logic model for identifying program goals and dynamics, suggested quantitative and qualitative evaluation methods,…
Effects of Stigma and Discrimination Reduction Programs Conducted Under the California Mental Health Services Authority: An Evaluation of Runyon Saltzman Einhorn, Inc., Documentary Screening Events.

PubMed

Cerully, Jennifer L; Collins, Rebecca L; Wong, Eunice C; Roth, Elizabeth; Marks, Joyce; Yu, Jennifer

2016-05-09

Describes the methods and results of a RAND evaluation of stigma and discrimination reduction efforts by Runyon Saltzman Einhorn, Inc., involving screenings of a documentary film called "A New State of Mind: Ending the Stigma of Mental Illness."
An Investigation of Methods for Reducing Sampling Error in Certain IRT (Item Response Theory) Procedures.

DTIC Science & Technology

1983-08-01

34th Streets Lawrence, KS 66045 Baltimore, MD 21218 ENIC Facility-Acquisitions 1 Dr. Ron Hambleton 4t33 Rugby Avenue School of Education Lcthesda, !ID...Sector Dr. V. R. R. Uppuluri 1 Dr. Rand R. Wilcox Union Carbide Corporation University of Southern California Nuclear Division Department of
Quality indicators for in-hospital geriatric co-management programmes: a systematic literature review and international Delphi study.

PubMed

Van Grootven, Bastiaan; McNicoll, Lynn; Mendelson, Daniel A; Friedman, Susan M; Fagard, Katleen; Milisen, Koen; Flamaing, Johan; Deschodt, Mieke

2018-03-16

To find consensus on appropriate and feasible structure, process and outcome indicators for the evaluation of in-hospital geriatric co-management programmes. An international two-round Delphi study based on a systematic literature review (searching databases, reference lists, prospective citations and trial registers). Western Europe and the USA. Thirty-three people with at least 2 years of clinical experience in geriatric co-management were recruited. Twenty-eight experts (16 from the USA and 12 from Europe) participated in both Delphi rounds (85% response rate). Participants rated the indicators on a nine-point scale for their (1) appropriateness and (2) feasibility to use the indicator for the evaluation of geriatric co-management programmes. Indicators were considered appropriate and feasible based on a median score of seven or higher. Consensus was based on the level of agreement using the RAND/UCLA Appropriateness Method. In the first round containing 37 indicators, there was consensus on 14 indicators. In the second round containing 44 indicators, there was consensus on 31 indicators (structure=8, process=7, outcome=16). Experts indicated that co-management should start within 24 hours of hospital admission using defined criteria for selecting appropriate patients. Programmes should focus on the prevention and management of geriatric syndromes and complications. Key areas for comprehensive geriatric assessment included cognition/delirium, functionality/mobility, falls, pain, medication and pressure ulcers. Key outcomes for evaluating the programme included length of stay, time to surgery and the incidence of complications. The indicators can be used to assess the performance of geriatric co-management programmes and identify areas for improvement. Furthermore, the indicators can be used to monitor the implementation and effect of these programmes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
REDOSER project: optimising biological therapy dose for rheumatoid arthritis and spondyloarthritis patients.

PubMed

González-Álvaro, Isidoro; Blasco, Antonio J; Lázaro, Pablo; Sánchez-Piedra, Carlos; Almodovar, Raquel; Bachiller-Corral, Javier; Balsa, Alejandro; Caliz, Rafael; Candelas, Gloria; Fernández-Carballido, Cristina; García-Aparicio, Angel; García-Magallón, Blanca; García-Vicuña, Rosario; Gómez-Centeno, Antonio; Ortiz, Ana M; Sanmartí, Raimon; Sanz, Jesús; Tejera, Beatriz

2017-11-01

Reducing the dose of biological therapy (BT) when patients with immune-mediated arthritis achieve a sustained therapeutic goal may help to decrease costs for national health services and reduce the risk of serious infection. However, there is little information about whether such a decision can be applied universally. Therefore, the objective of this study was to develop appropriateness criteria for reducing the dose of BT in patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and peripheral spondyloarthritis (pSpA). The RAND/UCLA appropriateness method was coordinated by experts in the methodology. Five rheumatologists with clinical research experience in RA and/or SpA selected and precisely defined the variables considered relevant when deciding to reduce the dose of BT in the 3 diseases, in order to define patient profiles. Ten rheumatologists with experience in prescribing BT anonymously rated each profile on a scale of 1 (completely inappropriate) to 9 (completely appropriate) after revising a summary of the evidence obtained from 4 systematic literature reviews carried out specifically for this project. A total of 2,304 different profiles were obtained for RA, 768 for axSpA, and 3,072 for pSpA. Only 327 (14.2%) patient profiles in RA, 80 (10.4%) in axSpA, and 154 (5%) in pSpA were considered appropriate for reducing the dose of BT. By contrast, 749 (32.5%) patient profiles in RA, 270 (35.3%) in axSpA, and 1,243 (40.5%) in pSpA were considered inappropriate. The remaining profiles were considered uncertain. Appropriateness criteria for reducing the dose of BT were developed in 3 inflammatory conditions. These criteria can help clinicians treating these disorders to optimize the BT dose. However, further research is needed, since more than 50% of the profiles were considered uncertain and the real prevalence of each profile in daily clinical practice remains unknown.
Federal Programs Supporting Educational Change, Vol. VIII: Implementing and Sustaining Innovations.

ERIC Educational Resources Information Center

Berman, Paul; McLaughlin, Milbrey Wallin

This report reviews and synthesizes the findings of a four year, two-phase study conducted by the Rand Corporation to examine and evaluate a national sample of educational innovations funded by Federal programs. Section I of this document provides background information and descriptions of the study. Section II discusses Rand's research approach…

Domestic Research at Rand.

ERIC Educational Resources Information Center

Rand Corp., Santa Monica, CA.

This third descriptive inventory of the Rand Corporation's domestic non-military research covers all projects since 1972, as well as its special 1969-1975 program for New York City. For each of over 300 research projects in nine program areas, brief summaries identify the project title and sponsor, beginning and ending dates, person-years of work…
58. View of high pressure IngersollRand dehumidifier/dessicator and compressor system ...

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

58. View of high pressure Ingersoll-Rand dehumidifier/dessicator and compressor system to supply dry pressurized air to waveguides. - Clear Air Force Station, Ballistic Missile Early Warning System Site II, One mile west of mile marker 293.5 on Parks Highway, 5 miles southwest of Anderson, Anderson, Denali Borough, AK
Strategies and Models for Promoting Adolescent Vaccination for Low-Income Populations

ERIC Educational Resources Information Center

Harris, Katherine M.; Martin, Laurie T.; Lurie, Nicole

2009-01-01

In 2007, Sanofi Pasteur asked RAND Health, a division of the RAND Corporation, to study the current climate for adolescent immunization in the United States, to recommend broad strategies for immunizing low-income adolescents (through age 18), and to identify promising "on the ground" practices consistent with the proposed strategic…
Eternal Hope: America’s International Narcotics Efforts,

DTIC Science & Technology

1985-02-01

85 10 02 110 -. ’%6 X:V§: kv7 V * The Rand Paper Series Papers are issued by The Rand Corporation as a service to its profes- sional staff. Their...drug entrepreneurs. Second, new export-import channels developed very rapidly too. Prior to 1970, there seems to have been a trivial amount of Mexican
Fels-Rand: an Xlisp-Stat program for the comparative analysis of data under phylogenetic uncertainty.

PubMed

Blomberg, S

2000-11-01

Currently available programs for the comparative analysis of phylogenetic data do not perform optimally when the phylogeny is not completely specified (i.e. the phylogeny contains polytomies). Recent literature suggests that a better way to analyse the data would be to create random trees from the known phylogeny that are fully-resolved but consistent with the known tree. A computer program is presented, Fels-Rand, that performs such analyses. A randomisation procedure is used to generate trees that are fully resolved but whose structure is consistent with the original tree. Statistics are then calculated on a large number of these randomly-generated trees. Fels-Rand uses the object-oriented features of Xlisp-Stat to manipulate internal tree representations. Xlisp-Stat's dynamic graphing features are used to provide heuristic tools to aid in analysis, particularly outlier analysis. The usefulness of Xlisp-Stat as a system for phylogenetic computation is discussed. Available from the author or at http://www.uq.edu.au/~ansblomb/Fels-Rand.sit.hqx. Xlisp-Stat is available from http://stat.umn.edu/~luke/xls/xlsinfo/xlsinfo.html. s.blomberg@abdn.ac.uk
Definition of frailty in older men according to questionnaire data (RAND-36/SF-36): The Helsinki Businessmen Study.

PubMed

Sirola, J; Pitkala, K H; Tilvis, R S; Miettinen, T A; Strandberg, T E

2011-11-01

To explore the association of frailty according to questionnaire data (modified Fried criteria) with important endpoints in older men. Prospective cohort study (the Helsinki Businessmen Study) in Finland. In 1974, clinically healthy men (born 1919-1934, n=1815) of similar socioeconomic status were identified. After a 26-year follow-up in 2000 (mean age 73 years), disease prevalence, mobility-disability, and frailty status (80.9% of survivors, n=1125) were appraised using a postal questionnaire including RAND-36. Four criteria were used for definition: 1) >5% weight loss from midlife, or body mass index (BMI) <21 kg/m2; 2) reported physical inactivity; 3) low vitality (RAND-36); 4) physical weakness (RAND-36). Responders with 3-4, 1-2, and zero criteria were classified as frail (n=108), prefrail (n=567), and nonfrail (n=450), respectively. Eight-year mortality was assessed from registers, and in 2007, survivors were re-assessed with questionnaires. Nonfrail as referent and adjusted for age, BMI and smoking, both prefrail (HR 2.26; 95% CI, 1.57-3.26), and frail status (4.09; 95% CI, 2.60-6.44) were significant predictors of mortality. Nonfrailty predicted better survival independently of the frailty components, diseases, and disability, and also predicted faster walking speed and less disability 7 years later. Frailty, and also prefrailty, as defined using questionnaire data (RAND-36) independently predicted important endpoints in older men.
Living on the edge: timing of Rand Flora disjunctions congruent with ongoing aridification in Africa.

PubMed

Pokorny, Lisa; Riina, Ricarda; Mairal, Mario; Meseguer, Andrea S; Culshaw, Victoria; Cendoya, Jon; Serrano, Miguel; Carbajal, Rodrigo; Ortiz, Santiago; Heuertz, Myriam; Sanmartín, Isabel

2015-01-01

The Rand Flora is a well-known floristic pattern in which unrelated plant lineages show similar disjunct distributions in the continental margins of Africa and adjacent islands-Macaronesia-northwest Africa, Horn of Africa-Southern Arabia, Eastern Africa, and Southern Africa. These lineages are now separated by environmental barriers such as the arid regions of the Sahara and Kalahari Deserts or the tropical lowlands of Central Africa. Alternative explanations for the Rand Flora pattern range from vicariance and climate-driven extinction of a widespread pan-African flora to independent dispersal events and speciation in situ. To provide a temporal framework for this pattern, we used published data from nuclear and chloroplast DNA to estimate the age of disjunction of 17 lineages that span 12 families and nine orders of angiosperms. We further used these estimates to infer diversification rates for Rand Flora disjunct clades in relation to their higher-level encompassing lineages. Our results indicate that most disjunctions fall within the Miocene and Pliocene periods, coinciding with the onset of a major aridification trend, still ongoing, in Africa. Age of disjunctions seemed to be related to the climatic affinities of each Rand Flora lineage, with sub-humid taxa dated earlier (e.g., Sideroxylon) and those with more xeric affinities (e.g., Campylanthus) diverging later. We did not find support for significant decreases in diversification rates in most groups, with the exception of older subtropical lineages (e.g., Sideroxylon, Hypericum, or Canarina), but some lineages (e.g., Cicer, Campylanthus) showed a long temporal gap between stem and crown ages, suggestive of extinction. In all, the Rand Flora pattern seems to fit the definition of biogeographic pseudocongruence, with the pattern arising at different times in response to the increasing aridity of the African continent, with interspersed periods of humidity allowing range expansions.
A MOLA-controlled RAND-USGS Control Network for Mars

NASA Technical Reports Server (NTRS)

Archinal, B. A.; Colvin, T. R.; Davies, M. E.; Kirk, R. L.; Duxbury, T. C.; Lee, E. M.; Cook, D.; Gitlin, A. R.

2002-01-01

We are undertaking, in support of the Mars Digital Image Mosaic (MDIM) 2.1, many improvements in the RAND-USGS photogrammetric control network for Mars, primarily involving the use of Mars Orbiter Laser Altimeter (MOLA)-derived radii and DIMs to improve control point absolute radii and horizontal positions. Additional information is contained in the original extended abstract.
Ayn Rand: To be Selfish or Not to be Selfish--That is the Question

ERIC Educational Resources Information Center

Doctor, Tyrus L.; Kritsonis, William Allan

2009-01-01

Ayn Rand's "The Virtue of Selfishness" (1961) is comprised of a philosophy that defies the entire premise of what our education system is and shall be built upon. The "Objectivist" perspective has depicted a clear distinction between the "Have's" and the "Have Not's" or the Bourgeoisie and Proletariat. The "Objectivist" perspective believes that…
An Analysis of the Objectivist Ethics in Educational Leadership through Ayn Rand's "The Virtues of Selfishness" (1964)

ERIC Educational Resources Information Center

Jacobs, Karen Dupre; Kritsonis, William Allan

2007-01-01

Educational leadership is vital to sustain quality educational institutions. It is the role of the school leader to indoctrinate stakeholders with the objectivist ethics-embracing egoism and relinquishing altruistic ideals when it comes to invigorating the system with sustainable change. Ayn Rand's timeless piece of literature "The Virtue of…
Los Angeles County Juvenile Justice Crime Prevention Act. RAND Quarterly Report, October 2008. TR-621-LACPD

ERIC Educational Resources Information Center

Fain, Terry; Turner, Susan; Ridgeway, Greg

2008-01-01

In July 2008, RAND Corporation staff conducted Correctional Program Checklist (CPC) assessments of five home-based programs (Asian Youth Center, Communities in Schools, Inter-Agency Drug Abuse Recovery Programs, Soledad Enrichment Action, and Stars Behavioral Health Group) as part of its ongoing evaluation of Juvenile Justice Crime Prevention Act…
Designing an Effective Prevention Program: Principles Underlying the Rand Smoking and Drug Prevention Experiment.

ERIC Educational Resources Information Center

Ellickson, Phyllis L.

This paper describes the Project ALERT program (Adolescent Learning Experiences in Resistance Training) which was established by the Rand Corporation to prevent smoking and drug use among seventh graders. The program is based on the social influence model of drug use initiation. Curriculum features are described including motivation to resist and…
Recent Large Service Aquisitions in the Department of Defense: Lessons for the Office of the Secretary of Defense

DTIC Science & Technology

2004-01-01

In August 2001, the Directorate of Acquisition Resources and Analysis in the Office of the Secretary of Defense (OSD) asked the RAND Corporation to...Research Institute (NDRI), a unit of the RAND Corporation. NDRI is a federally funded research and development center (FFRDC) sponsored by the Office of
ENVIRONMENTAL TECHNOLOGY VERIFICATION REPORT-INGERSOLL-RAND ENERGY SYSTEMS IR POWERWORKS(TM) 70 KW MICROTURBINE SYSTEM

EPA Science Inventory

The Environmental Technology Verification report discusses the technology and performance of the IR PowerWorks 70kW Microturbine System manufactured by Ingersoll-Rand Energy Systems. This system is a 70 kW electrical generator that puts out 480 v AC at 60 Hz and that is driven by...
Perceptions Audit for the General Teaching Council for England. Technical Report

ERIC Educational Resources Information Center

Levitt, Ruth; Rabinovich, Lila; van Dijk, Lidia Villalba

2009-01-01

The General Teaching Council for England (GTC) commissioned RAND Europe in 2008 to undertake a perceptions audit, to take the temperature on its current status and to inform its future work with teachers, organisational partners and the wider public. A perceptions audit is a method for gathering opinions and views of selected informants about how…
Bibliometrics as a Tool for Supporting Prospective R&D Decision-Making in the Health Sciences

PubMed Central

Ismail, Sharif; Nason, Edward; Marjanovic, Sonja; Grant, Jonathan

2012-01-01

Abstract Bibliometric analysis is an increasingly important part of a broader “toolbox” of evaluation methods available to research and development (R&D) policymakers to support decision-making. In the US, UK and Australia, for example, there is evidence of gradual convergence over the past ten years towards a model of university research assessment and ranking incorporating the use of bibliometric measures. In Britain, the Department of Health (England) has shown growing interest in using bibliometric analysis to support prospective R&D decision-making, and has engaged RAND Europe's expertise in this area through a number of exercises since 2005. These range from the macro-level selection of potentially high impact institutions, to micro-level selection of high impact individuals for the National Institute for Health Research's faculty of researchers. The aim of this study is to create an accessible, “beginner's guide” to bibliometric theory and application in the area of health R&D decision-making. The study also aims to identify future directions and possible next steps in this area, based on RAND Europe's work with the Department of Health to date. It is targeted at a range of audiences, and will be of interest to health and biomedical researchers, as well as R&D decision-makers in the UK and elsewhere. The study was completed with funding support from RAND Europe's Health R&D Policy Research Unit with the Department of Health. PMID:28083218
Qigong Ameliorates Symptoms of Chronic Fatigue: A Pilot Uncontrolled Study

PubMed Central

Turner, Warren; Zammit-Maempe, Joseph; Lee, Myeong Soo

2009-01-01

Traditional Chinese Medicine practitioners consider that chronic fatigue reflects a disharmony and depletion in the supply of qi in the body. Qigong is one of the traditional complementary interventions used to strengthen qi through self-practice, and to manage the state of qi to prevent and cure disease. The aim of this study is to assess whether qigong could be used to manage the symptoms of chronic fatigue. Eighteen Caucasian, British female participants were recruited, taught a qigong routine during weekly classes over 6 months, and asked to practice it daily for 15 min. Participants completed the core set of the RAND Medical Outcomes Study questionnaire (RAND MOS) and a sleep diary during the 2-week baseline control period, and at 3 and 6 months following the start of the trial. The qigong intervention resulted in significant changes in sleep rate score and in the following subscales of the RAND MOS: SF36 Vitality, Sleep Problems, Social Activity, Social Activity Limitation due to Health, Health Distress, Mental Health Index and Psychological Well-being. Qigong seems to improve factors related to chronic fatigue such as sleep, pain, mental attitude and general mobility after 3 and 6 months. Qigong's positive effects indicate that it represents a potentially safe method of treatment for chronic fatigued patients. However, we cannot completely discount the possible influence of placebo effects, and more objective clinical measures are needed to reproduce our findings with long-term follow-up in a randomized, controlled study involving a larger number of subjects. PMID:18955297
Sexual Assault and Sexual Harassment in the U.S. Military: Top-Line Estimates for Active-Duty Service Members from the 2014 RAND Military Workplace Study

DTIC Science & Technology

2014-01-01

enhance the validity of their answers. The development of this new approach to measuring sexual assault and sex-based MEO violations was completed...include the buttocks, inner thigh, breast, groin, anus, vagina, penis and testicles. Top-Line Results from the RAND Military Workplace Study 41 12
The RAND Change Agent Study Ten Years Later: Macro Perspectives and Micro Realities.

ERIC Educational Resources Information Center

McLaughlin, Milbrey Wallin

From 1973 to 1978, the Rand Corporation conducted a national study of local public schools' responses to various federal programs requiring educational change--Title III of the 1965 Elementary and Secondary Education Act (ESEA), Title VII of the ESEA, programs financed by the 1968 Vocational Education Act, and the Right-to-Read program. This paper…
Investigation of DBMS for Use in a Research Environment. Rand Paper Series 7002.

ERIC Educational Resources Information Center

Rosenfeld, Pilar N.

This investigation of the use of database management systems (DBMS) in a research environment used the Rand Corporation as a case study. After a general introduction in section 1, eight sections present the major components of the study. Section 2 contains an overview of DBMS terminology and concepts, followed in section 3 by a general dsecription…

Beyond al-Qaeda. Part 1. The Global Jihadist Movement

DTIC Science & Technology

2006-01-01

of Western Converts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 CHAPTER FOUR Al-Qaeda’s Finances ...terrorists associated with al-Qaeda. (See pp. 44–47.) Al-Qaeda’s Finances Al-Qaeda has also modified the way it moves funds around the globe. Before...and Anthony Davis. Within RAND we cannot fail to acknowledge the important contributions to our understanding of al-Qaeda finances made by the RAND
Navy Satellite Communications in the Hellenic Environment

DTIC Science & Technology

1988-06-01

spherical pressurized balloon with an envelope of plastic mylar and aluminum. Its communication capabilities were for a voice baseband bandwidth of 200...N-1780-ARPA, November 1981. 24. Betrosian, Edward Electromagnetic Properties and Communication caracteristics of PACSAT, Rand Corp (R-2920-ARPA...Survivable Command and Control, RAND Note N-1780-ARPA, November 1981. 4. Betrosian, Edward Electromagnetic Properties and Communication caracteristics of
A Theory of Dark Network Design

DTIC Science & Technology

2010-12-01

Theoretical Framework for Analysis.” Master’s Thesis, Naval Postgraduate School, 1996 . de Nooy, Wouter, Andrej Mrvar , and Vladimir Batagelj ...understanding the nature of relationships in networks. Wouter de Nooy, Andrej Mrvar and Vladimir Batagelj , Exploratory Social Network Analysis with Pajek...34 RAND Corporation, 1996 , http://www.rand.org/pubs/monograph_reports/MR789/ (accessed November 5, 2009) and John Arquilla and David Ronfeldt
Gaining New Military Capability: An Experiment in Concept Development.

DTIC Science & Technology

1998-01-01

Angeles Police Department ( LAPD ) were invited, at- tended, and made important contributions.1 ORGANIZING COG DISCUSSIONS We sought to structure COG...Terry Covington, RAND; Charles Duke, Los Angeles Police Department ; Gene Gritton, RAND; Thomas Karr, Lawrence Livermore Laboratory; LTC Will Irwin, USA...Munition Joint Requirements Oversight Council Joint Stand-off Weapon Joint Strategic Tracking and Radar System Laser radar Los Angeles Police
Rand Arroyo Center 2014

DTIC Science & Technology

2015-01-01

field effective command and control sys- tems within the framework of current policies and processes. Cost Considerations in Cloud Computing ...www.rand.org/t/PE113 Finds that cloud provider costs can vary compared with tradi- tional information system alternatives because of different cost structures...for analysts evaluating new cloud investments. U.S. Army photo by Staff Sgt. Christopher Calvert FOCUS ON Capabilities Development and Acquisition
Technological Innovation, Corporate R&D Alliances and Organizational Learning

DTIC Science & Technology

1995-01-01

public corporations . On the other hand, the questionnaire response bias was a potential problem. As explained in Section 4, the size and innovativeness...DISSERTATION RAND. " " .,’ Technological Innovation, Corporate R&D Alliances and Organizational Learning Wayne G. Walker RAND Graduate School... response , including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
Metadata-driven Delphi rating on the Internet.

PubMed

Deshpande, Aniruddha M; Shiffman, Richard N; Nadkarni, Prakash M

2005-01-01

Paper-based data collection and analysis for consensus development is inefficient and error-prone. Computerized techniques that could improve efficiency, however, have been criticized as costly, inconvenient and difficult to use. We designed and implemented a metadata-driven Web-based Delphi rating and analysis tool, employing the flexible entity-attribute-value schema to create generic, reusable software. The software can be applied to various domains by altering the metadata; the programming code remains intact. This approach greatly reduces the marginal cost of re-using the software. We implemented our software to prepare for the Conference on Guidelines Standardization. Twenty-three invited experts completed the first round of the Delphi rating on the Web. For each participant, the software generated individualized reports that described the median rating and the disagreement index (calculated from the Interpercentile Range Adjusted for Symmetry) as defined by the RAND/UCLA Appropriateness Method. We evaluated the software with a satisfaction survey using a five-level Likert scale. The panelists felt that Web data entry was convenient (median 4, interquartile range [IQR] 4.0-5.0), acceptable (median 4.5, IQR 4.0-5.0) and easily accessible (median 5, IQR 4.0-5.0). We conclude that Web-based Delphi rating for consensus development is a convenient and acceptable alternative to the traditional paper-based method.
The RAND Health Insurance Experiment, Three Decades Later*

PubMed Central

Aron-Dine, Aviva; Einav, Liran; Finkelstein, Amy

2013-01-01

We re-present and re-examine the analysis from the famous RAND Health Insurance Experiment from the 1970s on the impact of consumer cost sharing in health insurance on medical spending. We begin by summarizing the experiment and its core findings in a manner that would be standard in the current age. We then examine potential threats to the validity of a causal interpretation of the experimental treatment effects stemming from different study participation and differential reporting of outcomes across treatment arms. Finally, we re-consider the famous RAND estimate that the elasticity of medical spending with respect to its out-of-pocket price is −0.2, emphasizing the challenges associated with summarizing the experimental treatment effects from non-linear health insurance contracts using a single price elasticity. PMID:24610973
Medical Archives and Digital Culture

PubMed Central

Biernoff, Suzannah

2012-01-01

When BioShock was released in 2007, reviewers praised the moral complexities of the narrative and the game's dystopian vision of what Ayn Rand dubbed the “virtue of selfishness”. What critics overlooked was the extent to which the disturbingly realistic artwork and musical score relied on found images and sound, including a recording of distressed breathing from a physician's website, and digitised First World War medical photographs of soldiers with facial injuries. This article examines the implications of these acts of appropriation from a range of critical perspectives including Susan Sontag's commentary on the representation of suffering; recent literature on the ethics of computer games; and an online discussion forum in which players of BioShock discuss the moral “grey areas” of the game. PMID:27152120
Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: an appropriateness ratings evaluation.

PubMed

Blakeman, Tom; Griffith, Kathryn; Lasserson, Dan; Lopez, Berenice; Tsang, Jung Y; Campbell, Stephen; Tomson, Charles

2016-10-11

Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result. A 10-person panel was purposively sampled with representation from clinical biochemistry, acute and emergency medicine and general practice. General practitioners (GPs) represented typical practice in relation to rural and urban practice, out of hours care, GP commissioning and those interested in reducing the impact of medicalisation and 'overdiagnosis'. There was agreement that delivery of AKI warning stage test results through interruptive methods of communication (ie, telephone) from laboratories to primary care was the appropriate next step for patients with an AKI warning stage 3 test result. In the context of acute illness, waiting up to 72 hours to respond to an AKI warning stage test result was deemed an inappropriate action in 62 out of the 65 (94.5%) cases. There was agreement that a clinician response was required within 6 hours, or less, in 39 out of 40 (97.5%) clinical cases relating AKI warning stage test results in the presence of moderate hyperkalaemia. The study has informed national guidance to support a timely and calibrated response to AKI warning stage test results for adults in primary care. Further research is needed to support effective implementation, with a view to examine the effect on health outcomes and costs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey.

PubMed

Aeyels, Daan; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Coeckelberghs, Ellen; Bruyneel, Luk; Vanhaecht, Kris

2017-12-13

Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.
The Cost of a Military Person-Year. A Method for Computing Savings from Force Reductions

DTIC Science & Technology

2007-01-01

personnel FASAB Federal Accounting Standards Advisory Board FASB Financial Accounting Standards Board FERS Federal Employee Retirement System FG federal...an average prescribed SMCR of only $61,393, which is clearly problematic: Using the Comptroller’s own methods as mandated by DoD financial man... financial commitment the Figure 4.2 Probability-Adjusted Present Values of Retirement Benefits for Current Members by YOS RAND MG598-4.2 1,400 $ th o u
Engineering Design Handbook. Explosions in Air. Part One

DTIC Science & Technology

1974-07-15

Characteristics in the 6. R. E. Shear, Detonation Properties of Calculation of Non-Steady Compressible Pentolite, BRL Rept. No. 1159, 1961. Flows, Los Alamos ...6 (June 1955). Particle-and-Force Method, Los Alamos Sci. Lab., LA 3144, September 1964. 19. H. L Brode, Point Source Explosion in Air, The Rand Corp...RM-1824-AEC, 29. F. H. Harlow and B. D. Meixner, The December 3, 1956. Particle-and-Force Computing Method in Fluid Dynamics, Los Alamos Scientific
Rand Project Air Force Annual Report 2011

DTIC Science & Technology

2011-01-01

types of biomass ) or from nonpetroleum fossil fuels (such as coal or natural gas). The Air Force has played a leading role in DoD efforts to evaluate...coal gasification and centers on the Fischer-Tropsch fuel production method. The Fischer-Tropsch method has been recently updated through the...configured to accept a combination of coal and biomass and to capture and sequester nearly all the CO2 generated at the plant site. Thus, within a few
NATO’s Northeastern Flank: Emerging Opportunities for Engagement

DTIC Science & Technology

2017-01-01

information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization that...styled Islamic State, all of the allies currently most likely to call for North Atlantic Treaty Organization (NATO) military action by invoking Article 5...Ministry of Defense MODCR Ministry of Defense of the Czech Republic NATO North Atlantic Treaty Organization NBG Nordic Battlegroup NCO
Life-Cycle Analysis of Aircraft Turbine Engines

DTIC Science & Technology

1977-11-01

actual experience. Mixed but promisng results were obtained in modeling ownership costs for military engines. Depot maintenance costs were more...Acquisition Experience, The Rand Corporation, RM-6072-PR, November 1969. System Acquisition Stategies , The Rand Corporation, R-733-PR/ARPA, June 1971. 98...Paris, 1971I. Phillips. Almarin, Technology and Market Structure, IA•xington Books, D.C. Heath and Company, Lexington, Mass.. 1971. A Position Paper on
Annual Report 2011-2012 (RAND National Security Research Division)

DTIC Science & Technology

2012-01-01

Charles Nemfakos, Chad J . R . Ohlandt, Caroline Reilly, Rena Rudavsky, Jerry M . Sollinger, Katharine Watkins Webb, and Carolyn Wong, MG-1171/1-OSD...Assessment of Marine Corps Intelligence, Christopher Paul, Harry J . Thie, Katharine Watkins Webb, Stephanie Young, Colin P . Clarke, Susan G . Straus...counterinsurgency campaign. For more information, see Reintegrating Afghan Insurgents, Seth G . Jones, OP-327-MCIA, 2011 . Online at www .rand .org/pubs
Measuring Underemployment Among Military Spouses

DTIC Science & Technology

2010-01-01

military wives in their distribu- tion of age, citizenship, race, education , parental status, potential expe- rience, region of residence, and whether or...that the “look-alike” civilians are similar to the military wives in age, citi- zenship, race, education , parental status, experience, recent moving...available from www.rand.org as a public service of the RAND Corporation. Jump down to document THE ARTS CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY
Analysis to Inform Defense Planning Despite Austerity

DTIC Science & Technology

2014-01-01

available from www.rand.org as a public service of the RAND Corporation. CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND...xvii S.3. Cost-Effectiveness Landscape , by Strategic Perspective . . . . . . xxiii 1.1. Problems Go Far Beyond Fiscal Constraints...objectives for each regional and functional area, as well as such cross-cutting challenges as simul - taneous conflicts. It might also have different
Applying Rapid Acquisition Policy Lessons for Defense Innovation

DTIC Science & Technology

2017-12-21

51 Applying Rapid Acquisition Policy Lessons for Defense Innovation Jonathan Wong Abstract: With the Department of Defense’s (DOD) recent focus on ...finds that DOD can incorporate innovation practices by dispersing organizations focused on new capabilities development across the agency to avoid...adjunct political scientist at the Rand Corporation. His research focuses on the intersection of new technology and defense acquisition. Prior to Rand

Candidate Quality Measures for Hand Surgery.

PubMed

2017-11-01

Quality measures are tools used by physicians, health care systems, and payers to evaluate performance, monitor the outcomes of interventions, and inform quality improvement efforts. A paucity of quality measures exist that address hand surgery care. We completed a RAND/UCLA (University of California Los Angeles) Delphi Appropriateness process with the goal of developing and evaluating candidate hand surgery quality measures to be used for national quality measure development efforts. A consortium of 9 academic upper limb surgeons completed a RAND/UCLA Delphi Appropriateness process to evaluate the importance, scientific acceptability, usability, and feasibility of 44 candidate quality measures. These addressed hand problems the panelists felt were most appropriate for quality measure development. Panelists rated the measures on an ordinal scale between 1 (definitely not valid) and 9 (definitely valid) in 2 rounds (preliminary round and final round) with an intervening face-to-face discussion. Ratings from 1 to 3 were considered not valid, 4 to 6 as equivocal or uncertain, and 7 to 9 as valid. If no more than 2 of the 9 ratings were outside the 3-point range that included the median (1-3, 4-6, or 7-9), the panelists were considered to be in agreement. If 3 or more of the panelists' ratings of a measure were within the 1 to 3 range and 3 or more ratings were in the 7 to 9 range, the panelists were considered to be in disagreement. There was agreement on 43% (19) of the measures as important, 27% (12) as scientifically sound, 48% (21) as usable, and 59% (26) as feasible to complete. Ten measures met all 4 of these criteria and were, therefore, considered valid measurements of quality. Quality measures that were developed address outcomes (patient-reported outcomes for assessment and improvement of function) and processes of care (utilization rates of imaging, antibiotics, occupational therapy, ultrasound, and operative treatment). The consortium developed 10 measures of hand surgery quality using a validated methodology. These measures merit further development. Quality measures can be used to evaluate the quality of care provided by physicians and health systems and can inform quality and value-based reimbursement models. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Registered Replication Report: Rand, Greene, and Nowak (2012).

PubMed

Bouwmeester, S; Verkoeijen, P P J L; Aczel, B; Barbosa, F; Bègue, L; Brañas-Garza, P; Chmura, T G H; Cornelissen, G; Døssing, F S; Espín, A M; Evans, A M; Ferreira-Santos, F; Fiedler, S; Flegr, J; Ghaffari, M; Glöckner, A; Goeschl, T; Guo, L; Hauser, O P; Hernan-Gonzalez, R; Herrero, A; Horne, Z; Houdek, P; Johannesson, M; Koppel, L; Kujal, P; Laine, T; Lohse, J; Martins, E C; Mauro, C; Mischkowski, D; Mukherjee, S; Myrseth, K O R; Navarro-Martínez, D; Neal, T M S; Novakova, J; Pagà, R; Paiva, T O; Palfi, B; Piovesan, M; Rahal, R-M; Salomon, E; Srinivasan, N; Srivastava, A; Szaszi, B; Szollosi, A; Thor, K Ø; Tinghög, G; Trueblood, J S; Van Bavel, J J; van 't Veer, A E; Västfjäll, D; Warner, M; Wengström, E; Wills, J; Wollbrant, C E

2017-05-01

In an anonymous 4-person economic game, participants contributed more money to a common project (i.e., cooperated) when required to decide quickly than when forced to delay their decision (Rand, Greene & Nowak, 2012), a pattern consistent with the social heuristics hypothesis proposed by Rand and colleagues. The results of studies using time pressure have been mixed, with some replication attempts observing similar patterns (e.g., Rand et al., 2014) and others observing null effects (e.g., Tinghög et al., 2013; Verkoeijen & Bouwmeester, 2014). This Registered Replication Report (RRR) assessed the size and variability of the effect of time pressure on cooperative decisions by combining 21 separate, preregistered replications of the critical conditions from Study 7 of the original article (Rand et al., 2012). The primary planned analysis used data from all participants who were randomly assigned to conditions and who met the protocol inclusion criteria (an intent-to-treat approach that included the 65.9% of participants in the time-pressure condition and 7.5% in the forced-delay condition who did not adhere to the time constraints), and we observed a difference in contributions of -0.37 percentage points compared with an 8.6 percentage point difference calculated from the original data. Analyzing the data as the original article did, including data only for participants who complied with the time constraints, the RRR observed a 10.37 percentage point difference in contributions compared with a 15.31 percentage point difference in the original study. In combination, the results of the intent-to-treat analysis and the compliant-only analysis are consistent with the presence of selection biases and the absence of a causal effect of time pressure on cooperation.
Registered Replication Report: Rand, Greene, and Nowak (2012)

PubMed Central

Bouwmeester, S.; Verkoeijen, P. P. J. L.; Aczel, B.; Barbosa, F.; Bègue, L.; Brañas-Garza, P.; Chmura, T. G. H.; Cornelissen, G.; Døssing, F. S.; Espín, A. M.; Evans, A. M.; Ferreira-Santos, F.; Fiedler, S.; Flegr, J.; Ghaffari, M.; Glöckner, A.; Goeschl, T.; Guo, L.; Hauser, O. P.; Hernan-Gonzalez, R.; Herrero, A.; Horne, Z.; Houdek, P.; Johannesson, M.; Koppel, L.; Kujal, P.; Laine, T.; Lohse, J.; Martins, E. C.; Mauro, C.; Mischkowski, D.; Mukherjee, S.; Myrseth, K. O. R.; Navarro-Martínez, D.; Neal, T. M. S.; Novakova, J.; Pagà, R.; Paiva, T. O.; Palfi, B.; Piovesan, M.; Rahal, R.-M.; Salomon, E.; Srinivasan, N.; Srivastava, A.; Szaszi, B.; Szollosi, A.; Thor, K. Ø.; Tinghög, G.; Trueblood, J. S.; Van Bavel, J. J.; van ‘t Veer, A. E.; Västfjäll, D.; Warner, M.; Wengström, E.; Wills, J.; Wollbrant, C. E.

2017-01-01

In an anonymous 4-person economic game, participants contributed more money to a common project (i.e., cooperated) when required to decide quickly than when forced to delay their decision (Rand, Greene & Nowak, 2012), a pattern consistent with the social heuristics hypothesis proposed by Rand and colleagues. The results of studies using time pressure have been mixed, with some replication attempts observing similar patterns (e.g., Rand et al., 2014) and others observing null effects (e.g., Tinghög et al., 2013; Verkoeijen & Bouwmeester, 2014). This Registered Replication Report (RRR) assessed the size and variability of the effect of time pressure on cooperative decisions by combining 21 separate, preregistered replications of the critical conditions from Study 7 of the original article (Rand et al., 2012). The primary planned analysis used data from all participants who were randomly assigned to conditions and who met the protocol inclusion criteria (an intent-to-treat approach that included the 65.9% of participants in the time-pressure condition and 7.5% in the forced-delay condition who did not adhere to the time constraints), and we observed a difference in contributions of −0.37 percentage points compared with an 8.6 percentage point difference calculated from the original data. Analyzing the data as the original article did, including data only for participants who complied with the time constraints, the RRR observed a 10.37 percentage point difference in contributions compared with a 15.31 percentage point difference in the original study. In combination, the results of the intent-to-treat analysis and the compliant-only analysis are consistent with the presence of selection biases and the absence of a causal effect of time pressure on cooperation. PMID:28475467
Magnetic resonance imaging for the detection, localisation, and characterisation of prostate cancer: recommendations from a European consensus meeting.

PubMed

Dickinson, Louise; Ahmed, Hashim U; Allen, Clare; Barentsz, Jelle O; Carey, Brendan; Futterer, Jurgen J; Heijmink, Stijn W; Hoskin, Peter J; Kirkham, Alex; Padhani, Anwar R; Persad, Raj; Puech, Philippe; Punwani, Shonit; Sohaib, Aslam S; Tombal, Bertrand; Villers, Arnauld; van der Meulen, Jan; Emberton, Mark

2011-04-01

Multiparametric magnetic resonance imaging (mpMRI) may have a role in detecting clinically significant prostate cancer in men with raised serum prostate-specific antigen levels. Variations in technique and the interpretation of images have contributed to inconsistency in its reported performance characteristics. Our aim was to make recommendations on a standardised method for the conduct, interpretation, and reporting of prostate mpMRI for prostate cancer detection and localisation. A consensus meeting of 16 European prostate cancer experts was held that followed the UCLA-RAND Appropriateness Method and facilitated by an independent chair. Before the meeting, 520 items were scored for "appropriateness" by panel members, discussed face to face, and rescored. Agreement was reached in 67% of 260 items related to imaging sequence parameters. T2-weighted, dynamic contrast-enhanced, and diffusion-weighted MRI were the key sequences incorporated into the minimum requirements. Consensus was also reached on 54% of 260 items related to image interpretation and reporting, including features of malignancy on individual sequences. A 5-point scale was agreed on for communicating the probability of malignancy, with a minimum of 16 prostatic regions of interest, to include a pictorial representation of suspicious foci. Limitations relate to consensus methodology. Dominant personalities are known to affect the opinions of the group and were countered by a neutral chairperson. Consensus was reached on a number of areas related to the conduct, interpretation, and reporting of mpMRI for the detection, localisation, and characterisation of prostate cancer. Before optimal dissemination of this technology, these outcomes will require formal validation in prospective trials. Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Assessing the U.S. Air Force Unified Engagement Building Partnerships Seminars

DTIC Science & Technology

2011-01-01

INTERNATIONAL AFFAIRS LAW AND BUSINESS NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY SCIENCE AND TECHNOLOGY TERRORISM AND HOMELAND SECURITY Report...Monica, Calif.: RAND Corporation, TR-907-AF, 2010. • Jennifer D. P. Moroney, Jefferson P. Marquis, Cathryn Quantic Thurston, and Gregory F. Treverton, A...15, 2010: http://www.rand.org/pubs/monographs/MG868.html Moroney, Jennifer D. P., Jefferson P. Marquis, Cathryn Quantic Thurston, and Gregory F
Russia and the West After the Ukrainian Crisis: European Vulnerabilities to Russian Pressures

DTIC Science & Technology

2017-01-01

reprint and linking permissions, please visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization that develops solutions...North Atlan- tic Treaty Organization (NATO) and European Union (EU) member states to Russian military and economic pressures and to Russian influ...Nuclear Forces LNG liquefied natural gas NATO North Atlantic Treaty Organization OIES Oxford Institute of Energy Studies PVV Party for Freedom (Partij voor
China in the Middle East: The Wary Dragon

DTIC Science & Technology

2016-12-05

use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization ...in Central Asia, the Middle East, and beyond. Further west, North Atlantic Treaty Organization (NATO) member countries, located some distance away...2011 and 2013, and Yemen in 2015, all organized by PRC civilian ministries, including the Ministry of Foreign Affairs, but none of these—except Yemen
Assessing and Evaluating Department of Defense Efforts to Inform, Influence, and Persuade: Worked Example

DTIC Science & Technology

2017-01-01

intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to...permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the...world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND’s publications do
The Extent of Restrictions on the Service of Active-Component Military Women

DTIC Science & Technology

2012-01-01

from www.rand.org as a public service of the RAND Corporation. CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND...EN engineman, GM gunner’s mate, IT information systems, ET electronics technician, FC fire control, LS logistics spe- cialist, and CS culinary ...sonar technician rating. Women in non–submarine- specific ratings, such as YN yeoman, CS culinary specialist, and LS logistics specialist, are
China: Domestic Change and Foreign Policy.

DTIC Science & Technology

1995-01-01

prepared for the RAND- Sejong Project on East Asia’s Potential for Instability and Crisis, February 1995. Political-Military Leadership Trends 15...prepared for the RAND- Sejong Project on East Asia’s Potential for Instability and Crisis, February 1995. Swaine, Michael D., "Strategic Appraisal... King , "Prospects for Democratization in China," Problems of Communism, Vol. 41, May-June 1992, pp. 58-70. Wolf, Charles, Jr., et al., Long-Term
The Advantages and Disadvantages of Seeking Commonality in Military Equipment

DTIC Science & Technology

2011-01-01

rand 2011 www.rand.org The Advantages and Disadvantages of Seeking Commonality in Military Equipment I ncreasingly, the Army and the Department...advantages and disadvantages of commonality and developed a decision aid to help Army policymakers manage these tradeoffs. The study drew upon...TITLE AND SUBTITLE The Advantages and Disadvantages of Seeking Commonality in Military Equipment 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM
Developing a Standard Update Process for the Army’s Annual MOS Availability Factors (AMAFs)

DTIC Science & Technology

2007-01-01

as a public service of the RAND Corporation. 6Jump down to document THE ARTS CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY AND ENVIRONMENT HEALTH AND...HEALTH CARE INTERNATIONAL AFFAIRS NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY SCIENCE AND TECHNOLOGY SUBSTANCE ABUSE TERRORISM AND HOMELAND...RAND Arroyo Center View document details For More Information Purchase this document Browse Books & Publications Make a charitable contribution Support
Counter-Attrition Programs in the United States Armed Forces

DTIC Science & Technology

1984-07-01

the average pretest - posttest improvement of ART students on the Gates-MacGinitie Reading Test was 2.5 RGL. No comparison control group change scores...retraining programs, elaborate quasi - experimentation could be readily built Into the existing operational system. Every major installation has one or more...research on teach-n. Chicago: Rand McNally, 1963, pp. 171-246. Reprinted as Experimental and quasi - experimental designs for research. Chicago: Rand
Army Warfighters’ Forums Can Be Innovative and Successful

DTIC Science & Technology

2011-01-01

RAND ReseARch AReAs Children and Families eduCation and the arts energy and environment health and health Care inFrastruCture and transportation...rand 2011 www.rand.org Army Warfighters’ Forums Can Be Innovative and Successful T he U.S. Army fielded Stryker Brigades to fill the void...Army created the Stryker Brigade Combat Team (SBCT) Warfighters’ Forum , a networked and collaborative means of sharing information that leverages
Energy Security in the United States

DTIC Science & Technology

2012-05-01

gas facility. Biomass can also be burned with coal (at volumes of up to 10 percent without affecting performance) to generate electricity.26 In...2008, coal-burning facilities substituted biomass for coal to generate 1.3 percent of electricity. 26. See David Ortiz and others, Near-Term...Opportunities for Integrat- ing Biomass into the U.S. Electricity Supply (Santa Monica, Calif.: RAND, 2011), www.rand.org/pubs/technical_reports/ TR984.html
The Role of Special and Incentive Pays in Retaining Military Mental Health Care Providers

DTIC Science & Technology

2017-01-01

visit www.rand.org/pubs/permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make... dental , optometry, veterinary, psychiatric nurse practitioner, and clinical or counseling psychology programs (GoArmy.com, no date). It pays school...reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please
Evaluating the Impact of the Department of Defense Regional Centers for Security Studies

DTIC Science & Technology

2014-01-01

herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is... CARE INFRASTRUCTURE AND TRANSPORTATION INTERNATIONAL AFFAIRS LAW AND BUSINESS NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY SCIENCE AND...images: © Jezper, Fotolia.com © Copyright 2014 RAND Corporation This document and trademark(s) contained herein are protected by law. This representation
Development of the 7-Item Binge-Eating Disorder Screener (BEDS-7)

PubMed Central

Deal, Linda S.; DiBenedetti, Dana B.; Nelson, Lauren; Fehnel, Sheri E.; Brown, T. Michelle

2016-01-01

Objective Develop a brief, patient-reported screening tool designed to identify individuals with probable binge-eating disorder (BED) for further evaluation or referral to specialists. Methods Items were developed on the basis of the DSM-5 diagnostic criteria, existing tools, and input from 3 clinical experts (January 2014). Items were then refined in cognitive debriefing interviews with participants self-reporting BED characteristics (March 2014) and piloted in a multisite, cross-sectional, prospective, noninterventional study consisting of a semistructured diagnostic interview (to diagnose BED) and administration of the pilot Binge-Eating Disorder Screener (BEDS), Binge Eating Scale (BES), and RAND 36-Item Short-Form Health Survey (RAND-36) (June 2014–July 2014). The sensitivity and specificity of classification algorithms (formed from the pilot BEDS item-level responses) in predicting BED diagnosis were evaluated. The final algorithm was selected to minimize false negatives and false positives, while utilizing the fewest number of BEDS items. Results Starting with the initial BEDS item pool (20 items), the 13-item pilot BEDS resulted from the cognitive debriefing interviews (n = 13). Of the 97 participants in the noninterventional study, 16 were diagnosed with BED (10/62 female, 16%; 6/35 male, 17%). Seven BEDS items (BEDS-7) yielded 100% sensitivity and 38.7% specificity. Participants correctly identified (true positives) had poorer BES scores and RAND-36 scores than participants identified as true negatives. Conclusions Implementation of the brief, patient-reported BEDS-7 in real-world clinical practice is expected to promote better understanding of BED characteristics and help physicians identify patients who may have BED. PMID:27486542
The Social Cognition Psychometric Evaluation Study: Results of the Expert Survey and RAND Panel

PubMed Central

Pinkham, Amy E.; Penn, David L.; Green, Michael F.; Buck, Benjamin; Healey, Kristin; Harvey, Philip D.

2014-01-01

Background: In schizophrenia, social cognition is strongly linked to functional outcome and is increasingly seen as a viable treatment target. The goal of the Social Cognition Psychometric Evaluation (SCOPE) study is to identify and improve the best existing measures of social cognition so they can be suitably applied in large-scale treatment studies. Initial phases of this project sought to (1) develop consensus on critical domains of social cognition and (2) identify the best existing measures of social cognition for use in treatment studies. Methods: Experts in social cognition were invited to nominate key domains of social cognition and the best measures of those domains. Nominations for measures were reduced according to set criteria, and all available psychometric information about these measures was summarized and provided to RAND panelists. Panelists rated the quality of each measure on multiple criteria, and diverging ratings were discussed at the in-person meeting to obtain consensus. Results: Expert surveys identified 4 core domains of social cognition—emotion processing, social perception, theory of mind/mental state attribution, and attributional style/bias. Using RAND panel consensus ratings, the following measures were selected for further evaluation: Ambiguous Intentions Hostility Questionnaire, Bell Lysaker Emotion Recognition Task, Penn Emotion Recognition Test, Relationships Across Domains, Reading the Mind in the Eyes Test, The Awareness of Social Inferences Test, Hinting Task, and Trustworthiness Task. Discussion: While it was possible to establish consensus, only a limited amount of psychometric information is currently available for the candidate measures, which underscores the need for well-validated and standardized measures in this area. PMID:23728248
Data Collection Methods. Semi-Structured Interviews and Focus Groups

DTIC Science & Technology

2009-01-01

erence. For example, consider the dif- ferences between informants, subjects, respondents, and actors.3 Bernard (2000) notes that anthropology generally...Cohesion, and Morale, Santa Monica, Calif.: RAND Corporation, MR-896-OSD, 1997; and Margaret C. Harrell, Laura Werber Castaneda, Peter Schirmer, Bryan...not divulging “secrets” if the researcher already knows ( Bernard , 2002). There are a couple of potential problems with probes for which the

[Consensus document: a model of integrated management of patients with psycomotor agitation].

PubMed

2016-01-01

Psychomotor agitation (PMA) is a heterogeneous clinical syndrome associated with a widenumber of pathological conditions. The currently available recommendations and guidelines on PMA correct assessment and management are significantly dishomogeneous and suffer from a lack of standardization, especially regarding pharmacological interventions. Based on this deficiency, and on multidisciplinary nature of PMA, that includes factors shared by different health professionals other than pharmacoeconomic and risk management aspects, we started a project aimed to elaborate a shared model of integrated management for PMA patients. The model, developed by a scientific board and a multidisciplinary panel using the consensus Delphi-RAND method, aims to give indications of good clinical practice for the management of these patients. The present document reports the results of this consensus process, whose main principles are the centrality of the patient, as an active and collaborating subject, the importance of prompt and not coercive interventions able to block the escalation to violence and to allow a correct diagnostic and therapeutic workup, the appropriate use of pharmacological interventions based on the severity of symptoms and the importance of an integrated and harmonized approach by the different professionals involved in PMA management.
[Quality of care indicators for benign prostatic hyperplasia. A qualitative study].

PubMed

Navarro-Pérez, Jorge; Peiró, Salvador; Brotons-Muntó, Francisco; López-Alcina, Emilio; Real-Romaguera, Arcadio

2014-05-01

To assess quality of care indicators for benign prostatic hyperplasia (BPH), and to evaluate their strengths and weaknesses for incorporation into health information systems. Structured expert meeting, using procedures adapted from the nominal group techniques and the Rand consensus method. Valencian School of Health Studies. Forty panellists (74% doctors, 70% from primary care settings) with experience in the management of BPH from 15 departments of the Valencia Health Agency. Three workshops were held simultaneously (examination and diagnosis, drug therapy, and appropriateness and results), and the 15 quality indicators selected by the coordination group were assessed. Eleven of the 15 indicators scored in the range of high relevance. The 5 best rated were: the use of alpha-blockers + 5-alpha reductase inhibitor from certain severity level, digital rectal examination in the initial assessment, follow-up with the International Prostate Symptoms Score (IPSS), the rate of urgent catheterization in Hospital Accident & Emergency Units, initial assessment with the IPSS and the use of alpha-blockers prior to catheter removal for acute retention of urine. Some of the assessed indicators can be useful for incorporation into health information systems. Copyright © 2013 Elsevier España, S.L. All rights reserved.
Winning Bodies and Souls: State Building and the Necessity of Nationalism

DTIC Science & Technology

2008-12-01

the citizens that live within its territory. The RAND study, America’s Role in Nation Building: from Germany to Iraq, nicely encapsulates the...neglect of nationalism in the theory and practice of the state building when it blithely observes that: What principally distinguishes Germany , Japan...Nation Building: From Germany to Iraq (Santa Monica: RAND, 2003), xix. 6 This argument views nation-building projects as primarily the result of what
Cheaper, Faster, Better? Commercial Approaches to Weapons Acquisition

DTIC Science & Technology

2000-01-01

Heppenheimer , T. A ., Turbulent Skies: The History of Commercial Aviation, John Wiley & Sons, Inc., New York, 1995. Holley, Irving B., Ideas and Weapons, New...DISTRIBUTION STATEMENT A Approved for Public Release Distribution Unlimited ,**■’ .% Project AIR FORCE * RAND The research reported here was sponsored...United States. I. Lorell, MarkA., 1947- . UC263.C494 2000 355.6�—dc21 99-058412 RAND is a nonprofit institution that helps improve policy and
Variable speed gas engine-driven air compressor system

NASA Astrophysics Data System (ADS)

Morgan, J. R.; Ruggles, A. E.; Chen, T. N.; Gehret, J.

1992-11-01

Tecogen Inc. and Ingersoll-Rand Co. as a subcontractor have designed a nominal 150-hp gas engine-driven air compressor utilizing the TECODRIVE 8000 engine and the Ingersoll-Rand 178.5-mm twin screw compressor. Phase 1 included the system engineering and design, economic and applications studies, and a draft commercialization plan. Phase 2 included controls development, laboratory prototype construction, and performance testing. The testing conducted verified that the compressor meets all design specifications.
Chinese Economic Coercion Against Taiwan: A Tricky Weapon to Use

DTIC Science & Technology

2007-01-01

View document details For More Information Purchase this document Browse Books & Publications Make a charitable contribution Support RAND This PDF...is a registered trademark. © Copyright 2007 RAND Corporation All rights reserved. No part of this book may be reproduced in any form by any...Taiwan Statistical Year- book , 1995, pp. 192–193, cited in Zhao, 1999, pp. 24, 28. 84 Chinese Economic Coercion Against Taiwan: A Tricky Weapon to Use
Congressional Testimony on Educational Innovations. Testimony to the Subcommittee on Elementary, Secondary and Vocational Education Committee on Education and Labor. U.S. House of Representatives. Rand Paper Series No. 5983.

ERIC Educational Resources Information Center

Berman, Paul

This testimony summarizes the results of the Rand Corporation's change agent study of educational innovations funded by federal programs. The second section consists of policy recommendations for ESEA Title IV Consolidated Programs, Part C. The study aimed to help improve federal policies by describing how the process of innovation and educational…
Working Around the Military: Challenges to Military Spouse Employment and Education

DTIC Science & Technology

2004-01-01

POPULATION AND AGING PUBLIC SAFETY SCIENCE AND TECHNOLOGY SUBSTANCE ABUSE TERRORISM AND HOMELAND SECURITY TRANSPORTATION AND INFRASTRUCTURE The RAND...failing to comply with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE 2004 2. REPORT TYPE 3...RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R® is a registered trademark. © Copyright 2004 RAND
California’s K-12 Public Schools: How Are They Doing?

DTIC Science & Technology

2005-01-01

series. RAND monographs present major research findings that address the challenges facing the public and private sectors. All RAND mono- graphs...percent Asian and other, and 9 percent black. It is likely that by 2012–2013, the majority of California public school children will be Hispanic... majority of school district revenues. The school dis- tricts currently have few options for raising their own funds. Further, a growing share of education
The Laser-Guided Bomb: Case History of a Development

DTIC Science & Technology

1974-06-01

is part of Rand’s R&D and Acquisition Studies Program , supported by tJSAF Project RAND. Previous research done at Rarn has dealt with stu.les of...particular development programs , institutional aspects of Air Force acquisition decisiormaking, and improvements in system acquisition policy wieh respect...Corn- parative Study of Doctrine, Technology, and Organization in the USAF Ballistic and Cruise Missile Programs , 1950-1960, RM-48%3-PR, August 1966
Assessing Locally Focused Stability Operations

DTIC Science & Technology

2014-01-01

Detailed Theory -of-Change Chart RAND RR387-4.2 LFSO actions Immediate goals LFSO main goal Higher -level goals Sustainable stability in region Reduced...projects in the vil- lage, and laying the groundwork for starting a village council. At the higher level, the Theory of Change now documents the assumption... Theory of Change RAND RR387-4.5 LFSO actions Immediate goals Chain of consequences LFSO main goal Higher -level goals HN commandos targeting INS 13
Reshaping the Army’s Active and Reserve Components

DTIC Science & Technology

2011-01-01

career fields are still doing work , and the Army will proba- bly not want to convert all those billets to high-utilization career fields. Factors That...herein are protected by law as indicated in a notice appearing later in this work . This electronic representation of RAND intellectual property is...NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) RAND Corporation,National Security Research Division,1776 Main Street, PO
The Security Dynamics of Demographic Factors

DTIC Science & Technology

2000-01-01

Tianjin, Manila, Cairo, Seoul, Istanbul, Rio de Janeiro , Buenos Aires, Lahore, Hyderabad, Bangkok, Lima, and Tehran. Chapter Four THE SECURITY...Street, Santa Monica, CA, 90407-2138, e -mail Julie_DaVanzo@rand.org, or visit the project’s Web site at http://www.rand.org/popmatters For more...Third and finally, some basic recommendations for U.S. pol- icy will be offered in light of the emerging demographic realities. WHAT DO WE MEAN BY
Sexual Assault and Sexual Harassment in the U.S. Military: Evaluating Estimates from the 2014 RAND Military Workplace Study

DTIC Science & Technology

2016-01-01

harassment, and gender discrimination in the military. The RAND Military Workplace Study (RMWS) included one of the largest surveys of its kind: Almost...approach to counting service members who experienced sexual assault, sexual harassment, and gender discrimination , providing DoD with unprecedented...harassment, or gender discrimination . Specifically, both the phone and web follow-up surveys revealed possible nonresponse bias in the RMWS estimates, but
Jointness: A Selected Bibliography

DTIC Science & Technology

2010-12-01

2010. 113pp. (U260 .E33 2010) http://www.rand.org/pubs/monographs/2010/RAND_MG675.pdf Button, Robert , et al . Maritime Prepositioning Force (Future...SiteCollectionDocuments/ILW%20Web-ExclusivePubs/ Land%20Warfare%20Papers/LWP69.pdf Cole, Ronald H., et al . The History of the Unified Command Plan...http://handle.dtic.mil/100.2/ADA479692 Conley, Raymond E., et al . Enhancing the Performance of Senior Department of Defense Civilian Executives
Military Review: The Professional Journal of the U.S. Army. May-June 2002

DTIC Science & Technology

2002-06-01

artisans formed corporations , and in the Middle Ages, tradesmen formed guilds.5 In the U.S. Army, recurring officers’ calls and lunchtime discussions...Analysis of Air-Based Mechanization and Vertical Envel- opment Concepts and Technologies, DB-321-A (Santa Monica, CA: RAND Corporation , 2001). 4. Colonel...AB-169-A/OSD (Santa Monica, CA: RAND Corporation , September 1997); and John Matsumura et al., Rapid Force Projection Technologies: Assessing the
Building the Future: Summary of Four Studies to Develop the Private Sector, Education, Health Care, and Data for Decisionmaking for the Kurdistan Region - Iraq (with Arabic-language version).

PubMed

Anthony, C Ross; Hansen, Michael L; Kumar, Krishna B; Shatz, Howard J; Vernez, Georges

2013-01-01

In 2010, the Kurdistan Regional Government (KRG) asked the RAND Corporation to undertake four studies aimed at improving the economic and social development of the Kurdistan Region of Iraq. RAND's work was intended to help the KRG expand access to high-quality education and health care, increase private-sector development and employment for the expanding labor force, and design a data-collection system to support high-priority policies. The studies were carried out over the year beginning February 2010. The RAND teams worked closely with the Ministries of Planning, Education, and Health to develop targeted solutions to the critical issues faced by the KRG. This article summarizes the health care study. It is intended to provide a high-level overview of the approaches, followed by the studies, key findings, and major recommendations.
OARSI guidelines for the non-surgical management of knee osteoarthritis.

PubMed

McAlindon, T E; Bannuru, R R; Sullivan, M C; Arden, N K; Berenbaum, F; Bierma-Zeinstra, S M; Hawker, G A; Henrotin, Y; Hunter, D J; Kawaguchi, H; Kwoh, K; Lohmander, S; Rannou, F; Roos, E M; Underwood, M

2014-03-01

To develop concise, up-to-date, patient-focused, evidence-based, expert consensus guidelines for the management of knee osteoarthritis (OA), intended to inform patients, physicians, and allied healthcare professionals worldwide. Thirteen experts from relevant medical disciplines (primary care, rheumatology, orthopedics, physical therapy, physical medicine and rehabilitation, and evidence-based medicine), three continents and ten countries (USA, UK, France, Netherlands, Belgium, Sweden, Denmark, Australia, Japan, and Canada) and a patient representative comprised the Osteoarthritis Guidelines Development Group (OAGDG). Based on previous OA guidelines and a systematic review of the OA literature, 29 treatment modalities were considered for recommendation. Evidence published subsequent to the 2010 OARSI guidelines was based on a systematic review conducted by the OA Research Society International (OARSI) evidence team at Tufts Medical Center, Boston, USA. Medline, EMBASE, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials were initially searched in first quarter 2012 and last searched in March 2013. Included evidence was assessed for quality using Assessment of Multiple Systematic Reviews (AMSTAR) criteria, and published criticism of included evidence was also considered. To provide recommendations for individuals with a range of health profiles and OA burden, treatment recommendations were stratified into four clinical sub-phenotypes. Consensus recommendations were produced using the RAND/UCLA Appropriateness Method and Delphi voting process. Treatments were recommended as Appropriate, Uncertain, or Not Appropriate, for each of four clinical sub-phenotypes and accompanied by 1-10 risk and benefit scores. Appropriate treatment modalities for all individuals with knee OA included biomechanical interventions, intra-articular corticosteroids, exercise (land-based and water-based), self-management and education, strength training, and weight management. Treatments appropriate for specific clinical sub-phenotypes included acetaminophen (paracetamol), balneotherapy, capsaicin, cane (walking stick), duloxetine, oral non-steroidal anti-inflammatory drugs (NSAIDs; COX-2 selective and non-selective), and topical NSAIDs. Treatments of uncertain appropriateness for specific clinical sub-phenotypes included acupuncture, avocado soybean unsaponfiables, chondroitin, crutches, diacerein, glucosamine, intra-articular hyaluronic acid, opioids (oral and transdermal), rosehip, transcutaneous electrical nerve stimulation, and ultrasound. Treatments voted not appropriate included risedronate and electrotherapy (neuromuscular electrical stimulation). These evidence-based consensus recommendations provide guidance to patients and practitioners on treatments applicable to all individuals with knee OA, as well as therapies that can be considered according to individualized patient needs and preferences. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
Evaluation and Recommendations for Improvement of the Department of Defense Small Business Innovation Research (SBIR) Program

DTIC Science & Technology

2006-01-01

representation of RAND intellectual property is provided for non- commercial use only. Permission is required from RAND to reproduce, or reuse in another...Law 97-219) created the Small Business Innovation Research (SBIR) program by mandating that all federal research, development, test , and evaluation (RDT...contractors and the small, technology-oriented business community. 6. Expand intellectual capital in the United States. POLICY OPTIONS FOR THE DOD SBIR PROGRAM
The Development and Application of the RAND Program Classification Tool. The RAND Toolkit, Volume 1

DTIC Science & Technology

2014-01-01

one may be selected.)  Pretest /baseline only  Posttest only  Pre-post  Pre-post with comparison group ...following outcome data (used to identify the results of a program’s efforts)? (More than one may be selected.)  Pretest /baseline only  Posttest only...results of a program’s efforts)? o Pretest /baseline only o Posttest only o Pre-post o Pre-post with comparison group o Randomized controlled trial

Soldiers for Peace: Critical Operational Issues.

DTIC Science & Technology

1996-01-01

or policies of its research sponsors. Published 1996 by RAND 1700 Main Street, RO. Box 2138, Santa Monica, CA 90407-2138 RAND URL: http...force in Cyprus, a corps of 30,000 men equipped with 265 A5 M-48 main battle tanks, over 100 armored personnel carriers, and nearly 200 pieces of...AMX-30B main battle tanks from 52 to 104 and took delivery of 18 BMP-3 infantry fighting vehicles. In addition, the National Guard improved its
Stabilization and Reconstruction Staffing. Developing U.S. Civilian Personnel Capabilities

DTIC Science & Technology

2008-01-01

www.rand.org as a public service of the RAND Corporation. 6Jump down to document THE ARTS CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY AND ENVIRONMENT HEALTH AND...staff, the CPA, and its parent organizations and the Depart- ment of Defense (DoD), had to answer basic human-resources ques- tions, including: Which...validated (i.e., a formal determination that the position is needed and properly defined) requirements placed on them by their parent agencies
Three Essays on Education Policy: Empirical Analyses of the Challenges and Opportunities with For-Profit Colleges, Military Enlistment and Immigration

DTIC Science & Technology

2014-01-01

on immigrant students was made possible by a broader project funded by the Spencer Foundation. RAND Labor and Population and RAND Education...under financial support from the Spencer Foundation, and I thank Robert Bozick and Trey Miller for entrusting me with the opportunity to develop...financial support from the Spencer Foundation and thank Peter Brownell and Paco Martorell for their comments. 94 rankings of development other than
Small Business and Strategic Sourcing: Lessons from Past Research and Current Data

DTIC Science & Technology

2014-01-01

from www.rand.org as a public service of the RAND Corporation. CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND HEALTH...Susan M., and Kristin J. Leuschner, eds., In the Name of Entrepreneurship ? The Logic and Effects of Special Regulatory Treatment for Small Business...Well They Perform, and How We Can Learn More About Them,” International Review of Entrepreneurship , Vol. 8, No. 3, 2010, pp. 1–32. Hanks, Christopher
Fixing Leaks: Assessing the Department of Defense’s Approach to Preventing and Deterring Unauthorized Disclosures

DTIC Science & Technology

2013-01-01

HEALTH CARE INFRASTRUCTURE AND TRANSPORTATION INTERNATIONAL AFFAIRS LAW AND BUSINESS NATIONAL SECURITY POPULATION AND AGING PUBLIC SAFETY SCIENCE ...ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) RAND...RAND project team concerning the activities of the UD PIT for the period from mid-September 2012 through January 2013; then, building off those
Capabilities for Joint Analysis in the Department of Defense: Rethinking Support for Strategic Analysis

DTIC Science & Technology

2016-01-01

activity, completed ana- lytic baselines, current memoranda describing in-progress work , briefings sent to high officials, and published papers by...Is Enough, Santa Monica, Calif.: RAND Corporation , MR-400-RC, 1994. ———, “Report of Working Group: Overall Force Planning Concepts, in Lessons...RAND’s Work on Planning Under Uncertainty for National Security, Santa Monica, Calif.: RAND Corporation , TR-1249-OSD, 2012. As of July 22, 2016: http
Best Practices in Developing Proactive Supply Strategies for Air Force Low-Demand ServiceParts

DTIC Science & Technology

2010-01-01

research clients and sponsors. R ® is a registered trademark. © Copyright 2010 RAND Corporation Permission is given to duplicate this document for personal...RAND Corporation, MG-274-AF, 2005 • Nancy Y. Moore, Cynthia R . Cook, Clifford A. Grammich, and Charles Lindenblatt, Using a Spend Analysis to...poration, DB-434-AF, 2004 • Nancy Y. Moore, Laura H. Baldwin, Frank Camm, and Cynthia R . Cook, Implementing Best Purchasing and Supply Management Preface
What Veterans Bring to Civilian Workplaces: A Prototype Toolkit for Helping Veterans Communicate to Private-Sector Employers About the Nontechnical Skills Taught in the Military

DTIC Science & Technology

2015-01-01

reflect the opinions of its research clients and sponsors. Support RAND Make a tax-deductible charitable contribution at www.rand.org/giving...This Toolkit 5 Continuous learning (related terms: adaptive learning, willingness to learn, active learning, metacognition ): Takes the necessary...even when not under direct supervision; displays self -discipline and self -control; diligently checks work to ensure that all essential details have
The Post-Cold War Force-Sizing Debate: Paradigms, Metaphors, and Disconnects

DTIC Science & Technology

1992-01-01

Lynn D . Pullen, John Y. Schrader, and Michael D . Swaine, A New Strategy and Fewer Forces: The Pacifu: Dimension. RAND, R -4089/2- USDP, 1992. 80...and Forces, Vol. II. RAND, N-3098/2-DAG, October 1990. Wohlstetter, Roberta, Pearl Harbor: Warning and Decision. Stan- ford: Stanford University Press, 1962. RAN D / R -4243-JS ...The Post-Cold War Force-Sizing Debate Paradigms, Metaphors, and Disconnects James A. Winnefeld RAN D I NATIONAL DEFENSE RESEARCH INSTITUTE
Defense Manpower Policy: Presentations from the 1976 Rand Conference on Defense Manpower

DTIC Science & Technology

1978-12-01

organizations working on defense manpower issues and problems, This book contains selected presentations from ti -a Rand Confer- ence on Defense Manpower...the complete Conference agenda.) Nevertheless, the papers included here provide a reasonably good sampling of the topics and issues addressed at the...one of the key concerns in the Pentagon and on Capitol Hill. Accordingly, the purpose of this book is to shed some light on some of the major issues
Evaluating the Impact of Whole-Body Vibration (WBV) on Fatigue and the Implications for Driver Safety.

PubMed

Troxel, Wendy M; Helmus, Todd C; Tsang, Flavia; Price, Carter C

2016-05-09

Driver fatigue is a significant contributor to motor vehicle accidents and fatalities, although the exact share of those events attributable to fatigue is still uncertain. In 2013, accidents involving heavy trucks killed more than 3,944 people in the United States, with over 80 percent of those killed not in the truck. Numerous factors contribute to driver fatigue among commercial drivers, including shiftwork schedules; high prevalence of alcohol and substance use; extended hours; comorbid medical conditions, such as pain; and high prevalence of sleep disorders. Many of these factors have been studied extensively in the trucking industry. Whole-body vibration (WBV) is another potential factor that may contribute to driver fatigue, but it has received little attention. Beginning in January 2015, Bose Corporation and AIG commissioned the RAND Corporation to study the link between WBV and driver fatigue. This article summarizes the findings from RAND's systematic review of the literature on WBV and fatigue as well as considers appropriate study designs and methodology that will inform new areas of research focused on improving the safety of truckers and those who share the road with them. The literature review identified 24 studies examining the impact of WBV on fatigue or sleepiness. The majority of studies (n = 18) found a significant association between WBV and fatigue or sleepiness; however, there are several limitations of the existing literature that preclude definitive conclusions regarding the impact of WBV on these outcomes. This research concludes with recommendations for future studies to strengthen the evidence base.
Hybrid Threat Center of Gravity Analysis: Cutting the Gordian Knot

DTIC Science & Technology

2016-04-04

water avoids the heights … so an army avoids strengths and strikes weakness … water has no constant form.”1 - Sun Tzu Hybrid warfare is a topic...1 Sun Tzu , The Art of War, (Oxford University Press, London, 1963), 101. 2 Alba Iulia...and Boyer, Matthew. Vulnerability Assessment Method Pocket Guide: A Tool for Center of Gravity Analysis. RAND, 2014. Tzu , Sun . The Art of War
Extracorporeal treatment for thallium poisoning: recommendations from the EXTRIP Workgroup.

PubMed

Ghannoum, Marc; Nolin, Thomas D; Goldfarb, David S; Roberts, Darren M; Mactier, Robert; Mowry, James B; Dargan, Paul I; Maclaren, Robert; Hoegberg, Lotte C; Laliberté, Martin; Calello, Diane; Kielstein, Jan T; Anseeuw, Kurt; Winchester, James F; Burdmann, Emmanuel A; Bunchman, Timothy E; Li, Yi; Juurlink, David N; Lavergne, Valery; Megarbane, Bruno; Gosselin, Sophie; Liu, Kathleen D; Hoffman, Robert S

2012-10-01

The EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatment (ECTR) in poisoning. To test and validate its methods, the workgroup reviewed data for thallium (Tl). After an extensive search, the co-chairs reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed during a conference call. A second vote determined the final recommendations. Forty-five articles met inclusion criteria. Only case reports and case series were identified, yielding a very low quality of evidence for all recommendations. Data on 74 patients, including 11 who died, were abstracted. The workgroup concluded that Tl is slightly dialyzable and made the following recommendations: ECTR is recommended in severe Tl poisoning (1D). ECTR is indicated if Tl exposure is highly suspected on the basis of history or clinical features (2D) or if the serum Tl concentration is >1.0 mg/L (2D). ECTR should be initiated as soon as possible, ideally within 24-48 hours of Tl exposure (1D), and be continued until the serum Tl concentration is <0.1 mg/L for a minimal duration of 72 hours (2D). Despite Tl's low dialyzability and the limited evidence, the workgroup strongly recommended extracorporeal removal in the case of severe Tl poisoning.
U.S. and Soviet Relations with Argentina: Obstacles and Opportunities for the U. S. Army

DTIC Science & Technology

1989-11-01

the tactors that conIstrain tle use of such assistance. The Note was writtcn prior to the Ma I 9S9 Argenti ne presidential elcction, and therefore does...821711 and Development Center for studies and analysis operated by The RAND Corporation . Thw Arroyo Center provides the Army with objective. ind.pendent...Center aork is performed under contract MDA903-86-C-0059. The Arroyo Center is housed in RANDs Arn Research Division. The R:ND Corporation is a private
Using Marijuana May Not Raise the Risk of Using Harder Drugs

DTIC Science & Technology

2003-02-01

Using Marijuana May Not Raise the Risk of Using Harder Drugs Marijuana is widely regarded as a "gateway" drug, that is, one whose use results in an...laws prohibiting the use or possession of marijuana . A recent analysis by RAND’s Drug Policy Research Center (DPRC) suggests that data typically used...to support a marijuana gateway effect can be explained as well by a different theory. The new research, by Andrew Morral, associate director of RAND
Thinking About America’s Defense. An Analytical Memoir

DTIC Science & Technology

2008-01-01

www.rand.org as a public service of the RAND Corporation. 6Jump down to document THE ARTS CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY AND ENVIRONMENT HEALTH...strategic relationship: [ The enemy’s] manifest invulnerability to our first strike could be to our advantage if it relieved him of a principal concern... invulnerable SSBNs at sea, (2) the number and effectiveness of “killer” RVs that are useful in a counterforce attack against the other’s ICBM-borne RVs in
An Evolving Joint Space Campaign Concept and the Army’s Role

DTIC Science & Technology

1992-05-29

Military Art and Science thesis (Fort Leavenworth, X3: US Army Conmd and general Staff College, 2 June 1989). 01. This is not a new approach for US strategy...the Undersecretary of Defense fop Acquisition, December 1967 (83E2T. Diukes. Francis J. (LTC, USA), "Space, Iltitary or Civilian?" student thesis , AW...RAND Paper, Santa Monica, Cft The RAND Corporation, not dated. Harris, Elwyn and Richard Darilek, Kenneth Horn, Mark Nelson, "The Army’s Role in Space
Tweede Serie Ergonomietests Lichtgewicht Bommenpakken (Second Series of Ergonomic Tests on Lightweight Bomb Disposal Suits)

DTIC Science & Technology

2007-12-01

warmtebelastingtests vast te stellen en (sit-and-reach, stand-and-reach. abductie referentiewaarden te bepalen door het van de arnen, anteflexie van de armen ...volgende, bewegingbeperkingtests: sit-and-reach, stand-and-reach. abductie van de armen , anteflexie van de armen en beperking van zicht. Bij de sit-and...gebogen op de rand van een tafel en houdt de armen zo ver mogeijk gestrekt naar voren op tafel. Daarbij wordt de afstand vanaf de rand van de tafel tot
A New Age for Aerostats: Proving Airfield-Centric MANPADS Defense for Civil Aircraft Supporting Military Operations

DTIC Science & Technology

2010-04-01

Maintaining Readiness, RAND Report MR-1506 (Santa Monica, CA: RAND, 2003, 58. 15 Graham, David R . Statement before the U.S. Congress Committee on...2. 19 Ibid., 4. 20 Ibid., 2. 21 Bolkcom, Christopher, CRAF, 9. 22 Graham, David R ., 3. 23 Cortez, Robert K. Statement before the U.S...Retrieved from http://www.state.gov/ r /pa/prs/ps/2009/july/126397.htm on 8 Dec 2009. 30 GlobalSecurity.org. “Man Portable Air Defense Systems (MANPADS
Chinese Grand Strategy: How Anti-Access/Area Denial (A2/AD) Fits in China’s Plan

DTIC Science & Technology

2014-04-01

Qiao and Wang, Unrestricted Warfare, 142. 6. Corpus, “America’s Acupuncture Points” Asia Times Online, (Part 2, Section 5). 7. Ibid. 8. Stokes...Corpus, “America’s Acupuncture Points”, (Part 1, Section 1). 46. Qiao and Wang, Unrestricted Warfare, 93. 47. Ibid. 48. Military Factory, “American War...Employment Concepts in the 21st Century. RAND Report FA7014-06-C-0001. Santa Monica, CA: RAND, 2011. Corpus, Victor N. “America’s Acupuncture Points

POW/MIA Issues. Volume 3. Appendixes

DTIC Science & Technology

1994-01-01

RANDS Johansen Charles SSgt/AF- 4 July 52 TFRM A611 RMC B-29/Photo op Vernon 19124748 TFRS 91st Strat RANDM Recon RANDS Rivers Bernard SSgt/AF- 4 July 52...Pvt Bellar, Bennie E. RA14326111 Cpl Beller, James E. RA18333098 Pvt Bernard , Elton J RA18281438 Cpl Besemer, Robert L. RA16263944 Cpl Billigmeier... Bernard AF31378023 Airman 1st class Mooradian, Ara A0932011 Capt Moore, John G. A0886003 Capt Myers, Thomas E. 13136A Capt Nelson, Lawrence A. A02221692
The RAND Online Measure Repository for Evaluating Psychological Health and Traumatic Brain Injury Programs. The RAND Toolkit, Volume 2

DTIC Science & Technology

2014-01-01

tempo may raise the risk for mental health challenges. During this time, the U.S. Department of Defense (DoD) has implemented numerous programs to...and were based on the constraints of each electronic database. However, most searches were variations on a basic three-category format: The first...Gerontology, 1983, 38: 111–116. Iannuzzo RW, Jaeger J, Goldberg JF, Kafantaris V, Sublette ME. “Development and Reliability of the Ham-D/MADRS
Validating Measures of Real-World Outcome: The Results of the VALERO Expert Survey and RAND Panel

PubMed Central

Leifker, Feea R.; Patterson, Thomas L.; Heaton, Robert K.; Harvey, Philip D.

2011-01-01

Background: People with schizophrenia demonstrate considerable discrepancy between self-reported functioning and informant reports. It is not clear whether these discrepancies originate from the instruments used or from the perspectives of different informants. The goal of the Validation of Everyday Real-World Outcomes (VALERO) Study is to enhance the measurement of real-world (RW) outcomes in the social, residential, and vocational domains through selection of optimal scales and informants using a multistep process similar to the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative. Methods: Forty-eight experts provided their opinion regarding the best scales measuring RW outcomes. Fifty-nine measures were nominated. The investigators selected the 11 scales that were the most highly nominated, had the most published validity data, and best represented the domains of interest. Information was provided to other experts who served as RAND panelists. Panelists rated each measure for its suitability across multiple a priori domains. Discrepant ratings were discussed until consensus was reached. Results: Following the RAND Panel, the 2 scales that scored highest across the various criteria for each of the classes of scales (hybrid, social functioning, and everyday living skills) were selected for use in the first substudy of VALERO. The scales selected were the Quality-of-Life Scale, Specific Levels of Functioning Scale, Social Behavior Schedule, Social Functioning Scale, Independent Living Skills Schedule, and Life Skills Profile. Discussion: The results show that although there are significant limitations with current scales used for the assessment of RW outcome in schizophrenia, a consensus is possible. Further, several existing instruments were rated as useful for measuring social, residential, and vocational outcomes. PMID:19525354
High deductible health plans: does cost sharing stimulate increased consumer sophistication?

PubMed

Gupta, Neal; Polsky, Daniel

2015-06-01

To determine whether increased cost sharing in health insurance plans induces higher levels of consumer sophistication in a non-elderly population. This analysis is based on the collection of survey and demographic data collected from enrollees in the RAND health insurance experiment (HIE). During the RAND HIE, enrollees were randomly assigned to different levels of cost sharing (0, 25, 50 and 95%). The study population compromises about 2000 people enrolled in the RAND HIE, between the years 1974 and 1982. Effects on health-care decision making were measured using the results of a standardized questionnaire, administered at the beginning and end of the experiment. Points of enquiry included whether or not enrollees' (i) recognized the need for second opinions (ii) questioned the effectiveness of certain therapies and (iii) researched the background/skill of their medical providers. Consumer sophistication was also measured for regular health-care consumers, as indicated by the presence of a chronic disease. We found no statically significant changes (P < 0.05) in the health-care decision-making strategies between individuals randomized to high cost sharing plans and low cost sharing plans. Furthermore, we did not find a stronger effect for patients with a chronic disease. The evidence from the RAND HIE does not support the hypothesis that a higher level of cost sharing incentivizes the development of consumer sophistication. As a result, cost sharing alone will not promote individuals to become more selective in their health-care decision-making. © 2012 Blackwell Publishing Ltd.
General Path-Integral Successive-Collision Solution of the Bounded Dynamic Multi-Swarm Problem.

DTIC Science & Technology

1983-09-23

coefficients (i.e., moments of the distribution functions), and/or (il) fnding the distribution functions themselves. The present work is concerned with the...collisions since their first appearance in the system. By definition, a swarm particle sufers a *generalized collision" either when it collides with a...studies6-rand the present work have contributed to- wards making the path-integral successive-collision method a practicable tool of transport theory
Assessing Gas and Oil Resources in the Intermountain West. Review of Methods and Framework For a New Approach

DTIC Science & Technology

2002-01-01

Green River Basin ............................... 28 4.1. Economically Recoverable Oil and Gas in the United States (USGS...viable gas and oil resource. The next step will be to apply this methodology to estimate the viable resource in individual basins . RAND will begin this...effort by analyzing the Green River Basin . The analysis will specify the relationships among gas and oil deposits, technological options, economic
Faster-than-Light Particles: A Review of Tachyon Characteristics.

DTIC Science & Technology

1980-10-01

A-DlAO9(4 529 RAND CORP SANTA MNtICA CA F/6 20/S FASTER-THAN-LIBI4T PARTICLES: A REVIEW OF TACHYON CHARACTERISTIC--ETCWU) OCT B0 E A PUSCHER F49620...77-C-0023 UNCLASSIFIED RAI0IN-1530-AF N. I nmui ininmuuuI LEVEL A RAND NOTE FASTER-THAN-LIGHT PARTICLES: A REVIEW OF ) ( TACHYON CHARACTERISTICS Edward...RECIPIENT’S CATALOG NUMBER 4TIT LE ( d Subtitle) TYPE OF REPORT & PERIOD COVERED ( Faster-than-Light Particles: A Review of /Interim -i Tachyon
Consumer Surplus, Demand Functions, and Policy Analysis,

DTIC Science & Technology

1983-06-01

ARD-AL758 865 CONSUMER SURPLUS DEMAND FUNCTIONS AND POLICY ANALYSIS 1/2 (U) RAND CORP SANTA MONICA CA F CANM JUN 83 RAND/R-3848-RC UNCLASSIFIED F/O 5...8217 - * 2, Consumer Surplus, Demand Functions, and Policy Analysis Frank Camm OCFILE COEYI b0 loo Thi! d Ci rr.i h,13 bea~n approvedS i i l ot p...ui.- r~aoz an~d sale; its (5 06 VP1 d’ *. . . * . ~ - V * * . R-3048-RC Consumer Surplus, Demand Functions, and Policy Analysis Frank Caomm June 1983
How Is Deployment to Iraq and Afghanistan Affecting U.S. Service Members and Their Families? An Overview of Early Rand Research on the Topic

DTIC Science & Technology

2011-01-01

herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is...shorter or much longer than expected decreased the intention to stay in the military. This finding implies that service members feel discontent when...when the deployment will occur and how long it will be, and to feel assured that expectations will be met. • The intention to stay in the military
Improving Air Force Depot Programming by Linking Resources to Capabilities

DTIC Science & Technology

2012-01-01

thank Rick Grisenthwaite at Warner Robins Air Logistics Center, Jamie Jeter at Okla- homa City Air Logistics Center, and Glen Brown at Ogden Air...consistency, we use the term block cycle instead of SCU in our F-16 discussions. 4 8 Im p ro vin g A ir Fo rce D ep o t Pro g ram m in g b y Lin kin...Requirements RAND TR905-B.8 Figure B.9 Depot Purchased Equipment Maintenance Model Output: Projected Aircraft Availability RAND TR905-B.9 A ir cr af t av
Potential Applications of Manual Games,

DTIC Science & Technology

1984-02-01

34 just because some electronic equipment is used to keep track of logistics, combat results, and force status. Even a highly computerized game like...D-A152 541 POTENTIAL APPLICATIONS OF MANUAL GAMES (U) RAND CORP ii SANTA MONICA CA T A BROW~N FEB 84 RAND/P-6957 UNCLASI7FIED F/G 12/2 N El..I 111 1...128 112.5 111 m; * _ 1.8 I1111 ’I’ll MICROCOPY RESOLUTION TEST CHART NATI NAl fii~ t1 RI 1A L4k, I POTENTIAL APPLICATIONS OF MANUJAL GAMES Lfl N Lfl
Proceedings of the Annual RAND-China Reform Forum Conference (6th) Held in Santa Monica, California on August 28-29, 2003

DTIC Science & Technology

2005-01-01

documents for commercial use. Limited Electronic Distribution Rights For More Information CHILD POLICY CIVIL JUSTICE EDUCATION ENERGY AND ENVIRONMENT HEALTH...Reform Forum Conference. August 28-29, 2003 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK...have been reviewed and approved by RAND Science and Technology. Proceedings of the 6th Annual RAND–China Reform Forum Conference August 28–29
Deterrence from Cold War to Long War: Lessons from Six Decades of RAND Research

DTIC Science & Technology

2008-01-01

highly credible intention. Declaring an intention to retaliate for an attack on U.S. territory was no threat in Schelling’s formulation ; it was a...unconditional commitments are not rational . We shall say 14 Deterrence—From Cold War to Long War that they represent a non- rational element in...this method is impractical. Another strategy that Schelling discussed was embracing non- rationality and simply giving the impression that U.S
The Military Spouse Education and Career Opportunities Program: Recommendations for an Internal Monitoring System

DTIC Science & Technology

2016-01-01

Family Policy’s SECO program, which reviewed existing SECO metrics and data sources, as well as analytic methods of previ- ous research, to determine ...process that requires an iterative cycle of assessment of collected data (typically, but not solely, quantitative data) to determine whether SECO...RAND suggests five steps to develop and implement the SECO inter- nal monitoring system: Step 1. Describe the logic or theory of how activities are
GEEC All the Way Down

DTIC Science & Technology

2015-01-13

applying formal methods to systems software, e.g., IronClad [16] and seL4 [19], promise that this vision is not a fool’s er- rand after all. In this...kernel seL4 [19] is fully verified for functional correct- ness and it runs with other deprivileged services. How- ever, the verification process used...portion, which is non-trivial for theorem proving-based approaches. In our COSS example, adding the trusted network logging extensions to seL4 will
Partnerships for parks and physical activity.

PubMed

Shulaker, Bianca D; Isacoff, Jennifer W; Cohen, Deborah A; Marsh, Terry; Wier, Megan; Bhatia, Rajiv

2014-01-01

Given the need for comprehensive and multidisciplinary active living interventions, this article describes an innovative partnership for park design and evaluation. The Trust for Public Land partnered with the RAND Corporation and the San Francisco Department of Public Health to generate context-sensitive active park design, establish evaluation methods, and build the framework for future collaboration. These partners worked together from 2009 to 2012 to design, renovate, and study parks in San Francisco, California. The three partnering organizations are the focus of this article. The Trust for Public Land's Parks for People-Bay Area Program raised more than $16 million to renovate three San Francisco parks, which served as the intervention for a study that initially brought the three partnering organizations together. The authors, who represent the three partners, collaborated to develop the lessons learned. This article is a description and commentary about a partnership that emphasized community involvement and rigorous evaluation. Lessons learned and elements for successful partnerships include collaborating with organizations with differing expertise, deciding upon goals initially, finding a common language, involving local communities, and recognizing the importance and appropriate role of evaluations. The model for collaboration and community involvement presented supports and encourages other organizations to use strategic, multidisciplinary partnerships and highlights the importance of evaluation.
Developing an item bank and short forms that assess the impact of asthma on quality of life.

PubMed

Stucky, Brian D; Edelen, Maria Orlando; Sherbourne, Cathy D; Eberhart, Nicole K; Lara, Marielena

2014-02-01

The present work describes the process of developing an item bank and short forms that measure the impact of asthma on quality of life (QoL) that avoids confounding QoL with asthma symptomatology and functional impairment. Using a diverse national sample of adults with asthma (N = 2032) we conducted exploratory and confirmatory factor analyses, and item response theory and differential item functioning analyses to develop a 65-item unidimensional item bank and separate short form assessments. A psychometric evaluation of the RAND Impact of Asthma on QoL item bank (RAND-IAQL) suggests that though the concept of asthma impact on QoL is multi-faceted, it may be measured as a single underlying construct. The performance of the bank was then evaluated with a real-data simulated computer adaptive test. From the RAND-IAQL item bank we then developed two short forms consisting of 4 and 12 items (reliability = 0.86 and 0.93, respectively). A real-data simulated computer adaptive test suggests that as few as 4-5 items from the bank are needed to obtain highly precise scores. Preliminary validity results indicate that the RAND-IAQL measures distinguish between levels of asthma control. To measure the impact of asthma on QoL, users of these items may choose from two highly reliable short forms, computer adaptive test administration, or content-specific subsets of items from the bank tailored to their specific needs. Copyright © 2013 Elsevier Ltd. All rights reserved.
Addiction research centres and the nurturing of creativity. RAND's Drug Policy Research Center.

PubMed

Reuter, Peter; Pacula, Rosalie Liccardo; Caulkins, Jonathan P

2011-02-01

In September 1989, amid an emotional and ideological debate regarding problematic drug use in the United States and the 'war on drugs', RAND's Drug Policy Research Center (DPRC) was created through private foundation funds. The purpose of this new research center was to provide objective empirical analysis on which to base sound drug policy. Twenty years later, RAND's DPRC continues its work, drawing on a broad range of analytical expertise to evaluate, compare and assess the effectiveness of a similarly broad range of drug policies. More than 60 affiliated researchers in the United States and Europe make up the Center, which attempts to provide objective empirical analyses to better inform drug policies within the United States and abroad. This paper provides a look back at the creation, evolution and growth of the Center. It then describes how the Center operates today and how it has maintained its clear identity and focus by drawing on the analytical capabilities of a talented group of researchers from a broad range of academic disciplines. © 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.
Maastricht Delphi Consensus on Event Definitions for Classification of Recurrence in Breast Cancer Research

PubMed Central

van Roozendaal, Lori M.; Strobbe, Luc J. A.; Aebi, Stefan; Cameron, David A.; Dixon, J. Michael; Giuliano, Armando E.; Haffty, Bruce G.; Hickey, Brigid E.; Hudis, Clifford A.; Klimberg, V. Suzanne; Koczwara, Bogda; Kühn, Thorsten; Lippman, Marc E.; Lucci, Anthony; Piccart, Martine; Smith, Benjamin D.; Tjan-Heijnen, Vivianne C. G.; van de Velde, Cornelis J. H.; Van Zee, Kimberly J.; Vermorken, Jan B.; Viale, Giuseppe; Voogd, Adri C.; Wapnir, Irene L.; White, Julia R.; Smidt, Marjolein L.

2014-01-01

Background In breast cancer studies, many different endpoints are used. Definitions are often not provided or vary between studies. For instance, “local recurrence” may include different components in similar studies. This limits transparency and comparability of results. This project aimed to reach consensus on the definitions of local event, second primary breast cancer, regional and distant event for breast cancer studies. Methods The RAND-UCLA Appropriateness method (modified Delphi method) was used. A Consensus Group of international breast cancer experts was formed, including representatives of all involved clinical disciplines. Consensus was reached in two rounds of online questionnaires and one meeting. Results Twenty-four international breast cancer experts participated. Consensus was reached on 134 items in four categories. Local event is defined as any epithelial breast cancer or ductal carcinoma in situ (DCIS) in the ipsilateral breast, or skin and subcutaneous tissue on the ipsilateral thoracic wall. Second primary breast cancer is defined as epithelial breast cancer in the contralateral breast. Regional events are breast cancer in ipsilateral lymph nodes. A distant event is breast cancer in any other location. Therefore, this includes metastasis in contralateral lymph nodes and breast cancer involving the sternal bone. If feasible, tissue sampling of a first, solitary, lesion suspected for metastasis is highly recommended. Conclusion This project resulted in consensus-based event definitions for classification of recurrence in breast cancer research. Future breast cancer research projects should adopt these definitions to increase transparency. This should facilitate comparison of results and conducting reviews as well as meta-analysis. PMID:25381395
Dynamic Measurement of Disease Activity in Acute Pancreatitis: The Pancreatitis Activity Scoring System

PubMed Central

Wu, Bechien U.; Batech, Michael; Quezada, Michael; Lew, Daniel; Fujikawa, Kelly; Kung, Jonathan; Jamil, Laith H.; Chen, Wansu; Afghani, Elham; Reicher, Sonya; Buxbaum, James; Pandol, Stephen J.

2017-01-01

OBJECTIVES Acute pancreatitis has a highly variable course. Currently there is no widely accepted method to measure disease activity in patients hospitalized for acute pancreatitis. We aimed to develop a clinical activity index that incorporates routine clinical parameters to assist in the measurement, study, and management of acute pancreatitis. METHODS We used the UCLA/RAND appropriateness method to identify items for inclusion in the disease activity instrument. We conducted a systematic literature review followed by two sets of iterative modified Delphi meetings including a panel of international experts between November 2014 and November 2015. The final instrument was then applied to patient data obtained from five separate study cohorts across Southern California to assess profiles of disease activity. RESULTS From a list of 35 items comprising 6 domains, we identified 5 parameters for inclusion in the final weighted clinical activity scoring system: organ failure, systemic inflammatory response syndrome, abdominal pain, requirement for opiates and ability to tolerate oral intake. We applied the weighted scoring system across the 5 study cohorts comprising 3,123 patients. We identified several distinct patterns of disease activity: (i) overall there was an elevated score at baseline relative to discharge across all study cohorts, (ii) there were distinct patterns of disease activity related to duration of illness as well as (iii) early and persistent elevation of disease activity among patients with severe acute pancreatitis defined as persistent organ failure. CONCLUSIONS We present the development and initial validation of a clinical activity score for real-time assessment of disease activity in patients with acute pancreatitis. PMID:28462914

Health status assessment via the World Wide Web.

PubMed Central

Bell, D. S.; Kahn, C. E.

1996-01-01

We explored the use of the World Wide Web to collect health status information for medical outcomes research. The RAND 36-Item Health Survey 1.0 (RAND-36), which contains the 36 multiple-choice questions of the Medical Outcomes Study SF-36 "Short Form" and differs only in its simplified scoring scheme, was made available for anonymous use on the Internet. Participation in the survey was invited through health-related Internet news groups and mailing lists. Participants entered data and received, their scores using the World Wide Web protocol. Entries were recorded from 15 June 1995 to 14 June 1996 (1 year). The survey was completed anonymously by 4876 individuals with access to the World Wide Web. Two-thirds completed the survey within 5 minutes, and 97% did so within 10 minutes. The item-completion rate was 99.28%. Values of Cronbach's alpha of 0.76 to 0.90 for the scoring scales matched the high reliability found in the Medical Outcomes Study. The World Wide Web provides a method of rapidly measuring individual health status and may play an important role in advancing health services research and outcomes-based patient care. PMID:8947684
First results of Liguria-Trento transplant network project: a model for a macroregional network and real-time registry in Italy.

PubMed

Valente, R; Cambiaso, F; Santori, G; Ghirelli, R; Gianelli, A; Valente, U

2004-04-01

In Italy, health-care telematic is funded and supported at the level of national government or regional institutions. In 1999, the Italian Ministry of Health started to fund the Liguria-Trento Transplant Network (LTTN) project, a health research project with the aim to build an informative system for donor management and transplantation activity in a macroregional area. At the time of LTTN project proposal, no published Transplant Network Informative System fulfilled Italian rules on telematic management of electronic documentation concerning transplantation activity. Partnership of LTTN project were two Regional Transplant Coordinating Centres, Nord Italia Transplant Interregional Coordinating Centre and the Italian Institute of Health/National Transplant Coordinating Centre. Project Total Quality Management methods were adopted. Technological and case analysis followed ANSI-HL7, CEN-TC251, and Object-Oriented Software Engineering standards. A low-tech prototype powered by a web access relational database is running on a transplant network including web-based clients located in 17 intensive care units, in Nord Italia Transplant Interregional Coordinating Centre, and at the Italian Institute of Health/National Transplant Coordinating Centre. LTTN registry includes pretransplant, surgical, and posttransplant phases regarding liver, kidney, pancreas, and kidney-pancreas transplantation in adult and pediatric recipients. Clinical specifications were prioritized in agreement with the RAND/UCLA appropriateness method. Further implementation will include formal rules for data access and output release, fault tolerance, and a continuous registry evolution plan.
Asian Security in the 1980s: Problems and Policies for a Time of Transition,

DTIC Science & Technology

1979-11-01

A7416 RAND CORP SANTA MONICA CAF/54AO7R ASIAN SECURITY INM THE 198CS: PROBLEMS AND POLICIES FOR A TIME O-ETC(U) WCASF NOV 79 R H SOLOMON N0A903-77-C...O115 UN LAFED RAND/R-2692-IA NL14 mEEEmmEEEE -EEiiEEmiEEEE iinnninnnnnnlinn Illlliilillllu,. -EEEEag/Ilh/lI -EiilllllEilE Asian Security in the 1980s...INTERNATIONAL SECURITY AFFAIRS R-2492-ISA November 1979 ".80 CO ) L j ... -- The research described in this report was sponsored by the Department of
The Boundary Element Method Applied to the Two Dimensional Stefan Moving Boundary Problem

DTIC Science & Technology

1991-03-15

Unc), - ( UGt )t - (UG,,),,] - (UG), If we integrate this equation with respect to r from 0 to t - c and with respect to and ij on the region 11(r...and others. "Moving Boundary Problems in Phase Change Mod- els," SIGNUM Newsletter, 20: 8-12 (1985). 21. Stefan, J. "Ober einige Probleme der Theorie ...ier Wirmelcitung," S.-B. \\Vein. Akad. Mat. Natur., 98: 173-484 (1889). 22.-. "flber (lie Theorie der Eisbildung insbesondere fiber die lisbildung im
RAND’s Portfolio Analysis Tool (PAT): Theory, Methods, and Reference Manual

DTIC Science & Technology

2009-01-01

language , such as Analytica® (a product of Lumina Decision Systems, Inc., [www.lumina.com]). We used such a connection approach in our work for MDA...with $ signs ) so that the formulas will be automatically adjusted if they change PAT’s structure by, e.g., adding a column or row. Checking is...year, in real (inflation-protected) dollars. The sign is positive or negative, depending on whether one is receiving or paying and on the syntax of
Gender differences in health-related quality of life in patients undergoing coronary angiography.

PubMed

Gijsberts, Crystel M; Agostoni, Pierfrancesco; Hoefer, Imo E; Asselbergs, Folkert W; Pasterkamp, Gerard; Nathoe, Hendrik; Appelman, Yolande E; de Kleijn, Dominique P V; den Ruijter, Hester M

2015-01-01

Health-related quality of life (HRQOL) reflects the general well-being of individuals. In patients with coronary artery disease (CAD), HRQOL is compromised. Female patients with CAD have been reported to have lower HRQOL. In this study, we investigate gender differences in HRQOL and in associations of patient characteristics with HRQOL in patients with coronary angiography (CAG). We cross-sectionally analysed patients from the Utrecht Coronary Biobank undergoing CAG. All patients filled in an HRQOL questionnaire (RAND-36 and EuroQoL) on inclusion. RAND-36 and EuroQoL HRQOL measures were compared between the genders across indications for CAG, CAD severity and treatment of CAD. RAND-36 HRQOL measures were compared with the general Dutch population. Additionally, we assessed interactions of gender with patient characteristics in their association with HRQOL (EuroQoL). We included 1421 patients (1020 men and 401 women) with a mean age of 65 in our analysis. Women reported lower HRQOL measures than men (mean EuroQoL self-rated health grade 6.84±1.49 in men, 6.46±1.40 in women, p<0.001). The reduction in RAND-36 HRQOL as compared with the general Dutch population was larger in women than in men. From regression analysis, we found that diabetes, a history of cardiovascular disease and symptoms of shortness of breath determined HRQOL (EuroQoL) more strongly in men than in women. Women reported lower HRQOL than men throughout all indications for CAG and regardless of CAD severity or treatment. As compared with the general population, the reduction in HRQOL was more extreme in women than in men. Evident gender differences were found in determinants of HRQOL in patients undergoing CAG, which deserve attention in future research. NCT02304744 (clinicaltrials.gov).
Health-related quality of life 6 months after burns among hospitalized patients: Predictive importance of mental disorders and burn severity.

PubMed

Palmu, Raimo; Partonen, Timo; Suominen, Kirsi; Saarni, Samuli I; Vuola, Jyrki; Isometsä, Erkki

2015-06-01

Major burns are likely to have a strong impact on health-related quality of life (HRQoL). We investigated the level of and predictors for quality of life at 6 months after acute burn. Consecutive acute adult burn patients (n=107) admitted to the Helsinki Burn Centre were examined with a structured diagnostic interview (SCID) at baseline, and 92 patients (86%) were re-examined at 6 months after injury. During follow-up 55% (51/92) suffered from at least one mental disorder. The mean %TBSA was 9. TBSA of men did not differ from that of women. Three validated instruments (RAND-36, EQ-5, 15D) were used to evaluate the quality of life at 6 months. All the measures (RAND-36, EQ-5, 15D) consistently indicated mostly normal HRQoL at 6 months after burn. In the multivariate linear regression model, %TBSA predicted HRQoL in one dimension (role limitations caused by physical health problems, p=0.039) of RAND-36. In contrast, mental disorders overall and particularly major depressive disorder (MDD) during follow-up (p-values of 0.001-0.002) predicted poor HRQoL in all dimensions of RAND-36. HRQoL of women was worse than that of men. Self-perceived HRQoL among acute burn patients at 6 months after injury seems to be mostly as good as in general population studies in Finland. The high standard of acute treatment and the inclusion of small burns (%TBSA<5) in the cohort may partly explain the weak effect of burn itself on HRQoL. Mental disorders strongly predicted HRQoL at 6 months. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.
Evaluating the reliability, validity and minimally important difference of the Taiwanese version of the diabetes quality of life (DQOL) measurement

PubMed Central

Huang, I-Chan; Liu, Jung-Hua; Wu, Albert W; Wu, Ming-Yen; Leite, Walter; Hwang, Chyng-Chuang

2008-01-01

Background Few diabetes HRQOL instruments are available in Chinese language. We tested psychometric properties of a Diabetes Quality of Life (DQOL) in Chinese language for diabetes patients in Taiwan and estimated its minimally important differences (MIDs). Methods Data were collected from 337 patients treated in diabetes clinics of a Taiwan teaching hospital. Pearson's correlations among domain scores of the DQOL (satisfaction, impact, and worry), the D-39S (a diabetes-specific instrument, including domains of diabetes control, energy and mobility, social burden and anxiety and worry, and sexual functioning) and the RAND-12 (a generic instrument, including physical health composite (PHC) and mental health composite (MHC)) were estimated to determine convergent/discriminant validity. Known-groups validity was examined using 2-hour postprandial plasma glucose (2 h PPG), hemoglobin A1c (HbA1c)) and presence of complications (retinopathy, neuropathy, and diabetic foot complications rather than the known groups of cardiovascular and cerebrovascular complications). We used a combined anchor- and distribution-based approach to establish MIDs. Results The DQOL scores were more strongly correlated with the physical domains of the D-39S (diabetes control and energy and mobility) and RAND-12 PHC than psychological domains of the D-39S (social burden, anxiety and worry, and sexual functioning) and RAND-12 MHC. The DQOL showed satisfactory discriminative ability for the known groups of 2 h PPG and HbA1c (effect size (ES) ≥ 0.2) and retinopathy, neuropathy, and diabetic foot complications (ES ≥ 0.3), but less satisfactory for the known groups of cardiovascular and cerebrovascular complications. MIDs for the DQOL domains were 3–5 points for satisfaction, 4–5 points for impact, 6–8 points for worry, and 3–4 points for overall HRQOL. Conclusion We validated a DQOL in Chinese language for diabetes patients in Taiwan and provided MIDs to facilitate the measure of diabetes HRQOL. PMID:18957127
Validation of an Arabic version of Fatigue Severity Scale

PubMed Central

Al-Sobayel, Hana I.; Al-Hugail, Hind A.; AlSaif, Ranyah M.; Albawardi, Nada M.; Alnahdi, Ali H.; Daif, Abdulkader M.; Al-Arfaj, Hussein F.

2016-01-01

Objectives: To develop and test the psychometric properties of an Arabic version of Fatigue Severity Scale (FSS-Ar) that can be used to measure fatigue in Arabic patients with disorders where fatigue is a major symptom. Methods: Forward and backward translations of FSS were undertaken to develop an Arabic version. The validity and reliability of the FSS-Ar was then tested on 28 patients with systemic lupus erythematosus (SLE), 24 patients with multiple sclerosis (MS), and 31 healthy subjects. Exploratory factor analysis and hypothesis testing methods were used to examine construct validity. The correlation between FSS-Ar and the vitality domain of the RAND 36-Item Health was examined to test construct validity. The study was conducted at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between February and June 2012. Results: Using a score of ≥4.05 to define fatigue, 39 of 52 (75%) participants were fatigued compared with 10 out of 31 (32%) healthy participants. The correlation between the FSS-Ar and the vitality domain of the RAND-36 was acceptable (r = -0.46). Factor analysis showed that items of the FSS-Ar measured one underlying construct, namely, fatigue. Test-retest reliability and internal consistency of the FSS-Ar was acceptable (intraclass correlation coefficient model 2,1 = 0.80; Cronbach’s alpha = 0.84). Conclusion: The Arabic version of the FSS demonstrated acceptable psychometric properties and was able to differentiate between patients with SLE or MS, and healthy subjects. PMID:26739978
Cost estimation: An expert-opinion approach. [cost analysis of research projects using the Delphi method (forecasting)

NASA Technical Reports Server (NTRS)

Buffalano, C.; Fogleman, S.; Gielecki, M.

1976-01-01

A methodology is outlined which can be used to estimate the costs of research and development projects. The approach uses the Delphi technique a method developed by the Rand Corporation for systematically eliciting and evaluating group judgments in an objective manner. The use of the Delphi allows for the integration of expert opinion into the cost-estimating process in a consistent and rigorous fashion. This approach can also signal potential cost-problem areas. This result can be a useful tool in planning additional cost analysis or in estimating contingency funds. A Monte Carlo approach is also examined.
The ISTSS/Rand guidelines on mental health training of primary healthcare providers for trauma-exposed populations in conflict-affected countries.

PubMed

Eisenman, David; Weine, Stevan; Green, Bonnie; de Jong, Joop; Rayburn, Nadine; Ventevogel, Peter; Keller, Allen; Agani, Ferid

2006-02-01

Mental health care for trauma-exposed populations in conflict-affected developing countries often is provided by primary healthcare providers (PHPs), including doctors, nurses, and lay health workers. The Task Force on International Trauma Training, through an initiative sponsored by the International Society for Traumatic Stress Studies and the RAND Corporation, has developed evidence- and consensus-based guidelines for the mental health training of PHPs in conflict-affected developing countries. This article presents the Guidelines, which provide a conceptual framework and specific principles for improving the quality of mental health training for PHPs working with trauma-exposed populations.
Should Medical Care be Free? Cost Sharing and Health Financing Policy,

DTIC Science & Technology

1982-06-01

CopyrIght 0 192 UT Rand Corporation B~~, 4 -1- Debate over the wisdom of having patients pay for some or all of their medical care services has...AD-Al 22 889 SHOULD MEDICAL CARE 4E FREE? COST SHARINd AND HEALTH I// FINANCING POL ICy(U) RAND CORP SANTA MONICA CAEHUE U 2R P6 UNCL7ASSIFIED F/G A...5 NL 7 *EE1Eh h I L mllll lll IL III2 lilt ig 1 .0 1.25 LA 6= MICIROCPY RESOLUTION TEST CHART, NATIONAL BUREAU OF SIANDAROS-1963-A r-l SHOULD MEDICAL
A cost benefit analysis of an enhanced seat belt enforcement program in South Africa.

PubMed

Harris, G T; Olukoga, I A

2005-04-01

To examine whether a program to increase the wearing of seat belts in a South African urban area would be worthwhile in societal terms. A cost benefit analysis of a one year enhanced seat belt enforcement program in eThekwini (Durban) Municipality. Data were drawn from two main sources--a 1998 study of the cost of road crashes in South Africa and, given the absence of other data, a meta-analysis of the effectiveness of various types of interventions to reduce road crash casualties in the United States--and were analyzed using cost benefit analysis. A program designed to enforce greater wearing of seat belts, estimated to cost 2 million rand in one year, could be reasonably expected to increase seat belt usage rates by 16 percentage points and reduce fatalities and injuries by 9.5%. This would result in saved social costs of 13.6 million rand in the following year or a net present value of 11.6 million rand. There would also be favorable consequences for municipal finances. Investment in a program to increase seat belt wearing rates is highly profitable in societal terms.
Stakeholder Perspectives on a Culture of Health: Key Findings.

PubMed

Acosta, Joie D; Whitley, Margaret D; May, Linnea Warren; Dubowitz, Tamara; Williams, Malcolm V; Chandra, Anita

2017-06-01

Since 2013, the Robert Wood Johnson Foundation (RWJF) has embarked on a pioneering effort to advance a Culture of Health. The Culture of Health action framework is founded on a vision in which "everyone in our diverse society leads healthier lives now and for generations to come." To put the Culture of Health vision into action, RWJF asked RAND Health to support the development of an action framework and measurement strategy. This article summarizes the stakeholder engagement efforts that RAND used to inform this work. It draws on a series of interviews and focus groups that RAND researchers conducted with stakeholders both within and outside the United States. It should be of interest to RWJF, as well as to those individuals and organizations interested in advancing the Culture of Health action framework. Given that RWJF is focused on using the Culture of Health action framework and measures to catalyze national dialogue about content and investments to improve population health and well-being, the study should be beneficial to a range of national, state, and local leaders across a variety of sectors that contribute to health as described by the Culture of Health action framework.
Making democracy safe for oil. Oilmen and the Islamic East

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

Rand, C.T.

1975-01-01

Here is a devastating expose of what, according to Mr. Rand, is the most powerful conglomerate of wealth in America: the oil industry. Mr. Rand, a Persian and Arabic expert as well as a former oil industry employee who has lived in the Middle East, combines research with knowledge acquired firsthand. His analysis shows that the oil crisis, far from being a recent phenomenon, was years in developing. For the first time we learn just how energy is provided for--or withheld from--the public. Armed with facts, figures, and case histories, Rand divulges the full story behind Aramco, SoCal, Exxon, andmore » the other oil producers. He uncovers the political ramifications of ''oil diplomacy'' in both the Arab world and in America, revealing the Executive Branch's reluctance to intervene as well as Congress's inability to do so. And he discusses what we can expect in the future, including suggestions about how we might cope with the problem. ''Making Democracy Safe for Oil,'' startling, timely, is a critique no one can afford to ignore, for the explosive situation continues to affect each one of us directly. (From book jacket)« less
RandSpg: An open-source program for generating atomistic crystal structures with specific spacegroups

NASA Astrophysics Data System (ADS)

Avery, Patrick; Zurek, Eva

2017-04-01

A new algorithm, RANDSPG, that can be used to generate trial crystal structures with specific space groups and compositions is described. The program has been designed for systems where the atoms are independent of one another, and it is therefore primarily suited towards inorganic systems. The structures that are generated adhere to user-defined constraints such as: the lattice shape and size, stoichiometry, set of space groups to be generated, and factors that influence the minimum interatomic separations. In addition, the user can optionally specify if the most general Wyckoff position is to be occupied or constrain select atoms to specific Wyckoff positions. Extensive testing indicates that the algorithm is efficient and reliable. The library is lightweight, portable, dependency-free and is published under a license recognized by the Open Source Initiative. A web interface for the algorithm is publicly accessible at http://xtalopt.openmolecules.net/randSpg/randSpg.html. RANDSPG has also been interfaced with the XTALOPT evolutionary algorithm for crystal structure prediction, and it is illustrated that the use of symmetric lattices in the first generation of randomly created individuals decreases the number of structures that need to be optimized to find the global energy minimum.
Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico

PubMed Central

2012-01-01

Background Several low and middle-income countries are implementing electronic health records (EHR). In the near future, EHRs could become an efficient tool to evaluate healthcare performance if appropriate indicators are developed. The aims of this study are: a) to develop quality of care indicators (QCIs) for type 2 diabetes (T2DM) in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCIs using the IMSS EHR data; and c) to evaluate the quality of care (QC) provided to IMSS patients with T2DM. Methods We used a three-stage mixed methods approach: a) development of QCIs following the RAND-UCLA method; b) EHR data extraction and construction of indicators; c) QC evaluation using EHR data from 25,130 T2DM patients who received care in 2009. Results We developed 18 QCIs, of which 14 were possible to construct using available EHR data. QCIs comprised both process of care and health outcomes. Several flaws in the EHR design and quality of data were identified. The indicators of process and outcomes of care suggested areas for improvement. For example, only 13.0% of patients were referred to an ophthalmologist; 3.9% received nutritional counseling; 63.2% of overweight/obese patients were prescribed metformin, and only 23% had HbA1c <7% (or plasma glucose ≤130 mg/dl). Conclusions EHR data can be used to evaluate QC. The results identified both strengths and weaknesses in the electronic information system as well as in the process and outcomes of T2DM care at IMSS. This information can be used to guide targeted interventions to improve QC. PMID:22672471
On Using Ethical Principles of Community-Engaged Research in Translational Science

PubMed Central

Mikesell, Lisa; Schraiber, Ron; Booth, Marika; Bromley, Elizabeth

2015-01-01

The transfer of new discoveries into both clinical practice and the wider community calls for reliance on interdisciplinary translational teams that include researchers with different areas of expertise, representatives of healthcare systems and community organizations, and patients. Engaging new stakeholders in research, however, calls for a re-consideration or expansion of the meaning of ethics in translational research. We explored expert opinion on the applicability of ethical principles commonly practiced in community-engaged research (CEnR) to translational research. To do so, we conducted two online, modified-Delphi panels with 63 expert stakeholders who iteratively rated and discussed nine ethical principles commonly used in CEnR in terms of their importance and feasibility for use in translational research. The RAND/UCLA Appropriateness Method was used to analyze the data and determine agreement and disagreement among participating experts. Both panels agreed that ethical translational research should be “grounded in trust.” While the academic panel endorsed “culturally appropriate” and “forthcoming with community about study risks and benefits,” the mixed academic-community panel endorsed “scientifically valid” and “ready to involve community in interpretation and dissemination” as important and feasible principles of ethical translational research. These findings suggest that in addition to protecting human subjects, contemporary translational science models need to account for the interests of, and owe ethical obligations to, members of the investigative team and the community at large. PMID:26773561
Best Practices for Suicide Prevention Messaging and Evaluating California's "Know the Signs" Media Campaign.

PubMed

Acosta, Joie; Ramchand, Rajeev; Becker, Amariah

2017-09-01

Although communication is a key component of US strategies to prevent suicide and there are a number of marketing campaigns promoting messages that suicide is a preventable public health problem, there has been little evaluation of these campaigns. The study describes the development of a checklist of best practices for suicide prevention communication campaigns and the use of the checklist to evaluate California's investment in "Know the Signs" (KTS-M), a suicide prevention mass media campaign. We conducted a literature review and solicited expert feedback to identify best practices and then used the RAND/UCLA appropriateness method to assess whether KTS-M was consistent with the identified best practices. Overall, experts agreed that KTS-M adhered to most of the 46 checklist items and suggested that the campaign was among the best suicide prevention media campaigns they had observed. The checklist was developed through expert input and literature review and focuses only on media campaigns. Given the nascent state of the evidence about what makes an effective suicide prevention message and the growing number of campaigns, the checklist of best practices reflects one way of promoting quality in this evolving field. The consistency between the experts' comments and their ratings of KTS-M suggests that the checklist may provide important guidance to inform the development of future campaigns and the evaluation of ongoing campaigns.
Dynamic Measurement of Disease Activity in Acute Pancreatitis: The Pancreatitis Activity Scoring System.

PubMed

Wu, Bechien U; Batech, Michael; Quezada, Michael; Lew, Daniel; Fujikawa, Kelly; Kung, Jonathan; Jamil, Laith H; Chen, Wansu; Afghani, Elham; Reicher, Sonya; Buxbaum, James; Pandol, Stephen J

2017-07-01

Acute pancreatitis has a highly variable course. Currently there is no widely accepted method to measure disease activity in patients hospitalized for acute pancreatitis. We aimed to develop a clinical activity index that incorporates routine clinical parameters to assist in the measurement, study, and management of acute pancreatitis. We used the UCLA/RAND appropriateness method to identify items for inclusion in the disease activity instrument. We conducted a systematic literature review followed by two sets of iterative modified Delphi meetings including a panel of international experts between November 2014 and November 2015. The final instrument was then applied to patient data obtained from five separate study cohorts across Southern California to assess profiles of disease activity. From a list of 35 items comprising 6 domains, we identified 5 parameters for inclusion in the final weighted clinical activity scoring system: organ failure, systemic inflammatory response syndrome, abdominal pain, requirement for opiates and ability to tolerate oral intake. We applied the weighted scoring system across the 5 study cohorts comprising 3,123 patients. We identified several distinct patterns of disease activity: (i) overall there was an elevated score at baseline relative to discharge across all study cohorts, (ii) there were distinct patterns of disease activity related to duration of illness as well as (iii) early and persistent elevation of disease activity among patients with severe acute pancreatitis defined as persistent organ failure. We present the development and initial validation of a clinical activity score for real-time assessment of disease activity in patients with acute pancreatitis.

Quality measures for the diagnosis and non-operative management of carpal tunnel syndrome in occupational settings.

PubMed

Nuckols, Teryl; Harber, Philip; Sandin, Karl; Benner, Douglas; Weng, Haoling; Shaw, Rebecca; Griffin, Anne; Asch, Steven

2011-03-01

Providing higher quality medical care to workers with occupationally associated carpal tunnel syndrome (CTS) may reduce disability, facilitate return to work, and lower the associated costs. Although many workers' compensation systems have adopted treatment guidelines to reduce the overuse of unnecessary care, limited attention has been paid to ensuring that the care workers do receive is high quality. Further, guidelines are not designed to enable objective assessments of quality of care. This study sought to develop quality measures for the diagnostic evaluation and non-operative management of CTS, including managing occupational activities and functional limitations. Using a variation of the well-established RAND/UCLA Appropriateness Method, we developed draft quality measures using guidelines and literature reviews. Next, in a two-round modified-Delphi process, a multidisciplinary panel of 11 U.S. experts in CTS rated the measures on validity and feasibility. Of 40 draft measures, experts rated 31 (78%) valid and feasible. Nine measures pertained to diagnostic evaluation, such as assessing symptoms, signs, and risk factors. Eleven pertain to non-operative treatments, such as the use of splints, steroid injections, and medications. Eleven others address assessing the association between symptoms and work, managing occupational activities, and accommodating functional limitations. These measures will complement existing treatment guidelines by enabling providers, payers, policymakers, and researchers to assess quality of care for CTS in an objective, structured manner. Given the characteristics of previous measures developed with these methods, greater adherence to these measures will probably lead to improved patient outcomes at a population level.
DOE Office of Scientific and Technical Information (OSTI.GOV)

Richter, B.

In this paper I have reviewed the possibilities for new colliders that might be available in the 1990's. One or more new proton should be available in the late-90s based on plans of Europe, the US and the USSR. The two very high energy machines, LHC and SSC, are quite expensive, and their construction will be more decided by the politicians' view on the availability of resources than by the physicists' view of the need for new machines. Certainly something will be built, but the question is when. New electron colliders beyond LEP II could be available in the latemore » 1990's as well. Most of the people who have looked at this problem believe that at a minimum three years of RandD are required before a proposal can be made, two years will be required to convince the authorities to go ahead, and five years will be required to build such a machine. Thus the earliest time a new electron collider at high energy could be available is around 1988. A strong international RandD program will be required to meet that schedule. In the field of B factories, PSI's proposal is the first serious step beyond the capabilities of CESR. There are other promising techniques but these need more RandD. The least RandD would be required for the asymmetric storage ring systems, while the most would be required for high luminosity linear colliders. For the next decade, high energy physics will be doing its work at the high energy frontier with Tevatron I and II, UNK, SLC, LEP I and II, and HERA. The opportunities for science presented by experiments at these facilities are very great, and it is to be hoped that the pressure for funding to construct the next generation facilities will not badly affect the operating budgets of the ones we now have or which will soon be turning on. 9 refs., 12 figs., 6 tabs.« less
The effect of obesity on long-term survival and health-related quality of life after coronary artery bypass grafting: a 12-year follow-up.

PubMed

Hokkanen, Matti; Järvinen, Otso; Huhtala, Heini; Laurikka, Jari

2018-04-20

The proportion of obese patients undergoing coronary artery bypass graft (CABG) surgery is increasing. In this study, our main objective was to assess the effect of obesity on long-term mortality and changes in quality of life (QoL) after GABG. Data of 508 patients who underwent isolated GABG were prospectively collected. RAND-36 Health Survey (RAND-36) was used as an indicator of QoL. BMI was used to assess obesity, and the analysis was based primarily on two patient groups: BMI less than 30 kg/m (408 patients) and BMI of at least 30 (100 patients). All assessments were made preoperatively and repeated 1 and 12 years after CABG surgery. The follow-up of the cohort was complete in 95 and 84% of the alive patients at 1 and 12 years, respectively. Thirty-day, 1-year, and 10-year survival rates were 99.0, 97.0, and 78.0%, respectively, in the obese and 98.0, 96.8, and 79.2%, respectively, in the nonobese group. Obese showed significant (P<0.05) improvements only in four and nonobese in seven of eight RAND-36 dimensions of QoL. In both obese and nonobese patients, improved RAND-36 physical component summary and mental component summary scores were seen in comparison with the preoperative values. Yet, obese patients had a more pronounced diminution in their physical component summary and mental component summary scores, whereas nonobese patients maintained their physical and mental health status better. Despite an on-going decline in 12 years after the CABG, both patient groups showed improvements in their health status in comparison with preoperative values. Obese patients gained less benefit in terms of QoL dimension, but there was no significant difference in overall mortality in the long-term follow-up.
Developing a Research Strategy for Suicide Prevention in the Department of Defense

PubMed Central

Ramchand, Rajeev; Eberhart, Nicole K.; Guo, Christopher; Pedersen, Eric R.; Savitsky, Terrance Dean; Tanielian, Terri; Voorhies, Phoenix

2014-01-01

Abstract In response to the elevated rate of suicide among U.S. service members, a congressionally mandated task force recommended that the U.S. Department of Defense (DoD) create a unified, comprehensive strategic plan for suicide prevention research to ensure that DoD–funded studies align with DoD's goals. To help meet this objective, a RAND study cataloged the research funded by DoD and other entities that is directly relevant to military personnel, examined the extent to which current research maps to DoD's strategic research needs, and provided recommendations to ensure that proposed research strategies align with the national research strategy and integrate with DoD's data collection and program evaluation strategies. The study found that although DoD is one of the largest U.S. funders of research related to suicide prevention, its current funding priorities do not consistently reflect its research needs. The study indexed each of 12 research goals according to rankings of importance, effectiveness, cultural acceptability, cost, and learning potential provided by experts who participated in a multistep elicitation exercise. The results revealed that research funding is overwhelmingly allocated to prevention goals already considered by experts to be effective. Other goals considered by experts to be important and appropriate for the military context receive relatively little funding and have been the subject of relatively few studies, meaning that there is still much to learn about these strategies. Furthermore, DoD, like other organizations, suffers from a research–to–practice gap. The most promising results from studies funded by DoD and other entities do not always find their way to those responsible for implementing suicide prevention programs that serve military personnel. The RAND study recommended approaches to thoughtfully integrate the latest research findings into DoD's operating procedures to ensure that evidence–based approaches can benefit suicide prevention programs and prevent the further loss of lives to suicide. PMID:28560085
Development of a monitoring instrument to assess the performance of the Swiss primary care system.

PubMed

Ebert, Sonja T; Pittet, Valérie; Cornuz, Jacques; Senn, Nicolas

2017-11-29

The Swiss health system is customer-driven with fee-for-service paiement scheme and universal coverage. It is highly performing but expensive and health information systems are scarcely implemented. The Swiss Primary Care Active Monitoring (SPAM) program aims to develop an instrument able to describe the performance and effectiveness of the Swiss PC system. Based on a Literature review we developed a conceptual framework and selected indicators according to their ability to reflect the Swiss PC system. A two round modified RAND method with 24 inter-/national experts took place to select primary/secondary indicators (validity, clarity, agreement). A limited set of priority indicators was selected (importance, priority) in a third round. A conceptual framework covering three domains (structure, process, outcome) subdivided into twelve sections (funding, access, organisation/ workflow of resources, (Para-)Medical training, management of knowledge, clinical-/interpersonal care, health status, satisfaction of PC providers/ consumers, equity) was generated. 365 indicators were pre-selected and 335 were finally retained. 56 were kept as priority indicators.- Among the remaining, 199 were identified as primary and 80 as secondary indicators. All domains and sections are represented. The development of the SPAM program allowed the construction of a consensual instrument in a traditionally unregulated health system through a modified RAND method. The selected 56 priority indicators render the SPAM instrument a comprehensive tool supporting a better understanding of the Swiss PC system's performance and effectiveness as well as in identifying potential ways to improve quality of care. Further challenges will be to update indicators regularly and to assess validity and sensitivity-to-change over time.
Stability-based validation of dietary patterns obtained by cluster analysis.

PubMed

Sauvageot, Nicolas; Schritz, Anna; Leite, Sonia; Alkerwi, Ala'a; Stranges, Saverio; Zannad, Faiez; Streel, Sylvie; Hoge, Axelle; Donneau, Anne-Françoise; Albert, Adelin; Guillaume, Michèle

2017-01-14

Cluster analysis is a data-driven method used to create clusters of individuals sharing similar dietary habits. However, this method requires specific choices from the user which have an influence on the results. Therefore, there is a need of an objective methodology helping researchers in their decisions during cluster analysis. The objective of this study was to use such a methodology based on stability of clustering solutions to select the most appropriate clustering method and number of clusters for describing dietary patterns in the NESCAV study (Nutrition, Environment and Cardiovascular Health), a large population-based cross-sectional study in the Greater Region (N = 2298). Clustering solutions were obtained with K-means, K-medians and Ward's method and a number of clusters varying from 2 to 6. Their stability was assessed with three indices: adjusted Rand index, Cramer's V and misclassification rate. The most stable solution was obtained with K-means method and a number of clusters equal to 3. The "Convenient" cluster characterized by the consumption of convenient foods was the most prevalent with 46% of the population having this dietary behaviour. In addition, a "Prudent" and a "Non-Prudent" patterns associated respectively with healthy and non-healthy dietary habits were adopted by 25% and 29% of the population. The "Convenient" and "Non-Prudent" clusters were associated with higher cardiovascular risk whereas the "Prudent" pattern was associated with a decreased cardiovascular risk. Associations with others factors showed that the choice of a specific dietary pattern is part of a wider lifestyle profile. This study is of interest for both researchers and public health professionals. From a methodological standpoint, we showed that using stability of clustering solutions could help researchers in their choices. From a public health perspective, this study showed the need of targeted health promotion campaigns describing the benefits of healthy dietary patterns.
Mathematical Optimization Techniques

NASA Technical Reports Server (NTRS)

Bellman, R. (Editor)

1963-01-01

The papers collected in this volume were presented at the Symposium on Mathematical Optimization Techniques held in the Santa Monica Civic Auditorium, Santa Monica, California, on October 18-20, 1960. The objective of the symposium was to bring together, for the purpose of mutual education, mathematicians, scientists, and engineers interested in modern optimization techniques. Some 250 persons attended. The techniques discussed included recent developments in linear, integer, convex, and dynamic programming as well as the variational processes surrounding optimal guidance, flight trajectories, statistical decisions, structural configurations, and adaptive control systems. The symposium was sponsored jointly by the University of California, with assistance from the National Science Foundation, the Office of Naval Research, the National Aeronautics and Space Administration, and The RAND Corporation, through Air Force Project RAND.
Issues With Access to Acquisition Data and Information in the Department of Defense: Policy and Practice

DTIC Science & Technology

2016-04-30

qÜáêíÉÉåíÜ=^ååì~ä= ^Åèìáëáíáçå=oÉëÉ~êÅÜ= póãéçëáìã= tÉÇåÉëÇ~ó=pÉëëáçåë= sçäìãÉ=f= = Issues With Access to Acquisition Data & Information in the Department of...Chief Information Officer (CIO), United States Air Force Issues With Access to Acquisition Data & Information in the Department of Defense: Policy...Practice Megan McKernan, Defense Research Analyst, RAND Jessie Riposo, Senior Operations Researcher, RAND Issues With Access to Acquisition Data
Mixed methods inquiry into traditional healers' treatment of mental, neurological and substance abuse disorders in rural South Africa.

PubMed

Audet, Carolyn M; Ngobeni, Sizzy; Graves, Erin; Wagner, Ryan G

2017-01-01

Traditional healers are acceptable and highly accessible health practitioners throughout sub-Saharan Africa. Patients in South Africa often seek concurrent traditional and allopathic treatment leading to medical pluralism. We studied the cause of five traditional illnesses known locally as "Mavabyi ya nhloko" (sickness of the head), by conducting 27 in-depth interviews and 133 surveys with a randomly selected sample of traditional healers living and working in rural, northeastern South Africa. These interviews were carried out to identify treatment practices of mental, neurological, and substance abuse (MNS) disorders. Participating healers were primarily female (77%), older in age (median: 58.0 years; interquartile range [IQR]: 50-67), had very little formal education (median: 3.7 years; IQR: 3.2-4.2), and had practiced traditional medicine for many years (median: 17 years; IQR: 9.5-30). Healers reported having the ability to successfully treat: seizure disorders (47%), patients who have lost touch with reality (47%), paralysis on one side of the body (59%), and substance abuse (21%). Female healers reported a lower odds of treating seizure disorders (Odds Ratio (OR):0.47), patients who had lost touch with reality (OR:0.26; p-value<0.05), paralysis of one side of the body (OR:0.36), and substance abuse (OR:0.36) versus males. Each additional year of education received was found to be associated with lower odds, ranging from 0.13-0.27, of treating these symptoms. Each additional patient seen by healers in the past week was associated with roughly 1.10 higher odds of treating seizure disorders, patients who have lost touch with reality, paralysis of one side of the body, and substance abuse. Healers charged a median of 500 South African Rand (~US$35) to treat substance abuse, 1000 Rand (~US$70) for seizure disorders or paralysis of one side of the body, and 1500 Rand (~US$105) for patients who have lost touch with reality. While not all healers elect to treat MNS disorders, many continue to do so, delaying allopathic health services to acutely ill patients.
Secondary metabolites produced by Sardiniella urbana, a new emerging pathogen on European hackberry.

PubMed

Cimmino, Alessio; Maddau, Lucia; Masi, Marco; Linaldeddu, Benedetto Teodoro; Evidente, Antonio

2018-05-30

In this study the production of secondary metabolites by a virulent strain of Sardiniella urbana, a recently described pathogen originally found on declining European hackberry trees in Italy, was investigated for the first time. Chemical analysis of the culture filtrate extracts led to the isolation of three well known compounds as R-(-)-mellein and (3R,4R)-and (3R,4S)-4-hydroxy melleins which were identified by spectroscopic methods (essentially NMR and ESIMS). The isolated compounds were tested for their phytotoxic, antifungal and zootoxic activities. Among them, only R-(-)-mellein was found to be active.
A SELECTED LIST OF UNCLASSIFIED PUBLICATIONS OF THE SOCIAL SCIENCE DEPARTMENT-THE RAND CORPORATION

DTIC Science & Technology

BIBLIOGRAPHIES, * SOCIAL SCIENCES, MILITARY OPERATIONS, CIVIL DEFENSE, COMMUNISM, FOREIGN POLICY, POLITICAL SCIENCE, PROPAGANDA, PSYCHOLOGICAL WARFARE, PSYCHOLOGY, RELIGION, REPORTS, STRESS (PSYCHOLOGY)
Cross-Cultural Adaptation and Psychometric Properties Testing of the Arabic Anterior Knee Pain Scale

PubMed Central

Alshehri, Abdullah; Lohman, Everett; Daher, Noha S.; Bahijri, Khalid; Alghamdi, Abdulmohsen; Altorairi, Nezar; Arnos, Arin; Matar, Abdullah

2017-01-01

Background PFPS is one of the most frequently occurring overuse injuries affecting the lower limbs. A variety of functional and self-reported outcome measures have been used to assess clinical outcomes of patients with PFPS, however, only the Anterior Knee Pain Scale (AKPS) has been designed for PFPS patients. Material/Methods We followed international recommendations to perform a cross-cultural adaptation of the AKPS. The Arabic AKPS and the Arabic RAND 36-item Health Survey were administered to 40 patients who were diagnosed with PFPS. Participants were assessed at baseline and after 2 to 3 days assessed with the Arabic AKPS only. The measurements tested were reliability, validity, and feasibility. Results The Arabic AKPS showed high reliability for both temporal stability, internal consistency (Cronbach’s alpha was 0.81 for the first assessment and 0.75 for the second), excellent test-retest reliability (Intraclass Correlation Coefficients ICC=0.96; 95% confidence interval (CI): 0.93, 0.98) and good agreement (standard error of measurement SEM=1.8%). The Arabic AKPS was significantly correlated with physical components of the RAND 36-Item Health Survey (Spearman’s rho=0.69: p<0.001). No ceiling or floor effects were observed. Conclusions The Arabic AKPS is a valid and reliable tool and is comparable to the original English version and other translated versions. PMID:28364114
Cross-Cultural Adaptation and Psychometric Properties Testing of the Arabic Anterior Knee Pain Scale.

PubMed

Alshehri, Abdullah; Lohman, Everett; Daher, Noha S; Bahijri, Khalid; Alghamdi, Abdulmohsen; Altorairi, Nezar; Arnons, Arin; Matar, Abdullah

2017-04-01

BACKGROUND PFPS is one of the most frequently occurring overuse injuries affecting the lower limbs. A variety of functional and self-reported outcome measures have been used to assess clinical outcomes of patients with PFPS, however, only the Anterior Knee Pain Scale (AKPS) has been designed for PFPS patients. MATERIAL AND METHODS We followed international recommendations to perform a cross-cultural adaptation of the AKPS. The Arabic AKPS and the Arabic RAND 36-item Health Survey were administered to 40 patients who were diagnosed with PFPS. Participants were assessed at baseline and after 2 to 3 days assessed with the Arabic AKPS only. The measurements tested were reliability, validity, and feasibility. RESULTS The Arabic AKPS showed high reliability for both temporal stability, internal consistency (Cronbach's alpha was 0.81 for the first assessment and 0.75 for the second), excellent test-retest reliability (Intraclass Correlation Coefficients ICC=0.96; 95% confidence interval (CI): 0.93, 0.98) and good agreement (standard error of measurement SEM=1.8%). The Arabic AKPS was significantly correlated with physical components of the RAND 36-Item Health Survey (Spearman's rho=0.69: p<0.001). No ceiling or floor effects were observed. CONCLUSIONS The Arabic AKPS is a valid and reliable tool and is comparable to the original English version and other translated versions.
An appraisal of the 2012 American College of Rheumatology Guidelines for the Management of Gout.

PubMed

Nuki, George

2014-03-01

Appraisal of the 2012 American College of Rheumatology (ACR) Guidelines for the Management of Gout. The ACRs first clinical practice guidelines for the management of gout focus on recommendations for nonpharmacologic and pharmacologic approaches to hyperuricaemia and the treatment and prophylaxis of acute gouty arthritis. The RAND/UCLA appropriateness methodology employed assessed risks and benefits of alternative treatments for efficacy, safety and quality but not for cost-effectiveness. Novel recommendations include the use of either allopurinol or febuxostat for first-line urate-lowering drug therapy (ULT), screening for HLA-B*5801 prior to initiation of allopurinol in Asians at relatively high risk for allopurinol hypersensitivity, and the use of pegloticase for patients with severe, symptomatic, tophaceous gout refractory to, or intolerant of, appropriately dosed ULTs. Appraisal and comparison with other guidelines using Guidelines International Network and Appraisal of Guidelines, Research and Evaluation (AGREE II) criteria showed good scores for scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, editorial independence and, overall quality, but not for applicability. The ACR guidelines provide comprehensive, up-to-date, good-quality, evidence-based, expert consensus recommendations for the management of gout in clinical practice but score poorly for applicability. To improve the management of gout in the community a summary of key recommendations, criteria for audit and standards of care are now required.
Energy systems research and development for petroleum refineries

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

Robertson, J.L.

1982-08-01

For the past several years, Exxon Reasearch and Engineering has carried out a specific RandD program aimed at improving refinery energy efficiency through optimization of energy systems. Energy systems include: steam/power systems, heat exchange systems including hot oil and hot water belts and fuel systems, as well as some of the processes. This paper will describe the three major thrusts of this program which are: development of methods to support Site Energy Survey activities; development of energy management methods; and energy system optimization, which includes development of consistent, realistic, economic incentives for energy system improvements. Project selection criteria will alsomore » be discussed. The technique of a site energy survey will also be described briefly.« less
Rand Corporation

MedlinePlus

... Posts America Is Great at Fighting Terrorism, but Terror Is Alive and Well Can Vaping Help Smokers ... Commentary: America Is Great at Fighting Terrorism, but Terror Is Alive and Well William Shadel @william_shadel ...
MODIFICATIONS OF THE RAND REAC,

DTIC Science & Technology

The major items of the modification program were the installation of a removable plugboard of the type used on the International Business Machines punched card tabulators, and a digital readout device.
Quality of life and emotional state in chronic skin disease.

PubMed

Pärna, Ene; Aluoja, Anu; Kingo, Külli

2015-03-01

The aim of this study was to evaluate the associations between chronic inflammatory skin conditions and patients' emotional state and quality of life. The following self-rated questionnaires were used: Emotional State Questionnaire, a self-report scale assessing depression and anxiety symptoms; Dermatology Life Quality Index (DLQI); and RAND-36, a measure of health-related quality of life. The study group comprised 40 patients with psoriasis, 40 with eczema, 40 with acne, 15 with seborrhoeic dermatitis and 40 healthy controls. Patients with chronic skin diseases had lower DLQI and lower RAND-36 physical functioning scores, more perceived physical limitations and pain, and lower emotional well-being and general health ratings compared with the control group. In conclusion, chronic skin diseases are associated with symptoms of emotional distress, in particular insomnia and general anxiety.
Extracorporeal treatment for barbiturate poisoning: recommendations from the EXTRIP Workgroup.

PubMed

Mactier, Robert; Laliberté, Martin; Mardini, Joelle; Ghannoum, Marc; Lavergne, Valery; Gosselin, Sophie; Hoffman, Robert S; Nolin, Thomas D

2014-09-01

The EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup conducted a systematic review of barbiturate poisoning using a standardized evidence-based process to provide recommendations on the use of extracorporeal treatment (ECTR) in patients with barbiturate poisoning. The authors reviewed all articles, extracted data, summarized key findings, and proposed structured voting statements following a predetermined format. A 2-round modified Delphi method was used to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. 617 articles met the search inclusion criteria. Data for 538 patients were abstracted and evaluated. Only case reports, case series, and nonrandomized observational studies were identified, yielding a low quality of evidence for all recommendations. Using established criteria, the workgroup deemed that long-acting barbiturates are dialyzable and short-acting barbiturates are moderately dialyzable. Four key recommendations were made. (1) The use of ECTR should be restricted to cases of severe long-acting barbiturate poisoning. (2) The indications for ECTR in this setting are the presence of prolonged coma, respiratory depression necessitating mechanical ventilation, shock, persistent toxicity, or increasing or persistently elevated serum barbiturate concentrations despite treatment with multiple-dose activated charcoal. (3) Intermittent hemodialysis is the preferred mode of ECTR, and multiple-dose activated charcoal treatment should be continued during ECTR. (4) Cessation of ECTR is indicated when clinical improvement is apparent. This report provides detailed descriptions of the rationale for all recommendations. In summary, patients with long-acting barbiturate poisoning should be treated with ECTR provided at least one of the specific criteria in the first recommendation is present. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Extracorporeal Treatment in Phenytoin Poisoning: Systematic Review and Recommendations from the EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup.

PubMed

Anseeuw, Kurt; Mowry, James B; Burdmann, Emmanuel A; Ghannoum, Marc; Hoffman, Robert S; Gosselin, Sophie; Lavergne, Valery; Nolin, Thomas D

2016-02-01

The Extracorporeal Treatments in Poisoning (EXTRIP) Workgroup conducted a systematic literature review using a standardized process to develop evidence-based recommendations on the use of extracorporeal treatment (ECTR) in patients with phenytoin poisoning. The authors reviewed all articles, extracted data, summarized findings, and proposed structured voting statements following a predetermined format. A 2-round modified Delphi method was used to reach a consensus on voting statements, and the RAND/UCLA Appropriateness Method was used to quantify disagreement. 51 articles met the inclusion criteria. Only case reports, case series, and pharmacokinetic studies were identified, yielding a very low quality of evidence. Clinical data from 31 patients and toxicokinetic grading from 46 patients were abstracted. The workgroup concluded that phenytoin is moderately dialyzable (level of evidence = C) despite its high protein binding and made the following recommendations. ECTR would be reasonable in select cases of severe phenytoin poisoning (neutral recommendation, 3D). ECTR is suggested if prolonged coma is present or expected (graded 2D) and it would be reasonable if prolonged incapacitating ataxia is present or expected (graded 3D). If ECTR is used, it should be discontinued when clinical improvement is apparent (graded 1D). The preferred ECTR modality in phenytoin poisoning is intermittent hemodialysis (graded 1D), but hemoperfusion is an acceptable alternative if hemodialysis is not available (graded 1D). In summary, phenytoin appears to be amenable to extracorporeal removal. However, because of the low incidence of irreversible tissue injury or death related to phenytoin poisoning and the relatively limited effect of ECTR on phenytoin removal, the workgroup proposed the use of ECTR only in very select patients with severe phenytoin poisoning. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Development and Measurement of Guidelines-Based Quality Indicators of Caesarean Section Care in the Netherlands: A RAND-Modified Delphi Procedure and Retrospective Medical Chart Review

PubMed Central

de Boer, Karin; Burggraaf, Henriëtte; Derks, Jan B.; van Dijk, Det; van Dillen, Jeroen; Dirksen, Carmen D.; Duvekot, Johannes J.; Franx, Arie; Hasaart, Tom H. M.; Huisjes, Anjoke J. M.; Kolkman, Diny; Kwee, Anneke; Mol, Ben W.; van Pampus, Mariëlle G.; de Roon-Immerzeel, Alieke; van Roosmalen, Jos J. M.; Roumen, Frans J. M. E.; Smid-Koopman, Ellen; Spaans, Wilbert A.; Visser, Harry; van Wijngaarden, Wim J.; Willekes, Christine; Wouters, Maurice G. A. J.

2016-01-01

Background There is an ongoing discussion on the rising CS rate worldwide. Suboptimal guideline adherence may be an important contributor to this rise. Before improvement of care can be established, optimal CS care in different settings has to be defined. This study aimed to develop and measure quality indicators to determine guideline adherence and identify target groups for improvement of care with direct effect on caesarean section (CS) rates. Method Eighteen obstetricians and midwives participated in an expert panel for systematic CS quality indicator development according to the RAND-modified Delphi method. A multi-center study was performed and medical charts of 1024 women with a CS and a stratified and weighted randomly selected group of 1036 women with a vaginal delivery were analysed. Quality indicator frequency and adherence were scored in 2060 women with a CS or vaginal delivery. Results The expert panel developed 16 indicators on planned CS and 11 indicators on unplanned CS. Indicator adherence was calculated, defined as the number of women in a specific obstetrical situation in which care was performed as recommended in both planned and unplanned CS settings. The most frequently occurring obstetrical situations with low indicator adherence were: 1) suspected fetal distress (frequency 17%, adherence 46%), 2) non-progressive labour (frequency 12%, CS performed too early in over 75%), 3) continuous support during labour (frequency 88%, adherence 37%) and 4) previous CS (frequency 12%), with adequate counselling in 15%. Conclusions We identified four concrete target groups for improvement of obstetrical care, which can be used as a starting point to reduce CS rates worldwide. PMID:26783742
4. INGERSOLLRAND AMMONIA COMPRESSOR AND CONTROL PANEL INSIDE BUILDING 2; ...

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

4. INGERSOLL-RAND AMMONIA COMPRESSOR AND CONTROL PANEL INSIDE BUILDING 2; LOOKING SOUTHWEST - Rath Packing Company, Engine Room, Sycamore Street between Elm & Eighteenth Streets, Waterloo, Black Hawk County, IA
U.S. satellite proposals, 1945-49

NASA Technical Reports Server (NTRS)

Saegesser, L. D.

1977-01-01

Views concerning the possibility of the development of multistage rockets capable of orbiting the earth had been expressed by von Braun during an interview with members of a U.S. technical intelligence team in 1945. Recommendations to adopt a program with the ultimate objective of launching an earth satellite were submitted in October 1945 by a committee established within the Navy Bureau of Aeronautics. In 1946 it was recommended by the Aeronautical Board that the services proceed independently with their satellite studies. A report concerning the 'preliminary design of an experimental world-circling spaceship' was published by RAND on May 2, 1946. RAND in early 1949 was again asked to study for the Air Force the possible uses of earth satellites. The reasons which prevented at that time a further development and implementation of initial concepts and study results are examined
Validation of quality indicators for the organization of palliative care: a modified RAND Delphi study in seven European countries (the Europall project).

PubMed

Woitha, Kathrin; Van Beek, Karen; Ahmed, Nisar; Jaspers, Birgit; Mollard, Jean M; Ahmedzai, Sam H; Hasselaar, Jeroen; Menten, Johan; Vissers, Kris; Engels, Yvonne

2014-02-01

Validated quality indicators can help health-care professionals to evaluate their medical practices in a comparative manner to deliver optimal clinical care. No international set of quality indicators to measure the organizational aspects of palliative care settings exists. To develop and validate a set of structure and process indicators for palliative care settings in Europe. A two-round modified RAND Delphi process was conducted to rate clarity and usefulness of a previously developed set of 110 quality indicators. In total, 20 multi-professional palliative care teams of centers of excellence from seven European countries. In total, 56 quality indicators were rated as useful. These valid quality indicators concerned the following domains: the definition of a palliative care service (2 quality indicators), accessibility to palliative care (16 quality indicators), specific infrastructure to deliver palliative care (8 quality indicators), symptom assessment tools (1 quality indicator), specific personnel in palliative care services (9 quality indicators), documentation methodology of clinical data (14 quality indicators), evaluation of quality and safety procedures (1 quality indicator), reporting of clinical activities (1 quality indicator), and education in palliative care (4 quality indicator). The modified RAND Delphi process resulted in 56 international face-validated quality indicators to measure and compare organizational aspects of palliative care. These quality indicators, aimed to assess and improve the organization of palliative care, will be pilot tested in palliative care settings all over Europe and be used in the EU FP7 funded IMPACT project.
Home Health Care for California's Injured Workers: Options for Implementing a Fee Schedule.

PubMed

Wynn, Barbara O; Boustead, Anne

2015-07-15

The California Department of Industrial Relations/Division of Worker's Compensation asked RAND to provide technical assistance in developing a fee schedule for home health services provided to injured workers. The fee schedule needs to address the full spectrum of home health services ranging from skilled nursing and therapy services to unskilled personal care or chore services that may be provided by family members. RAND researchers consulted with stakeholders in the California workers' compensation system to outline issues the fee schedule should address, reviewed home health fee schedules used by other payers, and conducted interviews with WC administrators from other jurisdictions to elicit their experiences. California stakeholders identified unskilled attendant services as most problematic in determining need and payment rates, particularly services furnished by family members. RAND researchers concentrated on fee schedule options that would result in a single fee schedule covering the full range of home health care services furnished to injured workers and made three sets of recommendations. The first set pertains to obtaining additional information that would highlight the policy issues likely to occur with the implementation of the fee schedule and alternatives for assessing an injured worker's home health care needs. Another approach conforms most closely with the Labor Code requirements. It would integrate the fee schedules used by Medicare, In-Home Health Supportive Services, and the federal Office of Workers' Compensation. The third approach would base the home health fee schedule on rules used by the federal Office of Workers' Compensation.
Measuring physical and mental health using the SF-12: implications for community surveys of mental health.

PubMed

Windsor, Timothy D; Rodgers, Bryan; Butterworth, Peter; Anstey, Kaarin J; Jorm, Anthony F

2006-09-01

The effects of using different approaches to scoring the SF-12 summary scales of physical and mental health were examined with a view to informing the design and interpretation of community-based survey research. Data from a population-based study of 7485 participants in three cohorts aged 20-24, 40-44 and 60-64 years were used to examine relationships among measures of physical and mental health calculated from the same items using the SF-12 and RAND-12 approaches to scoring, and other measures of chronic physical conditions and psychological distress. A measure of physical health constructed using the RAND-12 scoring showed a monotonic negative association with psychological distress as measured by the Goldberg depression and anxiety scales. However, a non-monotonic association was evident in the relationship between SF-12 physical health scores and distress, with very high SF-12 physical health scores corresponding with high levels of distress. These relationships highlight difficulties in interpretation that can arise when using the SF-12 summary scales in some analytical contexts. It is recommended that community surveys that measure physical and mental functioning using the SF-12 items generate summary scores using the RAND-12 protocol in addition to the SF-12 approach. In general, researchers should be wary of using factor scores based on orthogonal rotation, which assumes that measures are uncorrelated, to represent constructs that have an actual association.
Methamphetamine exposure and chronic illness in police officers

PubMed Central

Ross, Gerald H; Sternquist, Marie C

2012-01-01

Background: The medical literature reports health hazards for law enforcement personnel from repeated exposure to methamphetamine and related chemical compounds. Most effects appear transitory, but some Utah police officers with employment-related methamphetamine exposures developed chronic symptoms, some leading to disability. This report is of an uncontrolled retrospective medical chart evaluation of symptomatic officers treated with a sauna detoxification protocol designed to reduce the chronic symptoms and improve the quality of life. Methods: Sixty-nine officers consecutively entering the Utah Meth Cops Project were assessed before and after a treatment program involving gradual exercise, comprehensive nutritional support and physical sauna therapy. Evaluations included pre- and post-treatment scores of the Research and Development Corporation (RAND) 36-item Short Form Health Survey (SF-36) in comparison with RAND population norms, pre- and post-treatment symptom score intensities, neurotoxicity scores, Mini-Mental Status Examination, presenting symptom frequencies and a structured evaluation of treatment program safety. Results: Statistically significant health improvements were seen in the SF-36 evaluations, symptom scores and neurotoxicity scores. The detoxification protocol was well tolerated, with a 92.8% completion rate. Conclusions: This investigation strongly suggests that utilizing sauna and nutritional therapy may alleviate chronic symptoms appearing after chemical exposures associated with methamphetamine-related law enforcement activities. This report also has relevance to addressing the apparent ill effects of other complex chemical exposures. In view of the positive clinical outcomes in this group, broader investigation of this sauna-based treatment regimen appears warranted. PMID:22089658
Space transportation systems, launch systems, and propulsion for the Space Exploration Initiative: Results from Project Outreach

NASA Technical Reports Server (NTRS)

Garber, T.; Hiland, J.; Orletsky, D.; Augenstein, B.; Miller, M.

1991-01-01

A number of transportation and propulsion options for Mars exploration missions are analyzed. As part of Project Outreach, RAND received and evaluated 350 submissions in the launch vehicle, space transportation, and propulsion areas. After screening submissions, aggregating those that proposed identical or nearly identical concepts, and eliminating from further consideration those that violated known physical princples, we had reduced the total number of viable submissions to 213. In order to avoid comparing such disparate things as launch vehicles and electric propulsion systems, six broad technical areas were selected to categorize the submissions: space transportation systems; earth-to-orbit (ETO) launch systems; chemical propulsion; nuclear propulsion; low-thrust propulsion; and other. To provide an appropriate background for analyzing the submissions, an extensive survey was made of the various technologies relevant to the six broad areas listed above. We discuss these technologies with the intent of providing the reader with an indication of the current state of the art, as well as the advances that might be expected within the next 10 to 20 years.
11. Historic American Buildings Survey Alex Bush, Photographer, June 4, ...

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

11. Historic American Buildings Survey Alex Bush, Photographer, June 4, 1937 OLD TIME TOOLS USED IN ANTI-BELLUM TIMES, TUSCUMBIA VICINITY. - Carl Rand House, 501 East Third Street, Tuscumbia, Colbert County, AL
Proposal of quality indicators for cardiac rehabilitation after acute coronary syndrome in Japan: a modified Delphi method and practice test.

PubMed

Ohtera, Shosuke; Kanazawa, Natsuko; Ozasa, Neiko; Ueshima, Kenji; Nakayama, Takeo

2017-01-27

Cardiac rehabilitation is underused and its quality in practice is unclear. A quality indicator is a measurable element of clinical practice performance. This study aimed to propose a set of quality indicators for cardiac rehabilitation following an acute coronary event in the Japanese population and conduct a small-size practice test to confirm feasibility and applicability of the indicators in real-world clinical practice. This study used a modified Delphi technique (the RAND/UCLA appropriateness method), a consensus method which involves an evidence review, a face-to-face multidisciplinary panel meeting and repeated anonymous rating. Evidence to be reviewed included clinical practice guidelines available in English or Japanese and existing quality indicators. Performance of each indicator was assessed retrospectively using medical records at a university hospital in Japan. 10 professionals in cardiac rehabilitation for the consensus panel. In the literature review, 23 clinical practice guidelines and 16 existing indicators were identified to generate potential indicators. Through the consensus-building process, a total of 30 indicators were assessed and finally 13 indicators were accepted. The practice test (n=39) revealed that 74% of patients underwent cardiac rehabilitation. Median performance of process measures was 93% (IQR 46-100%). 'Communication with the doctor who referred the patient to cardiac rehabilitation' and 'continuous participation in cardiac rehabilitation' had low performance (32% and 38%, respectively). A modified Delphi technique identified a comprehensive set of quality indicators for cardiac rehabilitation. The single-site, small-size practice test confirmed that most of the proposed indicators were measurable in real-world clinical practice. However, some clinical processes which are not covered by national health insurance in Japan had low performance. Further studies will be needed to clarify and improve the quality of care in cardiac rehabilitation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia.

PubMed

Kröger, Edeltraut; Tourigny, André; Morin, Diane; Côté, Lise; Kergoat, Marie-Jeanne; Lebel, Paule; Robichaud, Line; Imbeault, Shirley; Proulx, Solange; Benounissa, Zohra

2007-11-29

This study aimed at evaluating face and content validity, feasibility and reliability of process quality indicators developed previously in the United States or other countries. The indicators can be used to evaluate care and services for vulnerable older adults affected by cognitive impairment or dementia within an integrated service system in Quebec, Canada. A total of 33 clinical experts from three major urban centres in Quebec formed a panel representing two medical specialties (family medicine, geriatrics) and seven health or social services specialties (nursing, occupational therapy, psychology, neuropsychology, pharmacy, nutrition, social work), from primary or secondary levels of care, including long-term care. A modified version of the RAND(R)/University of California at Los Angeles (UCLA) appropriateness method, a two-round Delphi panel, was used to assess face and content validity of process quality indicators. The appropriateness of indicators was evaluated according to a) agreement of the panel with three criteria, defined as a median rating of 7-9 on a nine-point rating scale, and b) agreement among panellists, judged by the statistical measure of the interpercentile range adjusted for symmetry. Feasibility of quality assessment and reliability of appropriate indicators were then evaluated within a pilot study on 29 patients affected by cognitive impairment or dementia. For measurable indicators the inter-observer reliability was calculated with the Kappa statistic. Initially, 82 indicators for care of vulnerable older adults with cognitive impairment or dementia were submitted to the panellists. Of those, 72 (88%) were accepted after two rounds. Among 29 patients for whom medical files of the preceding two years were evaluated, 63 (88%) of these indicators were considered applicable at least once, for at least one patient. Only 22 indicators were considered applicable at least once for ten or more out of 29 patients. Four indicators could be measured with the help of a validated questionnaire on patient satisfaction. Inter-observer reliability was moderate (Kappa = 0.57). A multidisciplinary panel of experts judged a large majority of the initial indicators valid for use in integrated care systems for vulnerable older adults in Quebec, Canada. Most of these indicators can be measured using patient files or patient or caregiver interviews and reliability of assessment from patient-files is moderate.
Near-term feasibility of alternative jet fuels

DOT National Transportation Integrated Search

2009-01-01

This technical report documents the results of a joint study by the Massachusetts Institute of Technology (MIT) and the RAND Corporation on alternative fuels for commercial aviation. The study compared potential alternative jet fuels on the basis of ...
Unconventional fossil-based fuels : economic and environmental trade-offs

DOT National Transportation Integrated Search

2008-01-01

Both high import payments for petroleum motor fuels and concerns regarding emissions of carbon dioxide (CO2) are motivating interest in possible fuel substitutes. In this report, RAND researchers assess the potential future production levels, product...
Space and surface power for the space exploration initiative: Results from project outreach

NASA Technical Reports Server (NTRS)

Shipbaugh, C.; Solomon, K.; Gonzales, D.; Juncosa, M.; Bauer, T.; Salter, R.

1991-01-01

The analysis and evaluations of the Space and Surface Power panel, one of eight panels created by RAND to screen and analyze submissions to the Space Exploration Initiative (SEI) Outreach Program, is documented. In addition to managing and evaluating the responses, or submissions, to this public outreach program, RAND conducted its own analysis and evaluation relevent to SEI mission concepts, systems, and technologies. The Power panel screened and analyzed submissions for which a substantial portion of the concepts involved power generation sources, transmission, distribution, thermal management, and handling of power (including conditioning, conversion, packaging, and enhancements in system components). A background discussion of the areas the Power panel covered and the issues the reviewers considered pertinent to the analysis of power submissions are presented. An overview of each of the highest-ranked submissions and then a discussion of these submissions is presented. The results of the analysis is presented.
The World Health Organization's water safety plan is much more than just an integrated drinking water quality management plan.

PubMed

Viljoen, F C

2010-01-01

South Africa is a country of contrasts with far ranging variations in climate, precipitation rates, cultures, demographics, housing levels, education, wealth and skills levels. These differences have an impact on water services delivery as do expectations, affordability and available resources. Although South Africa has made much progress in supplying drinking water, the same cannot be said regarding water quality throughout the country. A concerted effort is currently underway to correct this situation and as part of this drive, water safety plans (WSP) are promoted. Rand Water, the largest water services provider in South Africa, used the World Health Organization (WHO) WSP framework as a guide for the development of its own WSP which was implemented in 2003. Through the process of implementation, Rand Water found the WHO WSP to be much more than just another integrated quality system.
Development of Quality Metrics in Ambulatory Pediatric Cardiology.

PubMed

Chowdhury, Devyani; Gurvitz, Michelle; Marelli, Ariane; Anderson, Jeffrey; Baker-Smith, Carissa; Diab, Karim A; Edwards, Thomas C; Hougen, Tom; Jedeikin, Roy; Johnson, Jonathan N; Karpawich, Peter; Lai, Wyman; Lu, Jimmy C; Mitchell, Stephanie; Newburger, Jane W; Penny, Daniel J; Portman, Michael A; Satou, Gary; Teitel, David; Villafane, Juan; Williams, Roberta; Jenkins, Kathy

2017-02-07

The American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Section had attempted to create quality metrics (QM) for ambulatory pediatric practice, but limited evidence made the process difficult. The ACPC sought to develop QMs for ambulatory pediatric cardiology practice. Five areas of interest were identified, and QMs were developed in a 2-step review process. In the first step, an expert panel, using the modified RAND-UCLA methodology, rated each QM for feasibility and validity. The second step sought input from ACPC Section members; final approval was by a vote of the ACPC Council. Work groups proposed a total of 44 QMs. Thirty-one metrics passed the RAND process and, after the open comment period, the ACPC council approved 18 metrics. The project resulted in successful development of QMs in ambulatory pediatric cardiology for a range of ambulatory domains. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Development of the 7-Item Binge-Eating Disorder Screener (BEDS-7).

PubMed

Herman, Barry K; Deal, Linda S; DiBenedetti, Dana B; Nelson, Lauren; Fehnel, Sheri E; Brown, T Michelle

2016-01-01

Develop a brief, patient-reported screening tool designed to identify individuals with probable binge-eating disorder (BED) for further evaluation or referral to specialists. Items were developed on the basis of the DSM-5 diagnostic criteria, existing tools, and input from 3 clinical experts (January 2014). Items were then refined in cognitive debriefing interviews with participants self-reporting BED characteristics (March 2014) and piloted in a multisite, cross-sectional, prospective, noninterventional study consisting of a semistructured diagnostic interview (to diagnose BED) and administration of the pilot Binge-Eating Disorder Screener (BEDS), Binge Eating Scale (BES), and RAND 36-Item Short-Form Health Survey (RAND-36) (June 2014-July 2014). The sensitivity and specificity of classification algorithms (formed from the pilot BEDS item-level responses) in predicting BED diagnosis were evaluated. The final algorithm was selected to minimize false negatives and false positives, while utilizing the fewest number of BEDS items. Starting with the initial BEDS item pool (20 items), the 13-item pilot BEDS resulted from the cognitive debriefing interviews (n = 13). Of the 97 participants in the noninterventional study, 16 were diagnosed with BED (10/62 female, 16%; 6/35 male, 17%). Seven BEDS items (BEDS-7) yielded 100% sensitivity and 38.7% specificity. Participants correctly identified (true positives) had poorer BES scores and RAND-36 scores than participants identified as true negatives. Implementation of the brief, patient-reported BEDS-7 in real-world clinical practice is expected to promote better understanding of BED characteristics and help physicians identify patients who may have BED.
How Is Deployment to Iraq and Afghanistan Affecting U.S. Service Members and Their Families?: An Overview of Early RAND Research on the Topic.

PubMed

Hosek, James

2011-01-01

The conflicts in Iraq and Afghanistan, which have extended over the past decade, have put America's all-volunteer force to its most severe test since its inception in 1973. In this environment of ongoing demand for battle-ready soldiers, sailors, airmen, and marines, there is concern about the effects and consequences of prolonged stress on the force as a whole and on individual service members and their families. The well-being of troops and the people close to them is an issue of much importance, both because it affects military readiness and the ability of the U.S. armed forces to carry out their mission and because the nation is committed to acting on its appreciation of the sacrifices made by military families. To devise policies effective for facilitating the well-being of this community, there must first be a comprehensive understanding of the myriad issues and consequences that service members and their families may face because of deployment. Yet for much of the 2000s, this understanding was largely lacking. Recognizing the need for analysis, RAND launched a program of research around 2005, its goal being to investigate this topic and, where possible, offer policymakers informed recommendations. This article introduces this body of work-still being added to today-through descriptions of six of RAND's earliest studies on various aspects of the topic. It calls attention to the pressing policy questions; summarizes the key findings, insights into the issues, and policy implications; and, where applicable, lays out recommendations.
Challenges in microarray class discovery: a comprehensive examination of normalization, gene selection and clustering

PubMed Central

2010-01-01

Background Cluster analysis, and in particular hierarchical clustering, is widely used to extract information from gene expression data. The aim is to discover new classes, or sub-classes, of either individuals or genes. Performing a cluster analysis commonly involve decisions on how to; handle missing values, standardize the data and select genes. In addition, pre-processing, involving various types of filtration and normalization procedures, can have an effect on the ability to discover biologically relevant classes. Here we consider cluster analysis in a broad sense and perform a comprehensive evaluation that covers several aspects of cluster analyses, including normalization. Result We evaluated 2780 cluster analysis methods on seven publicly available 2-channel microarray data sets with common reference designs. Each cluster analysis method differed in data normalization (5 normalizations were considered), missing value imputation (2), standardization of data (2), gene selection (19) or clustering method (11). The cluster analyses are evaluated using known classes, such as cancer types, and the adjusted Rand index. The performances of the different analyses vary between the data sets and it is difficult to give general recommendations. However, normalization, gene selection and clustering method are all variables that have a significant impact on the performance. In particular, gene selection is important and it is generally necessary to include a relatively large number of genes in order to get good performance. Selecting genes with high standard deviation or using principal component analysis are shown to be the preferred gene selection methods. Hierarchical clustering using Ward's method, k-means clustering and Mclust are the clustering methods considered in this paper that achieves the highest adjusted Rand. Normalization can have a significant positive impact on the ability to cluster individuals, and there are indications that background correction is preferable, in particular if the gene selection is successful. However, this is an area that needs to be studied further in order to draw any general conclusions. Conclusions The choice of cluster analysis, and in particular gene selection, has a large impact on the ability to cluster individuals correctly based on expression profiles. Normalization has a positive effect, but the relative performance of different normalizations is an area that needs more research. In summary, although clustering, gene selection and normalization are considered standard methods in bioinformatics, our comprehensive analysis shows that selecting the right methods, and the right combinations of methods, is far from trivial and that much is still unexplored in what is considered to be the most basic analysis of genomic data. PMID:20937082
Lessons for the Global Spatial Data Infrastructure : international case study analysis

DOT National Transportation Integrated Search

2002-01-01

This report presents a RAND analysis of international collaboration for the Global Spatial Data Infrastructure (GSDI). Ten in-depth international and regional collaboration case studies were conducted to assess lessons learned for GSDI development an...

Fighting phytophthora in blueberries

USDA-ARS?s Scientific Manuscript database

Phytophthora cinnamomi Rands is a ubiquitous soilborne pathogen associated with root rot in many woody perennial plant species, including highbush blueberry (Vaccinium sp.). To identify genotypes with resistance to the pathogen, cultivars and advanced selections of highbush blueberry were grown in a...
Transportation challenges for the new administration : perspectives of past DOT secretaries

DOT National Transportation Integrated Search

2009-01-01

On January 29, 2009, the RAND Corporation hosted a panel discussion with three former U.S. secretaries of transportation. This wide-ranging discussion, held the week after President : Barack Obamas inauguration and during the congressional debate ...
Annual Report 2005

DTIC Science & Technology

2005-01-01

Program Integration PROJECT LEADERS: Bernard Rostker and Laura Miller 20 RAND National Security Research Division The more intensive use of the...Lim, Laura Werber Castaneda, Daniela Golinelli. MG-196-OSD. NOTE: MG stands for monograph; CF for confer- ence proceedings; CT for congressional
DETAIL INTERIOR VIEW OF THE CYANAMIDE (LN) OVEN BUILDING LOOKING ...

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

DETAIL INTERIOR VIEW OF THE CYANAMIDE (L-N) OVEN BUILDING LOOKING SOUTHEAST AT INGERSOLL-RAND COMPRESSORS #BE565 & 564. (NOT ORIGINAL LOCATION). - United States Nitrate Plant No. 2, Reservation Road, Muscle Shoals, Muscle Shoals, Colbert County, AL
DETAIL INTERIOR VIEW OF THE CYANAMIDE (LN) OVEN BUILDING LOOKING ...

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

DETAIL INTERIOR VIEW OF THE CYANAMIDE (L-N) OVEN BUILDING LOOKING WEST AT INGERSOLL-RAND COMPRESSORS #BE565 & 564. (NOT ORIGINAL LOCATION). - United States Nitrate Plant No. 2, Reservation Road, Muscle Shoals, Muscle Shoals, Colbert County, AL
Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

PubMed Central

Barber, Claire E. H.; Marshall, Deborah A; Alvarez, Nanette; John Mancini, G. B.; Lacaille, Diane; Keeling, Stephanie; Aviña-Zubieta, J. Antonio; Khodyakov, Dmitry; Barnabe, Cheryl; Faris, Peter; Smith, Alexa; Noormohamed, Raheem; Hazlewood, Glen; Martin, Liam O.; Esdaile, John M.

2016-01-01

Objective Patients with rheumatoid arthritis (RA) have a high risk of premature cardiovascular disease (CVD). We developed CVD quality indicators (QIs) for screening and use in Rheumatology clinics. Methods A systematic review of the literature on CVD risk reduction in RA and the general population was conducted. Based on the best practices identified from this review, a draft set of 12 candidate QIs were presented to a Canadian panel of rheumatologists and cardiologists (n=6) from three academic centers to achieve consensus on the QI specifications. The resulting 11 QIs were then evaluated by an online modified-Delphi panel of multidisciplinary health professionals and patients (n = 43) to determine their relevance, validity and feasibility in three rounds of online voting and threaded discussion using a modified RAND/UCLA Appropriateness Methodology. Results Response rates for the online panel were 86%. All 11 QIs were rated as highly relevant, valid and feasible (median rating ≥7 on a 1–9 scale) with no significant disagreement. The final QI set addresses the following themes: communication to primary care about increased CV risk in RA, CV risk assessment, defining smoking status and providing cessation counseling, screening and addressing hypertension, dyslipidemia and diabetes, exercise recommendations, body mass index screening and lifestyle counseling, minimizing corticosteroid use and communicating to patients at high risk of CVD about the risks/benefits of non-steroidal anti-inflammatory drugs. Conclusion Eleven QIs for CVD care in RA patients have been developed and are rated as highly relevant, valid and feasible by an international multidisciplinary panel. PMID:26178275
Evaluating the Quality of Colorectal Cancer Care across the Interface of Healthcare Sectors

PubMed Central

Ludt, Sabine; Urban, Elisabeth; Eckardt, Jörg; Wache, Stefanie; Broge, Björn; Kaufmann-Kolle, Petra; Heller, Günther; Miksch, Antje; Glassen, Katharina; Hermann, Katja; Bölter, Regine; Ose, Dominik; Campbell, Stephen M.; Wensing, Michel; Szecsenyi, Joachim

2013-01-01

Background Colorectal cancer (CRC) has a high prevalence in western countries. Diagnosis and treatment of CRC is complex and requires multidisciplinary collaboration across the interface of health care sectors. In Germany, a new nationwide established program aims to provide quality information of healthcare delivery across different sectors. Within this context, this study describes the development of a set of quality indicators charting the whole pathway of CRC-care including data specifications that are necessary to operationalize these indicators before practice testing. Methods Indicators were developed following a systematic 10 step modified ‘RAND/UCLA Appropriateness Method’ which involved a multidisciplinary panel of thirteen participants. For each indicator in the final set, data specifications relating to sources of quality information, data collection procedures, analysis and feedback were described. Results The final indicator set included 52 indicators covering diagnostic procedures (11 indicators), therapeutic management (28 indicators) and follow-up (6 indicators). In addition, 7 indicators represented patient perspectives. Primary surgical tumor resection and pre-operative radiation (rectum carcinoma only) were perceived as most useful tracer procedures initiating quality data collection. To assess the quality of CRC care across sectors, various data sources were identified: medical records, administrative inpatient and outpatient data, sickness-funds billing code systems and patient survey. Conclusion In Germany, a set of 52 quality indicators, covering necessary aspects across the interfaces and pathways relevant to CRC-care has been developed. Combining different sectors and sources of health care in quality assessment is an innovative and challenging approach but reflects better the reality of the patient pathway and experience of CRC-care. PMID:23658684
Developing quality indicators for older adults: transfer from the USA to the UK is feasible.

PubMed

Steel, N; Melzer, D; Shekelle, P G; Wenger, N S; Forsyth, D; McWilliams, B C

2004-08-01

Measurement of the quality of health care is essential for quality improvement, and patients are an underused source of data about quality of care. We describe the adaptation of a set of USA quality indicators for use in patient interview surveys in England, to measure the extent to which older patients receive a broad range of effective health care interventions in both primary and secondary care. One hundred and nineteen quality indicators covering 16 clinical areas, based on a set of indicators for the care of vulnerable elderly patients in the USA, were reviewed by a panel of 10 clinical experts in England. A modified version of the RAND/UCLA appropriateness method was used and panel members were supplied with literature reviews summarising the evidence base for each quality indicator. The indicators were sent for comment before the panel meeting to UK charitable organisations for older people. The panel rated 102 of the 119 indicators (86%) as valid for use in England; 17 (14%) were rejected as invalid. All 58 indicators about treatment or continuity and follow up were rated as valid compared with just over half (13 of 24) of the indicators about screening. These 102 indicators are suitable for use in patient interview surveys, including the English Longitudinal Study of Ageing (ELSA). The systematic measurement of quality of care at the population level and identification of gaps in quality is essential for quality improvement. There is potential for transfer of quality indicators between countries, at least for the health care of older people.
Sleep-deprived motor vehicle operators are unfit to drive: a multidisciplinary expert consensus statement on drowsy driving.

PubMed

Czeisler, Charles A; Wickwire, Emerson M; Barger, Laura K; Dement, William C; Gamble, Karen; Hartenbaum, Natalie; Ohayon, Maurice M; Pelayo, Rafael; Phillips, Barbara; Strohl, Kingman; Tefft, Brian; Rajaratnam, Shantha M W; Malhotra, Raman; Whiton, Kaitlyn; Hirshkowitz, Max

2016-06-01

This article presents the consensus findings of the National Sleep Foundation Drowsy Driving Consensus Working Group, which was an expert panel assembled to establish a consensus statement regarding sleep-related driving impairment. The National Sleep Foundation assembled a expert panel comprised of experts from the sleep community and experts appointed by stakeholder organizations. A systematic literature review identified 346 studies that were abstracted and provided to the panelists for review. A modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting was used to reach consensus. A final consensus was reached that sleep deprivation renders motorists unfit to drive a motor vehicle. After reviewing growing evidence of impairment and increased crash risk among drivers who obtained less than optimal sleep duration in the preceding 24 hours, the panelists recognized the need for public policy guidance as to when it is certainly unsafe to drive. Toward this end, the panelists agreed upon the following expert consensus statement: "Drivers who have slept for two hours or less in the preceding 24 hours are not fit to operate a motor vehicle." Panelists further agreed that most healthy drivers would likely be impaired with only 3 to 5 hours of sleep during the prior 24 hours. There is consensus among experts that healthy individuals who have slept for 2 hours or less in the preceding 24 hours are too impaired to safely operate a motor vehicle. Prevention of drowsy driving will require sustained and collaborative effort from multiple stakeholders. Implications and limitations of the consensus recommendations are discussed. Copyright © 2016. Published by Elsevier Inc.
Strategies to Reduce Hospitalizations of Children With Medical Complexity Through Complex Care: Expert Perspectives.

PubMed

Coller, Ryan J; Nelson, Bergen B; Klitzner, Thomas S; Saenz, Adrianna A; Shekelle, Paul G; Lerner, Carlos F; Chung, Paul J

Interventions to reduce disproportionate hospital use among children with medical complexity (CMC) are needed. We conducted a rigorous, structured process to develop intervention strategies aiming to reduce hospitalizations within a complex care program population. A complex care medical home program used 1) semistructured interviews of caregivers of CMC experiencing acute, unscheduled hospitalizations and 2) literature review on preventing hospitalizations among CMC to develop key drivers for lowering hospital utilization and link them with intervention strategies. Using an adapted version of the RAND/UCLA Appropriateness Method, an expert panel rated each model for effectiveness at impacting each key driver and ultimately reducing hospitalizations. The complex care program applied these findings to select a final set of feasible intervention strategies for implementation. Intervention strategies focused on expanding access to familiar providers, enhancing general or technical caregiver knowledge and skill, creating specific and proactive crisis or contingency plans, and improving transitions between hospital and home. Activities aimed to facilitate family-centered, flexible implementation and consideration of all of the child's environments, including school and while traveling. Tailored activities and special attention to the highest utilizing subset of CMC were also critical for these interventions. A set of intervention strategies to reduce hospitalizations among CMC, informed by key drivers, can be created through a structured, reproducible process. Both this process and the results may be relevant to clinical programs and researchers aiming to reduce hospital utilization through the medical home for CMC. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Monitoring outcomes for the Medicare Advantage program: methods and application of the VR-12 for evaluation of plans.

PubMed

Kazis, Lewis E; Selim, Alfredo J; Rogers, William; Qian, Shirley X; Brazier, John

2012-01-01

The Veterans RAND 12-Item Health Survey (VR-12) is one of the major patient-reported outcomes for ranking the Medicare Advantage (MA) plans in the Health Outcomes Survey (HOS). Approaches for scoring physical and mental health are given using contemporary norms and regression estimators. A new metric approach for the VR-12 called the "VR-6D" is presented with case-mix adjustments for monitoring plans that combine utilities and mortality. Results show that the models for ranking health outcomes of the plans are robust and credible. Future directions include the use of utilities for evaluating and ranking of MA plans.
The fast neutron fluence and the activation detector activity calculations using the effective source method and the adjoint function

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

Hep, J.; Konecna, A.; Krysl, V.

2011-07-01

This paper describes the application of effective source in forward calculations and the adjoint method to the solution of fast neutron fluence and activation detector activities in the reactor pressure vessel (RPV) and RPV cavity of a VVER-440 reactor. Its objective is the demonstration of both methods on a practical task. The effective source method applies the Boltzmann transport operator to time integrated source data in order to obtain neutron fluence and detector activities. By weighting the source data by time dependent decay of the detector activity, the result of the calculation is the detector activity. Alternatively, if the weightingmore » is uniform with respect to time, the result is the fluence. The approach works because of the inherent linearity of radiation transport in non-multiplying time-invariant media. Integrated in this way, the source data are referred to as the effective source. The effective source in the forward calculations method thereby enables the analyst to replace numerous intensive transport calculations with a single transport calculation in which the time dependence and magnitude of the source are correctly represented. In this work, the effective source method has been expanded slightly in the following way: neutron source data were performed with few group method calculation using the active core calculation code MOBY-DICK. The follow-up neutron transport calculation was performed using the neutron transport code TORT to perform multigroup calculations. For comparison, an alternative method of calculation has been used based upon adjoint functions of the Boltzmann transport equation. Calculation of the three-dimensional (3-D) adjoint function for each required computational outcome has been obtained using the deterministic code TORT and the cross section library BGL440. Adjoint functions appropriate to the required fast neutron flux density and neutron reaction rates have been calculated for several significant points within the RPV and RPV cavity of the VVER-440 reacto rand located axially at the position of maximum power and at the position of the weld. Both of these methods (the effective source and the adjoint function) are briefly described in the present paper. The paper also describes their application to the solution of fast neutron fluence and detectors activities for the VVER-440 reactor. (authors)« less
Integrating U.S. climate, energy, and transportation policies : RAND workshops address challenges and potential solutions

DOT National Transportation Integrated Search

2009-01-01

There is growing consensus among policymakers that bold government action is needed : to mitigate climate change, particularly through integrated climate, energy, and transportation : policy initiatives. In an effort to share different perspectives o...
Homeland Security Intelligence: To What End

DTIC Science & Technology

2010-09-01

decision making is generous (Treverton & Gabbard , 2008; Reveron 2007). This literature commonly falls into roughly one of two categories, 1) the...Treverton, G.F. & Gabbard , C.B. (2008). Assessing the tradecraft of intelligence analysis. Arlington VA: RAND. Turner, M. (2005). Why secret intelligence
Portfolio Management Best Practices: Observations from Industry

DTIC Science & Technology

2008-05-15

Andreas and Ortwin Renn , “A New Approach to Risk Evaluation and Management: Risk-Based, Precaution-Based, and Discourse-Based Strategies”, Risk...Research and Development, RAND Corporation (2004). Stummer, Christian , and Kurt Heidenberger, “Interactive R&D Portfolio Selection Considering Multiple
Validation of hierarchical cluster analysis for identification of bacterial species using 42 bacterial isolates

NASA Astrophysics Data System (ADS)

Ghebremedhin, Meron; Yesupriya, Shubha; Luka, Janos; Crane, Nicole J.

2015-03-01

Recent studies have demonstrated the potential advantages of the use of Raman spectroscopy in the biomedical field due to its rapidity and noninvasive nature. In this study, Raman spectroscopy is applied as a method for differentiating between bacteria isolates for Gram status and Genus species. We created models for identifying 28 bacterial isolates using spectra collected with a 785 nm laser excitation Raman spectroscopic system. In order to investigate the groupings of these samples, partial least squares discriminant analysis (PLSDA) and hierarchical cluster analysis (HCA) was implemented. In addition, cluster analyses of the isolates were performed using various data types consisting of, biochemical tests, gene sequence alignment, high resolution melt (HRM) analysis and antimicrobial susceptibility tests of minimum inhibitory concentration (MIC) and degree of antimicrobial resistance (SIR). In order to evaluate the ability of these models to correctly classify bacterial isolates using solely Raman spectroscopic data, a set of 14 validation samples were tested using the PLSDA models and consequently the HCA models. External cluster evaluation criteria of purity and Rand index were calculated at different taxonomic levels to compare the performance of clustering using Raman spectra as well as the other datasets. Results showed that Raman spectra performed comparably, and in some cases better than, the other data types with Rand index and purity values up to 0.933 and 0.947, respectively. This study clearly demonstrates that the discrimination of bacterial species using Raman spectroscopic data and hierarchical cluster analysis is possible and has the potential to be a powerful point-of-care tool in clinical settings.
Comparison between Hardy-Rand-Rittler 4th edition and Ishihara color plate tests for detection of dyschromatopsia in optic neuropathy.

PubMed

Huna-Baron, Ruth; Glovinsky, Yoseph; Habot-Wilner, Zohar

2013-02-01

The aim of this work was to compare the specificity-sensitivity balance of the Hardy-Rand-Rittler (HRR) 4th edition with the Ishihara color plate tests for color-vision defects in patients with optic neuropathy. This is a prospective case-control study. The study group included 43 patients (48 eyes) with newly diagnosed optic neuropathy, and the control group included 33 patients (33 right eyes) who were referred to the eye clinic for conditions other than optic nerve or retinal macular disorders. Individuals with visual acuity of less than 20/70 (0.54 Log MAR) were excluded. All patients underwent comprehensive eye examination and color-vision evaluation with both tests in a random order under standardized lighting conditions. The scores of the Ishihara and HRR tests were set as the number of plates identified out of 12 and six respectively. The receiver operating characteristics (ROC) curve was statistically significantly better when using the HRR test (area under curve [AUC] = 0.93 ± 0.03) than for the Ishihara test (AUC = 0.77 ± 0.05) (P = 0.0006). The best specificity-sensitivity balance for the HRR was 100 % and 79 % respectively, and for the Ishihara test 100 % and 48 % respectively. The HRR 4th edition test proved to be superior to the Ishihara test in detecting acquired dyschromatopsia due to optic neuropathy. We recommend using the HRR 4th edition test as a screening method for detection of color-vision defects in patients with optic neuropathy.
Color vision deficiency compensation for Visual Processing Disorder using Hardy-Rand-Rittler test and color transformation

NASA Astrophysics Data System (ADS)

Balbin, Jessie R.; Pinugu, Jasmine Nadja J.; Bautista, Joshua Ian C.; Nebres, Pauline D.; Rey Hipolito, Cipriano M.; Santella, Jose Anthony A.

2017-06-01

Visual processing skill is used to gather visual information from environment however, there are cases that Visual Processing Disorder (VPD) occurs. The so called visual figure-ground discrimination is a type of VPD where color is one of the factors that contributes on this type. In line with this, color plays a vital role in everyday living, but individuals that have limited and inaccurate color perception suffers from Color Vision Deficiency (CVD) and still not aware on their case. To resolve this case, this study focuses on the design of KULAY, a Head-Mounted Display (HMD) device that can assess whether a user has a CVD or not thru the standard Hardy-Rand-Rittler (HRR) test. This test uses pattern recognition in order to evaluate the user. In addition, color vision deficiency simulation and color correction thru color transformation is also a concern of this research. This will enable people with normal color vision to know how color vision deficient perceives and vice-versa. For the accuracy of the simulated HRR assessment, its results were validated thru an actual assessment done by a doctor. Moreover, for the preciseness of color transformation, Structural Similarity Index Method (SSIM) was used to compare the simulated CVD images and the color corrected images to other reference sources. The output of the simulated HRR assessment and color transformation shows very promising results indicating effectiveness and efficiency of the study. Thus, due to its form factor and portability, this device is beneficial in the field of medicine and technology.
Performance Assessment of Kernel Density Clustering for Gene Expression Profile Data

PubMed Central

Zeng, Beiyan; Chen, Yiping P.; Smith, Oscar H.

2003-01-01

Kernel density smoothing techniques have been used in classification or supervised learning of gene expression profile (GEP) data, but their applications to clustering or unsupervised learning of those data have not been explored and assessed. Here we report a kernel density clustering method for analysing GEP data and compare its performance with the three most widely-used clustering methods: hierarchical clustering, K-means clustering, and multivariate mixture model-based clustering. Using several methods to measure agreement, between-cluster isolation, and withincluster coherence, such as the Adjusted Rand Index, the Pseudo F test, the r2 test, and the profile plot, we have assessed the effectiveness of kernel density clustering for recovering clusters, and its robustness against noise on clustering both simulated and real GEP data. Our results show that the kernel density clustering method has excellent performance in recovering clusters from simulated data and in grouping large real expression profile data sets into compact and well-isolated clusters, and that it is the most robust clustering method for analysing noisy expression profile data compared to the other three methods assessed. PMID:18629292
The Impact of Network Performance on Warfighter Effectiveness

DTIC Science & Technology

2006-01-01

SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research organization providing objective...Support Es- tablishment, Auckland , New Zealand), 2000. Lauren, M., R. Stephen, and N. Hore, “Application of the MANA Model to Operations in East Timor

47 CFR 24.202 - Service areas.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS... 1992 Commercial Atlas & Marketing Guide, 123rd Edition, at pages 38-39 (“BTA/MTA Map”). Rand McNally... Commercial Atlas & Marketing Guide, 123rd Edition, at pages 38-39, with the following exceptions and...
47 CFR 24.202 - Service areas.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES PERSONAL COMMUNICATIONS... 1992 Commercial Atlas & Marketing Guide, 123rd Edition, at pages 38-39 (“BTA/MTA Map”). Rand McNally... Commercial Atlas & Marketing Guide, 123rd Edition, at pages 38-39, with the following exceptions and...
Annual Report 2011 (RAND Arroyo Center)

DTIC Science & Technology

2011-01-01

Portfolio Management for Army Science and Technology Programs Under Uncertainties Brian G. Chow, Richard Silberglitt, Scott Hiromoto, Caroline Reilly, and...in the ceremony and requested publishing of the promotion order. LTC Speaks’s spouse, Catherine, and son, Mason, pinned the silver oak leaf to each
Twenty-five years of violence: the epidemiology of terrorism in South America.

PubMed

Báez, Amado Alejandro; Sztajnkrycer, Matthew D; Zane, Richard; Giräldez, Ediza

2008-01-01

Terrorism is a global public health burden. South Americans have been victims of terrorism for many decades. While the causes vary, the results are the same: death, disability, and suffering. The objective of this study was to perform a comprehensive, epidemiological, descriptive study of terrorist incidents in South America. This is a cross-sectional, descriptive study. Data from January 1971 to July 2006 was selected using the RAND Terrorism Chronology 1968-1997 and RAND-Memorial Institute for Prevention of Terrorism (MIPT) Terrorism Incident database (1998-Present). Statistical significance was set at 0.05. The database reported a total of 2,997 incidents in South American countries that resulted in 3,435 victims with injuries (1.15 per incident) and 1,973 fatalities (0.66 per incident). The overall case fatality ratio (CFR) was 35.8%. Colombia had the majority of incidents with 57.9% (1,734 of 2,997), followed by Peru with 363 (12.1%), and Argentina with 267 (8.9%). The highest individual CFR occurred in Paraguay (83.3%), and the lowest in Chile with 4.8%. Of the total injuries and deaths, Colombia had 66.1% (2,269 of 2,997) of all injuries and 75.2% (1,443 out of 1,920) of all deaths. Living in the country of Colombia was associated with a 16 times greater likelihood of becoming a victim of terrorist violence [odds ratio (OR) 16.15; 95% CI 13.45 to 19.40; p < 0.0001]. The predominant method of choice for terrorist incidents was the use of conventional explosives with 2,543 of2,883 incidents (88.2%). Terrorist incidents in South America have accounted for nearly 2,000 deaths, with conventional explosive devices as the predominant method of choice. Understanding the nature of terrorist attacks and the medical consequences assist emergency preparedness and disaster management officials in allocating resources and preparing for potential future events.
Development of quality indicators for low-risk labor care provided by midwives using a RAND-modified Delphi method.

PubMed

Ueda, Kayo; Ohtera, Shosuke; Kaso, Misato; Nakayama, Takeo

2017-09-22

In childbirth, most deliveries are low-risk, defined as spontaneous labor at full term without special high-risk facts or complications, especially in high-resource countries where maternal and perinatal mortality rates are very low. Indeed, the majority of mothers and infants have no serious conditions during labor. However, the quality of care provided is not assured, and performance may vary by birthing facility and provider. The overuse of technology in childbirth in some parts of the world is almost certainly based on assumptions like, "something can go wrong at any minute." There is a need to assess the quality of care provided for mothers and infants in low-risk labor. We aimed to develop specific quality indicators for low-risk labor care provided primarily by midwives in Japan. We used a RAND-modified Delphi method, which integrates evidence review with expert consensus development. The procedure comprises five steps: (1) literature review, including clinical practice guidelines, to extract and develop quality indicator candidates; (2) formation of a multidisciplinary panel; (3) independent panel ratings (Round 1); (4) panel meeting and independent panel ratings (Round 2); and (5) independent panel ratings (Round 3). The three independent panel ratings (Rounds 1-3) were held between July and December 2012. The assembled multidisciplinary panel comprised eight clinicians (two pediatricians, three obstetricians, and three midwives) and three mothers who were nonclinicians. Evidentiary review extracted 166 key recommendations from 32 clinical practice guidelines, and 31 existing quality indicators were added. After excluding duplicate recommendations and quality indicators, the panel discussed 25 candidate indicators. Of these, 18 were adopted, one was modified, six were not adopted, and four were added during the meeting, respectively. We established 23 quality indicators for low-risk labor care provided by midwives in labor units in Japan.
The sup 40 Ar/ sup 39 Ar geochronology of the Pelona schist and related rocks, southern California

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

Jacobson, C.E.

1990-01-10

Seventeen {sup 40}Ar/{sup 39}Ar ages for hornblende, celadonitic muscovite, and biotite from the Pelona, Orocopia, Rand, and Portal Ridge (POR) schists range from 39 to 85 Ma. Two muscovites and one hornblende from the Rand Schist have ages of 72 to 74 Ma, indistinguishable from the K-Ar age of 74 Ma for hornblende from a posttectonic granodiorite that intrudes the schist, but younger than the 70 Ma U-Pb age of the intrusion. Four muscovite and two hornblende ages for schist and mylonite from the East Fork area of the San Gabriel Mountains range from 55 to 61 Ma. Concordance ofmore » schist and upper plate ages confirms structural and metamorphic evidence that the Vincent thrust in the San Gabriel Mountains has not undergone significant postmetamorphic disruption. Ages from the Orocopia Mountains are 75 Ma for hornblende from nonmylonitic upper plate, 52 Ma for muscovite from structurally high Orocopia Schist that is mylonitic, and 41 Ma for muscovite from nonmylonitic Orocopia Schist. These are consistent with field evidence that the Orocopia thrust is a postmetamorphic normal fault. Muscovite and hornblende from the Gavilan Hills have ages of 48 to 50 Ma, younger than ages from the San Gabriel Mountains but similar to schist ages from the Orocopia Mountains. The geochronologic and structural complexities of the Vincent, Chocolate Mountains, Orocopia, and Rand thrusts imply that previously cited northeastward vergence may not relate to prograde metamorphism (subduction) of the POR schists. The data indicate substantial uplift of the POR schists prior to middle Tertiary detachment faulting, which confirms other geochronologic evidence of uplift in southern California and southern Arizona during the Late Cretaceous-early Tertiary.« less
Assessment of the quality of medical care among patients with early stage prostate cancer undergoing expectant management in the United States.

PubMed

Ritchey, Jamie; Gay, E Greer; Spencer, Benjamin A; Miller, David C; Wallner, Lauren P; Stewart, Andrew K; Dunn, Rodney L; Litwin, Mark S; Wei, John T

2012-09-01

Given the increased attention to the quality and cost of medical care, the Institute of Medicine and Centers for Medicare and Medicaid Services have called for performance measurement and reporting. The clinical management of prostate cancer has been outlined, yet is not intended to describe quality prostate cancer care. Therefore, RAND researchers developed quality indicators for early stage prostate cancer. The ACoS (American College of Surgeons) used these indicators to perform the first national assessment to our knowledge of the quality of care among men with early stage prostate cancer undergoing expectant management. Information from medical records was abstracted for evidence of compliance with the RAND indicators (structure and process). Weighted and stratified proportions were calculated to assess indicator compliance. Logistic regression models were fit and evaluated by hospital type and patient factors. A weighted and stratified total of 13,876 early stage prostate cancer cases on expectant management in 2000 to 2001 were investigated. Compliance with structural indicators was high (greater than 80%) and compliance with process indicators varied (19% to 87%). Differences in process indicators were observed from models by hospital type and comorbid conditions, but not for age, race or insurance status. Using the RAND quality indicators this study revealed several process areas for quality improvement among men with early stage prostate cancer on expectant management in the United States. Efforts to improve the quality of early stage prostate cancer care need to move beyond the paradigm of age, race and insurance status. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Mentorship in the context of interdisciplinary geriatric research: lessons learned from the RAND/Hartford Program for Building Interdisciplinary Geriatric Research Centers.

PubMed

Keyser, Donna J; Abedin, Zainab; Schultz, Dana J; Pincus, Harold Alan

2012-08-01

In light of the growing trend toward formalized research mentorship for effectively transmitting the values, standards, and practices of science from one generation of researchers to the next, this article provides the results of an exploratory study. It reports on research mentorship in the context of interdisciplinary geriatric research based on experiences with the RAND/Hartford Program for Building Interdisciplinary Geriatric Research Centers. At the end of the 2-year funding period, staff from the RAND Coordinating Center conducted 60- to 90-minute open-ended telephone interviews with the co-directors of the seven centers. Questions focused on interdisciplinary mentorship activities, barriers to implementing these activities, and strategies for overcoming them, as well as a self-assessment tool with regard to programs, policies, and structures across five domains, developed to encourage research mentorship. In addition, the mentees at the centers were surveyed to assess their experiences with interdisciplinary mentoring and the center. According to the interviewees, some barriers to successful interdisciplinary mentoring included the mentor's lack of time, structural support, and the lack of a clear definition of interdisciplinary research. Most centers had formal policies in place for mentor identification and limited policies on mentor incentives. Mentees uniformly reported their relationships with their mentors as positive. More than 50% of mentees reported having a primary mentor from within their discipline and had more contact with their primary mentor than their secondary mentors. Further research is needed to understand the complexity of institutional levers that emerging programs might employ to encourage and support research mentorship. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
A physarum-inspired prize-collecting steiner tree approach to identify subnetworks for drug repositioning.

PubMed

Sun, Yahui; Hameed, Pathima Nusrath; Verspoor, Karin; Halgamuge, Saman

2016-12-05

Drug repositioning can reduce the time, costs and risks of drug development by identifying new therapeutic effects for known drugs. It is challenging to reposition drugs as pharmacological data is large and complex. Subnetwork identification has already been used to simplify the visualization and interpretation of biological data, but it has not been applied to drug repositioning so far. In this paper, we fill this gap by proposing a new Physarum-inspired Prize-Collecting Steiner Tree algorithm to identify subnetworks for drug repositioning. Drug Similarity Networks (DSN) are generated using the chemical, therapeutic, protein, and phenotype features of drugs. In DSNs, vertex prizes and edge costs represent the similarities and dissimilarities between drugs respectively, and terminals represent drugs in the cardiovascular class, as defined in the Anatomical Therapeutic Chemical classification system. A new Physarum-inspired Prize-Collecting Steiner Tree algorithm is proposed in this paper to identify subnetworks. We apply both the proposed algorithm and the widely-used GW algorithm to identify subnetworks in our 18 generated DSNs. In these DSNs, our proposed algorithm identifies subnetworks with an average Rand Index of 81.1%, while the GW algorithm can only identify subnetworks with an average Rand Index of 64.1%. We select 9 subnetworks with high Rand Index to find drug repositioning opportunities. 10 frequently occurring drugs in these subnetworks are identified as candidates to be repositioned for cardiovascular diseases. We find evidence to support previous discoveries that nitroglycerin, theophylline and acarbose may be able to be repositioned for cardiovascular diseases. Moreover, we identify seven previously unknown drug candidates that also may interact with the biological cardiovascular system. These discoveries show our proposed Prize-Collecting Steiner Tree approach as a promising strategy for drug repositioning.
A protocol for an exploratory phase I mixed-methods study of enhanced integrated care for care home residents with advanced dementia: the Compassion Intervention.

PubMed

Elliott, Margaret; Harrington, Jane; Moore, Kirsten; Davis, Sarah; Kupeli, Nuriye; Vickerstaff, Victoria; Gola, Anna; Candy, Bridget; Sampson, Elizabeth L; Jones, Louise

2014-06-17

In the UK approximately 700,000 people are living with, and a third of people aged over 65 will die with, dementia. People with dementia may receive poor quality care towards the end of life. We applied a realist approach and used mixed methods to develop a complex intervention to improve care for people with advanced dementia and their family carers. Consensus on intervention content was achieved using the RAND UCLA appropriateness method and mapped to sociological theories of process and impact. Core components are: (1) facilitation of integrated care, (2) education, training and support, (3) investment from commissioners and care providers. We present the protocol for an exploratory phase I study to implement components 1 and 2 in order to understand how the intervention operates in practice and to assess feasibility and acceptability. An 'Interdisciplinary Care Leader (ICL)' will work within two care homes, alongside staff and associated professionals to facilitate service integration, encourage structured needs assessment, develop the use of personal and advance care plans and support staff training. We will use qualitative and quantitative methods to collect data for a range of outcome and process measures to detect effects on individual residents, family carers, care home staff, the intervention team, the interdisciplinary team and wider systems. Analysis will include descriptive statistics summarising process and care home level data, individual demographic and clinical characteristics and data on symptom burden, clinical events and quality of care. Qualitative data will be explored using thematic analysis. Findings will inform a future phase II trial. Ethical approval was granted (REC reference 14/LO/0370). We shall publish findings at conferences, in peer-reviewed journals, on the Marie Curie Cancer Care website and prepare reports for dissemination by organisations involved with end-of-life care and dementia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Developing adaptive interventions for adolescent substance use treatment settings: protocol of an observational, mixed-methods project.

PubMed

Grant, Sean; Agniel, Denis; Almirall, Daniel; Burkhart, Q; Hunter, Sarah B; McCaffrey, Daniel F; Pedersen, Eric R; Ramchand, Rajeev; Griffin, Beth Ann

2017-12-19

Over 1.6 million adolescents in the United States meet criteria for substance use disorders (SUDs). While there are promising treatments for SUDs, adolescents respond to these treatments differentially in part based on the setting in which treatments are delivered. One way to address such individualized response to treatment is through the development of adaptive interventions (AIs): sequences of decision rules for altering treatment based on an individual's needs. This protocol describes a project with the overarching goal of beginning the development of AIs that provide recommendations for altering the setting of an adolescent's substance use treatment. This project has three discrete aims: (1) explore the views of various stakeholders (parents, providers, policymakers, and researchers) on deciding the setting of substance use treatment for an adolescent based on individualized need, (2) generate hypotheses concerning candidate AIs, and (3) compare the relative effectiveness among candidate AIs and non-adaptive interventions commonly used in everyday practice. This project uses a mixed-methods approach. First, we will conduct an iterative stakeholder engagement process, using RAND's ExpertLens online system, to assess the importance of considering specific individual needs and clinical outcomes when deciding the setting for an adolescent's substance use treatment. Second, we will use results from the stakeholder engagement process to analyze an observational longitudinal data set of 15,656 adolescents in substance use treatment, supported by the Substance Abuse and Mental Health Services Administration, using the Global Appraisal of Individual Needs questionnaire. We will utilize methods based on Q-learning regression to generate hypotheses about candidate AIs. Third, we will use robust statistical methods that aim to appropriately handle casemix adjustment on a large number of covariates (marginal structural modeling and inverse probability of treatment weights) to compare the relative effectiveness among candidate AIs and non-adaptive decision rules that are commonly used in everyday practice. This project begins filling a major gap in clinical and research efforts for adolescents in substance use treatment. Findings could be used to inform the further development and revision of influential multi-dimensional assessment and treatment planning tools, or lay the foundation for subsequent experiments to further develop or test AIs for treatment planning.
GRAPHIC INPUT TABLETS FOR PROGRAMMED INSTRUCTION.

ERIC Educational Resources Information Center

BOOKER, C.A., JR.; AND OTHERS

TO FACILITATE STUDENT-COMPUTER COMMUNICATION IN PROGRAMED INSTRUCTION, A MODIFICATION OF THE RAND TABLET, WHICH CONVERTS POSITION INFORMATION INTO ELECTRICAL SIGNALS, IS PROPOSED. MANUFACTURE OF THE DEVICE WOULD BE MORE ECONOMICAL, AND THE ELECTRONICS PACKAGE, REDESIGNED WITH INTEGRATED CIRCUITS, WOULD BE SMALLER AND MORE FLEXIBLE. MODIFICATION OF…
77 FR 61031 - Investigations Regarding Eligibility To Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-05

.......... 09/18/12 09/11/12 One-Stop). 81976 Custom Food (State/One- Shreveport, LA........ 09/18/12 09/17/12... 81980 Bank of America (State/One- Addison, TX 09/19/12 09/18/12 Stop). 81981 Ingersoll Rand (Aire Fort...
STAR - Copperhead Interface.

DTIC Science & Technology

1981-03-01

elements which fall outside the original box initiate new clusters. 65 ELL. CH ECK This routine provides the calculation which determines if a target...US Air Force Project Rand Report 3-152b-PR, March 197 88 INITIAL DISTRIBUTION LIST 1o. Copies 1. Defense Technical Information Center 2 Cameron
Chicago neoliberalism versus Cowles planning: perspectives on patents and public goods in Cold War economic thought.

PubMed

Van Horn, Robert; Klaes, Matthias

2011-01-01

In post-Sputnik America, when many policymakers and social scientists feared the Soviet Union had a technological advantage over the United States, assessing the relative importance of patents for inventive activity and examining whether scientific research constituted a public good were paramount concerns. The neoliberals of the University of Chicago and the planners of the Cowles Commission both spoke to these issues. This paper sheds light on their views on patents and public goods in the late 1950s and early 1960s by examining representatives of Cowles and Chicago, Kenneth Arrow and Ronald Coase, respectively. Furthermore, it evaluates whether their views on patents and public goods clashed with the interests of RAND, at which both Arrow and Coase worked at some point during this time period. The paper argues that the Chicago-neoliberal position of Coase undermined the interests of RAND, while the Cowles-planning conclusions of Arrow furthered those interests. © 2011 Wiley Periodicals, Inc.
Supporting the Development of a New Health R&D Strategy

PubMed Central

Grant, Jonathan; Pollitt, Alexandra; Castle-Clarke, Sophie; Cochrane, Gavin; Sondergaard, Susanne; Horvath, Veronika

2014-01-01

Abstract The HelseOmsorg21 initiative was set up by the Ministry of Health and Care Services to develop a new research and innovation strategy for health and care services in Norway. The HelseOmsorg21 Strategy Group, through the Research Council of Norway which is providing the secretariat for the strategy development, asked RAND Europe to support the strategic review process. RAND Europe's role was to conduct a series of rapid evidence reviews around the recommendations arising from the five working groups that comprise the initiative. The reviews were conducted around networks and collaboration, data linkage and exchange, culture, values and leadership, and incentives for innovation, while capacity building was a recurrent theme throughout. This study presents the rapid evidence reviews, summarising relevant literature and highlighting international examples of particularly relevant or innovative approaches. The issues and ideas identified around each theme are then pulled together in a suggested conceptual representation of the Norwegian health and care research system. PMID:28083346
The Effect of Eliminating the Affordable Care Act's Tax Credits in Federally Facilitated Marketplaces.

PubMed

Saltzman, Evan; Eibner, Christine

2015-07-15

In this study, RAND Corporation researchers assess the expected change in enrollment and premiums in the Patient Protection and Affordable Care Act (ACA)-compliant individual market in federally facilitated marketplace (FFM) states if the U.S. Supreme Court decides to eliminate subsidies in FFM states. The analysis used the Comprehensive Assessment of Reform Efforts (COMPARE) microsimulation model, an economic model developed by RAND researchers, to assess the impact of proposed health reforms. The authors found that enrollment in the ACA-compliant individual market, including plans sold in the marketplaces and those sold outside of the marketplaces that comply with ACA regulations, would decline by 9.6 million, or 70 percent, in FFM states if subsidies were eliminated. They also found that unsubsidized premiums in the ACA-compliant individual market would increase 47 percent in FFM states. This corresponds to a $1,610 annual increase for a 40-year-old nonsmoker purchasing a silver plan.
Individual, interpersonal, and institutional level factors associated with the mental health of college students.

PubMed

Byrd, Deannah R; McKinney, Kristen J

2012-01-01

This study investigates the individual, interpersonal, and institutional level factors that are associated with overall mental health among college students. Data are from an online cross-sectional survey of 2,203 students currently enrolled at a large public university. Mental health was ascertained using a subcomponent of the RAND Medical Outcomes Study functioning and well-being measures developed by the RAND corporation. Stepwise regression was used to determine if self-reported measures of individual (ie, coping abilities), interpersonal (ie, intergroup awareness), and institutional (ie, campus climate/tension) level factors were associated with overall mental health, after controlling for demographic characteristics. The combined effects of both individual and institutional level measures were associated with student mental health. In particular, limited coping abilities and a perceived racially tense campus climate contributed to the psychological distress of college students. Simultaneously addressing the individual and institutional level influences on mental health offers the most promising help for students.
Illuminant and observer metamerism and the Hardy-Rand-Rittler color vision test editions.

PubMed

Dain, Stephen J

2006-01-01

A previous study identified a significant metamerism in the several editions of the Hardy-Rand-Rittller pseudoisochromatic plates (HRR) but did not proceed to quantify the consequences of that metamerism (Dain, 2004). Metamerism arises from two sources and is almost inevitable when a printed color vision test is reproduced in several editions. Metamerism has two consequences; these are illuminant/source-based changes in performance and changes in performance with observer (less well known) when assessing anomalous trichromats. This study addresses the effects of illuminant/source and observer metamerism on the fourth editions of HRR. Groups of colors intended to lie on a dichromat confusion line generally remain on a confusion line when the source id changed. The plates appear to be resistant to each form of metamerism, perhaps because the features of the spectral reflectance are similar for figure color and background gray. As a consequence, the clinician needs to be less concerned about using a non-recommended source than was previously believed.
Multi-Stakeholder Informed Guidelines for Direct Admission of Children to Hospital.

PubMed

Leyenaar, JoAnna K; Shevenell, Megan; Rizzo, Paul A; Hill, Vanessa L; Lindenauer, Peter K

2018-04-25

To develop pediatric direct admission guidelines and prioritize outcomes to evaluate the safety and effectiveness of hospital admission processes. We conducted deliberative discussions at 1 children's hospital and 2 community hospitals, engaging parents of hospitalized children and inpatient, outpatient, and emergency department physicians and nurses to identify shared and dissenting perspectives regarding direct admission processes and outcomes. Discussions were audio-recorded, professionally transcribed, and analyzed using a general inductive approach. We then convened a national panel to prioritize guideline components and outcome measures using a RAND/UCLA Modified Delphi approach. Forty-eight stakeholders participated in 6 deliberative discussions. Emergent themes related to effective multistakeholder communication, resources needed for high quality direct admissions, written direct admission guidelines, including criteria to identify children appropriate for and inappropriate for direct admission, and families' needs. Building on these themes, Delphi panelists endorsed 71 guideline components as both appropriate and necessary at children's hospitals and community hospitals and 13 outcomes to evaluate hospital admission systems. Guideline components include (1) pre-admission communication, (2) written guidelines, (3) hospital resources to optimize direct admission processes, (4) special considerations for pediatric populations that may be at particular risk of nosocomial infection and/or stress in emergency departments, (5) communication with families referred for direct admission, and (6) quality reviews to evaluate admission systems. These direct admission guidelines can be adapted by hospitals and health systems to inform hospital admission policies and protocols. Multistakeholder engagement in evaluation of hospital admission processes may improve transitions of care and health system integration. Copyright © 2018 Elsevier Inc. All rights reserved.

Advancing Aeronautics: A Decision Framework for Selecting Research Agendas

NASA Technical Reports Server (NTRS)

Anton, Philip S.; Ecola, Liisa; Kallimani, James G.; Light, Thomas; Ohlandt, Chad J. R.; Osburg, Jan; Raman, Raj; Grammich, Clifford A.

2011-01-01

Publicly funded research has long played a role in the development of aeronautics, ranging from foundational research on airfoils to development of the air-traffic control system. Yet more than a century after the research and development of successful controlled, sustained, heavier-than-air flight vehicles, there are questions over the future of aeronautics research. The field of aeronautics is relatively mature, technological developments within it have become more evolutionary, and funding decisions are sometimes motivated by the continued pursuit of these evolutionary research tracks rather than by larger factors. These developments raise questions over whether public funding of aeronautics research continues to be appropriate or necessary and at what levels. Tightened federal budgets and increasing calls to address other public demands make these questions sharper still. To help it address the questions of appropriate directions for publicly funded aeronautics research, the National Aeronautics and Space Administration's (NASA's) Aeronautics Research Mission Directorate (ARMD) asked the RAND Corporation to assess the elements required to develop a strategic view of aeronautics research opportunities; identify candidate aeronautic grand challenges, paradigms, and concepts; outline a framework for evaluating them; and exercise the framework as an example of how to use it. Accordingly, this research seeks to address these questions: What aeronautics research should be supported by the U.S. government? What compelling and desirable benefits drive government-supported research? How should the government--especially NASA--make decisions about which research to support? Advancing aeronautics involves broad policy and decisionmaking challenges. Decisions involve tradeoffs among competing perspectives, uncertainties, and informed judgment.
Consensus process to develop a best-practice document on the role of chiropractic care in health promotion, disease prevention, and wellness.

PubMed

Hawk, Cheryl; Schneider, Michael; Evans, Marion Willard; Redwood, Daniel

2012-09-01

The purposes of this project were to develop consensus definitions for a set of best practices that doctors of chiropractic may use for promoting health and wellness and preventing disease and to describe the appropriate components and procedures for these practices. A multidisciplinary steering committee of 10 health care professionals developed seed statements based on their clinical experience and relevant literature. A Delphi consensus process was conducted from January to July 2011, following the RAND methodology. Consensus was reached when at least 80% of the panelists were in agreement. There were 44 Delphi panelists (36 doctors of chiropractic, 6 doctors of philosophy, 1 doctor of naturopathy, 1 registered nurse). The statements developed defined the terms and practices for chiropractic care to promote health and wellness and prevent disease. This document describes the procedures and features of wellness care that represent a reasonable approach to wellness care and disease prevention in chiropractic clinical practice. This living document provides a general framework for an evidence-based approach to chiropractic wellness care. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Bag the gag rule. Poll indicates most Americans think global gag rule is wrong.

PubMed

Ernst, J; Farmer, A

2000-09-01

According to studies conducted by the Rand Corporation and the District of Columbia-based Center for Development and Population Activities, conservative and liberal Americans alike overwhelmingly support foreign assistance to international family planning programs. In addition, the 1998 poll shows that 92% of Americans believe that couples have the right to family planning, and a slight majority support government funding of legal overseas abortion services. Despite such evidence, members of the House Representative voted to restrict foreign family planning organizations that receive federal money from using their own non-US funds to provide abortion services overseas. To this effect, foreign family planning organizations and other concerned agencies argued that such a restriction undermines the objectives of the US and effectively denies access to desperately needed support to millions of women worldwide. In particular, organizations like the Center for Reproductive Law and Policy are lobbying lawmakers to strike the gag rule language from the final appropriations bill that will reach US President Clinton's desk, as well as to increase family planning funding levels. However, Clinton has indicated a veto if congress does pass gag rule legislation for the second year in a row.
Antimicrobial Stewardship

PubMed Central

King, Sarah; Exley, Josephine; Taylor, Jirka; Kruithof, Kristy; Larkin, Jody; Pardal, Mafalda

2016-01-01

Abstract RAND Europe undertook a systematic review of the evidence of effectiveness and cost effectiveness on changing the public's risk related behaviour pertaining to antimicrobial use to inform the development of a NICE public health guideline aimed at delaying antimicrobial resistance (AMR). The review considered educational interventions targeting individuals, communities or the general public delivered via any mode. Specifically, it aimed to address: 1. Which educational interventions are effective and cost-effective in changing the public's behaviour to ensure they only ask for antimicrobials when appropriate and use them correctly? 2. Which educational interventions are effective and cost-effective in changing the public's behaviour to prevent infection and reduce the spread of antimicrobial resistance? Overall, 60 studies met the inclusion criteria; 29 related to research question 1, and 36 related to research question 2 (five studies were applicable to both). The key findings are summarised in “Evidence Statements” in accordance with NICE guidelines. Evidence Statements provide a high level overview of the key features of the evidence including: the number of studies, the quality of evidence, and the direction of the estimated effect followed by a brief summary of each of the supporting studies. Studies are grouped into Evidence Statements by setting and intervention. PMID:28083399
European Surveillance of Antimicrobial Consumption (ESAC): quality indicators for outpatient antibiotic use in Europe

PubMed Central

Coenen, Samuel; Ferech, Matus; Haaijer‐Ruskamp, Flora M; Butler, Chris C; Stichele, Robert H Vander; Verheij, Theo J M; Monnet, Dominique L; Little, Paul; Goossens, Herman

2007-01-01

Background and objective Indicators to measure the quality of healthcare are increasingly used by healthcare professionals and policy makers. In the context of increasing antimicrobial resistance, this study aimed to develop valid drug‐specific quality indicators for outpatient antibiotic use in Europe, derived from European Surveillance of Antimicrobial Consumption (ESAC) data. Methods 27 experts (15 countries), in a European Science Foundation workshop, built on the expertise within the European Drug Utilisation Research Group, the General Practice Respiratory Infections Network, the ESCMID Study Group on Primary Care Topics, the Belgian Antibiotic Policy Coordination Committee, the World Health Organization, ESAC, and other experts. A set of proposed indicators was developed using 1997–2003 ESAC data. Participants scored the relevance of each indicator to reducing antimicrobial resistance, patient health benefit, cost effectiveness and public health policy makers (scale: 1 (completely disagree) to 9 (completely agree)). The scores were processed according to the UCLA‐RAND appropriateness method. Indicators were judged relevant if the median score was not in the 1–6 interval and if there was consensus (number of scores within the 1–3 interval was fewer than one third of the panel). From the relevant indicators providing overlapping information, the one with the highest scores was selected for the final set of quality indicators—values were updated with 2004 ESAC data. Results 22 participants (12 countries) completed scoring of a set of 22 proposed indicators. Nine were rated as relevant antibiotic prescribing indicators on all four dimensions; five were rated as relevant if only relevance to reducing antimicrobial resistance and public health policy makers was taken into account. A final set of 12 indicators was selected. Conclusion 12 of the proposed ESAC‐based quality indicators for outpatient antibiotic use in Europe have face validity and are potentially applicable. These indicators could be used to better describe antibiotic use in ambulatory care and assess the quality of national antibiotic prescribing patterns in Europe. PMID:18055888
Rand Project AIR FORCE Annual Report 2010

DTIC Science & Technology

2010-01-01

LLC Michael Lynton, Chairman and Chief Executive Officer, Sony Pictures Entertainment Ronald L. Olson, Partner, Munger, Tolles & Olson LLP Paul H...management, and his Air Force career centered on research. Even a shared love of music finds them in different parts of the orchestra, with Ray as a
Summer Learning That Sticks

ERIC Educational Resources Information Center

Browne, Daniel

2017-01-01

A new RAND Corporation study shows that voluntary summer programs can benefit children from low-income families, particularly those with high attendance. Programs studied in five school districts had several elements in common: a mix of academics and enrichment activities, certified teachers, small class sizes, full-day programming provided five…
U.S. Policy for Central America: A Briefing,

DTIC Science & Technology

1984-03-01

do not promote upheavals else- waere or align with our global adversaries. For their part, nationalist leaders in and around Central America should...See Joseph H. Stodder and Kevin F. McCarthy, Profiles of the Caribbean Basin in 1960/1980: Changing Geopolitical and Geostrategic Dimcnsim.. The Rand
Studies in Intelligence. Volume 56, Number 4

DTIC Science & Technology

2012-12-01

two hour walk in the nearby woods . It was drizzling, but neither of us noticed. He insisted at each subsequent meeting that he would terminate...Shambaugh, and Murray Scot Tanner. See, also, Michael Swaine, The Role of the Chinese Military in National Security Policymaking (Santa Monica, CA: RAND
A Variable-Selection Heuristic for K-Means Clustering.

ERIC Educational Resources Information Center

Brusco, Michael J.; Cradit, J. Dennis

2001-01-01

Presents a variable selection heuristic for nonhierarchical (K-means) cluster analysis based on the adjusted Rand index for measuring cluster recovery. Subjected the heuristic to Monte Carlo testing across more than 2,200 datasets. Results indicate that the heuristic is extremely effective at eliminating masking variables. (SLD)
All Children Deserve Uninterrupted Learning!

ERIC Educational Resources Information Center

Brown, Fred

2015-01-01

Teachers often start a new school year working extremely hard to reteach last year's content, particularly for their lower income students. According to "Making Summer Count," a report commissioned by The Wallace Foundation and written by researchers at Rand, rigorous studies of voluntary summer programs, mandatory summer programs, and…
Occupational Differences between Hispanics and Non-Hispanics. A Rand Note.

ERIC Educational Resources Information Center

Stolzenberg, Ross M.

A study examined the occupational differences between Hispanics and non-Hispanics. The study focused on the determinants of Hispanic occupational achievement; differences in the process of occupational achievement among different Hispanic ethnic subgroups; variations in the process of occupational achievement across geographic areas; and…
Promoting International Energy Security. Volume 1: Understanding Potential Air Force Roles

DTIC Science & Technology

2012-01-01

obtain additional information, contact Distribution Services: Telephone: (310) 451 -7002; Fax: (310) 451 -6915; Email: order@rand.org Library of...raise the temperature of one pound of water one degree Fahrenheit ) DoD Department of Defense EIA U.S. Energy Information Administration IEA International
Resistor Susceptibility Survey

DTIC Science & Technology

1976-11-01

SATIN IV ATTN: DCKE, L. Staples ATTN. YWES ATTN XRE-Surv. ATTN- MCAE, Lt Col Sparks ATTN: XRP , Maj Gingrich Sandia Lab. ATTN 3141 ATTN E...Diamond Lab. ATTN: Lib. HQ USAF ATTN: XOOWD AFSC Tech. Lib. ATTN: DLCAW ATTN: XRP ! Sperry Rand Fit. Sys. Div. ATTN: Tech. Lib. ATTN: D
Diversity of Service Academy Entrants and Graduates

DTIC Science & Technology

2010-01-01

ABUSE TERRORISM AND HOMELAND SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit research... Women in the Officer Corps, by Service, and Among Employed Civilian College Graduates, 21–35 Years, 1997–2007...16 2.6. Percentage of Women Among Officer Accessions
The Perfect Storm: The Goldwater-Nichols Act and Its Effect on Navy Acquisition

DTIC Science & Technology

2010-01-01

TECHNOLOGY SUBSTANCE ABUSE TERRORISM AND HOMELAND SECURITY TRANSPORTATION AND INFRASTRUCTURE WORKFORCE AND WORKPLACE The RAND Corporation is a nonprofit...the two stars’ comunications with the Systems Commanders, who were ultimately removed from the acquisition chain because the new PEOs 16 The
Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion.

PubMed

Paruthi, Shalini; Brooks, Lee J; D'Ambrosio, Carolyn; Hall, Wendy A; Kotagal, Suresh; Lloyd, Robin M; Malow, Beth A; Maski, Kiran; Nichols, Cynthia; Quan, Stuart F; Rosen, Carol L; Troester, Matthew M; Wise, Merrill S

2016-11-15

Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are recommended: Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 6 to 12 years of age should sleep 9 to 12 hours per 24 hours on a regular basis to promote optimal health. Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a regular basis to promote optimal health. Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Regularly sleeping fewer than the number of recommended hours is associated with attention, behavior, and learning problems. Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression. Insufficient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and suicide attempts. A commentary on this article apears in this issue on page 1439. © 2016 American Academy of Sleep Medicine
Optimising the clinical strategy for autoimmune liver diseases: Principles of value-based medicine.

PubMed

Carbone, Marco; Cristoferi, Laura; Cortesi, Paolo Angelo; Rota, Matteo; Ciaccio, Antonio; Okolicsanyi, Stefano; Gemma, Marta; Scalone, Luciana; Cesana, Giancarlo; Fabris, Luca; Colledan, Michele; Fagiuoli, Stefano; Ideo, Gaetano; Belli, Luca Saverio; Munari, Luca Maria; Mantovani, Lorenzo; Strazzabosco, Mario

2018-04-01

Autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis represent the three major autoimmune liver diseases (AILDs). Their management is highly specialized, requires a multidisciplinary approach and often relies on expensive, orphan drugs. Unfortunately, their treatment is often unsatisfactory, and the care pathway heterogeneous across different centers. Disease-specific clinical outcome indicators (COIs) able to evaluate the whole cycle of care are needed to assist both clinicians and administrators in improving quality and value of care. Aim of our study was to generate a set of COIs for the three AILDs. We then prospectively validated these indicators based on a series of consecutive patients recruited at three tertiary clinical centers in Lombardy, Italy. In phase I using a Delphi method and a RAND 9-point appropriateness scale a set of COIs was generated. In phase II the indicators were applied in a real-life dataset. Two-hundred fourteen patients were enrolled and followed-up for a median time of 54months and the above COIs were recorded using a web-based electronic medical record program. The COIs were easy to collect in the clinical practice environment and their values compared well with the available natural history studies. We have generated a comprehensive set of COIs which sequentially capture different clinical outcome of the three AILDs explored. These indicators represent a critical tool to implement a value-based approach to patients with these conditions, to monitor, compare and improve quality through benchmarking of clinical performance and to assess the significance of novel drugs and technologies. This article is part of a Special Issue entitled: Cholangiocytes in Health and Diseaseedited by Jesus Banales, Marco Marzioni, Nicholas LaRusso and Peter Jansen. Copyright © 2017. Published by Elsevier B.V.
A new algorithm to build bridges between two patient-reported health outcome instruments: the MOS SF-36® and the VR-12 Health Survey.

PubMed

Selim, Alfredo; Rogers, William; Qian, Shirley; Rothendler, James A; Kent, Erin E; Kazis, Lewis E

2018-04-19

To develop bridging algorithms to score the Veterans Rand-12 (VR-12) scales for comparability to those of the SF-36® for facilitating multi-cohort studies using data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER) linked to Medicare Health Outcomes Survey (MHOS), and to provide a model for minimizing non-statistical error in pooled analyses stemming from changes to survey instruments over time. Observational study of MHOS cohorts 1-12 (1998-2011). We modeled 2-year follow-up SF-36 scale scores from cohorts 1-6 based on baseline SF-36 scores, age, and gender, yielding 100 clusters using Classification and Regression Trees. Within each cluster, we averaged follow-up SF-36 scores. Using the same cluster specifications, expected follow-up SF-36 scores, based on cohorts 1-6, were computed for cohorts 7-8 (where the VR-12 was the follow-up survey). We created a new criterion validity measure, termed "extensibility," calculated from the square root of the mean square difference between expected SF-36 scale averages and observed VR-12 item score from cohorts 7-8, weighted by cluster size. VR-12 items were rescored to minimize this quantity. Extensibility of rescored VR-12 items and scales was considerably improved from the "simple" scoring method for comparability to the SF-36 scales. The algorithms are appropriate across a wide range of potential subsamples within the MHOS and provide robust application for future studies that span the SF-36 and VR-12 eras. It is possible that these surveys in a different setting outside the MHOS, especially in younger age groups, could produce somewhat different results.
National implementation of multi-parametric magnetic resonance imaging for prostate cancer detection - recommendations from a UK consensus meeting.

PubMed

Brizmohun Appayya, Mrishta; Adshead, Jim; Ahmed, Hashim U; Allen, Clare; Bainbridge, Alan; Barrett, Tristan; Giganti, Francesco; Graham, John; Haslam, Phil; Johnston, Edward W; Kastner, Christof; Kirkham, Alexander P S; Lipton, Alexandra; McNeill, Alan; Moniz, Larissa; Moore, Caroline M; Nabi, Ghulam; Padhani, Anwar R; Parker, Chris; Patel, Amit; Pursey, Jacqueline; Richenberg, Jonathan; Staffurth, John; van der Meulen, Jan; Walls, Darren; Punwani, Shonit

2018-07-01

To identify areas of agreement and disagreement in the implementation of multi-parametric magnetic resonance imaging (mpMRI) of the prostate in the diagnostic pathway. Fifteen UK experts in prostate mpMRI and/or prostate cancer management across the UK (involving nine NHS centres to provide for geographical spread) participated in a consensus meeting following the Research and Development Corporation and University of California-Los Angeles (UCLA-RAND) Appropriateness Method, and were moderated by an independent chair. The experts considered 354 items pertaining to who can request an mpMRI, prostate mpMRI protocol, reporting guidelines, training, quality assurance (QA) and patient management based on mpMRI levels of suspicion for cancer. Each item was rated for agreement on a 9-point scale. A panel median score of ≥7 constituted 'agreement' for an item; for an item to reach 'consensus', a panel majority scoring was required. Consensus was reached on 59% of items (208/354); these were used to provide recommendations for the implementation of prostate mpMRI in the UK. Key findings include prostate mpMRI requests should be made in consultation with the urological team; mpMRI scanners should undergo QA checks to guarantee consistently high diagnostic quality scans; scans should only be reported by trained and experienced radiologists to ensure that men with unsuspicious prostate mpMRI might consider avoiding an immediate biopsy. Our consensus statements demonstrate a set of criteria that are required for the practical dissemination of consistently high-quality prostate mpMRI as a diagnostic test before biopsy in men at risk. © 2018 The Authors BJU International published by John Wiley & Sons Ltd on behalf of BJU International.

Patient engagement in the process of planning and designing outpatient care improvements at the Veterans Administration Health-care System: findings from an online expert panel.

PubMed

Khodyakov, Dmitry; Stockdale, Susan E; Smith, Nina; Booth, Marika; Altman, Lisa; Rubenstein, Lisa V

2017-02-01

There is a strong interest in the Veterans Administration (VA) Health-care System in promoting patient engagement to improve patient care. We solicited expert opinion using an online expert panel system with a modified Delphi structure called ExpertLens ™ . Experts reviewed, rated and discussed eight scenarios, representing four patient engagement roles in designing and improving VA outpatient care (consultant, implementation advisor, equal stakeholder and lead stakeholder) and two VA levels (local and regional). Rating criteria included desirability, feasibility, patient ability, physician/staff acceptance and impact on patient-centredness and care quality. Data were analysed using the RAND/UCLA Appropriateness Method for determining consensus. Experts rated consulting with patients at the local level as the most desirable and feasible patient engagement approach. Engagement at the local level was considered more desirable than engagement at the regional level. Being an equal stakeholder at the local level received the highest ratings on the patient-centredness and health-care quality criteria. Our findings illustrate expert opinion about different approaches to patient engagement and highlight the benefits and challenges posed by each. Although experts rated local consultations with patients on an as-needed basis as most desirable and feasible, they rated being an equal stakeholder at the local level as having the highest potential impact on patient-centredness and care quality. This result highlights a perceived discrepancy between what is most desirable and what is potentially most effective, but suggests that routine local engagement of patients as equal stakeholders may be a desirable first step for promoting high-quality, patient-centred care. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.
Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).

PubMed

Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael

2016-12-01

Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.
Surgery for constipation: systematic review and practice recommendations: Graded practice and future research recommendations.

PubMed

Knowles, C H; Grossi, U; Horrocks, E J; Pares, D; Vollebregt, P F; Chapman, M; Brown, S; Mercer-Jones, M; Williams, A B; Yiannakou, Y; Hooper, R J; Stevens, N; Mason, J

2017-09-01

This manuscript forms the final of seven that address the surgical management of chronic constipation (CC) in adults. The content coalesces results from the five systematic reviews that precede it and of the European Consensus process to derive graded practice recommendations (GPR). Summary of review data, development of GPR and future research recommendations as outlined in detail in the 'introduction and methods' paper. The overall quality of data in the five reviews was poor with 113/156(72.4%) of included studies providing only level IV evidence and only four included level I RCTs. Coalescence of data from the five procedural classes revealed that few firm conclusions could be drawn regarding procedural choice or patient selection: no single procedure dominated in addressing dynamic structural abnormalities of the anorectum and pelvic floor with each having similar overall efficacy. Of one hundred 'prototype' GPRs developed by the clinical guideline group, 85/100 were deemed 'appropriate' based on the independent scoring of a panel of 18 European experts and use of RAND-UCLA consensus methodology. The remaining 15 were all deemed uncertain. Future research recommendations included some potential RCTs but also a strong emphasis on delivery of large multinational high-quality prospective cohort studies. While the evidence base for surgery in CC is poor, the widespread European consensus for GPRs is encouraging. Professional bodies have the opportunity to build on this work by supporting the efforts of their membership to help convert the documented recommendations into clinical guidelines. © 2017 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
Counting the costs: Comparing depot medroxyprogesterone acetate and norethisterone oenanthate utilisation patterns in South Africa

PubMed Central

2001-01-01

Background In South Africa, where health care resources are limited, it is important to ensure that drugs provision and use is rational. The Essential Drug List includes depot medroxyprogesterone acetate (DMPA) and norethisterone oenanthate (NET-EN) as injectable progestagen-only contraceptives (IPCs), and both products are extensively used. Objectives and Methods Utilisation patterns of the injectable contraceptive products DMPA and NET-EN are compared in the context of current knowledge of the safety and efficacy of these agents. Utilisation patterns were analysed by means of a Pareto (ABC) analysis of IPCs issued from 4 South African provincial pharmaceutical depots over 3 financial years. A case study from rural KwaZulu-Natal, South Africa, is used to examine utilisation patterns and self-reported side effects experienced by 187 women using IPCs. Results IPCs accounted for a substantial share of total state expenditure on drugs. While more DMPA than NET-EN was issued, NET-EN distribution from 2 depots increased over the 3-year period. Since DMPA was cheaper, if all NET-EN clients in the 1999/2000 financial year (annualised) had used DMPA, the 4 depots could have saved 4.95 million South African Rands on product acquisition costs alone. The KZN case study showed slightly more NET-EN (54%) than DMPA (46%) use; no significant differences in self-reported side effects; and that younger women were more likely to use NET-EN than DMPA (p = 0.0001). Conclusions Providing IPCs on the basis of age is not appropriate or cost effective. Rational use of these products should include consideration of the cost of prescribing one over another. PMID:11401729
Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

PubMed

Stelfox, Henry T; Niven, Daniel J; Clement, Fiona M; Bagshaw, Sean M; Cook, Deborah J; McKenzie, Emily; Potestio, Melissa L; Doig, Christopher J; O'Neill, Barbara; Zygun, David

2015-01-01

Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap). We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare. We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14) and pediatric (n = 2) medical-surgical intensive care units (ICUs) in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38) and frontline providers (n = 1,790). Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale) and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback. Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants) over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate) evaluated the priorities, and rated 9 as 'necessary' (median score 7-9). Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU) and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs). A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.
Assessment of Suicidal Ideation and Behavior: Report of the International Society for CNS Clinical Trials and Methodology Consensus Meeting.

PubMed

Chappell, Phillip B; Stewart, Michelle; Alphs, Larry; DiCesare, Franco; DuBrava, Sarah; Harkavy-Friedman, Jill; Lim, Pilar; Ratcliffe, Sian; Silverman, Morton M; Targum, Steven D; Marder, Stephen R

2017-06-01

To develop consensus recommendations for assessment of suicidal ideation/suicidal behavior (SI/SB) in clinical trials. Stakeholders from academia, industry, regulatory agencies, National Institutes of Health, National Institute of Mental Health, and patient advocacy organizations participated in a consensus meeting that was sponsored by the International Society for CNS Clinical Trials and Methodology and held November 17-18, 2015. Prior to the meeting, teams of experts identified key areas of consensus and dissent related to SI/SB. The most critical issues were presented and discussed in the consensus meeting. Literature reviews and a pre-meeting survey were conducted. Findings were discussed in pre-meeting working group sessions and at the consensus meeting. Five pre-meeting working groups reviewed (1) nomenclature and classification schemes for SI/SB, (2) detection and assessment of SI/SB, (3) analysis of SI/SB data, (4) design of clinical trials for new treatments of SI/SB, and (5) public health approaches to SI/SB. A modification of the RAND/UCLA Appropriateness Method was used to combine review of scientific evidence with the collective views of experts and stakeholders to reach the final consensus statements. After discussion, all attendees voted using an electronic interactive audience response system. Areas of agreement and areas of continuing dissent were recorded. All 5 working groups agreed that a major barrier to advancement of the field of SI/SB research and the development of new treatments for SI/SB remains the lack of a universally accepted standardized nomenclature and classification system. Achieving alignment on definitions and classification of suicide-related phenomena is critical to improving the detection and assessment of SI/SB, the design of clinical trials for new treatments, and effective public health interventions. © Copyright 2017 Physicians Postgraduate Press, Inc.
Validity and reliability of the Dutch version of the Copenhagen Hip And Groin Outcome Score (HAGOS-NL) in patients with hip pathology.

PubMed

Giezen, Hilde; Stevens, Martin; van den Akker-Scheek, Inge; Reininga, Inge H F

2017-01-01

The Copenhagen Hip And Groin Outcome Score (HAGOS) was developed to assess disease-specific consequences in young to middle-aged, physically active hip and/or groin patients. The study aimed to determine validity and reliability of the Dutch version of the HAGOS (HAGOS-NL) for middle-aged patients with hip complaints. To assess validity, 117 participants completed five questionnaires: HAGOS-NL, international Hip Outcome Tool (iHOT-12NL), Hip disability and Osteoarthritis Outcome Score (HOOS), RAND-36 Health Survey and Tegner activity scale. Structural validity was determined by conducting confirmatory factor analysis. Construct validity was analyzed by formulating predefined hypotheses regarding relationships between the HAGOS-NL and subscales of the iHOT-12NL, HOOS, RAND-36 and Tegner activity scale. The HAGOS-NL was filled out again by 67 patients to explore test-retest reliability. Reliability was assessed in terms of Cronbach's alpha, Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC). The Bland and Altman method was used to explore absolute agreement. Factor analysis confirmed that the HAGOS-NL consists of six subscales. All hypotheses were confirmed, indicating good construct validity. Internal consistency was good, with Cronbach's alpha values ranging from 0.89 to 0.98. Test-retest reliability was considered good, with ICC values of 0.80 and higher. The SEM ranged from 6.6 to 12.3, and MDC at individual level from 18.3 to 34.1 and at group level from 2.3 to 4.4. Bland and Altman analyses showed no bias. The HAGOS-NL is a reliable and valid instrument for measuring pain, physical functioning and quality of life in middle-aged patients with hip complaints.
Development of quality metrics for ambulatory pediatric cardiology: Infection prevention.

PubMed

Johnson, Jonathan N; Barrett, Cindy S; Franklin, Wayne H; Graham, Eric M; Halnon, Nancy J; Hattendorf, Brandy A; Krawczeski, Catherine D; McGovern, James J; O'Connor, Matthew J; Schultz, Amy H; Vinocur, Jeffrey M; Chowdhury, Devyani; Anderson, Jeffrey B

2017-12-01

In 2012, the American College of Cardiology's (ACC) Adult Congenital and Pediatric Cardiology Council established a program to develop quality metrics to guide ambulatory practices for pediatric cardiology. The council chose five areas on which to focus their efforts; chest pain, Kawasaki Disease, tetralogy of Fallot, transposition of the great arteries after arterial switch, and infection prevention. Here, we sought to describe the process, evaluation, and results of the Infection Prevention Committee's metric design process. The infection prevention metrics team consisted of 12 members from 11 institutions in North America. The group agreed to work on specific infection prevention topics including antibiotic prophylaxis for endocarditis, rheumatic fever, and asplenia/hyposplenism; influenza vaccination and respiratory syncytial virus prophylaxis (palivizumab); preoperative methods to reduce intraoperative infections; vaccinations after cardiopulmonary bypass; hand hygiene; and testing to identify splenic function in patients with heterotaxy. An extensive literature review was performed. When available, previously published guidelines were used fully in determining metrics. The committee chose eight metrics to submit to the ACC Quality Metric Expert Panel for review. Ultimately, metrics regarding hand hygiene and influenza vaccination recommendation for patients did not pass the RAND analysis. Both endocarditis prophylaxis metrics and the RSV/palivizumab metric passed the RAND analysis but fell out during the open comment period. Three metrics passed all analyses, including those for antibiotic prophylaxis in patients with heterotaxy/asplenia, for influenza vaccination compliance in healthcare personnel, and for adherence to recommended regimens of secondary prevention of rheumatic fever. The lack of convincing data to guide quality improvement initiatives in pediatric cardiology is widespread, particularly in infection prevention. Despite this, three metrics were able to be developed for use in the ACC's quality efforts for ambulatory practice. © 2017 Wiley Periodicals, Inc.
Sleep-wake functions and quality of life in patients with subthalamic deep brain stimulation for Parkinson’s disease

PubMed Central

Eugster, Lukas; Oberholzer, Michael; Debove, Ines; Lachenmayer, M. Lenard; Mathis, Johannes; Pollo, Claudio; Schüpbach, W. M. Michael; Bassetti, Claudio L.

2017-01-01

Objectives Sleep-wake disturbances (SWD) are frequent in Parkinson’s disease (PD). The effect of deep brain stimulation (DBS) on SWD is poorly known. In this study we examined the subjective and objective sleep-wake profile and the quality of life (QoL) of PD patients in the context of subthalamic DBS. Patients and methods We retrospectively analyzed data from PD patients and candidates for DBS in the nucleus suthalamicus (STN). Pre-DBS, sleep-wake assessments included subjective and objective (polysomnography, vigilance tests and actigraphy) measures. Post-DBS, subjective measures were collected. QoL was assessed using the Parkinson’s Disease Questionnaire (PDQ-39) and the RAND SF-36-item Health Survey (RAND SF-36). Results Data from 74 PD patients (62% male, mean age 62.2 years, SD = 8.9) with a mean UPDRS-III (OFF) of 34.2 (SD = 14.8) and 11.8 (SD = 4.5) years under PD treatment were analyzed. Pre-DBS, daytime sleepiness, apathy, fatigue and depressive symptoms were present in 49%, 34%, 38% and 25% of patients respectively but not always as co-occurring symptoms. Sleep-wake disturbances were significantly correlated with QoL scores. One year after STN DBS, motor signs, QoL and sleepiness improved but apathy worsened. Changes in QoL were associated with changes in sleepiness and apathy but baseline sleep-wake functions were not predictive of STN DBS outcome. Conclusion In PD patients presenting for STN DBS, subjective and objective sleep-wake disturbances are common and have a negative impact on QoL before and after neurosurgery. Given the current preliminary evidence, prospective observational studies assessing subjective and objective sleep-wake variables prior to and after DBS are needed. PMID:29253029
The Importance of Nonlinear Transformations Use in Medical Data Analysis.

PubMed

Shachar, Netta; Mitelpunkt, Alexis; Kozlovski, Tal; Galili, Tal; Frostig, Tzviel; Brill, Barak; Marcus-Kalish, Mira; Benjamini, Yoav

2018-05-11

The accumulation of data and its accessibility through easier-to-use platforms will allow data scientists and practitioners who are less sophisticated data analysts to get answers by using big data for many purposes in multiple ways. Data scientists working with medical data are aware of the importance of preprocessing, yet in many cases, the potential benefits of using nonlinear transformations is overlooked. Our aim is to present a semi-automated approach of symmetry-aiming transformations tailored for medical data analysis and its advantages. We describe 10 commonly encountered data types used in the medical field and the relevant transformations for each data type. Data from the Alzheimer's Disease Neuroimaging Initiative study, Parkinson's disease hospital cohort, and disease-simulating data were used to demonstrate the approach and its benefits. Symmetry-targeted monotone transformations were applied, and the advantages gained in variance, stability, linearity, and clustering are demonstrated. An open source application implementing the described methods was developed. Both linearity of relationships and increase of stability of variability improved after applying proper nonlinear transformation. Clustering simulated nonsymmetric data gave low agreement to the generating clusters (Rand value=0.681), while capturing the original structure after applying nonlinear transformation to symmetry (Rand value=0.986). This work presents the use of nonlinear transformations for medical data and the importance of their semi-automated choice. Using the described approach, the data analyst increases the ability to create simpler, more robust and translational models, thereby facilitating the interpretation and implementation of the analysis by medical practitioners. Applying nonlinear transformations as part of the preprocessing is essential to the quality and interpretability of results. ©Netta Shachar, Alexis Mitelpunkt, Tal Kozlovski, Tal Galili, Tzviel Frostig, Barak Brill, Mira Marcus-Kalish, Yoav Benjamini. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 11.05.2018.
Enduring U.S. Interests in the Persian Gulf Region

DTIC Science & Technology

2012-03-02

building partner capacity” ( BPC ). BPC is part of a larger security assistance framework which provides defense articles, military training, and...Santa Monica, CA: Rand, 2010), 157 . 15The Cooperation Council for the Arab States of the Gulf; http://www.gcc-sg.org/eng/ indexfc7a.html?action=Sec
CETA: Is It Equitable for Women? A Rand Note.

ERIC Educational Resources Information Center

Berryman, Sue E.; And Others

A study assessed whether the Comprehensive Employment and Training Act (CETA) equitably allocates its training, employment, occupational, and wage benefits by sex. To analyze the sex equity of CETA's resource distribution, researchers used data from the Continuous Longitudinal Manpower Survey (CLMS) for fiscal 1976, 1977, and 1978 CETA enrollees.…
Libya After Qaddafi: Lessons and Implications for the Future

DTIC Science & Technology

2014-01-01

research findings and objective analysis that address the challenges facing the public and private sectors . All RAND reports undergo rigorous peer...8 The Need for Far-Reaching Security Sector Reform...World Bank , International Monetary Fund, IHS, Inter- national Foundation for Electoral Systems, Dartmouth College, the National Endowment for
Personality, Political Skill, and Job Performance

ERIC Educational Resources Information Center

Blickle, Gerhard; Meurs, James A.; Zettler, Ingo; Solga, Jutta; Noethen, Daniela; Kramer, Jochen; Ferris, Gerald R.

2008-01-01

Based on the socioanalytic perspective of performance prediction [Hogan, R. (1991). Personality and personality assessment. In M. D. Dunnette, L. Hough, (Eds.), "Handbook of industrial and organizational psychology" (2nd ed., pp. 873-919). Chicago: Rand McNally; Hogan, R., & Shelton, D. (1998). A socioanalytic perspective on job performance.…
47 CFR 27.1208 - BTA service areas.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... Except for incumbent BRS licenses, BRS service areas are Basic Trading Areas (BTAs) or additional service... in places where Rand McNally has not defined BTAs: American Samoa; Guam; Gulf of Mexico Zone A; Gulf of Mexico Zone B; Gulf of Mexico Zone C; Northern Mariana Islands; Mayaguez/Aguadilla-Ponce, Puerto...
Detection Performance of an Operator Using Lofar

DTIC Science & Technology

1976-04-01

Blur on Perimetric Thresholds," Aroh. of Opthalmology , 68:2, pp. 240-51 (1962). 15. Ferree, C.E., Rand, G., Hardy, C, "Refraction for the...Static Perimetric Technique Believed to Test Receptive Field Properties III Clinical Trials," Am. Jour. Opthalmology , 70:2, pp. 244-272 (Aug. 1970
Effects of simulated prescribed fire on American chestnut and northern red oak regeneration

Treesearch

Ethan P. Belair; Mike R. Saunders; Stacy L. Clark

2014-01-01

American chestnut (Castanea dentata [Marsh.] Borkh.) was a dominant species in the forests of eastern North America prior to the importation of chestnut blight (Cryphonectria parasitica [Murr.] Barr) in the early 1900s and ink disease (Phytophthora cinnamomi Rands) in the 1800s (Anagnostakis 2012). Historical...
The Iraq Effect: The Middle East After the Iraq War

DTIC Science & Technology

2010-01-01

Middle East After the Iraq War THE IRAQ EFFECT Frederic Wehrey Dalia Dassa Kaye Jessica Watkins Jeffrey Martini Robert A. Guffey The RAND...tx_ttnews[tt_news]=159 Jones, Seth , “The Rise of Afghanistan’s Insurgency: State Failure and Jihad,” International Security Journal, Vol. 32, No. 4
Comprehensive School Reform & Student Achievement in Kentucky Middle Schools

ERIC Educational Resources Information Center

Evans-Andris, Melissa; Usui, Wayne M.

2008-01-01

This project examines the effects of Comprehensive School Reform (CSR) models on the achievement of students in Kentucky middle schools. Previous studies exploring the effects of CSR on schools and student achievement have rendered mixed results (Berends, 2000; May & Supovitz, 2006; May, Supovitz, & Perda, 2004; RAND, 2002; Zhang,…
Understanding Low Survey Response Rates Among Young U.S. Military Personnel

DTIC Science & Technology

2015-01-01

and Training; Resource Management; and Strategy and Doctrine. The research reported here was prepared under contract FA7014-06-C-0001. Additional...Sampling Strategy ........................................................................................................................ 3 Response...27 Strategies to Reduce Nonresponse in the 2012 RAND Information and Communication Technology and Well-Being Survey

Expectations of Malaysian Mothers for the Schooling of Their Children.

ERIC Educational Resources Information Center

Waite, Linda J.; And Others

A Rand study develops a model concerning mothers in Peninsular Malaysia's three major ethnic groups (Malay, Chinese, Indian), investigating relationships between their early life experiences and their expectations for education levels of their children. The model examines three of the women's early life experiences that are governed by their…
Steps toward a Formative Evaluation of NSDL. Technical Report

ERIC Educational Resources Information Center

Bikson, Tora K.; Kalra, Nidhi; Galway, Lionel A.; Agnew, Grace

2011-01-01

The National Science Foundation's (NSF) National Science Digital Library/Distributed Learning (NSDL) program turned 10 years old in 2010. This report presents results of a preliminary program evaluation carried out by RAND and is organized around three principal goals: (1) Provide an initial evaluation of NSDL based on existing information…
2 CFR Appendix Viii to Part 200 - Nonprofit Organizations Exempted From Subpart E-Cost Principles of Part 200

Code of Federal Regulations, 2014 CFR

2014-01-01

..., Headquartered in Columbus, Ohio 7. Brookhaven National Laboratory, Upton, New York 8. Charles Stark Draper... 19. National Radiological Astronomy Observatory, Green Bank, West Virginia 20. National Renewable Energy Laboratory, Golden, Colorado 21. Oak Ridge Associated Universities, Oak Ridge, Tennessee 22. Rand...
Implementing Diagnostic/Prescriptive Reading Innovations.

ERIC Educational Resources Information Center

Wirt, John G.

The results of fieldwork in six diagnostic/prescriptive reading projects in school districts within and around Santa Monica, California, are summarized in this paper. The fieldwork was designed to examine the process of implementing diagnostic/prescriptive approach reading projects and was done as part of a large Rand study of innovative projects…
RAND Review. Volume 28, Number 2, Summer 2004

DTIC Science & Technology

2004-01-01

received an average of 23 percent district of Tijuana , more for unprotected sex (and up to 46 percent more if Mexico, displays the workers were judged...management. "Improvement in access to medica - eral ways, according to the reports. Vulnerable elders tions without quality assurance may result in a mere
Simultaneous Monitoring of Vascular Oxygenation and Tissue Oxygen Tension of Breast Tumors Under Hyperbaric Oxygen Exposure

DTIC Science & Technology

2008-04-01

28. Alagoz, T., R. Buller, B. Anderson, K. Terrell , R...and oxygenation Ann . New Acad. Sci. 838 29–45 Chapman J D, Stobbe C C, Arnfield M R, Santus R, Lee J and McPhee M S 1991 Oxygen dependency of tumor
Model Effectiveness as a Function of Personnel (ME = f(PER))

DTIC Science & Technology

1986-10-01

Human Factor in Military Modernization, The RAND Corporation, R- 2460-NA, 1979 AD-A072955 D-7. SUPPRESSION Mueller, M. P., K. H. Pietsch , Human Factors in...H. Pietsch , Human Factors in Field Experimentation, Design and Analysis of an Analytical Suppression Model, 1978 A061417 Office of Naval Research
Restructuring Military Education and Training. Lessons from RAND Research.

ERIC Educational Resources Information Center

Winkler, John D.; Steinberg, Paul S.

This report examines research on initiatives intended to restructure military training with a focus on specialized skill training in military schools. Chapter 1 addresses the status of restructuring initiatives. Chapter 2 focuses on a methodology to examine the effects of restructuring and consolidation. It discusses in detail the elements…
Analysis of Vietnamization: Summary and Evaluation

DTIC Science & Technology

1973-11-01

Ellsberg, Daniel . Some Lessons from Failure in Vietnam, P-4036. Santa Monica: The RAND Corp., July 1969. Fulbright, J. William (ed.). The Vietnam...34 Chira and North Vietnam: Two Revolutionary Paths, " Part I, Current Scene, Vol. IX, No. II (Nov 7, 1971), Part II, Current Scene. Vol. IX, No. IZ (Doc 7
Knowledge Acquisition, Knowledge Programming, and Knowledge Refinement.

ERIC Educational Resources Information Center

Hayes-Roth, Frederick; And Others

This report describes the principal findings and recommendations of a 2-year Rand research project on machine-aided knowledge acquisition and discusses the transfer of expertise from humans to machines, as well as the functions of planning, debugging, knowledge refinement, and autonomous machine learning. The relative advantages of humans and…
Rand Symposium on Pilot Training and the Pilot Career. (Santa Monica, Calif., Feb. 23-27, 1970).

ERIC Educational Resources Information Center

Stewart, W. A.; Wainstein, E. S.

This document contains discussions of the following: The pilot career; Career and education; The pilot skill--definition, measurement, and retention; Relevance of training to combat; Selection; Motivation; Training innovations and the role of research; Simulators; The instructor pilot; Topics for research. (Author/CK)
78 FR 1253 - Notice of Determinations Regarding Eligibility to Apply for Worker Adjustment Assistance

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-08

... Trade Commission as a member of a domestic industry in an investigation resulting in-- (A) An... date 82,024 Thermo King Corporation, Louisville, GA........ October 1, 2011. Ingersoll-Rand, Manpower... Pine, NC....... October 31, 2011. Recreational Products, Outboard Engine Division, Manpower. Negative...
Applying Concepts of Critical Pedagogy to Qatar's Educational Reform

ERIC Educational Resources Information Center

Romanowski, Michael H.; Amatullah, Tasneem

2016-01-01

Qatar is in the midst of a systemic education reform, Education For a New Era, steered by RAND's (a nonprofit research organization) analysis and report of Qatar's Educational system. Driven by a neoliberal agenda, the reform includes international curricula, curriculum standards, teacher licensure, and professional standards for school leaders…
The Reform of Qatar University. Monograph

ERIC Educational Resources Information Center

Moini, Joy S.; Bikson, Tora K.; Neu, C. Richard; DeSisto, Laura

2009-01-01

In 2003, the State of Qatar engaged the RAND-Qatar Policy Institute to assist Qatar University, the nation's first and only public higher education institution, with reform of its major administrative and academic structures, policies, and practices. This monograph summarizes that reform effort, which formally lasted from October 2003 through…
Planning and Financing Education Technology.

ERIC Educational Resources Information Center

Harvey, James, Ed.

This report summarizes one of a series of workshops organized by RAND's Critical Technologies Institute (CTI), on behalf of the U.S. Department of Education, to take advantage of the experience and insights of those already implementing new technologies in schools. The workshop consisted chiefly of dialogues with educators and experts from the…
Individual Difference Relations in Psychometric and Experimental Cognitive Tasks

DTIC Science & Technology

1980-04-01

underrepresented in the factor-analytic and correlational studies done to date. One such process is what is commonly called encoding (the process REPFRM de...IL 61820 Eugene OR 97403 1 ERIC Facility-Acquisitions 1 Dr. Barbara Hayes-Roth 41833 Rugby Avenue The Rand Corporation Bethesda, VAD 20014 1700 Main
Nanotechnology - Enabled Sensing

DTIC Science & Technology

2009-05-07

Sailor, Steve Semancik, Selim Shahriar, Ranga nathan Shashidhar, Richard Silberglitt, Joseph Stetter, Duncan Stewart, Mark Stiles, Thomas Thundat...Evans National Nanotechnology Coordination Office Patricia Foland World Technology Evaluation Center Richard Gaster‡ Stanford University Bonnie...Technology Selim Shahriar*, ◊ Northwestern University Ranganathan Shashidhar‡,†,◊ Polestar Technologies, Inc. Richard Silberglitt*,§, ◊ RAND
77 FR 24487 - Agency Information Collection Activities; Submission to OMB for Review and Approval; Comment...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-24

... INFORMATION CONTACT: Sally Rand, Climate Change Division, Office of Atmospheric Programs (6207J... are very potent greenhouse gases with global warming potentials several thousand times that of carbon....regulations.gov as EPA receives them and without change, unless the comment contains copyrighted material...
Improving Development and Utilization of U.S. Air Force Intelligence Officers

DTIC Science & Technology

2009-01-01

to such jobs in September 2005, those jobs are included in this study. 6 Gregory F. Treverton and C. Bryan Gabbard , Assessing the Tradecraft of... Gabbard , Assessing the Tradecraft of Intelligence Analysis, Santa Monica, Calif.: RAND Corporation, TR-293-CCNI(A), 2008. As of March 16, 2009: http
A Guide to Educational Performance Contracting.

ERIC Educational Resources Information Center

Hall, G. R.; And Others

This report is distilled from Rand's findings in previously reported research and from new research. It is addressed to school board members, administrators, and other educational decisionmakers who may be contemplating a performance contracting program. The guide follows the life cycle of a project and identifies the three major phases as…

Rediscovering the Alcoholism Field: New Trends and Needs.

ERIC Educational Resources Information Center

Dolan, Joseph S.

1987-01-01

Outlines trends developing in the alcoholism field including: youth, treatment, public policy, education, research, and the Rand Report. Identifies two needs: the need to look at the interrelationships of programs and trends and the need to foster an environment which does not tolerate drunkenness or intoxication. (Author/ABB)
47 CFR 101.1007 - Geographic service areas and number of licenses.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 5 2011-10-01 2011-10-01 false Geographic service areas and number of licenses. 101.1007 Section 101.1007 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) SAFETY AND... in the Rand McNally 1992 Commercial Atlas & Marketing Guide, 123rd Edition, at pages 38-39, that...
Shaping Columbia’s Stability through Strategic Communication: Evaluating U.S. Effectiveness

DTIC Science & Technology

2009-05-21

113-114. The authors have adapted the 10 Step framework for military applicability from Philip Kotler , Ned Roberto, and Nancy Lee, Social Marketing...Qaida. Santa Monica: RAND Corporation, 2008. Keegan, John. The Iraq War. New York: Alfred A. Knopf, 2004. Kotler , Philip , Ned Roberto, and Nancy
An Evaluation of Performance Contracting for HEW.

ERIC Educational Resources Information Center

Carpenter, Polly

This speech provides a summary of the Rand/HEW study of eight performance contract programs in the five cities of Gilroy, California; Texarkana, Arkansas; Gary, Indiana; Grand Rapids, Michigan; and Norfolk, Virginia. The effects of performance contracting on instruction and on student learning, the program costs and management, the contractors,…
The Market for Educational Software.

ERIC Educational Resources Information Center

Harvey, James, Ed.

This report summarizes one of a series of workshops organized by RAND's Critical Technologies Institute, on behalf of the U.S. Department of Education, to take advantage of the experience of those already implementing new technologies in the schools. The workshop consisted chiefly of dialogues with educators and experts from the private sector who…
Emerging Issues in Education: Policy Implications for the Schools.

ERIC Educational Resources Information Center

Bruno, James E., Ed.

Contents of this volume, one product of a collaboration between the Carnegie Corporation and Rand initiated in July 1969, include the following papers: "Emerging Issues in Education . . .," J. E. Bruno; "Societal Foundations for Change: Educational Alternatives for the Future," W. Harman: "Constitutional Aspects of Equality of Educational…
Schooling in Malaysia: Historical Trends and Recent Enrollments. A Rand Note.

ERIC Educational Resources Information Center

De Tray, Dennis

The educational history of Malaysia is discussed; policy, historical trends, and school attendance are emphasized. Increased schooling and increased returns to schooling have been essential ingredients in Malaysia's economic growth. Schooling levels have risen rapidly since independence and, while all Malaysians have shared substantially in this…
Planning Without History or Cultural Perspective

DTIC Science & Technology

2015-05-21

8217, News.Bbc.Co.Uk, last modified 2015, accessed January 20, 2015, http://news.bbc.co.uk/2/hi/middle_east/3557446.stm. 119 Nimrod Raphaeli, “Understanding...pubs/monographs/2008/RAND_MG595.3.pdf. Raphaeli, Nimrod . “Understanding Muqtada al-Sadr.” Middle East Quarterly (Fall 2004): 33-42. Rathmell, Andrew
ECONOMICS DEPARTMENT PUBLICATIONS, 1960-1965: AN AUTHOR INDEX OF THE OPEN LITERATURE, WITH ABSTRACTS,

DTIC Science & Technology

This is an author index for RAND Economics Department publications issued between January 1, 1960 and December 31, 1965, and available in the open...As a reference aid, the names of all authors are given alphabetically in the Author List immediately preceding the Author Index .
Relating Expected Inventory Backorders to Safety Stock Investment Levels.

DTIC Science & Technology

1981-09-01

Theory," RM-4185-PR. The Rand Corporation, Santa Monica CA, September 1964. 105 11. Haeussler, Ernest F. Jr., and Richard S. Paul. Introduc- tory...14. Lewis, Colin D. Demand Analysis and Inventor4 Control. Westmead, England: Saxon House D.C. Heath Ltd., 1975. 15. Lippert , Keith Wayne. "An
Discriminative power of Campylobacter phenotypic and genotypic typing methods.

PubMed

Duarte, Alexandra; Seliwiorstow, Tomasz; Miller, William G; De Zutter, Lieven; Uyttendaele, Mieke; Dierick, Katelijne; Botteldoorn, Nadine

2016-06-01

The aim of this study was to compare different typing methods, individually and combined, for use in the monitoring of Campylobacter in food. Campylobacter jejuni (n=94) and Campylobacter coli (n=52) isolated from different broiler meat carcasses were characterized using multilocus sequence typing (MLST), flagellin gene A restriction fragment length polymorphism typing (flaA-RFLP), antimicrobial resistance profiling (AMRp), the presence/absence of 5 putative virulence genes; and, exclusively for C. jejuni, the determination of lipooligosaccharide (LOS) class. Discriminatory power was calculated by the Simpson's index of diversity (SID) and the congruence was measured by the adjusted Rand index and adjusted Wallace coefficient. MLST was individually the most discriminative typing method for both C. jejuni (SID=0.981) and C. coli (SID=0.957). The most discriminative combination with a SID of 0.992 for both C. jejuni and C. coli was obtained by combining MLST with flaA-RFLP. The combination of MLST with flaA-RFLP is an easy and feasible typing method for short-term monitoring of Campylobacter in broiler meat carcass. Copyright © 2016 Elsevier B.V. All rights reserved.
Extracorporeal treatment for carbamazepine poisoning: Systematic review and recommendations from the EXTRIP workgroup

PubMed Central

Ghannoum, Marc; Yates, Christopher; Galvao, Tais F.; Sowinski, Kevin M.; Vo, Thi Hai Vân; Coogan, Andrew; Gosselin, Sophie; Lavergne, Valery; Nolin, Thomas D.; Hoffman, Robert S.

2014-01-01

Abstract Context. The Extracorporeal Treatments in Poisoning (EXTRIP) workgroup was created to provide evidence and consensus-based recommendations on the use of extracorporeal treatments (ECTRs) in poisoning. Objectives. To perform a systematic review and provide clinical recommendations for ECTR in carbamazepine poisoning. Methods. After a systematic literature search, the subgroup extracted the data and summarized the findings following a pre-determined format. The entire workgroup voted via a two-round modified Delphi method to reach a consensus on voting statements, using a RAND/UCLA Appropriateness Method to quantify disagreement. Anonymous votes were compiled, returned, and discussed in person. A second vote determined the final recommendations. Results. Seventy-four articles met inclusion criteria. Articles included case reports, case series, descriptive cohorts, pharmacokinetic studies, and in-vitro studies; two poor-quality observational studies were identified, yielding a very low quality of evidence for all recommendations. Data on 173 patients, including 6 fatalities, were reviewed. The workgroup concluded that carbamazepine is moderately dialyzable and made the following recommendations: ECTR is suggested in severe carbamazepine poisoning (2D). ECTR is recommended if multiple seizures occur and are refractory to treatment (1D), or if life-threatening dysrhythmias occur (1D). ECTR is suggested if prolonged coma or respiratory depression requiring mechanical ventilation are present (2D) or if significant toxicity persists, particularly when carbamazepine concentrations rise or remain elevated, despite using multiple-dose activated charcoal (MDAC) and supportive measures (2D). ECTR should be continued until clinical improvement is apparent (1D) or the serum carbamazepine concentration is below 10 mg/L (42 the μ in μmol/L looks weird.) (2D). Intermittent hemodialysis is the preferred ECTR (1D), but both intermittent hemoperfusion (1D) or continuous renal replacement therapies (3D) are alternatives if hemodialysis is not available. MDAC therapy should be continued during ECTR (1D). Conclusion. Despite the low quality of the available clinical evidence and the high protein binding capacity of carbamazepine, the workgroup suggested extracorporeal removal in cases of severe carbamazepine poisoning. PMID:25355482
Getting to Outcomes: A Best Practice Process to Help Schools Achieve Desired Outcomes

ERIC Educational Resources Information Center

Maras, Melissa A.; Wandersman, Abe; Splett, Joni Williams; Flaspohler, Paul; Weist, Mark

2012-01-01

This article describes Getting to Outcomes (GTO), a 10-step framework for accountability designed to facilitate effective implementation of evidence-based programs and improvement of home-grown practices (Getting to Outcomes and GTO are trademarks registered by the University of South Carolina and RAND; Wandersman, Imm, Chinman, & Kaftarian,…
Did Teachers' Verbal Ability and Race Matter in the 1960s? "Coleman" Revisited. RAND Reprints.

ERIC Educational Resources Information Center

Ehrenberg, Ronald G.; Brewer, Dominic J.

This paper reanalyzed data from the classic 1966 study "Equality of Educational Opportunity," or "Coleman Report." It addressed the issue of whether teacher characteristics, including verbal ability and race, influenced "synthetic gain scores" of students (mean test scores of upper grade students in a school minus…
Information Transfer Problems of the Partially Sighted: Recent Results and Project Summary.

ERIC Educational Resources Information Center

Genensky, S. M.; And Others

The fourth in a series of Rand reports on information transfer problems of the partially sighted reviews earlier reports and describes an experimental secretarial closed circuit TV (CCTV) system which enables the partially sighted to type from a printed or handwritten manuscript. Discussed are experiments using a pseudocolor system to determine…
A Synthesis of Literature on the Effectiveness of Community Orders. Technical Report Summary

ERIC Educational Resources Information Center

Davis, Robert; Rabinovich, Lila; Rubin, Jennifer; Kilmer, Beau; Heaton, Paul

2008-01-01

The U.K. National Audit Office (NAO) commissioned RAND Europe to conduct this review to identify and synthesize international research about the effectiveness of community orders in reducing re-offending. In this report, we review research on ten of the common requirements contained in community orders. Through examining reviews, systematic…
A Synthesis of Literature on the Effectiveness of Community Orders. Technical Report

ERIC Educational Resources Information Center

Davis, Robert; Rabinovich, Lila; Rubin, Jennifer; Kilmer, Beau; Heaton, Paul

2008-01-01

The U.K. National Audit Office (NAO) commissioned RAND Europe to conduct this review to identify and synthesize international research about the effectiveness of community orders in reducing re-offending. In this report, we review research on ten of the common requirements contained in community orders. Through examining reviews, systematic…
Unique Framework Helps Louisiana Community Prioritize Its Investments in Children and Families. Research Brief

ERIC Educational Resources Information Center

Wiseman, Shelley

2010-01-01

In 2008, the Shreveport-Bossier Community Foundation selected education, health, and poverty as funding priorities. But the foundation realized that it needed more specific guidelines on how best to distribute grants. RAND developed a framework for making investment decisions that incorporates the best of traditional decision making approaches.…
Assessing Impact Submissions for REF 2014: An Evaluation

ERIC Educational Resources Information Center

Manville, Catriona; Guthrie, Susan; Henham, Marie-Louise; Garrod, Bryn; Sousa, Sonia; Kirtley, Anne; Castle-Clarke, Sophie; Ling, Tom

2015-01-01

The Research Excellence Framework (REF) is a new system for assessing the quality of research in UK higher education institutions (HEIs). For the first time, part of the assessment included the wider impact of research. RAND Europe was commissioned to evaluate the assessment process of the impact element of REF submissions, and to explore the…
Understanding Our Gifted, Volume 2, Issues 1-6, September 1989-August 1990.

ERIC Educational Resources Information Center

Silverman, Linda, Ed.

1990-01-01

This document consists of six issues (all of volume 2) of a newsletter subtitled "Dedicated to Helping Gifted Children Reach their Full Potential". These issues deal with all aspects of parenting and educating gifted children. Major articles include: "Re-examining the Concept of Underachievement" (Joanne Rand Whitmore);…

Financial Futures of the Islamic State of Iraq and the Levant

DTIC Science & Technology

2017-03-27

iii Preface The Islamic State of Iraq and the Levant (ISIL) has been described as the wealthiest terrorist group in history. From seizing control of...interagency group within the U.S. government and conducted within the Intelligence Policy Center of the RAND National Defense Research Institute, a...17 CHAPTER FOUR
Rand Symposium on Pilot Training and the Pilot Career; Recollections of the Chairman.

ERIC Educational Resources Information Center

Stewart, W. A.

Topics discussed in this 1970 symposium included the economics of flight training, careers in flying, college versus high school graduates, defining the trained pilot, motivation and selection, innovation in pilot training, training goals, transfer of training, and the role of simulators. Conferees agreed that the present Air Force undergraduate…
The Politics of Staff Development.

ERIC Educational Resources Information Center

Mann, Dale

This report presents the methodology and some of the results from part of an on-going Rand Corporation study of change agent programs sponsored by the U.S. Office of Education. It concentrates on staff development as a vehicle for change in schools. After a brief introduction, the methodology of the study is presented. The third section examines…
China’s Evolving Nuclear Deterrent: Major Drivers and Issues for the United States

DTIC Science & Technology

2017-01-01

permissions. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout...13 Organization of This Report...Several exter- nal organizations have tried to fill the gaps in data and understanding. The Bulletin of the Atomic Scientists, for example, publishes an
A Comparison of the AFGL Flash, Draper Dart and AWS Haze Models with the Rand Wetta Model for Calculating Atmospheric Contrast Reduction.

DTIC Science & Technology

1982-03-01

52 ILLUSTRATIONS Figure I Horizontal Visibility Profiles for Stair-Step and Exponential Extinction Coefficient...background reflectances. These values were then numerically intergrated (via a combination of Simpson’s and Newton’s 3/8th rules) and compared with the
California's Demographic Future. A Rand Note.

ERIC Educational Resources Information Center

McCarthy, Kevin F.; Valdez, R. Burciaga

California's image as the Golden State is based largely on its rapid population and economic growth. However, recent trends show an aging population, a decline in population growth, a reduction in the number of migrants from other states, and a dramatic increase in foreign-born residents. Since 1960, the state's growth rate has slowed…
Prolonged Cycle Times and Schedule Growth in Defense Acquisition: A Literature Review

DTIC Science & Technology

2014-01-01

www.rand.org/pubs/monograph_reports/MR1362.html Blakeman, Seth T., Anthony R. Gibbs, and Jeyanthan Jeyasingam, Study of the Mine Resistant Ambush...Chad J. R. Ohlandt, Caroline Reilly, Rena Rudavsky, Jerry M. Sollinger, Katharine Watkins Webb, and Carolyn Wong, Root Cause Analyses of Nunn-McCurdy
Senate Hearing on Assured Access to Space

NASA Image and Video Library

2014-07-16

Dr. Yool Kim, Senior Engineer at the Rand Corporation, delivers her opening statment during a hearing in front of the Senate Subcommittee on Strategic Forces and Senate Committee on Commerce, Science, and Transportation on Wednesday, July 16, 2014, at the Hart Senate Office Building in Washington, DC. The Senate hearing focused on assured access to space.
Class Size Reduction or Rapid Formative Assessment?: A Comparison of Cost-Effectiveness

ERIC Educational Resources Information Center

Yeh, Stuart S.

2009-01-01

The cost-effectiveness of class size reduction (CSR) was compared with the cost-effectiveness of rapid formative assessment, a promising alternative for raising student achievement. Drawing upon existing meta-analyses of the effects of student-teacher ratio, evaluations of CSR in Tennessee, California, and Wisconsin, and RAND cost estimates, CSR…
Comprehensive School Reform: The Implementation Gap. Research Brief

ERIC Educational Resources Information Center

RAND Corporation, 2006

2006-01-01

Does Comprehensive School Reform (CSR) work? Research results have been mixed. Some studies have measured a modest improvement in student achievement; others have found no effect. A team of RAND researchers has approached the question of CSR's effectiveness by first focusing on an even more basic question: Has CSR been implemented? A shortcoming…
Federal Programs Supporting Educational Change, Vol. 5: Executive Summary.

ERIC Educational Resources Information Center

Berman, Paul; And Others

Under the sponsorship of the U. S. Office of Education, Rand is conducting a several-year study of federally funded programs designed to introduce and spread innovative practices in public schools. These change agent programs normally offer temporary federal funding to school districts as "seed money" or "risk capital." If an…
Project AIR FORCE Modeling Capabilities for Support of Combat Operations in Denied Environments

DTIC Science & Technology

2015-01-01

within the Air Force and OSD.7 First, we thank Generals Herbert Carlisle, PACAF/CC, and Janet Wolfenbarger, AFMC/CC, for sponsoring this work. Gen...March 2014: http://www.rand.org/pubs/monographs/MG176.html Stucker, James P., Ruth T. Berg, Andre A. Gerner, Amada Giarla, William L. Spencer
SMART Security Cooperation Objectives: Improving DoD Planning and Guidance

DTIC Science & Technology

2016-01-01

integrate them into a system for assessing, monitoring, and evaluating security cooperation programs and activities. This report evaluates DoD’s...effectiveness in developing SMART security coopera- tion objectives that facilitate assessment, monitoring, and evaluation . It also proposes a systematic...Cooperation Ends, Ways, and Means . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 RAND Evaluation and Revision of Selected
Understanding Iran

DTIC Science & Technology

2009-01-01

SPONSOR/MONITOR’S REPORT NUMBER( S ) 12. DISTRIBUTION /AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY...This document and trademark( s ) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic...documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. Limited Electronic Distribution Rights
South Oxnard Challenge Project: Report of What Works.

ERIC Educational Resources Information Center

Lane, Jodi; Schroeder, Amber; Turner, Susan; Fain, Terry

RAND Criminal Justice conducted a randomized experimental evaluation of the South Oxnard Challenge Project (SOCP), a collaborative project between county, city and private non-profit agencies based on the "Corrections of Place" (COP) model. The project targets youth who live in South Oxnard or Port Hueneme, are between 12 and 18 years old, have a…
Predicting the Onset of PTSD: An Analysis of Facial Expression of Emotion in Reaction to Aggressive Displays

DTIC Science & Technology

2011-04-01

amnesia and diminished responsiveness to the outside world (Henline). The RAND Corporation, a nonprofit research organization, conducted a study beginning...negative relationship between performance scores and NPY levels in that the less NPY a Soldier produced, the more likely the Soldier dissociated and
Soybean yield and nutrient utilization following long-term pelletized broiler litter application to cotton

USDA-ARS?s Scientific Manuscript database

Broiler litter may have long-lasting plant growth benefits after application is terminated. A study was conducted to determine the residual effects of pelletized litter relative to inorganic fertilizer applied to cotton in previous years on growth and yield of soybean. Experimental design was a rand...
Outplayed: Regaining Strategic Initiative in the Gray Zone

DTIC Science & Technology

2016-06-01

Harvard University Captain John Chambers, U.S. Army Navy Staff, N -513 Captain Robert Hein, U.S. Navy RAND Dr. David Johnson, Ph.D. Army Capabilities...p. 1. 118. Vitaly Shevchenko, “Little Green Men or Russian Invaders?” BBC Monitoring, March 11, 2014, available from www.bbc.com/news/world-europe
Get the Federal Government out of Education? That Wasn't the Founding Fathers' Vision

ERIC Educational Resources Information Center

Jennings, Jack

2011-01-01

During the 2010 election campaign, Senator Rand Paul from Kentucky demanded the dismantling of the U.S. Department of Education. "I am against any federal funding or control of education," he said. "Historically, education was funded and controlled locally" (Strauss, 2010). Another new Republican senator, Mike Lee from…
Identifying and Eliminating Barriers Faced by Nontraditional Department of Defense Suppliers

DTIC Science & Technology

2014-01-01

organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more...Commands, the Department of the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community . For more information on the RAND...17 Lack of Access to and Communication

28 CFR 21.5 - Use of table of distances.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... Mileage payable to witnesses under 28 U.S.C. 1821 shall be computed on the basis of odometer readings or the highway distances as stated in the Rand McNally Standard Highway Mileage Guide or in any generally accepted highway mileage guide which contains a shortline nationwide table of distances. However, with...
Tenure Shrugged

ERIC Educational Resources Information Center

Glenn, David

2007-01-01

In late April, John D. Lewis, a historian and classicist at Ashland University, flew to Virginia to deliver a lecture at George Mason University about U.S. policy toward Iran. Mr. Lewis is an admirer of the late Ayn Rand, and he shares her belief that democracies should respond to external attacks without much concern for civilian casualties. He…
Redesigning Qatar's Post-Secondary Scholarship System. Research Brief

ERIC Educational Resources Information Center

Augustine, Catherine H.; Krop, Cathy

2008-01-01

At the request of Qatar's Supreme Education Council (SEC), RAND researchers devised a new set of scholarship programs for college-bound Qatari students and proposed the formation of an institute to manage the programs and oversee other post-secondary functions. The suggested system balanced support for local institutions of higher learning with…
Qatar's Educational Reform Past and Future: Challenges in Teacher Development

ERIC Educational Resources Information Center

Nasser, Ramzi

2017-01-01

Until the late 1990s, Qatar's educational system used the intrinsic-nationalistic and cultural traditions of Arabic schools. The Qatari leadership and stakeholder was outdated; hence, they approached the RAND Corporation to examine and analyze the existing educational system and recommend options for building a new educational system. The RAND…
Revitalizing Qatar's National University. Research Brief

ERIC Educational Resources Information Center

Steinberg, Paul

2009-01-01

Although Qatar University (QU) had been well regarded in the past, its performance had deteriorated by 2003, and the country's leadership was concerned that the university was not meeting Qatar's needs. From 2003 to 2007, the university led a reform process facilitated by RAND and outside experts, which clarified QU's mission and reformed QU's…
47 CFR 27.1231 - Initiating the transition.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Basic Trading Area (BTA). BTAs are based on the Rand McNally 1992 Commercial Atlas & Marketing Guide...; and (C) Specify, if known, the adjacent channel D/U ratio that can be tolerated by any receiver(s) at... database; (F) The bandwidth of each channel or subchannel, the emission type for each channel or subchannel...
Investment Strategies for Improving Fifth-Generation Fighter Training

DTIC Science & Technology

2011-01-01

The pod is part of the fifth-generation P5 Combat Training System/Tactical Combat Training System designed by Cubic Corporation. (See Shamim , 2007...http://www.rand.org/pubs/monograph_reports/MR1286/ Shamim , Asif, “F-35 Lightning II News: Cubic Lands Contract for F-35 ACMI Training System,” F-16.net
Youth Labor Markets and the Military. The Rand Paper Series.

ERIC Educational Resources Information Center

Cooper, Richard V. L.

This paper argues that the military plays an extremely important role in youth labor markets by providing not only jobs but also experience and training which can later be transferred to the civilian labor market. Following the introduction, section II examines the military's demand for labor; its fluctuations due to secular, cyclical, and…
Logical Aspects of Question-Answering by Computer.

ERIC Educational Resources Information Center

Kuhns, J. L.

The problem of computerized question-answering is discussed in this paper from the point of view of certain technical, although elementary, notions of logic. Although the work reported herein has general application to the design of information systems, it is specifically motivated by the RAND Relational Data File. This system, for which a…
Analysis of Costs in an Algebra I Curriculum Effectiveness Study. Technical Report

ERIC Educational Resources Information Center

Daugherty, Lindsay; Phillips, Andrea; Pane, John F.; Karam, Rita

2012-01-01

In an ongoing study, RAND researchers are evaluating the effectiveness of Carnegie Learning's Cognitive Tutor Algebra I (CTAI) curriculum, a technology-based curriculum that combines classroom instruction with individualized instruction by a computer-based tutor. While the effectiveness of the curriculum in raising student achievement is the main…
Gramsci, Doke and the Marginalisation of the Ndebele Language in Zimbabwe

ERIC Educational Resources Information Center

Ndhlovu, Finex

2006-01-01

Clement M. Doke's 1929-1930 research on Zimbabwean languages has played a key role in shaping the tribalised and politicised linguistic terrain that characterises modern Zimbabwe. Doke, professor of linguistics at the University of Witwaters-rand, was commissioned in 1929 by the government of Southern Rhodesia (present-day Zimbabwe) to research…
Workforce Planning in the Intelligence Community: A Retrospective

DTIC Science & Technology

2013-01-01

segments of this work. We also wish to thank Dwayne M. Butler and Nelson Lim from RAND and Robert B. Murrett of the Syracuse University Department of Public...Taylor, Richard Eisenman, William Fedorochko, Clifford M. Graf II, Mark Hoyer, Paul Bracken, Norman T. O’Meara, Jerry M. Sollinger, Judith Larson
Dry coal feeder development program at Ingersoll-Rand Research, Incorporated. [for coal gasification systems

NASA Technical Reports Server (NTRS)

Mistry, D. K.; Chen, T. N.

1977-01-01

A dry coal screw feeder for feeding coal into coal gasification reactors operating at pressures up to 1500 psig is described. Results on the feeder under several different modes of operation are presented. In addition, three piston feeder concepts and their technical and economical merits are discussed.
75 FR 45160 - Ingersoll-Rand/Harrow Products, Inc., Formerly Known as Locknetics Including On-Site Leased...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-02

... account under the name Harrow Products, Inc. Accordingly, the Department is amending this certification to... Products, Inc., Formerly Known as Locknetics Including On-Site Leased Workers From Monroe Staffing Services, Adecco USA, Inc., and Infinistaff, LLC, Bristol, CT; Amended Certification Regarding Eligibility To Apply...
Combat Risk and Pay: Theory and Some Evidence

DTIC Science & Technology

2011-10-01

Kavanagh, and Laura Miller. 2006. “How Deployments Affect Service Members.” RAND Report MG432. Hosek, James R. and Mark E. Totten . 2004. “The Effect of...Richard Layard, 12: 641 92. Amsterdam, Netherlands: North Holland Publishing Co. Shogren, Jason F. and Tommy Stamland. 2002. “Skill and the Value of
A Study of Alternatives in American Education, Vol. IV: Family Choice in Schooling.

ERIC Educational Resources Information Center

Bridge, R. Gary; Blackman, Julie

Originating in the Rand Corporation's evaluation of the voucher demonstration project in the Alum Rock Union School District (California), this study of family choice in schooling focuses on these questions: Are parents motivated and competent to make intelligent choices among competing educational alternatives? What kinds of schools do parents…
Models, Simulations, and Games: A Survey.

ERIC Educational Resources Information Center

Shubik, Martin; Brewer, Garry D.

A Rand evaluation of activity and products of gaming, model-building, and simulation carried out under the auspices of the Defense Advanced Research Projects Agency aimed not only to assess the usefulness of gaming in military-political policymaking, but also to contribute to the definition of common standards and the refinement of objectives for…
Using Field Data to Improve Authorized Stockage List Push Packages

DTIC Science & Technology

2011-01-01

end-item such as the M777 is difficult. See Galway and Hanks, 1996, pp. 17–39. 19EDA data contain critical parts that cause equipment to be non...html Galway , Lionel, and Christopher Hanks, Data Quality Problems in Army Logistics Classification, Examples, and Solutions, Santa Monica, CA: RAND
What Teacher Characteristics Affect Student Achievement? Findings from Los Angeles Public Schools. Research Brief

ERIC Educational Resources Information Center

Giglio, Kate

2010-01-01

Teacher effectiveness is typically measured by traditional teacher qualification standards, such as experience, education, and scores on licensure examinations. RAND researchers found no evidence that these standards have a substantial effect on student achievement in Los Angeles public elementary, middle, and high schools. Alternative measures of…
Implementing No Child Left Behind in Three States. Research Brief

ERIC Educational Resources Information Center

Stecher, Brian M.; Epstein, Scott; Hamilton, Laura S.; Marsh, Julie A.; Robyn, Abby; McCombs, Jennifer Sloan; Russell, Jennifer; Naftel, Scott

2008-01-01

This research brief describes work done for RAND Education and documented in "Pain and Gain: Implementing No Child Left Behind in Three States, 2004-2006", Brian M. Stecher, Scott Epstein, Laura S. Hamilton, Julie A. Marsh, Abby Robyn, Jennifer Sloan McCombs, Jennifer Russell, and Scott Naftel." The three states discussed are:…

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