Characterizing the Breadth and Depth of Volunteer Water Monitoring Programs in the United States

NASA Astrophysics Data System (ADS)

Stepenuck, Kristine F.; Genskow, Kenneth D.

2018-01-01

A survey of 345 volunteer water monitoring programs in the United States was conducted to document their characteristics, and perceived level of support for data to inform natural resource management or policy decisions. The response rate of 86% provided information from 46 states. Programs represented a range of ages, budgets, objectives, scopes, and level of quality assurance, which influenced data uses and perceived support by sponsoring agency administrators and external decision makers. Most programs focused on rivers, streams, and lakes. Programs had not made substantial progress to develop EPA or state-approved quality assurance plans since 1998, with only 48% reporting such plans. Program coordinators reported feeling slightly more support for data to be used for management as compared to policy decisions. Programs with smaller budgets may be at particular risk of being perceived to lack credibility due to failure to develop quality assurance plans. Over half of programs identified as collaborative, in that volunteers assisted scientists in program design, data analysis and/or dissemination of results. Just under a third were contributory, in which volunteers primarily collected data in a scientist-defined program. Recommendations to improve perceived data credibility, and to augment limited budgets include developing quality assurance plans and gaining agency approval, and developing partnerships with other organizations conducting monitoring in the area to share resources and knowledge. Funding agencies should support development of quality assurance plans to help ensure data credibility. Service providers can aid in plan development by providing training to program staff over time to address high staff turnover rates.

Lake Champlain TMDL Modeling Quality Assurance Project Plan

EPA Pesticide Factsheets

This document presents the quality assurance project plan for providing support to US EPA Region 1 in revising the Lake Champlain Total Maximum Daily Load, under Contract Number EP-C-08-004, Task Order 80.

Vector-model-supported optimization in volumetric-modulated arc stereotactic radiotherapy planning for brain metastasis

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

Liu, Eva Sau Fan; Department of Health Technology and Informatics, The Hong Kong Polytechnic University; Wu, Vincent Wing Cheung

Long planning time in volumetric-modulated arc stereotactic radiotherapy (VMA-SRT) cases can limit its clinical efficiency and use. A vector model could retrieve previously successful radiotherapy cases that share various common anatomic features with the current case. The prsent study aimed to develop a vector model that could reduce planning time by applying the optimization parameters from those retrieved reference cases. Thirty-six VMA-SRT cases of brain metastasis (gender, male [n = 23], female [n = 13]; age range, 32 to 81 years old) were collected and used as a reference database. Another 10 VMA-SRT cases were planned with both conventional optimization and vector-model-supported optimization, followingmore » the oncologists' clinical dose prescriptions. Planning time and plan quality measures were compared using the 2-sided paired Wilcoxon signed rank test with a significance level of 0.05, with positive false discovery rate (pFDR) of less than 0.05. With vector-model-supported optimization, there was a significant reduction in the median planning time, a 40% reduction from 3.7 to 2.2 hours (p = 0.002, pFDR = 0.032), and for the number of iterations, a 30% reduction from 8.5 to 6.0 (p = 0.006, pFDR = 0.047). The quality of plans from both approaches was comparable. From these preliminary results, vector-model-supported optimization can expedite the optimization of VMA-SRT for brain metastasis while maintaining plan quality.« less

Support for Environmental Assessment Grants for Tribes in Region 6

EPA Pesticide Factsheets

All EPA-funded projects in which environmental measurements are taken must have a written Quality Assurance Project Plan (QAPP) or a Sampling and Analysis Plan (SAP) that contains the required quality assurance (QA) elements.

Support for Environmental Assessment Grants for Tribes in Region 9

EPA Pesticide Factsheets

All EPA-funded projects in which environmental measurements are taken must have a written Quality Assurance Project Plan (QAPP) or a Sampling and Analysis Plan (SAP) that contains the required quality assurance (QA) elements.

The Effects of Follow-up and Peer Interaction on Quality of Performance and Completion of Online Professional Development

ERIC Educational Resources Information Center

Green, Marybeth; Cifuentes, Lauren

2011-01-01

This study examined the effects of the inclusion of online follow-up and online peer interaction with a face-to face workshop on quality of support plan and completion of a support plan by Texas school librarians. The study used a posttest-only control group experimental design with randomly assigned self-selected participants. Three online…

Total Quality Management Implementation Plan: Defense Depot, Ogden

DTIC Science & Technology

1989-07-01

NUMBERS Total Quality Management Implementation Plan Defense Depot Ogden 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING...PAGES TQM (Total Quality Management ), Continuous Process Improvement, Depot Operations, Process Action Teams 16. PRICE CODE 17. SECURITY...034 A Message From The Commander On Total Quality Management i fully support the DLA aoproacii to Total Quality Management . As stated by General

Measuring the impact of diagnostic decision support on the quality of clinical decision making: development of a reliable and valid composite score.

PubMed

Ramnarayan, Padmanabhan; Kapoor, Ritika R; Coren, Michael; Nanduri, Vasantha; Tomlinson, Amanda L; Taylor, Paul M; Wyatt, Jeremy C; Britto, Joseph F

2003-01-01

Few previous studies evaluating the benefits of diagnostic decision support systems have simultaneously measured changes in diagnostic quality and clinical management prompted by use of the system. This report describes a reliable and valid scoring technique to measure the quality of clinical decision plans in an acute medical setting, where diagnostic decision support tools might prove most useful. Sets of differential diagnoses and clinical management plans generated by 71 clinicians for six simulated cases, before and after decision support from a Web-based pediatric differential diagnostic tool (ISABEL), were used. A composite quality score was calculated separately for each diagnostic and management plan by considering the appropriateness value of each component diagnostic or management suggestion, a weighted sum of individual suggestion ratings, relevance of the entire plan, and its comprehensiveness. The reliability and validity (face, concurrent, construct, and content) of these two final scores were examined. Two hundred fifty-two diagnostic and 350 management suggestions were included in the interrater reliability analysis. There was good agreement between raters (intraclass correlation coefficient, 0.79 for diagnoses, and 0.72 for management). No counterintuitive scores were demonstrated on visual inspection of the sets. Content validity was verified by a consultation process with pediatricians. Both scores discriminated adequately between the plans of consultants and medical students and correlated well with clinicians' subjective opinions of overall plan quality (Spearman rho 0.65, p < 0.01). The diagnostic and management scores for each episode showed moderate correlation (r = 0.51). The scores described can be used as key outcome measures in a larger study to fully assess the value of diagnostic decision aids, such as the ISABEL system.

Achieving performance breakthroughs in an HMO business process through quality planning.

PubMed

Hanan, K B

1993-01-01

Kaiser Permanente's Georgia Region commissioned a quality planning team to design a new process to improve payments to its suppliers and vendors. The result of the team's effort was a 73 percent reduction in cycle time. This team's experiences point to the advantages of process redesign as a quality planning model, as well as some general guidelines for its most effective use in teams. If quality planning project teams are carefully configured, sufficiently expert in the existing process, and properly supported by management, organizations can achieve potentially dramatic improvements in process performance using this approach.

Orienting health care information systems toward quality: how Group Health Cooperative of Puget Sound did it.

PubMed

Goverman, I L

1994-11-01

Group Health Cooperative of Puget Sound (GHC), a large staff-model health maintenance organization based in Seattle, is redesigning its information systems to provide the systems and information needed to support its quality agenda. Long-range planning for GHC's information resources was done in three phases. In assessment, interviews, surveys, and a benchmarking effort identified strengths and weaknesses of the existing information systems. We concluded that we needed to improve clinical care and patient management systems and enhance health plan applications. In direction setting, we developed six objectives (for example, approach information systems in a way that is consistent with quality improvement principles). Detailed planning was used to define projects, timing, and resource allocations. Some of the most important efforts in the resulting five-year plan include the development of (1) a computerized patient record; (2) a provider-based clinical workstation for access to patient information, order entry, results reporting, guidelines, and reminders; (3) a comprehensive set of patient management and service quality systems; (4) reengineered structures, policies, and processes within the health plan, supported by a complete set of integrated information systems; (5) a standardized, high-capacity communications network to provide linkages both within GHC and among its business partners; and (6) a revised oversight structure for information services, which forms partnerships with users. A quality focus ensured that each project not only produced its own benefits but also supported the larger organizational goals associated with "total" quality.

Beyond consumer-driven health care: purchasers' expectations of all plans.

PubMed

Lee, Peter V; Hoo, Emma

2006-01-01

Skyrocketing health care costs and quality deficits can only be addressed through a broad approach of quality-based benefit design. Consumer-directed health plans that are built around better consumer information tools and support hold the promise of consumer engagement, but purchasers expect these features in all types of health plans. Regardless of plan type, simply shifting costs to consumers is a threat to access and adherence to evidence-based medicine. Comparative and interactive consumer information tools, coupled with provider performance transparency and payment reform, are needed to advance accountability and support consumers in getting the right care at the right time.

The Effect of Teacher Training on the Knowledge of Positive Behavior Support and the Quality of Behavior Intervention Plans: A Preliminary Study in Taiwan

ERIC Educational Resources Information Center

Wu, Pei-Fang

2017-01-01

The purpose of this study was to investigate whether through a series of teacher training. The participants could acquire better knowledge on Positive Behavior Support (PBS), and develop high quality behavior intervention plans. Thirty-six teachers from three public schools participated in the study. The competency-based training consisted of 12…

Can high quality overcome consumer resistance to restricted provider access? Evidence from a health plan choice experiment.

PubMed

Harris, Katherine M

2002-06-01

To investigate the impact of quality information on the willingness of consumers to enroll in health plans that restrict provider access. A survey administered to respondents between the ages of 25 and 64 in the West Los Angeles area with private health insurance. An experimental approach is used to measure the effect of variation in provider network features and information about the quality of network physicians on hypothetical plan choices. Conditional logit models are used to analyze the experimental choice data. Next, choice model parameter estimates are used to simulate the impact of changes in plan features on the market shares of competing health plans and to calculate the quality level required to make consumers indifferent to changes in provider access. The presence of quality information reduced the importance of provider network features in plan choices as hypothesized. However, there were not statistically meaningful differences by type of quality measure (i.e., consumer assessed versus expert assessed). The results imply that large quality differences are required to make consumers indifferent to changes in provider access. The impact of quality on plan choices depended more on the particular measure and less on the type of measure. Quality ratings based on the proportion of survey respondents "extremely satisfied with results of care" had the greatest impact on plan choice while the proportion of network doctors "affiliated with university medical centers" had the least. Other consumer and expert assessed measures had more comparable effects. Overall the results provide empirical evidence that consumers are willing to trade high quality for restrictions on provider access. This willingness to trade implies that relatively small plans that place restrictions on provider access can successfully compete against less restrictive plans when they can demonstrate high quality. However, the results of this study suggest that in many cases, the level of quality required for consumers to accept access restrictions may be so high as to be unattainable. The results provide empirical support for the current focus of decision support efforts on consumer assessed quality measures. At the same time, however, the results suggest that consumers would also value quality measures based on expert assessments. This finding is relevant given the lack of comparative quality information based on expert judgment and research suggesting that consumers have apprehensions about their ability to meaningfully interpret performance-based quality measures.

Space tug point design study. Volume 4: Program requirements

NASA Technical Reports Server (NTRS)

1973-01-01

A study was conducted to determine the configuration of a space tug and to predict the performance parameters. The program plans and planning data generated in support of the tug development program are presented. The preliminary plans and supporting planning data emphasize the following requirements: (1) maintenance and refurbishment, (2) technology development, (3) production, (4) test facilities, (5) quality control, and (6) scheduling.

Long-Term Ecological Monitoring Field Sampling Plan for 2007

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

T. Haney

2007-07-31

This field sampling plan describes the field investigations planned for the Long-Term Ecological Monitoring Project at the Idaho National Laboratory Site in 2007. This plan and the Quality Assurance Project Plan for Waste Area Groups 1, 2, 3, 4, 5, 6, 7, 10, and Removal Actions constitute the sampling and analysis plan supporting long-term ecological monitoring sampling in 2007. The data collected under this plan will become part of the long-term ecological monitoring data set that is being collected annually. The data will be used t determine the requirements for the subsequent long-term ecological monitoring. This plan guides the 2007more » investigations, including sampling, quality assurance, quality control, analytical procedures, and data management. As such, this plan will help to ensure that the resulting monitoring data will be scientifically valid, defensible, and of known and acceptable quality.« less

Can High Quality Overcome Consumer Resistance to Restricted Provider Access? Evidence from a Health Plan Choice Experiment

PubMed Central

Harris, Katherine M

2002-01-01

Objective To investigate the impact of quality information on the willingness of consumers to enroll in health plans that restrict provider access. Data Sources and Setting A survey administered to respondents between the ages of 25 and 64 in the West Los Angeles area with private health insurance. Study Design An experimental approach is used to measure the effect of variation in provider network features and information about the quality of network physicians on hypothetical plan choices. Conditional logit models are used to analyze the experimental choice data. Next, choice model parameter estimates are used to simulate the impact of changes in plan features on the market shares of competing health plans and to calculate the quality level required to make consumers indifferent to changes in provider access. Principal Findings The presence of quality information reduced the importance of provider network features in plan choices as hypothesized. However, there were not statistically meaningful differences by type of quality measure (i.e., consumer assessed versus expert assessed). The results imply that large quality differences are required to make consumers indifferent to changes in provider access. The impact of quality on plan choices depended more on the particular measure and less on the type of measure. Quality ratings based on the proportion of survey respondents “extremely satisfied with results of care” had the greatest impact on plan choice while the proportion of network doctors “affiliated with university medical centers” had the least. Other consumer and expert assessed measures had more comparable effects. Conclusions Overall the results provide empirical evidence that consumers are willing to trade high quality for restrictions on provider access. This willingness to trade implies that relatively small plans that place restrictions on provider access can successfully compete against less restrictive plans when they can demonstrate high quality. However, the results of this study suggest that in many cases, the level of quality required for consumers to accept access restrictions may be so high as to be unattainable. The results provide empirical support for the current focus of decision support efforts on consumer assessed quality measures. At the same time, however, the results suggest that consumers would also value quality measures based on expert assessments. This finding is relevant given the lack of comparative quality information based on expert judgment and research suggesting that consumers have apprehensions about their ability to meaningfully interpret performance-based quality measures. PMID:12132595

Quality Management Plan for EPA Region 1

EPA Pesticide Factsheets

The QMP describes policies, procedures & management systems within EPA NE that govern quality assurance & quality control activities supporting the transparency & scientific defensibility of environmental data collected, used & disseminated by the Region.

Quality-assurance plan for water-resources activities of the U.S. Geological Survey in Idaho

USGS Publications Warehouse

Packard, F.A.

1996-01-01

To ensure continued confidence in its products, the Water Resources Division of the U.S. Geological Survey implemented a policy that all its scientific work be performed in accordance with a centrally managed quality-assurance program. This report establishes and documents a formal policy for current (1995) quality assurance within the Idaho District of the U.S. Geological Survey. Quality assurance is formalized by describing district organization and operational responsibilities, documenting the district quality-assurance policies, and describing district functions. The districts conducts its work through offices in Boise, Idaho Falls, Twin Falls, Sandpoint, and at the Idaho National Engineering Laboratory. Data-collection programs and interpretive studies are conducted by two operating units, and operational and technical assistance is provided by three support units: (1) Administrative Services advisors provide guidance on various personnel issues and budget functions, (2) computer and reports advisors provide guidance in their fields, and (3) discipline specialists provide technical advice and assistance to the district and to chiefs of various projects. The district's quality-assurance plan is based on an overall policy that provides a framework for defining the precision and accuracy of collected data. The plan is supported by a series of quality-assurance policy statements that describe responsibilities for specific operations in the district's program. The operations are program planning; project planning; project implementation; review and remediation; data collection; equipment calibration and maintenance; data processing and storage; data analysis, synthesis, and interpretation; report preparation and processing; and training. Activities of the district are systematically conducted under a hierarchy of supervision an management that is designed to ensure conformance with Water Resources Division goals quality assurance. The district quality-assurance plan does not describe detailed technical activities that are commonly termed "quality-control procedures." Instead, it focuses on current policies, operations, and responsibilities that are implemented at the management level. Contents of the plan will be reviewed annually and updated as programs and operations change.

Transforming an EPA QA/R-2 quality management plan into an ISO 9002 quality management system.

PubMed

Kell, R A; Hedin, C M; Kassakhian, G H; Reynolds, E S

2001-01-01

The Environmental Protection Agency's (EPA) Office of Emergency and Remedial Response (OERR) requires environmental data of known quality to support Superfund hazardous waste site projects. The Quality Assurance Technical Support (QATS) Program is operated by Shaw Environmental and Infrastructure, Inc. to provide EPA's Analytical Operations Center (AOC) with performance evaluation samples, reference materials, on-site laboratory auditing capabilities, data audits (including electronic media data audits), methods development, and other support services. The new QATS contract awarded in November 2000 required that the QATS Program become ISO 9000 certified. In a first for an EPA contractor, the QATS staff and management successfully transformed EPA's QA/R-2 type Quality Management Plan into a Quality Management System (QMS) that complies with the requirements of the internationally recognized ISO 9002 standard and achieved certification in the United States, Canada, and throughout Europe. The presentation describes how quality system elements of ISO 9002 were implemented on an already existing quality system. The psychological and organizational challenges of the culture change in QATS' day-to-day operations will be discussed for the benefit of other ISO 9000 aspirants.

The Thames Science Plan: Suggested Hydrologic Investigations to Support Nutrient-Related Water-Quality Improvements in the Thames River Basin, Connecticut

DTIC Science & Technology

2005-01-01

Nutrient- Related Water-Quality Improvements in the Thames River Basin, Connecticut Open-File Report 2005-1208 U.S. Department of the Interior U.S...Investigations to Support Nutrient- Related Water-Quality Improvements in the Thames River Basin, Connecticut 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM...Suggested Hydrologic Investigations to Support Nutrient- Related Water-Quality Improvements in the Thames River Basin, Connecticut By Elaine C. Todd

International Assistance for Low-Emission Development Planning: Coordinated Low Emissions Assistance Network (CLEAN) Inventory of Activities and Tools--Preliminary Trends

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

Cox, S.; Benioff, R.

2011-05-01

The Coordinated Low Emissions Assistance Network (CLEAN) is a voluntary network of international practitioners supporting low-emission planning in developing countries. The network seeks to improve quality of support through sharing project information, tools, best practices and lessons, and by fostering harmonized assistance. CLEAN has developed an inventory to track and analyze international technical support and tools for low-carbon planning activities in developing countries. This paper presents a preliminary analysis of the inventory to help identify trends in assistance activities and tools available to support developing countries with low-emission planning.

Visual Decision Support Tool for Supporting Asset Management Performance, Risk, and Cost Analysis (WERF Report INFR5R12)

EPA Science Inventory

Abstract:Managing urban water infrastructures faces the challenge of jointly dealing with assets of diverse types, useful life, cost, ages and condition. Service quality and sustainability require sound long-term planning, well aligned with tactical and operational planning and m...

Preliminary analysis of an integrated logistics system for OSSA payloads. Volume 3: OSSA integrated logistics support planning document

NASA Technical Reports Server (NTRS)

Palguta, T.; Bradley, W.; Stockton, T.

1988-01-01

Guidance in preparing and updating an integrated logistics support plan (ILSP) is given. Clear, concise, and detailed instructions are provided on the preparation and content of an ILSP in order to ensure a quality document that reflects total program requirements.

Development of a model web-based system to support a statewide quality consortium in radiation oncology.

PubMed

Moran, Jean M; Feng, Mary; Benedetti, Lisa A; Marsh, Robin; Griffith, Kent A; Matuszak, Martha M; Hess, Michael; McMullen, Matthew; Fisher, Jennifer H; Nurushev, Teamour; Grubb, Margaret; Gardner, Stephen; Nielsen, Daniel; Jagsi, Reshma; Hayman, James A; Pierce, Lori J

A database in which patient data are compiled allows analytic opportunities for continuous improvements in treatment quality and comparative effectiveness research. We describe the development of a novel, web-based system that supports the collection of complex radiation treatment planning information from centers that use diverse techniques, software, and hardware for radiation oncology care in a statewide quality collaborative, the Michigan Radiation Oncology Quality Consortium (MROQC). The MROQC database seeks to enable assessment of physician- and patient-reported outcomes and quality improvement as a function of treatment planning and delivery techniques for breast and lung cancer patients. We created tools to collect anonymized data based on all plans. The MROQC system representing 24 institutions has been successfully deployed in the state of Michigan. Since 2012, dose-volume histogram and Digital Imaging and Communications in Medicine-radiation therapy plan data and information on simulation, planning, and delivery techniques have been collected. Audits indicated >90% accurate data submission and spurred refinements to data collection methodology. This model web-based system captures detailed, high-quality radiation therapy dosimetry data along with patient- and physician-reported outcomes and clinical data for a radiation therapy collaborative quality initiative. The collaborative nature of the project has been integral to its success. Our methodology can be applied to setting up analogous consortiums and databases. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Strategic Plan. Vermont State Board of Education: Department of Education

ERIC Educational Resources Information Center

Vermont Department of Education, 2004

2004-01-01

The five-year plan is expressed in the five goals listed below, which are based on the respective Board and department roles and responsibilities. (1) Support high-quality, innovative instruction to improve student achievement; (2) Provide and promote high-quality educational leadership; (3) Promote safe and positive learning environments; (4)…

Decision Support Systems for Research and Management in Advanced Life Support

NASA Technical Reports Server (NTRS)

Rodriquez, Luis F.

2004-01-01

Decision support systems have been implemented in many applications including strategic planning for battlefield scenarios, corporate decision making for business planning, production planning and control systems, and recommendation generators like those on Amazon.com(Registered TradeMark). Such tools are reviewed for developing a similar tool for NASA's ALS Program. DSS are considered concurrently with the development of the OPIS system, a database designed for chronicling of research and development in ALS. By utilizing the OPIS database, it is anticipated that decision support can be provided to increase the quality of decisions by ALS managers and researchers.

Analysis of ETMS Data Quality for Traffic Flow Management Decisions

NASA Technical Reports Server (NTRS)

Chatterji, Gano B.; Sridhar, Banavar; Kim, Douglas

2003-01-01

The data needed for air traffic flow management decision support tools is provided by the Enhanced Traffic Management System (ETMS). This includes both the tools that are in current use and the ones being developed for future deployment. Since the quality of decision support provided by all these tools will be influenced by the quality of the input ETMS data, an assessment of ETMS data quality is needed. Motivated by this desire, ETMS data quality is examined in this paper in terms of the unavailability of flight plans, deviation from the filed flight plans, departure delays, altitude errors and track data drops. Although many of these data quality issues are not new, little is known about their extent. A goal of this paper is to document the magnitude of data quality issues supported by numerical analysis of ETMS data. Guided by this goal, ETMS data for a 24-hour period were processed to determine the number of aircraft with missing flight plan messages at any given instant of time. Results are presented for aircraft above 18,000 feet altitude and also at all altitudes. Since deviation from filed flight plan is also a major cause of trajectory-modeling errors, statistics of deviations are presented. Errors in proposed departure times and ETMS-generated vertical profiles are also shown. A method for conditioning the vertical profiles for improving demand prediction accuracy is described. Graphs of actual sector counts obtained using these vertical profiles are compared with those obtained using the Host data for sectors in the Fort Worth Center to demonstrate the benefit of preprocessing. Finally, results are presented to quantify the extent of data drops. A method for propagating track positions during ETMS data drops is also described.

222-S Laboratory Quality Assurance Plan. Revision 1

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

Meznarich, H.K.

1995-07-31

This Quality Assurance Plan provides,quality assurance (QA) guidance, regulatory QA requirements (e.g., 10 CFR 830.120), and quality control (QC) specifications for analytical service. This document follows the U.S Department of Energy (DOE) issued Hanford Analytical Services Quality Assurance Plan (HASQAP). In addition, this document meets the objectives of the Quality Assurance Program provided in the WHC-CM-4-2, Section 2.1. Quality assurance elements required in the Guidelines and Specifications for Preparing Quality Assurance Program Plans (QAMS-004) and Interim Guidelines and Specifications for Preparing Quality Assurance Project Plans (QAMS-005) from the US Environmental Protection Agency (EPA) are covered throughout this document. A qualitymore » assurance index is provided in the Appendix A. This document also provides and/or identifies the procedural information that governs laboratory operations. The personnel of the 222-S Laboratory and the Standards Laboratory including managers, analysts, QA/QC staff, auditors, and support staff shall use this document as guidance and instructions for their operational and quality assurance activities. Other organizations that conduct activities described in this document for the 222-S Laboratory shall follow this QA/QC document.« less

SUSTAIN – A Framework for Placement of Best Management Practices in Urban Watersheds to Protect Water Quality

EPA Science Inventory

Watershed and stormwater managers need modeling tools to evaluate alternative plans for water quality management and flow abatement techniques in urban and developing areas. A watershed-scale, decision-support framework that is based on cost optimization is needed to support gov...

Effects of Planning on Task Load, Knowledge, and Tool Preference: A Comparison of Two Tools

ERIC Educational Resources Information Center

Bonestroo, Wilco J.; de Jong, Ton

2012-01-01

Self-regulated learners are expected to plan their own learning. Because planning is a complex task, it is not self-evident that all learners can perform this task successfully. In this study, we examined the effects of two planning support tools on the quality of created plans, planning behavior, task load, and acquired knowledge. Sixty-five…

EPA Region 9 Guidance for Quality Assurance Program Plans - R9qa/03.2

EPA Pesticide Factsheets

In order for decision makers to have confidence in the quality of environmental data used to support their decisions, the organization must have structured and documented process for quality in place.

Use of information systems in Air Force medical treatment facilities in strategic planning and decision-making.

PubMed

Yap, Glenn A; Platonova, Elena A; Musa, Philip F

2006-02-01

An exploratory study used Ansoff's strategic planning model as a framework to assess perceived effectiveness of information systems in supporting strategic business plan development at Air Force medical treatment facilities (MTFs). Results showed information systems were most effective in supporting historical trend analysis, strategic business plans appeared to be a balance of operational and strategic plans, and facilities perceived a greater need for new clinical, vice administrative, information systems to support strategic planning processes. Administrators believed information systems should not be developed at the local level and perceived information systems have the greatest impact on improving clinical quality outcomes, followed by ability to deliver cost effective care and finally, ability to increase market share.

A new plan-scoring method using normal tissue complication probability for personalized treatment plan decisions in prostate cancer

NASA Astrophysics Data System (ADS)

Kim, Kwang Hyeon; Lee, Suk; Shim, Jang Bo; Yang, Dae Sik; Yoon, Won Sup; Park, Young Je; Kim, Chul Yong; Cao, Yuan Jie; Chang, Kyung Hwan

2018-01-01

The aim of this study was to derive a new plan-scoring index using normal tissue complication probabilities to verify different plans in the selection of personalized treatment. Plans for 12 patients treated with tomotherapy were used to compare scoring for ranking. Dosimetric and biological indexes were analyzed for the plans for a clearly distinguishable group ( n = 7) and a similar group ( n = 12), using treatment plan verification software that we developed. The quality factor ( QF) of our support software for treatment decisions was consistent with the final treatment plan for the clearly distinguishable group (average QF = 1.202, 100% match rate, n = 7) and the similar group (average QF = 1.058, 33% match rate, n = 12). Therefore, we propose a normal tissue complication probability (NTCP) based on the plan scoring index for verification of different plans for personalized treatment-plan selection. Scoring using the new QF showed a 100% match rate (average NTCP QF = 1.0420). The NTCP-based new QF scoring method was adequate for obtaining biological verification quality and organ risk saving using the treatment-planning decision-support software we developed for prostate cancer.

An Automated Treatment Plan Quality Control Tool for Intensity-Modulated Radiation Therapy Using a Voxel-Weighting Factor-Based Re-Optimization Algorithm.

PubMed

Song, Ting; Li, Nan; Zarepisheh, Masoud; Li, Yongbao; Gautier, Quentin; Zhou, Linghong; Mell, Loren; Jiang, Steve; Cerviño, Laura

2016-01-01

Intensity-modulated radiation therapy (IMRT) currently plays an important role in radiotherapy, but its treatment plan quality can vary significantly among institutions and planners. Treatment plan quality control (QC) is a necessary component for individual clinics to ensure that patients receive treatments with high therapeutic gain ratios. The voxel-weighting factor-based plan re-optimization mechanism has been proved able to explore a larger Pareto surface (solution domain) and therefore increase the possibility of finding an optimal treatment plan. In this study, we incorporated additional modules into an in-house developed voxel weighting factor-based re-optimization algorithm, which was enhanced as a highly automated and accurate IMRT plan QC tool (TPS-QC tool). After importing an under-assessment plan, the TPS-QC tool was able to generate a QC report within 2 minutes. This QC report contains the plan quality determination as well as information supporting the determination. Finally, the IMRT plan quality can be controlled by approving quality-passed plans and replacing quality-failed plans using the TPS-QC tool. The feasibility and accuracy of the proposed TPS-QC tool were evaluated using 25 clinically approved cervical cancer patient IMRT plans and 5 manually created poor-quality IMRT plans. The results showed high consistency between the QC report quality determinations and the actual plan quality. In the 25 clinically approved cases that the TPS-QC tool identified as passed, a greater difference could be observed for dosimetric endpoints for organs at risk (OAR) than for planning target volume (PTV), implying that better dose sparing could be achieved in OAR than in PTV. In addition, the dose-volume histogram (DVH) curves of the TPS-QC tool re-optimized plans satisfied the dosimetric criteria more frequently than did the under-assessment plans. In addition, the criteria for unsatisfied dosimetric endpoints in the 5 poor-quality plans could typically be satisfied when the TPS-QC tool generated re-optimized plans without sacrificing other dosimetric endpoints. In addition to its feasibility and accuracy, the proposed TPS-QC tool is also user-friendly and easy to operate, both of which are necessary characteristics for clinical use.

Bridging EOS remote sensing measurements and fire emissions, smoke dispersion, and air quality DSS in the Eastern US

Treesearch

John J. Qu; Xianjun Hao; Ruixin Yang; Swarvanu Dasgupta; Sanjeeb Bhoi; Menas Kafatos

1999-01-01

Fire eniissions, smoke dispersiotl. ancl air quality are very important for fire fighting and planing of prescribed burning. BlueskyRATNS (BSR) is a comprehenisive and state-of-the-art Decision Support System (DSS) for fire managers and air quality managers to plan fiiels treatments and support state air qiiality smoke regulatory actions, especially related to...

Increasing Access to Family Planning Choices Through Public-Sector Social Franchising: The Experience of Marie Stopes International in Mali

PubMed Central

Gold, Judy; Burke, Eva; Cissé, Boubacar; Mackay, Anna; Eva, Gillian; Hayes, Brendan

2017-01-01

Background: Mali has one of the world's lowest contraceptive use rates and a high rate of unmet need for family planning. In order to increase access to and choice of quality family planning services, Marie Stopes International (MSI) Mali introduced social franchising in public-sector community health centers (referred to as CSCOMs in Mali) in 3 regions under the MSI brand BlueStar. Program Description: Potential franchisees are generally identified from CSCOMs who have worked with MSI outreach teams; once accredited as franchisees, CSCOMs receive training, supervision, family planning consumables and commodities, and support for awareness raising and demand creation. To ensure availability and affordability of services, franchisees are committed to providing a wide range of contraceptive methods at low fixed prices. Methods and Results: The performance of the BlueStar network from inception in March 2012 until December 2015 was examined using information from routine monitoring data, clinical quality audits, and client exit interviews. During this period, the network grew from 70 to 135 franchisees; an estimated 123,428 clients received voluntary family planning services, most commonly long-acting reversible methods of contraception. Franchisee efficiency and clinical quality of services increased over time, and client satisfaction with services remained high. One-quarter of clients in 2015 were under 20 years old, and three-quarters were adopters of family planning (that is, they had not been using a modern method during the 3 months prior to their visit). Conclusion: Applying a social franchising support package, originally developed for for-profit private-sector providers, to public-sector facilities in Mali has increased access, choice, and use of family planning in 3 regions of Mali. The experience of BlueStar Mali suggests that interventions that support quality supply of services, while simultaneously addressing demand-side barriers such as service pricing, can successfully create demand for a broad range of family planning services, even in settings with low contraceptive prevalence. PMID:28655803

Increasing Access to Family Planning Choices Through Public-Sector Social Franchising: The Experience of Marie Stopes International in Mali.

PubMed

Gold, Judy; Burke, Eva; Cissé, Boubacar; Mackay, Anna; Eva, Gillian; Hayes, Brendan

2017-06-27

Mali has one of the world's lowest contraceptive use rates and a high rate of unmet need for family planning. In order to increase access to and choice of quality family planning services, Marie Stopes International (MSI) Mali introduced social franchising in public-sector community health centers (referred to as CSCOMs in Mali) in 3 regions under the MSI brand BlueStar. Potential franchisees are generally identified from CSCOMs who have worked with MSI outreach teams; once accredited as franchisees, CSCOMs receive training, supervision, family planning consumables and commodities, and support for awareness raising and demand creation. To ensure availability and affordability of services, franchisees are committed to providing a wide range of contraceptive methods at low fixed prices. The performance of the BlueStar network from inception in March 2012 until December 2015 was examined using information from routine monitoring data, clinical quality audits, and client exit interviews. During this period, the network grew from 70 to 135 franchisees; an estimated 123,428 clients received voluntary family planning services, most commonly long-acting reversible methods of contraception. Franchisee efficiency and clinical quality of services increased over time, and client satisfaction with services remained high. One-quarter of clients in 2015 were under 20 years old, and three-quarters were adopters of family planning (that is, they had not been using a modern method during the 3 months prior to their visit). Applying a social franchising support package, originally developed for for-profit private-sector providers, to public-sector facilities in Mali has increased access, choice, and use of family planning in 3 regions of Mali. The experience of BlueStar Mali suggests that interventions that support quality supply of services, while simultaneously addressing demand-side barriers such as service pricing, can successfully create demand for a broad range of family planning services, even in settings with low contraceptive prevalence. © Gold et al.

40 CFR 255.10 - Criteria for identifying regions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... volume of waste to support the goals and objectives of the State plan, including materials or energy... designated in accordance with the Safe Drinking Water Act, and with air quality planning agencies designated...

40 CFR 255.10 - Criteria for identifying regions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... volume of waste to support the goals and objectives of the State plan, including materials or energy... designated in accordance with the Safe Drinking Water Act, and with air quality planning agencies designated...

40 CFR 255.10 - Criteria for identifying regions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... volume of waste to support the goals and objectives of the State plan, including materials or energy... designated in accordance with the Safe Drinking Water Act, and with air quality planning agencies designated...

Monitoring quality in Israeli primary care: The primary care physicians' perspective

PubMed Central

2012-01-01

Background Since 2000, Israel has had a national program for ongoing monitoring of the quality of the primary care services provided by the country's four competing non-profit health plans. Previous research has demonstrated that quality of care has improved substantially since the program's inception and that the program enjoys wide support among health plan managers. However, prior to this study there were anecdotal and journalistic reports of opposition to the program among primary care physicians engaged in direct service delivery; these raised serious questions about the extent of support among physicians nationally. Goals To assess how Israeli primary care physicians experience and rate health plan efforts to track and improve the quality of care. Method The study population consisted of primary care physicians employed by the health plans who have responsibility for the quality of care of a panel of adult patients. The study team randomly sampled 250 primary-care physicians from each of the four health plans. Of the 1,000 physicians sampled, 884 met the study criteria. Every physician could choose whether to participate in the survey by mail, e-mail, or telephone. The anonymous questionnaire was completed by 605 physicians – 69% of those eligible. The data were weighted to reflect differences in sampling and response rates across health plans. Main findings The vast majority of respondents (87%) felt that the monitoring of quality was important and two-thirds (66%) felt that the feedback and subsequent remedial interventions improved medical care to a great extent. Almost three-quarters (71%) supported continuation of the program in an unqualified manner. The physicians with the most positive attitudes to the program were over age 44, independent contract physicians, and either board-certified in internal medicine or without any board-certification (i.e., residents or general practitioners). At the same time, support for the program was widespread even among physicians who are young, board-certified in family medicine, and salaried. Many physicians also reported that various problems had emerged to a great or very great extent: a heavier workload (65%), over-competitiveness (60%), excessive managerial pressure (48%), and distraction from other clinical issues (35%). In addition, there was some criticism of the quality of the measures themselves. Respondents also identified approaches to addressing these problems. Conclusions The findings provide perspective on the anecdotal reports of physician opposition to the monitoring program; they may well accurately reflect the views of the small number of physicians directly involved, but they do not reflect the views of primary care physicians as a whole, who are generally quite supportive of the program. At the same time, the study confirms the existence of several perceived problems. Some of these problems, such as excess managerial pressure, can probably best be addressed by the health plans themselves; while others, such as the need to refine the quality indicators, are probably best addressed at the national level. Cooperation between primary care physicians and health plan managers, which has been an essential component of the program's success thus far, can also play an important role in addressing the problems identified. PMID:22913311

77 FR 21663 - Air Quality Implementation Plans; Kentucky; Attainment Plan for the Kentucky Portion of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-11

... available, but not yet certified, in the Air Quality System (AQS) database for 2011 show that this Area.... Moreover, there is no support for the Commenter's contention, based on the flawed premise that allowance... strong legal basis. To the extent that the current status of CAIR and the Transport Rule affect any of...

78 FR 47241 - Amendments to the Water Quality Regulations, Water Code and Comprehensive Plan To Revise the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-05

...The Delaware River Basin Commission (``DRBC'' or ``Commission'') will hold a public hearing to receive comments on proposed amendments to the Commission's Water Quality Regulations, Water Code and Comprehensive Plan to revise the water quality criteria for polychlorinated biphenyls (``PCBs'') in the Delaware Estuary and Bay, DRBC Water Quality Management Zones 2 through 6, for the protection of human health from carcinogenic effects. The Commission will simultaneously solicit comment on a draft implementation strategy to support achievement of the criteria.

A two-stage approach for estimating a statewide truck trip table.

DOT National Transportation Integrated Search

2014-05-01

Statewide models, including passenger and freight movements, are frequently used for : supporting numerous statewide planning activities. Many states use them for traffic impact : studies, air quality conformity analysis, freight planning, economic d...

Total Quality Management in the Defense Fuel Supply Center: Issues and Observations.

ERIC Educational Resources Information Center

Matysek, Eugene F., Jr.

1993-01-01

Examines the Total Quality Management (TQM) activities at a federal government agency (i.e., the Defense Fuel Supply Center) using the following criteria established by the Federal Quality Institute: top management leadership and support; strategic quality planning; customer focus; training and recognition; employee empowerment and teamwork; and…

LANDSAT supports data needs for EPA 208 planning. [water quality control and waste treatment management

NASA Technical Reports Server (NTRS)

1979-01-01

Excerpts from federal legislation and regulations mandating areawide waster treatment management as a means of restoring and maintaining the integrity of the nation's water are presented along with requirements for grants to the states for water quality planning, management, and implementation. Experiences using LANDSAT to identify nonpoint sources of water pollution as well as land/use/land cover features in South Dakota, Kentucky, Georgia, New Jersey, and Texas are described. Present activities suggest that this type of remote sensing is an efficient, effective tool for areawide water quality planning. Interaction with cognizant federal, state, and local government personnel involved in EPA section 208 planning activities can guide the development of new capabilities and enhance their utility and prospect for use.

An Automated Treatment Plan Quality Control Tool for Intensity-Modulated Radiation Therapy Using a Voxel-Weighting Factor-Based Re-Optimization Algorithm

PubMed Central

Song, Ting; Li, Nan; Zarepisheh, Masoud; Li, Yongbao; Gautier, Quentin; Zhou, Linghong; Mell, Loren; Jiang, Steve; Cerviño, Laura

2016-01-01

Intensity-modulated radiation therapy (IMRT) currently plays an important role in radiotherapy, but its treatment plan quality can vary significantly among institutions and planners. Treatment plan quality control (QC) is a necessary component for individual clinics to ensure that patients receive treatments with high therapeutic gain ratios. The voxel-weighting factor-based plan re-optimization mechanism has been proved able to explore a larger Pareto surface (solution domain) and therefore increase the possibility of finding an optimal treatment plan. In this study, we incorporated additional modules into an in-house developed voxel weighting factor-based re-optimization algorithm, which was enhanced as a highly automated and accurate IMRT plan QC tool (TPS-QC tool). After importing an under-assessment plan, the TPS-QC tool was able to generate a QC report within 2 minutes. This QC report contains the plan quality determination as well as information supporting the determination. Finally, the IMRT plan quality can be controlled by approving quality-passed plans and replacing quality-failed plans using the TPS-QC tool. The feasibility and accuracy of the proposed TPS-QC tool were evaluated using 25 clinically approved cervical cancer patient IMRT plans and 5 manually created poor-quality IMRT plans. The results showed high consistency between the QC report quality determinations and the actual plan quality. In the 25 clinically approved cases that the TPS-QC tool identified as passed, a greater difference could be observed for dosimetric endpoints for organs at risk (OAR) than for planning target volume (PTV), implying that better dose sparing could be achieved in OAR than in PTV. In addition, the dose-volume histogram (DVH) curves of the TPS-QC tool re-optimized plans satisfied the dosimetric criteria more frequently than did the under-assessment plans. In addition, the criteria for unsatisfied dosimetric endpoints in the 5 poor-quality plans could typically be satisfied when the TPS-QC tool generated re-optimized plans without sacrificing other dosimetric endpoints. In addition to its feasibility and accuracy, the proposed TPS-QC tool is also user-friendly and easy to operate, both of which are necessary characteristics for clinical use. PMID:26930204

Integrated watershed planning across jurisdictional boundaries

NASA Astrophysics Data System (ADS)

Watts, A. W.; Roseen, R.; Stacey, P.; Bourdeau, R.

2014-12-01

We will present the foundation for an Coastal Watershed Integrated Plan for three communities in southern New Hampshire. Small communities are often challenged by complex regulatory requirements and limited resources, but are wary of perceived risks in engaging in collaborative projects with other communities. Potential concerns include loss of control, lack of resources to engage in collaboration, technical complexity, and unclear benefits. This project explores a multi-town subwatershed application of integrated planning across jurisdictional boundaries that addresses some of today's highest priority water quality issues: wastewater treatment plant upgrades for nutrient removal; green infrastructure stormwater management for developing and re-developing areas; and regional monitoring of ecosystem indicators in support of adaptive management to achieve nutrient reduction and other water quality goals in local and downstream waters. The project outcome is a collaboratively-developed inter-municipal integrated plan, and a monitoring framework to support cross jurisdictional planning and assess attainment of water quality management goals. This research project has several primary components: 1) assessment of initial conditions, including both the pollutant load inputs and the political, economic and regulatory status within each community, 2) a pollutant load model for point and non-point sources, 3) multi-criteria evaluation of load reduction alternatives 4) a watershed management plan optimized for each community, and for Subwatersheds combining multiple communities. The final plan will quantify the financial and other benefits/drawbacks to each community for both inter municipal and individual pollution control approaches. We will discuss both the technical and collaborative aspects of the work, with lessons learned regarding science to action, incorporation of social, economic and water quality assessment parameters, and stakeholder/researcher interaction.

Testing, Requirements, and Metrics

NASA Technical Reports Server (NTRS)

Rosenberg, Linda; Hyatt, Larry; Hammer, Theodore F.; Huffman, Lenore; Wilson, William

1998-01-01

The criticality of correct, complete, testable requirements is a fundamental tenet of software engineering. Also critical is complete requirements based testing of the final product. Modern tools for managing requirements allow new metrics to be used in support of both of these critical processes. Using these tools, potential problems with the quality of the requirements and the test plan can be identified early in the life cycle. Some of these quality factors include: ambiguous or incomplete requirements, poorly designed requirements databases, excessive or insufficient test cases, and incomplete linkage of tests to requirements. This paper discusses how metrics can be used to evaluate the quality of the requirements and test to avoid problems later. Requirements management and requirements based testing have always been critical in the implementation of high quality software systems. Recently, automated tools have become available to support requirements management. At NASA's Goddard Space Flight Center (GSFC), automated requirements management tools are being used on several large projects. The use of these tools opens the door to innovative uses of metrics in characterizing test plan quality and assessing overall testing risks. In support of these projects, the Software Assurance Technology Center (SATC) is working to develop and apply a metrics program that utilizes the information now available through the application of requirements management tools. Metrics based on this information provides real-time insight into the testing of requirements and these metrics assist the Project Quality Office in its testing oversight role. This paper discusses three facets of the SATC's efforts to evaluate the quality of the requirements and test plan early in the life cycle, thus preventing costly errors and time delays later.

Ernest Orlando Lawrence Berkeley National Laboratory Institutional Plan FY 2000-2004

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

Chartock, Mike; Hansen, Todd

1999-08-01

The FY 2000-2004 Institutional Plan provides an overview of the Ernest Orlando Lawrence Berkeley National Laboratory (Berkeley Lab, the Laboratory) mission, strategic plan, initiatives, and the resources required to fulfill its role in support of national needs in fundamental science and technology, energy resources, and environmental quality. To advance the Department of Energy's ongoing efforts to define the Integrated Laboratory System, the Berkeley Lab Institutional Plan reflects the strategic elements of our planning efforts. The Institutional Plan is a management report that supports the Department of Energy's mission and programs and is an element of the Department of Energy's strategicmore » management planning activities, developed through an annual planning process. The Plan supports the Government Performance and Results Act of 1993 and complements the performance-based contract between the Department of Energy and the Regents of the University of California. It identifies technical and administrative directions in the context of the national energy policy and research needs and the Department of Energy's program planning initiatives. Preparation of the plan is coordinated by the Office of Planning and Communications from information contributed by Berkeley Lab's scientific and support divisions.« less

NARSTO PROGRAM SUPPORT

EPA Science Inventory

The NARSTO program is a multi-national, public/private partnership of over 70 organizations sponsoring and participating in ozone and particulate air quality research in North America. Coordinate communication and planning with the NARSTO membership for air quality research, sci...

SU-E-T-97: An Analysis of Knowledge Based Planning for Stereotactic Body Radiation Therapy of the Spine

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

Foy, J; Marsh, R; Owen, D

2015-06-15

Purpose: Creating high quality SBRT treatment plans for the spine is often tedious and time consuming. In addition, the quality of treatment plans can vary greatly between treatment facilities due to inconsistencies in planning methods. This study investigates the performance of knowledge-based planning (KBP) for spine SBRT. Methods: Treatment plans were created for 28 spine SBRT patients. Each case was planned to meet strict dose objectives and guidelines. After physician and physicist approval, the plans were added to a custom model in a KBP system (RapidPlan, Varian Eclipse v13.5). The model was then trained to be able to predict estimatedmore » DVHs and provide starting objective functions for future patients based on both generated and manual objectives. To validate the model, ten additional spine SBRT cases were planned manually as well as using the model objectives. Plans were compared based on planning time and quality (ability to meet the plan objectives, including dose metrics and conformity). Results: The average dose to the spinal cord and the cord PRV differed between the validation and control plans by <0.25% demonstrating iso-toxicity. Six out of 10 validation plans met all dose objectives without the need for modifications, and overall, target dose coverage was increased by about 4.8%. If the validation plans did not meet the dose requirements initially, only 1–2 iterations of modifying the planning parameters were required before an acceptable plan was achieved. While manually created plans usually required 30 minutes to 3 hours to create, KBP can be used to create similar quality plans in 15–20 minutes. Conclusion: KBP for spinal tumors has shown to greatly decrease the amount of time required to achieve high quality treatment plans with minimal human intervention and could feasibly be used to standardize plan quality between institutions. Supported by Varian Medical Systems.« less

GLIMPSE – A computational framework for supporting state-level environmental and energy planning

EPA Pesticide Factsheets

GLIMPSE is an EPA modeling tool for environmental and energy planning used to find U.S. policy scenarios that simultaneously improve air quality, human health, reduce impacts to ecosystems, and mitigate climate change.

76 FR 7560 - Agency Information Collection Activities; Proposed Collection; Comment Request; Transportation...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-10

... Activities; Proposed Collection; Comment Request; Transportation Conformity Determinations for Federally... federally supported transportation activities are consistent with (``conform to'') the purpose of the state air quality implementation plan (SIP). Transportation activities include transportation plans...

Not planning a sustainable transport system

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

Finnveden, Göran, E-mail: goran.finnveden@abe.kth.se; Åkerman, Jonas

2014-04-01

The overall objective of the Swedish transport policy is to ensure the economically efficient and sustainable provision of transport services for people and business throughout the country. More specifically, the transport sector shall, among other things, contribute to the achievement of environmental quality objectives in which the development of the transport system plays an important role in the achievement of the objectives. The aim of this study is to analyse if current transport planning supports this policy. This is done by analysing two recent cases: the National Infrastructure Plan 2010–2021, and the planning of Bypass Stockholm, a major road investment.more » Our results show that the plans are in conflict with several of the environmental quality objectives. Another interesting aspect of the planning processes is that the long-term climate goals are not included in the planning processes, neither as a clear goal nor as factor that will influence future transport systems. In this way, the long-term sustainability aspects are not present in the planning. We conclude that the two cases do not contribute to a sustainable transport system. Thus, several changes must be made in the processes, including putting up clear targets for emissions. Also, the methodology for the environmental assessments needs to be further developed and discussed. - Highlights: • Two cases are studied to analyse if current planning supports a sustainable transport system. • Results show that the plans are in conflict with several of the environmental quality objectives. • Long-term climate goals are not included in the planning processes. • Current practices do not contribute to a sustainable planning processes. • Methodology and process for environmental assessments must be further developed and discussed.« less

Approaches to Process Performance Modeling: A Summary from the SEI Series of Workshops on CMMI High Maturity Measurement and Analysis

DTIC Science & Technology

2010-01-01

Soporte de Modelos Sistémicos: Aplicación al Sector de Desarrollo de Software de Argentina,” Tesis de PhD, Universidad Tecnológica Nacional-Facultad...with New Results 31  2.3  Other Simulation Approaches 37  Conceptual Planning , Execution, and Operation of Combat Fire Support Effectiveness: A...Figure 29:  Functional Structure of Multiple Regression Model 80  Figure 30:  TSP Quality Plan One 85  Figure 31:  TSP Quality Plan Two 85  Figure

A MODIS direct broadcast algorithm for mapping wildfire burned area in the western United States

Treesearch

S. P. Urbanski; J. M. Salmon; B. L. Nordgren; W. M. Hao

2009-01-01

Improved wildland fire emission inventory methods are needed to support air quality forecasting and guide the development of air shed management strategies. Air quality forecasting requires dynamic fire emission estimates that are generated in a timely manner to support real-time operations. In the regulatory and planning realm, emission inventories are essential for...

Monitoring game-based motor rehabilitation of patients at home for better plans of care and quality of life.

PubMed

Ponte, S; Gabrielli, S; Jonsdottir, J; Morando, M; Dellepiane, S

2015-01-01

This paper describes the biomedical, remote monitoring infrastructure developed and currently tested in the EU REHAB@HOME project to support home rehabilitation of the upper extremity of persons post-stroke and in persons with other neurological disorders, such as Multiple Sclerosis patients, in order to track their progress over therapy and improve their Quality of Life. The paper will specifically focus on describing the initial testing of the tele-rehabilitation system's components for patients' biomedical monitoring over therapy, which support the delivery and monitoring of more personalized, engaging plans of care by rehabilitation centers and services.

Quality user support: Supporting quality users

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

Woolley, T.C.

1994-12-31

During the past decade, fundamental changes have occurred in technical computing in the oil industry. Technical computing systems have moved from local, fragmented quantity, to global, integrated, quality. The compute power available to the average geoscientist at his desktop has grown exponentially. Technical computing applications have increased in integration and complexity. At the same time, there has been a significant change in the work force due to the pressures of restructuring, and the increased focus on international opportunities. The profile of the user of technical computing resources has changed. Users are generally more mature, knowledgeable, and team oriented than theirmore » predecessors. In the 1990s, computer literacy is a requirement. This paper describes the steps taken by Oryx Energy Company to address the problems and opportunities created by the explosive growth in computing power and needs, coupled with the contraction of the business. A successful user support strategy will be described. Characteristics of the program include: (1) Client driven support; (2) Empowerment of highly skilled professionals to fill the support role; (3) Routine and ongoing modification to the support plan; (4) Utilization of the support assignment to create highly trained advocates on the line; (5) Integration of the support role to the reservoir management team. Results of the plan include a highly trained work force, stakeholder teams that include support personnel, and global support from a centralized support organization.« less

MO-F-CAMPUS-T-03: Continuous Dose Delivery with Gamma Knife Perfexion

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

Ghobadi,; Li, W; Chung, C

2015-06-15

Purpose: We propose continuous dose delivery techniques for stereotactic treatments delivered by Gamma Knife Perfexion using inverse treatment planning system that can be applied to various tumour sites in the brain. We test the accuracy of the plans on Perfexion’s planning system (GammaPlan) to ensure the obtained plans are viable. This approach introduces continuous dose delivery for Perefxion, as opposed to the currently employed step-and-shoot approaches, for different tumour sites. Additionally, this is the first realization of automated inverse planning on GammaPlan. Methods: The inverse planning approach is divided into two steps of identifying a quality path inside the target,more » and finding the best collimator composition for the path. To find a path, we select strategic regions inside the target volume and find a path that visits each region exactly once. This path is then passed to a mathematical model which finds the best combination of collimators and their durations. The mathematical model minimizes the dose spillage to the surrounding tissues while ensuring the prescribed dose is delivered to the target(s). Organs-at-risk and their corresponding allowable doses can also be added to the model to protect adjacent organs. Results: We test this approach on various tumour sizes and sites. The quality of the obtained treatment plans are comparable or better than forward plans and inverse plans that use step- and-shoot technique. The conformity indices in the obtained continuous dose delivery plans are similar to those of forward plans while the beam-on time is improved on average (see Table 1 in supporting document). Conclusion: We employ inverse planning for continuous dose delivery in Perfexion for brain tumours. The quality of the obtained plans is similar to forward and inverse plans that use conventional step-and-shoot technique. We tested the inverse plans on GammaPlan to verify clinical relevance. This research was partially supported by Elekta, Sweden (vendor of Gamma Knife Perfexion)« less

Remediation plans in family medicine residency

PubMed Central

Audétat, Marie-Claude; Voirol, Christian; Béland, Normand; Fernandez, Nicolas; Sanche, Gilbert

2015-01-01

Abstract Objective To assess use of the remediation instrument that has been implemented in training sites at the University of Montreal in Quebec to support faculty in diagnosing and remediating resident academic difficulties, to examine whether and how this particular remediation instrument improves the remediation process, and to determine its effects on the residents’ subsequent rotation assessments. Design A multimethods approach in which data were collected from different sources: remediation plans developed by faculty, program statistics for the corresponding academic years, and students’ academic records and rotation assessment results. Setting Family medicine residency program at the University of Montreal. Participants Family medicine residents in academic difficulty. Main outcome measures Assessment of the content, process, and quality of remediation plans, and students’ academic and rotation assessment results (successful, below expectations, or failure) both before and after the remediation period. Results The framework that was developed for assessing remediation plans was used to analyze 23 plans produced by 10 teaching sites for 21 residents. All plans documented cognitive problems and implemented numerous remediation measures. Although only 48% of the plans were of good quality, implementation of a remediation plan was positively associated with the resident’s success in rotations following the remediation period. Conclusion The use of remediation plans is well embedded in training sites at the University of Montreal. The residents’ difficulties were mainly cognitive in nature, but this generally related to deficits in clinical reasoning rather than knowledge gaps. The reflection and analysis required to produce a remediation plan helps to correct many academic difficulties and normalize the academic career of most residents in difficulty. Further effort is still needed to improve the quality of plans and to support teachers.

'Who's actually gonna read this?' An evaluation of staff experiences of the value of information contained in written care plans in supporting care in three different dementia care settings.

PubMed

Drummond, C; Simpson, A

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: A written plan is designed to improve communication and co-ordinate care between mental health inpatient wards and community settings. Reports of care plan quality issues and staff and service user dissatisfaction with healthcare bureaucracy have focused on working age mental health or general hospital settings. Little is known about mental health staff perspectives on the value of written care plans in supporting dementia care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Competing demands on staff time and resources to meet administrative standards for care plans caused a tension with their own professional priorities for supporting care. Mental health staff face difficulties using electronic records alongside other systems of information sharing. Further exploration is needed of the gap between frontline staff values and those of the local organization and managers when supporting good dementia care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Frontline staff should be involved in designing new information systems including care plans. Care plan documentation needs to be refocused to ensure it is effective in enabling staff to communicate amongst themselves and with others to support people with dementia. Practice-based mentors could be deployed to strengthen good practice in effective information sharing. Background Reports of increased healthcare bureaucracy and concerns over care plan quality have emerged from research and surveys into staff and service user experiences. Little is known of mental health staff perspectives on the value of written care plans in supporting dementia care. Aim To investigate the experiences and views of staff in relation to care planning in dementia services in one National Health Service (NHS) provider Trust in England. Method Grounded Theory methodology was used. A purposive sample of 11 multidisciplinary staff were interviewed across three sites in one NHS Trust. Interviews were transcribed, coded and analysed using the constant comparative method. Findings Five themes were identified and are explored in detail below: (1) Repetition; (2) the impact of electronic records on practice; (3) ambivalence about the value of paperwork; (4) time conflicts; and (5) alternative sources of information to plan care. Discussion Participants perceived that written care plans did not help staff with good practice in planning care or to support dementia care generally. Staff were frustrated by repetitive documentation, inflexible electronic records and conflicting demands on their time. Implications for practice Frontline staff should be involved in designing new information systems including care plans. © 2017 John Wiley & Sons Ltd.

Early Discharge Planning and Improved Care Transitions: Pre-Admission Assessment for Readmission Risk in an Elective Orthopedic and Cardiovascular Surgical Population

PubMed Central

Mola, Ana; Rosenfeld, Peri; Ford, Shauna

2016-01-01

Background/Methods: Readmission prevention is a marker of patient care quality and requires comprehensive, early discharge planning for safe hospital transitions. Effectively performed, this process supports patient satisfaction, efficient resource utilization, and care integration. This study developed/tested the utility of a predictive early discharge risk assessment with 366 elective orthopedic/cardiovascular surgery patients. Quality improvement cycles were undertaken for the design and to inform analytic plan. An 8-item questionnaire, which includes patient self-reported health, was integrated into care managers’ telephonic pre-admission assessments during a 12-month period. Results: Regression models found the questionnaire to be predictive of readmission (p ≤ .005; R2 = .334) and length-of-stay (p ≤ .001; R2 = .314). Independent variables of “lives-alone” and “self-rated health” were statistically significant for increased readmission odds, as was “self-rated health” for increased length-of-stay. Quality measures, patient experience and increased rates of discharges-to-home further supported the benefit of embedding these questions into the pro-active planning process. Conclusion: The pilot discharge risk assessment was predictive of readmission risk and length-of-stay for elective orthopedic/cardiovascular patients. Given the usability of the questionnaire in advance of elective admissions, it can facilitate pro-active discharge planning essential for producing quality outcomes and addressing new reimbursement methodologies for continuum-based episodes of care. PMID:27616965

Can health feasibly be considered as part of the planning process in Scotland?

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

Higgins, Martin; Douglas, Margaret; Muirie, Jill

2005-10-15

The planning system is significant because of its capacity to determine the quality of the built environment as well as the health, well-being and quality of life of the individuals and communities therein. Development planning is especially important because of the long-term impact of the decisions. This paper was developed in response to increasing recognition amongst HIA practitioners in Scotland of the importance of planning for health. It focuses on the relationship between the planning system in Scotland, specifically the Development Planning element of it, and population health and considers how the health impact assessment (HIA) approach can facilitate andmore » support joint working with planners. In particular, consideration is given to the potential impact of the introduction of Strategic Environmental Assessment (SEA) on the linkages between health, HIA and planning.« less

TQM (Total Quality Management) SPARC (Special Process Action Review Committees) Handbook

DTIC Science & Technology

1989-08-01

This document describes the techniques used to support and guide the Special Process Action Review Committees for accomplishing their goals for Total Quality Management (TQM). It includes concepts and definitions, checklists, sample formats, and assessment criteria. Keywords: Continuous process improvement; Logistics information; Process analysis; Quality control; Quality assurance; Total Quality Management ; Statistical processes; Management Planning and control; Management training; Management information systems.

Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda

PubMed Central

Opio, Alex; Calnan, Jacqueline; Njeuhmeli, Emmanuel

2015-01-01

Background Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality. Methods and Findings Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the “good” range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring “good” rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events. Conclusion Public sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach. PMID:26207986

Power Extension Package (PEP) system definition extension, orbital service module systems analysis study. Volume 10: PEP project plan

NASA Technical Reports Server (NTRS)

1979-01-01

Contents: project plan summary; project and mission objectives; related studies and technology support activities; technical summary; management; procurement approach; project definition items and schedule; resources; management review; controlled items; and safety, reliability, and quality assurance.

International Summit Consensus Statement: Intellectual Disability Inclusion in National Dementia Plans.

PubMed

Watchman, Karen; Janicki, Matthew P; Splaine, Michael; Larsen, Frode K; Gomiero, Tiziano; Lucchino, Ronald

2017-06-01

The World Health Organization (WHO) has called for the development and adoption of national plans or strategies to guide public policy and set goals for services, supports, and research related to dementia. It called for distinct populations to be included within national plans, including adults with intellectual disability (ID). Inclusion of this group is important as having Down's syndrome is a significant risk factor for early-onset dementia. Adults with other ID may have specific needs for dementia-related care that, if unmet, can lead to diminished quality of old age. An International Summit on Intellectual Disability and Dementia, held in Scotland, reviewed the inclusion of ID in national plans and recommended that inclusion goes beyond just description and relevance of ID. Reviews of national plans and reports on dementia show minimal consideration of ID and the challenges that carers face. The Summit recommended that persons with ID, as well as family carers, should be included in consultation processes, and greater advocacy is required from national organizations on behalf of families, with need for an infrastructure in health and social care that supports quality care for dementia.

A Study of Quality Assurance Practices in the Universiti Sains Malaysia (USM), Malaysia

ERIC Educational Resources Information Center

Sim, Helen Khoo Chooi; Idrus, Rozhan M.

2004-01-01

This article looks at the quality assurance practices amongst three (3) groups of staff in the School of Distance Education, Universiti Sains Malaysia, i.e. lecturers, resident tutors and support staff. 9 dimensions of the Quality Assurance Practices i.e. Staff Development, Planning, Work Process, Team Work, Prioritise Customers, Performance…

30 CFR 285.659 - What requirements must I include in my SAP, COP, or GAP regarding air quality?

Code of Federal Regulations, 2010 CFR

2010-07-01

..., or GAP regarding air quality? 285.659 Section 285.659 Mineral Resources MINERALS MANAGEMENT SERVICE... must I include in my SAP, COP, or GAP regarding air quality? (a) You must comply with the Clean Air Act...) For air quality modeling that you perform in support of the activities proposed in your plan, you...

Behavioral Health Services in the Changing Landscape of Private Health Plans.

PubMed

Horgan, Constance M; Stewart, Maureen T; Reif, Sharon; Garnick, Deborah W; Hodgkin, Dominic; Merrick, Elizabeth L; Quinn, Amity E

2016-06-01

Health plans play a key role in facilitating improvements in population health and may engage in activities that have an impact on access, cost, and quality of behavioral health care. Although behavioral health care is becoming more integrated with general medical care, its delivery system has unique aspects. The study examined how health plans deliver and manage behavioral health care in the context of the Affordable Care Act (ACA) and the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA). This is a critical time to examine how health plans manage behavioral health care. A nationally representative survey of private health plans (weighted N=8,431 products; 89% response rate) was conducted in 2010 during the first year of MHPAEA, when plans were subject to the law but before final regulations, and just before the ACA went into effect. The survey addressed behavioral health coverage, cost-sharing, contracting arrangements, medical home innovations, support for technology, and financial incentives to improve behavioral health care. Coverage for inpatient and outpatient behavioral health services was stable between 2003 and 2010. In 2010, health plans were more likely than in 2003 to manage behavioral health care through internal arrangements and to contract for other services. Medical home initiatives were common and almost always included behavioral health, but financial incentives did not. Some plans facilitated providers' use of technology to improve care delivery, but this was not the norm. Health plans are key to mainstreaming and supporting delivery of high-quality behavioral health services. Since 2003, plans have made changes to support delivery of behavioral health services in the context of a rapidly changing environment.

The Village Green Project: Lesson Plans for K-8 Educators ...

EPA Pesticide Factsheets

This document contains lesson plans spanning kindergarten through 8th grade, that are written to connect next-generation science standards (USA) to the Village Green Project and related air quality topics. This document contains a series of classroom lesson plans to support connections between the Village Green Project and the USA National Science Standards at various education levels.

Determinants of Quality of Life for Breast Cancer Patients in Shanghai, China.

PubMed

Yan, Bei; Yang, Li-Ming; Hao, Li-Peng; Yang, Chen; Quan, Lei; Wang, Li-Hong; Wu, Zheng; Li, Xiao-Pan; Gao, Yu-Tang; Sun, Qiao; Yuan, Jian-Min

2016-01-01

To evaluate the association of social support status, health insurance and clinical factors with the quality of life of Chinese women with breast cancer. Information on demographics, clinical characteristics, and social support status was collected from 1,160 women with newly diagnosed breast cancer in Shanghai, China. The Perceived Social Support Scale was used to assess different sources of social support for breast cancer patients. The quality of life was evaluated using the Functional Assessment of Cancer Therapy-Breast Cancer that consisted of five domains: breast cancer-specific, emotional, functional, physical, and social & family well-being. Multivariate linear regression models were used to evaluate the associations of demographic variables, clinical characteristics, and social support status with the quality of life measures. Adequate social support from family members, friends and neighbors, and higher scores of Perceived Social Support Scale were associated with significantly improved quality of life of breast cancer patients. Higher household income, medical insurance plans with low copayment, and treatment with traditional Chinese medicine for breast cancer all were associated with higher (better) scores of quality of life measures whereas patients receiving chemotherapy had significantly lower scores of quality of life. Social support and financial aids may significantly improve the quality of life of breast cancer survivors.

Emperical Tests of Acceptance Sampling Plans

NASA Technical Reports Server (NTRS)

White, K. Preston, Jr.; Johnson, Kenneth L.

2012-01-01

Acceptance sampling is a quality control procedure applied as an alternative to 100% inspection. A random sample of items is drawn from a lot to determine the fraction of items which have a required quality characteristic. Both the number of items to be inspected and the criterion for determining conformance of the lot to the requirement are given by an appropriate sampling plan with specified risks of Type I and Type II sampling errors. In this paper, we present the results of empirical tests of the accuracy of selected sampling plans reported in the literature. These plans are for measureable quality characteristics which are known have either binomial, exponential, normal, gamma, Weibull, inverse Gaussian, or Poisson distributions. In the main, results support the accepted wisdom that variables acceptance plans are superior to attributes (binomial) acceptance plans, in the sense that these provide comparable protection against risks at reduced sampling cost. For the Gaussian and Weibull plans, however, there are ranges of the shape parameters for which the required sample sizes are in fact larger than the corresponding attributes plans, dramatically so for instances of large skew. Tests further confirm that the published inverse-Gaussian (IG) plan is flawed, as reported by White and Johnson (2011).

An Electronic Nursing Patient Care Plan Helps in Clinical Decision Support.

PubMed

Wong, C M; Wu, S Y; Ting, W H; Ho, K H; Tong, L H; Cheung, N T

2015-01-01

Information technology can help to improve health care delivery. The utilisation of informatics principle enhances the quality of nursing practices through improved communication, documentation and efficiency. The Nursing Profession constitutes 34% of the total workforce in the Hong Kong Hospital Authority (HA) and includes 21,000 nurses in 2012. To enhance the quality of care and patient safety in both hospitals and community care setting, it is essential that an integrated electronic decision support system for nurses is designed to track documentation and support care or service including observations, decisions, actions and outcomes throughout the care process at each point-of-care. The Patient Care Plan project was set up to achieve these objectives. The Project adheres to strict documentation information architecture to ensure data sharing is freely available. Preliminary results showed very promising improvement in clinical care.

Pacific Northwest National Laboratory Apatite Investigation at the 100-NR-2 Quality Assurance Project Plan

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

Fix, N. J.

This Quality Assurance Project Plan provides the quality assurance requirements and processes that will be followed by staff working on the 100-NR-2 Apatite Project. The U.S. Department of Energy, Fluor Hanford, Inc., Pacific Northwest National Laboratory, and the Washington Department of Ecology agreed that the long-term strategy for groundwater remediation at 100-N would include apatite sequestration as the primary treatment, followed by a secondary treatment. The scope of this project covers the technical support needed before, during, and after treatment of the targeted subsurface environment using a new high-concentration formulation.

Robust Decision Making to Support Water Quality Climate Adaptation: a Case Study in the Chesapeake Bay Watershed

NASA Astrophysics Data System (ADS)

Fischbach, J. R.; Lempert, R. J.; Molina-Perez, E.

2017-12-01

The U.S. Environmental Protection Agency (USEPA), together with state and local partners, develops watershed implementation plans designed to meet water quality standards. Climate uncertainty, along with uncertainty about future land use changes or the performance of water quality best management practices (BMPs), may make it difficult for these implementation plans to meet water quality goals. In this effort, we explored how decision making under deep uncertainty (DMDU) methods such as Robust Decision Making (RDM) could help USEPA and its partners develop implementation plans that are more robust to future uncertainty. The study focuses on one part of the Chesapeake Bay watershed, the Patuxent River, which is 2,479 sq km in area, highly urbanized, and has a rapidly growing population. We simulated the contribution of stormwater contaminants from the Patuxent to the overall Total Maximum Daily Load (TMDL) for the Chesapeake Bay under multiple scenarios reflecting climate and other uncertainties. Contaminants considered included nitrogen, phosphorus, and sediment loads. The assessment included a large set of scenario simulations using the USEPA Chesapeake Bay Program's Phase V watershed model. Uncertainties represented in the analysis included 18 downscaled climate projections (based on 6 general circulation models and 3 emissions pathways), 12 land use scenarios with different population projections and development patterns, and alternative assumptions about BMP performance standards and efficiencies associated with different suites of stormwater BMPs. Finally, we developed cost estimates for each of the performance standards and compared cost to TMDL performance as a key tradeoff for future water quality management decisions. In this talk, we describe how this research can help inform climate-related decision support at USEPA's Chesapeake Bay Program, and more generally how RDM and other DMDU methods can support improved water quality management under climate uncertainty.

Clinical Workflow Observations to Identify Opportunities for Nurse, Physicians and Patients to Share a Patient-centered Plan of Care

PubMed Central

Collins, Sarah A.; Gazarian, Priscilla; Stade, Diana; McNally, Kelly; Morrison, Conny; Ohashi, Kumiko; Lehmann, Lisa; Dalal, Anuj; Bates, David W.; Dykes, Patricia C.

2014-01-01

Patient- and Family-Centered Care (PFCC) is essential for high quality care in the critical and acute-specialty care hospital setting. Effective PFCC requires clinicians to form an integrated interprofessional team to collaboratively engage with the patient/family and contribute to a shared patient-centered plan of care. We conducted observations on a critical care and specialty unit to understand the plan of care activities and workflow documentation requirements for nurses and physicians to inform the development of a shared patient-centered plan of care to support patient engagement. We identified siloed plan of care documentation, with workflow opportunities to converge the nurses plan of care with the physician planned To-do lists and quality and safety checklists. Integration of nurses and physicians plan of care activities into a shared plan of care is a feasible and valuable step toward interprofessional teams that effectively engage patients in plan of care activities. PMID:25954345

Work plan for the radiological survey for the David Witherspoon, Incorporated, Landfill-1630 site, Knoxville, Tennessee

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

NONE

1996-07-01

This work plan establishes the methods and requirements for performing a radiological survey at the David Witherspoon, Incorporated, Landfill-1630 Site, Knoxville, Tennessee (DWI 1630 Site) in accordance with requirements under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA). The radiological survey will identify the radiological contamination level of the equipment and debris stored at the DWI 1630 Site. The data generated from the survey activities will support the decisions for characterization of the equipment/debris and aid in subsequent disposition and waste handling. The survey activities to be performed under this work plan include an equipment radiological survey,more » a walkover survey, and an immunoassay testing for polychlorinated biphenyls (PCBs). This work plan includes a quality assurance (QA)/quality control (QC) project plan, a health and safety (H&S) plan, and a waste management plan.« less

PROJECTING WILDLIFE RESPONSES TO ALTERNATIVE FUTURE LANDSCAPES IN OREGON'S WILLAMETTE VALLEY

EPA Science Inventory

Increasingly, environmental quality is becoming recognized as a critical factor that should constrain land use planning. One important measure of a landscape's quality is its capacity to support viable populations of wildlife species. But the ability of land managers to balance c...

40 CFR 131.12 - Antidegradation policy.

Code of Federal Regulations, 2011 CFR

2011-07-01

... minimum, be consistent with the following: (1) Existing instream water uses and the level of water quality... waters exceed levels necessary to support propagation of fish, shellfish, and wildlife and recreation in... continuing planning process, that allowing lower water quality is necessary to accommodate important economic...

Advanced Education and Technology Business Plan, 2009-12. Highlights

ERIC Educational Resources Information Center

Alberta Advanced Education and Technology, 2009

2009-01-01

Advanced Education and Technology provides strategic leadership for the development of the next generation economy in Alberta through the provision of accessible, affordable and quality learning opportunities for all Albertans and support for a dynamic and integrated innovation system. This paper provides the highlights of the business plan of the…

77 FR 41132 - Air Quality Implementation Plans; Alabama; Attainment Plan for the Alabama Portion of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-12

... modeling demonstration should include supporting technical analyses and descriptions of all relevant....5 and NO X . The attainment demonstration includes: Technical analyses that locate, identify, and... modeling analysis is a complex technical evaluation that began with selection of the modeling system. The...

76 FR 14584 - Approval and Promulgation of Air Quality Implementation Plans; Montana; Attainment Plan for Libby...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-17

... the timeframe provided in the statute. It must also include supporting technical analyses and... emissions inventory (EI), a woodstove air pollution control calculation, and a technical analysis showing... year (2010); and (2) an attainment demonstration consisting of: (a) Technical analyses that locate...

Using Implementation Planning to Increase Teachers' Adherence and Quality to Behavior Support Plans

ERIC Educational Resources Information Center

Sanetti, Lisa M. Hagermoser; Collier-Meek, Melissa A.; Long, Anna C. J.; Kim, Jisun; Kratochwill, Thomas R.

2014-01-01

Evidence-based practices within a response-to-intervention framework must be implemented with adequate treatment integrity to promote student outcomes. However, research findings indicate educators struggle to implement interventions and logistical considerations may limit the utility of performance feedback, an evidence-based treatment integrity…

The Effects of Structured Health Policy Education on Connecticut Registered Nurses' Clinical Documentation

ERIC Educational Resources Information Center

Lobo, Rosale Constance

2017-01-01

Registered Nurses use clinical documentation to describe care planning processes, measure quality outcomes, support reimbursement, and defend litigation. The Connecticut Department of Health, guided by federal Conditions of Participation, defines state-level healthcare policy to include required care planning processes. Nurses are educated in care…

Hospital culture--why create one?

PubMed

Sovie, M D

1993-01-01

Hospitals, to survive, must be transformed into responsive, participative organizations capable of new practices that produce improved results in both quality of care and service at reduced costs. Creating, managing, and changing the culture are critical leadership functions that will enable the hospital to succeed. Strategic planning and effective implementation of planned change will produce the desired culture. Work restructuring, a focus on quality management along with changes in clinical practices, as well as the care and support processes, are all a part of the necessary hospital cultural revolution.

The Utility of the OMI HCHO/NO2 in Air Quality Decision-Making Activities

NASA Technical Reports Server (NTRS)

Duncan, Bryan

2010-01-01

I will discuss a novel and practical application of the OMI HCHU and NO2 data products to the "weight of evidence" in the air quality decision-making process (e.g., State Implementation Plan (SIP)) for a city, region, or state to demonstrate that it is making progress toward attainment of the National Ambient Air Quality Standard (NAAQS) for ozone. Any trend, or lack thereof, in the observed OMI HCHO/NO2 may support that an emission control strategy implemented to reduce ozone is or is not occurring for a metropolitan area. In addition, the observed OMI HCHO/NO2 may be used to define new emission control strategies as the photochemical environments of urban areas evolve over time. I will demonstrate the utility of the OMI HCHO/NO2 over the U.S. for air quality applications with support from simulations with both a regional model and a photochemical box model. These results support mission planning of an OMI-like instrument for the proposed GEO-CAPE satellite that has as one of its objectives to study air quality from space. However, I'm attending the meeting as the Aura Deputy Project Scientist, so I don't technically need to present anything to justify the travel.

Unplanned pregnancy and subsequent psychological distress in partnered women: a cross-sectional study of the role of relationship quality and wider social support.

PubMed

Barton, Katherine; Redshaw, Maggie; Quigley, Maria A; Carson, Claire

2017-01-26

Research into the impact of unintended pregnancy on the wellbeing of women tends to focus on pregnancies ending in either termination or lone motherhood. Unintended pregnancy is common in partnered women, but little is known about the association between unintended pregnancy and postpartum affective disorders, such as depression and anxiety in this group. Poor relationship quality and lack of social support are considered risk factors for psychological distress (PD). We examined the association between unplanned motherhood and subsequent PD in partnered women, for whom evidence is sparse, accounting for the role of relationship quality and social support. Data for 12,462 partnered mothers were drawn from the first survey of Millennium Cohort Study, completed at 9 months postpartum. Women reported whether their baby was planned, and how they felt when they discovered that they were pregnant. Pregnancy intention is categorised as "planned", "unplanned/happy", "unplanned/ambivalent" and "unplanned/unhappy". PD was assessed using the modified 9-item Rutter Malaise Inventory. Social support was measured by a composite score for perceived support, and a measure of actual support from friends and family. Relationship quality was assessed using a modified Golombok-Rust Inventory of Marital State. The effect of pregnancy intention on the odds of PD at 9 months was estimated, adjusting for potential confounding factors. All analyses were weighted for response and design effects. In total 32.8%(weighted) (4343/12462) of mothers reported an unplanned pregnancy: 23.3 wt% (3087) of mothers felt happy, 3.5 wt% (475) ambivalent, and 6.0 wt% (781) unhappy upon discovery. Unplanned pregnancy was associated with a significantly increased odds of PD compared to planned (OR 1.73 (95%CI: 1.53, 1.95)). This was more pronounced among women who reported negative or ambivalent feelings in early pregnancy (OR 2.72 (95%CI:2.17, 3.41) and 2.56 (95%CI:1.95, 3.34), respectively), than those who reported positive feelings (OR 1.39 (95%CI:1.21, 1.60)). Adjustment for relationship quality, in particular, reduced odds of PD after unplanned pregnancy (e.g. from 2.19 (95%C: 1.74, 2.74) to 1.63 (95% CI: 1.29, 2.07 in the unplanned, unhappy group compared to the planned). A third of partnered mothers reported that their pregnancy was unintended, yet this group is under-researched. Unplanned motherhood was associated with increased risk of PD at 9 months postpartum, particularly among women who felt unhappy or ambivalent at the start. The roles of relationship quality and social support require further investigation, as possible means to intervene and improve maternal wellbeing.

Integrating Personalized and Community Services for Mobile Travel Planning and Management

NASA Astrophysics Data System (ADS)

Yu, Chien-Chih

Personalized and community services have been noted as keys to enhance and facilitate e-tourism as well as mobile applications. This paper aims at proposing an integrated service framework for combining personalized and community functions to support mobile travel planning and management. Major mobile tourism related planning and decision support functions specified include personalized profile management, information search and notification, evaluation and recommendation, do-it-yourself planning and design, community and collaboration management, auction and negotiation, transaction and payment, as well as trip tracking and quality control. A system implementation process with an example prototype is also presented for illustrating the feasibility and effectiveness of the proposed system framework, process model, and development methodology.

Measuring and modelling the quality of 40 post-disaster mental health and psychosocial support programmes.

PubMed

Dückers, Michel L A; Thormar, Sigridur B; Juen, Barbara; Ajdukovic, Dean; Newlove-Eriksson, Lindy; Olff, Miranda

2018-01-01

Disasters can have an enormous impact on the health and well-being of those affected. Internationally, governments and service providers are often challenged to address complex psychosocial problems. Ideally, the potentially broad range of support activities include a coherent, high-quality mental health and psychosocial support (MHPSS) programme. We present a theory-driven quantitative analysis of the quality of 40 MHPSS programmes, mostly implemented in European disaster settings. The objective is to measure quality domains recognized as relevant in the literature and to empirically test associations. During the EU project "Operationalizing Psychosocial Support in Crisis" (OPSIC) an evaluation survey was designed and developed for this purpose and completed by 40 MHPSS programme coordinators involved in different mass emergencies and disasters. We analysed the survey data in two steps. Firstly, we used the data to operationalize quality domains of a MHPSS programme, tested constructs and assessed their internal consistency reliability. A total of 26 out of 44 survey items clustered into three of the four domains identified within the theoretical framework: "planning and delivery system" (Cronbach's alpha 0.82); "general evaluation criteria" (Cronbach's alpha 0.82); and "essential psychosocial principles" (Cronbach's alpha 0.75). "Measures and interventions applied", theoretically a potential fourth domain, could not be confirmed to empirically cluster together. Secondly, several models with associations between domains and measures and interventions were tested and compared. The model with the best fit suggests that in MHPSS programmes with a higher planning and delivery systems score, a larger number of measures and interventions from evidence-informed guidelines are applied. In such programmes, coordinators are more positive about general evaluation criteria and the realization of essential psychosocial principles. Moreover, the analyses showed that some measures and interventions are more likely to be applied in programmes with more evolved planning and delivery systems, yet for most measures and interventions the likelihood of being applied is not linked to planning and delivery system status, nor to coordinator perceptions concerning psychosocial principles and evaluation criteria. Further research is necessary to validate and expand the findings and to learn more about success factors and obstacles for MHPSS programme implementation.

The Missing Link: Improving Quality With a Chronic Disease Management Intervention for the Primary Care Office

PubMed Central

Zweifler, John

2007-01-01

Bold steps are necessary to improve quality of care for patients with chronic diseases and increase satisfaction of both primary care physicians and patients. Office-based chronic disease management (CDM) workers can achieve these objectives by offering self-management support, maintaining disease registries, and monitoring compliance from the point of care. CDM workers can provide the missing link by connecting patients, primary care physicans, and CDM services sponsored by health plans or in the community. CDM workers should be supported financially by Medicare, Medicaid, and commercial health plans through reimbursements to physicians for units of service, analogous to California’s Comprehensive Perinatal Services Program. Care provided by CDM workers should be standardized, and training requirements should be sufficiently flexible to ensure wide dissemination. CDM workers can potentially improve quality while reducing costs for preventable hospitalizations and emergency department visits, but evaluation at multiple levels is recommended. PMID:17893388

Palliative Care Specialist Consultation Is Associated With Supportive Care Quality in Advanced Cancer.

PubMed

Walling, Anne M; Tisnado, Diana; Ettner, Susan L; Asch, Steven M; Dy, Sydney M; Pantoja, Philip; Lee, Martin; Ahluwalia, Sangeeta C; Schreibeis-Baum, Hannah; Malin, Jennifer L; Lorenz, Karl A

2016-10-01

Although recent randomized controlled trials support early palliative care for patients with advanced cancer, the specific processes of care associated with these findings and whether these improvements can be replicated in the broader health care system are uncertain. The aim of this study was to evaluate the occurrence of palliative care consultation and its association with specific processes of supportive care in a national cohort of Veterans using the Cancer Quality ASSIST (Assessing Symptoms Side Effects and Indicators of Supportive Treatment) measures. We abstracted data from 719 patients' medical records diagnosed with advanced lung, colorectal, or pancreatic cancer in 2008 over a period of three years or until death who received care in the Veterans Affairs Health System to evaluate the association of palliative care specialty consultation with the quality of supportive care overall and by domain using a multivariate regression model. All but 54 of 719 patients died within three years and 293 received at least one palliative care consult. Patients evaluated by a palliative care specialist at diagnosis scored seven percentage points higher overall (P < 0.001) and 11 percentage points higher (P < 0.001) within the information and care planning domain compared with those without a consult. Early palliative care specialist consultation is associated with better quality of supportive care in three advanced cancers, predominantly driven by improvements in information and care planning. This study supports the effectiveness of early palliative care consultation in three common advanced cancers within the Veterans Affairs Health System and provides a greater understanding of what care processes palliative care teams influence. Published by Elsevier Inc.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 1

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

Matthews, Patrick

2014-01-01

The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 105 based on the implementation of the corrective actions. Corrective action investigation (CAI) activities were performed from October 22, 2012, through May 23, 2013, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices.

[Development of integrated support software for clinical nutrition].

PubMed

Siquier Homar, Pedro; Pinteño Blanco, Manel; Calleja Hernández, Miguel Ángel; Fernández Cortés, Francisco; Martínez Sotelo, Jesús

2015-09-01

to develop an integrated computer software application for specialized nutritional support, integrated in the electronic clinical record, which detects automatically and early those undernourished patients or at risk of developing undernourishment, determining points of opportunity for improvement and evaluation of the results. the quality standards published by the Nutrition Work Group of the Spanish Society of Hospital Pharmacy (SEFH) and the recommendations by the Pharmacy Group of the Spanish Society of Parenteral and Enteral Nutrition (SENPE) have been taken into account. According to these quality standards, the nutritional support has to include the following healthcare stages or sub-processes: nutritional screening, nutritional assessment, plan for nutritional care, prescription, preparation and administration. this software allows to conduct, in an automated way, a specific nutritional assessment for those patients with nutritional risk, implementing, if necessary, a nutritional treatment plan, conducting follow-up and traceability of outcomes derived from the implementation of improvement actions, and quantifying to what extent our practice is close to the established standard. this software allows to standardize the specialized nutritional support from a multidisciplinary point of view, introducing the concept of quality control per processes, and including patient as the main customer. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

DCSC (Defense Construction Supply Center) Total Quality Management Master Plan

DTIC Science & Technology

1989-07-01

job while allowing them to establish a better balance between work and personal needs. 29 TQM SHORT-MID-LONG RANGE INITIATIVES MID RANGE (3 YEARS...all performance standards. IMPROVE THE QUALITY OF WORKLIFE - Projects requiring engineering support throughout FY 90 and beyond are: Construction of

Home Health Aides' Perceptions of Quality Care: Goals, Challenges, and Implications for a Rapidly Changing Industry.

PubMed

Franzosa, Emily; Tsui, Emma K; Baron, Sherry

2018-02-01

Home care payment models, quality measures, and care plans are based on physical tasks workers perform, ignoring relational care that supports clients' cognitive, emotional, and social well-being. As states seek to rein in costs and improve the efficiency and quality of care, they will need to consider how to measure and support relational care. In four focus groups ( n = 27) of unionized, agency-based New York City home health aides, workers reported aide-client relationships were a cornerstone of high-quality care, and building them required communication, respect, and going the extra mile. Since much of this care was invisible outside the worker-client relationship, aides received little supervisory support and felt excluded from the formal care team. Aligning payment models with quality requires understanding the full scope of services aides provide and a quality work environment that offers support and supervision, engages aides in patient care, and gives them a voice in policy decisions.

SU-G-TeP4-06: An Integrated Application for Radiation Therapy Treatment Plan Directives, Management, and Reporting

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

Matuszak, M; Anderson, C; Lee, C

Purpose: With electronic medical records, patient information for the treatment planning process has become disseminated across multiple applications with limited quality control and many associated failure modes. We present the development of a single application with a centralized database to manage the planning process. Methods: The system was designed to replace current functionalities of (i) static directives representing the physician intent for the prescription and planning goals, localization information for delivery, and other information, (ii) planning objective reports, (iii) localization and image guidance documents and (iv) the official radiation therapy prescription in the medical record. Using the Eclipse Scripting Applicationmore » Programming Interface, a plug-in script with an associated domain-specific SQL Server database was created to manage the information in (i)–(iv). The system’s user interface and database were designed by a team of physicians, clinical physicists, database experts, and software engineers to ensure usability and robustness for clinical use. Results: The resulting system has been fully integrated within the TPS via a custom script and database. Planning scenario templates, version control, approvals, and logic-based quality control allow this system to fully track and document the planning process as well as physician approval of tradeoffs while improving the consistency of the data. Multiple plans and prescriptions are supported along with non-traditional dose objectives and evaluation such as biologically corrected models, composite dose limits, and management of localization goals. User-specific custom views were developed for the attending physician review, physicist plan checks, treating therapists, and peer review in chart rounds. Conclusion: A method was developed to maintain cohesive information throughout the planning process within one integrated system by using a custom treatment planning management application that interfaces directly with the TPS. Future work includes quantifying the improvements in quality, safety and efficiency that are possible with the routine clinical use of this system. Supported in part by NIH-P01-CA-059827.« less

SU-D-BRB-02: Combining a Commercial Autoplanning Engine with Database Dose Predictions to Further Improve Plan Quality

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

Robertson, SP; Moore, JA; Hui, X

Purpose: Database dose predictions and a commercial autoplanning engine both improve treatment plan quality in different but complimentary ways. The combination of these planning techniques is hypothesized to further improve plan quality. Methods: Four treatment plans were generated for each of 10 head and neck (HN) and 10 prostate cancer patients, including Plan-A: traditional IMRT optimization using clinically relevant default objectives; Plan-B: traditional IMRT optimization using database dose predictions; Plan-C: autoplanning using default objectives; and Plan-D: autoplanning using database dose predictions. One optimization was used for each planning method. Dose distributions were normalized to 95% of the planning target volumemore » (prostate: 8000 cGy; HN: 7000 cGy). Objectives used in plan optimization and analysis were the larynx (25%, 50%, 90%), left and right parotid glands (50%, 85%), spinal cord (0%, 50%), rectum and bladder (0%, 20%, 50%, 80%), and left and right femoral heads (0%, 70%). Results: All objectives except larynx 25% and 50% resulted in statistically significant differences between plans (Friedman’s χ{sup 2} ≥ 11.2; p ≤ 0.011). Maximum dose to the rectum (Plans A-D: 8328, 8395, 8489, 8537 cGy) and bladder (Plans A-D: 8403, 8448, 8527, 8569 cGy) were significantly increased. All other significant differences reflected a decrease in dose. Plans B-D were significantly different from Plan-A for 3, 17, and 19 objectives, respectively. Plans C-D were also significantly different from Plan-B for 8 and 13 objectives, respectively. In one case (cord 50%), Plan-D provided significantly lower dose than plan C (p = 0.003). Conclusion: Combining database dose predictions with a commercial autoplanning engine resulted in significant plan quality differences for the greatest number of objectives. This translated to plan quality improvements in most cases, although special care may be needed for maximum dose constraints. Further evaluation is warranted in a larger cohort across HN, prostate, and other treatment sites. This work is supported by Philips Radiation Oncology Systems.« less

Leveraging standards to support patient-centric interdisciplinary plans of care.

PubMed

Dykes, Patricia C; DaDamio, Rebecca R; Goldsmith, Denise; Kim, Hyeon-eui; Ohashi, Kumiko; Saba, Virginia K

2011-01-01

As health care systems and providers move towards meaningful use of electronic health records, the once distant vision of collaborative patient-centric, interdisciplinary plans of care, generated and updated across organizations and levels of care, may soon become a reality. Effective care planning is included in the proposed Stages 2-3 Meaningful Use quality measures. To facilitate interoperability, standardization of plan of care messaging, content, information and terminology models are needed. This degree of standardization requires local and national coordination. The purpose of this paper is to review some existing standards that may be leveraged to support development of interdisciplinary patient-centric plans of care. Standards are then applied to a use case to demonstrate one method for achieving patient-centric and interoperable interdisciplinary plan of care documentation. Our pilot work suggests that existing standards provide a foundation for adoption and implementation of patient-centric plans of care that are consistent with federal requirements.

Factors Determining Quality of Care in Family Planning Services in Africa: A Systematic Review of Mixed Evidence

PubMed Central

Tessema, Gizachew Assefa; Streak Gomersall, Judith; Mahmood, Mohammad Afzal; Laurence, Caroline O.

2016-01-01

Background Improving use of family planning services is key to improving maternal health in Africa, and provision of quality of care in family planning services is critical to support higher levels of contraceptive uptake. The objective of this systematic review was to synthesize the available evidence on factors determining the quality of care in family planning services in Africa. Methods Quantitative and qualitative studies undertaken in Africa, published in English, in grey and commercial literature, between 1990 and 2015 were considered. Methodological quality of included studies was assessed using standardized tools. Findings from the quantitative studies were summarized using narrative and tables. Client satisfaction was used to assess the quality of care in family planning services in the quantitative component of the review. Meta-aggregation was used to synthesize the qualitative study findings. Results From 4334 records, 11 studies (eight quantitative, three qualitative) met the review eligibility criteria. The review found that quality of care was influenced by client, provider and facility factors, and structural and process aspects of the facilities. Client’s waiting time, provider competency, provision/prescription of injectable methods, maintaining privacy and confidentiality were the most commonly identified process factors. The quality of stock inventory was the most commonly identified structural factor. The quality of care was also positively associated with privately-owned facilities. The qualitative synthesis revealed additional factors including access related factors such as ‘pre-requisites to be fulfilled by the clients and cost of services, provider workload, and providers’ behaviour. Conclusion There is limited evidence on factors determining quality of care in family planning services in Africa that shows quality of care is influenced by multiple factors. The evidence suggests that lowering access barriers and avoiding unnecessary pre-requisites for taking contraceptive methods are important to improve the quality of care in family planning services. Strategies to improve provider behavior and competency are important. Moreover, strategies that minimize client waiting time and ensure client confidentiality should be implemented to ensure quality of care in family planning services. However, no strong evidence based conclusions and recommendations may be drawn from the evidence. Future studies are needed to identify the most important factors associated with quality of care in family planning services in a wider range of African countries. PMID:27812124

NASA total quality management 1989 accomplishments report

NASA Technical Reports Server (NTRS)

1990-01-01

Described here are the accomplishments of NASA as a result of the use of Total Quality Management (TQM). The principles in practice which led to these process refinements are important cultural elements to any organization's productivity and quality efforts. The categories of TQM discussed here are top management leadership and support, strategic planning, focus on the customer, employee training and recognition, employee empowerment and teamwork, measurement and analysis, and quality assurance.

Show Me My Health Plans: a study protocol of a randomized trial testing a decision support tool for the federal health insurance marketplace in Missouri.

PubMed

Politi, Mary C; Barker, Abigail R; Kaphingst, Kimberly A; McBride, Timothy; Shacham, Enbal; Kebodeaux, Carey S

2016-02-16

The implementation of the ACA has improved access to quality health insurance, a necessary first step to improving health outcomes. However, access must be supplemented by education to help individuals make informed choices for plans that meet their individual financial and health needs. Drawing on a model of information processing and on prior research, we developed a health insurance decision support tool called Show Me My Health Plans. Developed with extensive stakeholder input, the current tool (1) simplifies information through plain language and graphics in an educational component; (2) assesses and reviews knowledge interactively to ensure comprehension of key material; (3) incorporates individual and/or family health status to personalize out-of-pocket cost estimates; (4) assesses preferences for plan features; and (5) helps individuals weigh information appropriate to their interests and needs through a summary page with "good fit" plans generated from a tailored algorithm. The current study will evaluate whether the online decision support tool improves health insurance decisions compared to a usual care condition (the healthcare.gov marketplace website). The trial will include 362 individuals (181 in each group) from rural, suburban, and urban settings within a 90 mile radius around St. Louis. Eligibility criteria includes English-speaking individuals 18-64 years old who are eligible for the ACA marketplace plans. They will be computer randomized to view the intervention or usual care condition. Presenting individuals with options that they can understand tailored to their needs and preferences could help improve decision quality. By helping individuals narrow down the complexity of health insurance plan options, decision support tools such as this one could prepare individuals to better navigate enrollment in a plan that meets their individual needs. The randomized trial was registered in clinicaltrials.gov (NCT02522624) on August 6, 2015.

ICESat (GLAS) Science Processing Software Document Series. Volume 1; Science Software Management Plan; 3.0

NASA Technical Reports Server (NTRS)

Hancock, David W., III

1999-01-01

This document provides the Software Management Plan for the GLAS Standard Data Software (SDS) supporting the GLAS instrument of the EOS ICESat Spacecraft. The SDS encompasses the ICESat Science Investigator-led Processing System (I-SIPS) Software and the Instrument Support Terminal (IST) Software. For the I-SIPS Software, the SDS will produce Level 0, Level 1, and Level 2 data products as well as the associated product quality assessments and descriptive information. For the IST Software, the SDS will accommodate the GLAS instrument support areas of engineering status, command, performance assessment, and instrument health status.

A framework for institutionalizing quality assurance.

PubMed

Silimperi, Diana R; Franco, Lynne Miller; Veldhuyzen van Zanten, Tisna; MacAulay, Catherine

2002-12-01

To develop a framework to support the institutionalization of quality assurance (QA). The framework for institutionalizing QA consists of a model of eight essential elements and a 'roadmap' for the process of institutionalization. The essential elements are the building blocks required for implementing and sustaining QA activities. Core QA activities include defining, measuring and improving quality. The essential elements are grouped under three categories: the internal enabling environment (internal to the organization or system), organizing for quality, and support functions. The enabling environment contains the essential elements of leadership, policy, core values, and resources. Organizing for quality includes the structure for implementing QA. Three essential elements are primarily support functions: capacity building, communication and information, and rewarding quality. The model can be applied at the level of an organization or a system. The paper also describes the process of institutionalizing QA, starting from a state of preawareness, passing through four phases (awareness, experiential, expansion, and consolidation), and culminating in a state of maturity. The process is not linear; an organization may regress, vacillate between phases, or even remain stagnant. Some phases (e.g. awareness and experiential) may occur simultaneously. The framework has been introduced in nearly a dozen countries in Latin America and Africa. The conceptual model has been used to support strategic planning and directing Ministry of Health work plans, and also as a resource for determining the elements necessary to strengthen and sustain QA. The next step will be the development and evaluation of an assessment tool to monitor developmental progress in the institutionalization of QA.

Analyzing the efficiency of short-term air quality plans in European cities, using the CHIMERE air quality model.

PubMed

Thunis, P; Degraeuwe, B; Pisoni, E; Meleux, F; Clappier, A

2017-01-01

Regional and local authorities have the obligation to design air quality plans and assess their impacts when concentration levels exceed the limit values. Because these limit values cover both short- (day) and long-term (year) effects, air quality plans also follow these two formats. In this work, we propose a methodology to analyze modeled air quality forecast results, looking at emission reduction for different sectors (residential, transport, agriculture, etc.) with the aim of supporting policy makers in assessing the impact of short-term action plans. Regarding PM 10 , results highlight the diversity of responses across European cities, in terms of magnitude and type that raises the necessity of designing area-specific air quality plans. Action plans extended from 1 to 3 days (i.e., emissions reductions applied for 24 and 72 h, respectively) point to the added value of trans-city coordinated actions. The largest benefits are seen in central Europe (Vienna, Prague) while major cities (e.g., Paris) already solve a large part of the problem on their own. Eastern Europe would particularly benefit from plans based on emission reduction in the residential sectors; while in northern cities, agriculture seems to be the key sector on which to focus attention. Transport is playing a key role in most cities whereas the impact of industry is limited to a few cities in south-eastern Europe. For NO 2 , short-term action plans focusing on traffic emission reductions are efficient in all cities. This is due to the local character of this type of pollution. It is important, however, to stress that these results remain dependent on the selected months available for this study.

The challenges and related strategies of planning for wilderness experiences

Treesearch

Kerri Cahill

2012-01-01

Planning is where science, public interests and management of wilderness areas come together. Unfortunately, science and information specifically supporting wilderness experiences, if any exists, is often perceived by managers as subjective, value laden, and hard to defend. This can sometimes lead to the tough decisions about providing high quality wilderness...

Population and Australian development assistance.

PubMed

Jones, R

1992-07-01

Australia's position on international population issues is consistent with the major international statements on population: the World Population Plan of Action (1974), the Mexico City Declaration (1984), and the Amsterdam Declaration (1989). Australia's policy emphasizes the importance of population policies as an integral part of social, economic, and cultural development aimed at improving the quality of life of the people. Factors that would promote smaller families include improving economic opportunities, old-age security, education and health (particularly for women), as well as improving the accessibility and quality of family planning services. The quality of care approach is directly complementary to the Australian International Development Assistance Bureau (AIDAB)'s Women-In-Development Policy and its Health Policy, which stresses the theme of Women And Their Children's Health (WATCH). Australia's support for population programs and activities has increased considerably over the last few years. Total assistance for the year 1990/91 was around $7 million out of a total aid program of $1216 million. In recent years AIDAB has funded family planning activities or health projects with family planning components in a number of countries in the Asia-Pacific region. In the South Pacific region AIDAB has funded a reproductive health video project taking into consideration the cultural sensitivities and customs of the peoples of the region. AIDAB has supported a UN Population Fund project in Thailand that aims to strengthen the capacity of the National Statistical Office to collect population data. The US currently accounts for around 40% of all population-related development assistance to improve the health of women and children through family planning. The other major donors are Japan, the Scandinavian countries, and the Netherlands. Funding for population has been a relatively low percentage of overall development assistance budgets in OECD countries. In the future, Australian aid will improve the accessibility and quality of family planning services, and integrate family planning with health, education, environment, and poverty alleviation.

Locating Continuing Education Programs.

ERIC Educational Resources Information Center

Mason, Robert C.

1986-01-01

Emphasizes program location as an important component of the marketing plan for continuing education. Also discusses relations among program location and quality, costs, supportive services, and economies of scale. (CH)

Team factors that predict to sustainability indicators for community-based prevention teams.

PubMed

Perkins, Daniel F; Feinberg, Mark E; Greenberg, Mark T; Johnson, Lesley E; Chilenski, Sarah Meyer; Mincemoyer, Claudia C; Spoth, Richard L

2011-08-01

Because they often set out with a guarantee of only short-term funding, many community partnerships will face a threat to their sustainability almost as soon as the first money runs out. Research into the factors that enable some coalitions and partnerships to meet the challenge when others fail is limited. This study begins to fill this gap in our understanding by examining influences on the process of sustainability planning in the context of a collaborative partnership focused on youth development. We report on a longitudinal examination of the quality of planning and attitudes underpinning the sustainability of PROSPER community prevention teams whose members implement evidence-based programs designed to support positive youth development and reduce early substance use and other problem behaviors. The current research concentrates on a particular dimension of partnership effectiveness to establish whether perceptions about team functioning in play at 6 and 18 months predict the quality of sustainability planning at 36 and 48 months. How well teams functioned in the early stages was found to be strongly related to the quality of their later preparations for sustainability. Recruitment and integration of new team members, and the encouragement they subsequently received were also found to be key factors. The results strengthen the argument for providing technical assistance to meet the needs of those who promote prevention partnerships, and they provide longitudinal empirical data to support the hypotheses of other researchers who have similarly found a correlation between effective sustainability and early planning and support. Copyright © 2010 Elsevier Ltd. All rights reserved.

Role of technology in supporting quality control and treatment fidelity in a family caregiver clinical trial.

PubMed

Farran, Carol J; Etkin, Caryn D; McCann, Judith J; Paun, Olimpia; Eisenstein, Amy R; Wilbur, Joellen

2011-11-01

This article describes how a family caregiver lifestyle physical activity clinical trial uses research technology to enhance quality control and treatment fidelity. This trial uses a range of Internet, Blaise(®) Windows-based software and Echo Server technologies to support quality control issues, such as data collection, data entry, and study management advocated by the clinical trials literature, and to ensure treatment fidelity concerning intervention implementation (i.e., design, training, delivery, receipt, and enactment) as proposed by the National Institutes of Health Behavior Change Consortium. All research staff are trained to use these technologies. Strengths of this technological approach to support quality control and treatment fidelity include the comprehensive plan, involvement of all staff, and ability to maintain accurate and timely data. Limitations include the upfront time and costs for developing and testing these technological methods, and having support staff readily available to address technological issues if they occur.

WE-A-304-01: Strategies and Technologies for Cranial Radiosurgery Planning: MLC-Based Linac

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

Kim, G.

2015-06-15

The high fractional doses, stringent requirements for accuracy and precision, and surgical perspective characteristic of intracranial radiosurgery create considerations for treatment planning which are distinct from most other radiotherapy procedures. This session will introduce treatment planning techniques specific to two popular intracranial SRS modalities: Gamma Knife and MLC-based Linac. The basic treatment delivery characteristics of each device will be reviewed with a focus on how those characteristics determine the paradigm used for treatment planning. Basic techniques for treatment planning will be discussed, including considerations such as isodose selection, target and organ-at-risk definition, quality indices, and protection of critical structures. Futuremore » directions for SRS treatment planning will also be discussed. Learning Objectives: Introduce the basic physical principles of intracranial radiosurgery and how they are realized in the treatment planning paradigms for Gamma Knife and Linac radiosurgery. Demonstrate basic treatment planning techniques. Discuss metrics for evaluating SRS treatment plan quality. Discuss recent and future advances in SRS treatment planning. D. Schlesinger receives research support from Elekta, AB.« less

WE-A-304-02: Strategies and Technologies for Cranial Radiosurgery Planning: Gamma Knife

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

Schlesinger, D.

2015-06-15

The high fractional doses, stringent requirements for accuracy and precision, and surgical perspective characteristic of intracranial radiosurgery create considerations for treatment planning which are distinct from most other radiotherapy procedures. This session will introduce treatment planning techniques specific to two popular intracranial SRS modalities: Gamma Knife and MLC-based Linac. The basic treatment delivery characteristics of each device will be reviewed with a focus on how those characteristics determine the paradigm used for treatment planning. Basic techniques for treatment planning will be discussed, including considerations such as isodose selection, target and organ-at-risk definition, quality indices, and protection of critical structures. Futuremore » directions for SRS treatment planning will also be discussed. Learning Objectives: Introduce the basic physical principles of intracranial radiosurgery and how they are realized in the treatment planning paradigms for Gamma Knife and Linac radiosurgery. Demonstrate basic treatment planning techniques. Discuss metrics for evaluating SRS treatment plan quality. Discuss recent and future advances in SRS treatment planning. D. Schlesinger receives research support from Elekta, AB.« less

Transforming South-South technical support to fight noncommunicable diseases.

PubMed

Shakow, Aaron D A; Bukhman, Gene; Adebona, Olumuyiwa; Greene, Jeremy; de Dieu Ngirabega, Jean; Binagwaho, Agnès

2012-03-01

At the UN High-Level Meeting on non-communicable diseases (NCD) in September 2011, each member state was challenged to create a multisectoral national policy and plan for the prevention and control of non-communicable disease by 2013. Few low-income countries, however, currently have such plans. Their governments are likely to turn for assistance in drafting and implementation to multilateral agencies and Contract Technical Support Organizations recommended by development partners. Yet because many NCD seen in the lowest-income countries differ significantly from those prevalent elsewhere, existing providers of external technical support may lack the necessary experience to support strategic planning for NCD interventions in these settings. This article reviews currently available mechanisms of technical support for health sector planning. It places them in the broader historical context of post- World War II international development assistance and the more recent campaigns for horizontal "South-South" cooperation and aid effectiveness. It proposes bilateral technical assistance by low income-countries themselves as the natural evolution of development assistance in health. Such programs, it argues, may be able to improve the quality of technical support to low-income countries for strategic planning in the NCD area while directing resources to the regions where they are most needed. Copyright © 2012 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

Improved Specimen-Referral System and Increased Access to Quality Laboratory Services in Ethiopia: The Role of the Public-Private Partnership

PubMed Central

Kebede, Yenew; Fonjungo, Peter N.; Tibesso, Gudeta; Shrivastava, Ritu; Nkengasong, John N.; Kenyon, Thomas; Kebede, Amha; Gadde, Renuka; Ayana, Gonfa

2016-01-01

Background. Nonstandardized specimen-transport logistics, lack of laboratory personnel to transport specimens, lack of standard specimen containers, and long turnaround time (TAT) hindered access to quality laboratory services. The objective of the Becton, Dickinson, and Company (BD)–US President's Emergency Plan for AIDS Relief (PEPFAR) Public-Private Partnership (PPP) was to support country-specific programs to develop integrated laboratory systems, services, and quality improvement strategies, with an emphasis on strengthening the specimen-referral system (SRS). Methods. In 2007, through the Centers for Disease Control and Prevention (CDC), the Ethiopian Public Health Institute (EPHI) joined with the BD-PEPFAR PPP to strengthen laboratory systems. A joint planning and assessment committee identified gaps in the SRS for prioritization and intervention and piloted the system in Addis Ababa and Amhara Region. Results. The PPP established standardized, streamlined specimen logistics, using the Ethiopian Postal Service Enterprise to support a laboratory network in which 554 facilities referred specimens to 160 laboratories. The PPP supported procuring 400 standard specimen containers and the training of 586 laboratory personnel and 81 postal workers. The average TAT was reduced from 7 days (range, 2–14 days) to 2 days (range, 1–3 days) in Addis Ababa and from 10 days (range, 6–21 days) to 5 days (range, 2–6 days) in Amhara Region. Conclusions. This study highlights the feasibility and untapped potential of PPPs to strengthen laboratory systems. This planned and structured approach to improving specimen referral enhanced access to quality laboratory services. PMID:27025700

Spatial Coverage Planning for a Planetary Rover

NASA Technical Reports Server (NTRS)

Gaines, Daniel M.; Estlin, Tara; Chouinard, Caroline

2008-01-01

We are developing onboard planning and execution technologies to support the exploration and characterization of geological features by autonomous rovers. In order to generate high quality mission plans, an autonomous rover must reason about the relative importance of the observations it can perform. In this paper we look at the scientific criteria of selecting observations that improve the quality of the area covered by samples. Our approach makes use of a priori information, if available, and allows scientists to mark sub-regions of the area with relative priorities for exploration. We use an efficient algorithm for prioritizing observations based on spatial coverage that allows the system to update observation rankings as new information is gained during execution.

78 FR 25484 - Public Access to Federally Supported Research and Development Data and Publications: Two Planning...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

... NATIONAL SCIENCE FOUNDATION Public Access to Federally Supported Research and Development Data and... for Health and Human Services, Agency for Healthcare Research and Quality, Centers for Disease Control... Veterans Affairs, Environmental Protection Agency, Institute of Museum and Library Services, National...

The quality of paper-based versus electronic nursing care plan in Australian aged care homes: A documentation audit study.

PubMed

Wang, Ning; Yu, Ping; Hailey, David

2015-08-01

The nursing care plan plays an essential role in supporting care provision in Australian aged care. The implementation of electronic systems in aged care homes was anticipated to improve documentation quality. Standardized nursing terminologies, developed to improve communication and advance the nursing profession, are not required in aged care practice. The language used by nurses in the nursing care plan and the effect of the electronic system on documentation quality in residential aged care need to be investigated. To describe documentation practice for the nursing care plan in Australian residential aged care homes and to compare the quantity and quality of documentation in paper-based and electronic nursing care plans. A nursing documentation audit was conducted in seven residential aged care homes in Australia. One hundred and eleven paper-based and 194 electronic nursing care plans, conveniently selected, were reviewed. The quantity of documentation in a care plan was determined by the number of phrases describing a resident problem and the number of goals and interventions. The quality of documentation was measured using 16 relevant questions in an instrument developed for the study. There was a tendency to omit 'nursing problem' or 'nursing diagnosis' in the nursing process by changing these terms (used in the paper-based care plan) to 'observation' in the electronic version. The electronic nursing care plan documented more signs and symptoms of resident problems and evaluation of care than the paper-based format (48.30 vs. 47.34 out of 60, P<0.01), but had a lower total mean quality score. The electronic care plan contained fewer problem or diagnosis statements, contributing factors and resident outcomes than the paper-based system (P<0.01). Both types of nursing care plan were weak in documenting measurable and concrete resident outcomes. The overall quality of documentation content for the nursing process was no better in the electronic system than in the paper-based system. Omission of the nursing problem or diagnosis from the nursing process may reflect a range of factors behind the practice that need to be understood. Further work is also needed on qualitative aspects of the nurse care plan, nurses' attitudes towards standardized terminologies and the effect of different documentation practice on care quality and resident outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

NASA total quality management 1989 accomplishments report

NASA Technical Reports Server (NTRS)

Tai, Betty P. (Editor); Stewart, Lynne M. (Editor)

1990-01-01

NASA and contractor employees achieved many notable improvements in 1989. The highlights of those improvements, described in this seventh annual Accomplishments Report, demonstrate that the people who support NASA's activities are getting more involved in quality and continuous improvement efforts. Their gains solidly support NASA's and this Nation's goal to remain a leader in space exploration and in world-wide market competition, and, when communicated to others through avenues such as this report, foster improvement efforts across government and industry. The principles in practice which led to these process refinements are important cultural elements to any organization's productivity and quality efforts. The categories in this report reflect NASA principles set forth in the 1980's and are more commonly known today as Total Quality Management (TQM): top management leadership and support; strategic planning; focus on the customer; employee training and recognition; employee empowerment and teamwork; measurement and analysis; and quality assurance.

77 FR 4510 - Air Quality Implementation Plans; Kentucky; Attainment Plan for the Kentucky Portion of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-30

... and population based apportionment of the area and nonroad sectors to support the mobile source... and nitrogen oxides (NO X ) for the mobile source contribution to ambient PM 2.5 levels for the.... Attainment Date B. Insignificance Determination for the Mobile Source Contribution to PM 2.5 and NO X...

School Improvement Plans and Student Achievement: Preliminary Evidence from the Quality and Merit Project in Italy

ERIC Educational Resources Information Center

Caputo, Andrea; Rastelli, Valentina

2014-01-01

This study provides preliminary evidence from an Italian in-service training program addressed to lower secondary school teachers which supports school improvement plans (SIPs). It aims at exploring the association between characteristics/contents of SIPs and student improvement in math achievement. Pre-post standardized tests and text analysis of…

Constraints to Quality Education and Support for All: A Western Cape Case

ERIC Educational Resources Information Center

Dreyer, Lorna M.

2017-01-01

In its vision for education, the National Planning Commission (2011:264) of South Africa states that "all children can access and benefit from high quality education" through flexible services which are available, accessible and responsive to the needs of children, and that "specific consideration will be given to the most…

Monitoring Urban Quality of Life: The Porto Experience

ERIC Educational Resources Information Center

Santos, Luis Delfim; Martins, Isabel

2007-01-01

This paper describes the monitoring system of the urban quality of life developed by the Porto City Council, a new tool being used to support urban planning and management. The two components of this system--a quantitative approach based on statistical indicators and a qualitative analysis based on the citizens' perceptions of the conditions of…

Head Start/Child Care Partnerships: Program Characteristics and Classroom Quality

ERIC Educational Resources Information Center

Schilder, Diane; Smith Leavell, Ashley

2015-01-01

As part of President Obama's Early Education Plan, Congress authorized $500 million in the 2014 Omnibus Act to support states and communities in expanding high-quality early learning through the creation of a new Early Head Start-Child Care Partnership initiative. This initiative has placed renewed interest on research regarding the nature and…

Quality in Individualized Family Service Plans: Guidelines for Practitioners, Programs, and Families

ERIC Educational Resources Information Center

Gatmaitan, Michelle; Brown, Teresa

2016-01-01

The IFSP is both a document and process for developing, implementing, and evaluating the supports and services delivered to infants and toddlers with disabilities and their families eligible under Part C of the Individuals With Disabilities Education Improvement Act (IDEA; 2004). Recently, researchers have defined IFSP quality based on five…

78 FR 44144 - Sonny Bono Salton Sea National Wildlife Refuge Complex (Sonny Bono Salton Sea National Wildlife...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-23

... the sand dune habitat of the Coachella Valley. Access onto the Refuge is limited to a designated...), the Service would expand current habitat management activities to enhance habitat quality... support actions, implement an IPM plan to control invasive plants; enhance the habitat quality of an old...

[Professional's expectations to improve quality of care and social services utilization in geriatric oncology].

PubMed

Antoine, Valéry; de Wazières, Benoît; Houédé, Nadine

2015-02-01

Coordination of a multidisciplinary and multi-professional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social services utilization. Descriptive study in a French University Hospital. A 6-item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. The 37 respondents identified a total of 166 needs to improve quality of care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health care planning, were defined to answer to professional's needs with the aim of optimizing cancer treatment and global cares. Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014-2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Copyright © 2014 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Validation of the relative insensitivity of volumetric-modulated arc therapy (VMAT) plan quality to gantry space resolution

PubMed Central

Cora, Stefania; Khan, Ehsan Ullah

2017-01-01

Abstract Volumetric-modulated arc therapy (VMAT) is an efficient form of radiotherapy used to deliver intensity-modulated radiotherapy beams. The aim of this study was to investigate the relative insensitivity of VMAT plan quality to gantry angle spacing (GS). Most previous VMAT planning and dosimetric work for GS resolution has been conducted for single arc VMAT. In this work, a quantitative comparison of dose–volume indices (DIs) was made for partial-, single- and double-arc VMAT plans optimized at 2°, 3° and 4° GS, representing a large variation in deliverable multileaf collimator segments. VMAT plans of six prostate cancer and six head-and-neck cancer patients were simulated for an Elekta SynergyS® Linac (Elekta Ltd, Crawley, UK), using the SmartArc™ module of Pinnacle³ TPS, (version 9.2, Philips Healthcare). All optimization techniques generated clinically acceptable VMAT plans, except for the single-arc for the head-and-neck cancer patients. Plan quality was assessed by comparing the DIs for the planning target volume, organs at risk and normal tissue. A GS of 2°, with finest resolution and consequently highest intensity modulation, was considered to be the reference, and this was compared with GS 3° and 4°. The differences between the majority of reference DIs and compared DIs were <2%. The metrics, such as treatment plan optimization time and pretreatment (phantom) dosimetric calculation time, supported the use of a GS of 4°. The ArcCHECK™ phantom–measured dosimetric agreement verifications resulted in a >95.0% passing rate, using the criteria for γ (3%, 3 mm). In conclusion, a GS of 4° is an optimal choice for minimal usage of planning resources without compromise of plan quality. PMID:27974507

Hospital nurses' work environment, quality of care provided and career plans.

PubMed

Hinno, S; Partanen, P; Vehviläinen-Julkunen, K

2011-06-01

In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. A cross-sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse-assessed quality of care also increased and intentions to leave current job decreased linearly. Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals. © 2011 The Authors. International Nursing Review © 2011 International Council of Nurses.

Ensuring quality: a key consideration in scaling-up HIV-related point-of-care testing programs

PubMed Central

Fonjungo, Peter N.; Osmanov, Saladin; Kuritsky, Joel; Ndihokubwayo, Jean Bosco; Bachanas, Pam; Peeling, Rosanna W.; Timperi, Ralph; Fine, Glenn; Stevens, Wendy; Habiyambere, Vincent; Nkengasong, John N.

2016-01-01

Objective: The objective of the WHO/US President's Emergency Plan for AIDS Relief consultation was to discuss innovative strategies, offer guidance, and develop a comprehensive policy framework for implementing quality-assured HIV-related point-of-care testing (POCT). Methods: The consultation was attended by representatives from international agencies (WHO, UNICEF, UNITAID, Clinton Health Access Initiative), United States Agency for International Development, Centers for Disease Control and Prevention/President's Emergency Plan for AIDS Relief Cooperative Agreement Partners, and experts from more than 25 countries, including policy makers, clinicians, laboratory experts, and program implementers. Main outcomes: There was strong consensus among all participants that ensuring access to quality of POCT represents one of the key challenges for the success of HIV prevention, treatment, and care programs. The following four strategies were recommended: implement a newly proposed concept of a sustainable quality assurance cycle that includes careful planning; definition of goals and targets; timely implementation; continuous monitoring; improvements and adjustments, where necessary; and a detailed evaluation; the importance of supporting a cadre of workers [e.g. volunteer quality corps (Q-Corps)] with the role to ensure that the quality assurance cycle is followed and sustained; implementation of the new strategy should be seen as a step-wise process, supported by development of appropriate policies and tools; and joint partnership under the leadership of the ministries of health to ensure sustainability of implementing novel approaches. Conclusion: The outcomes of this consultation have been well received by program implementers in the field. The recommendations also laid the groundwork for developing key policy and quality documents for the implementation of HIV-related POCT. PMID:26807969

Linked Analysis of East Asia Emission Reduction Pathways

NASA Astrophysics Data System (ADS)

Kim, Y.; Woo, J. H.; Bu, C.; Lee, Y.; Kim, J.; Jang, Y.; Park, M.

2017-12-01

Air pollution and its impacts over the Northeast Asia are very severe because of the massive pollutant emissions and high population. Korea has been trying to improve air quality with the enhanced environmental legislation. The air quality over Korea, however, does not entirely dependent on its local emissions. Transboundary air pollution from China highly affects Korean atmosphere. The purpose of this research is to understand role of local and transbounday efforts to improve air quality changes over Korea. In this research, we have tried to set up the multiple emission scenario pathways for Korea and China using IIASA's GAINS (Greenhouse gas - Air pollution Interactions aNd Synergies) modeling framework. More up-to-date growth factors and control policy packets were made using regional socio-economic data and control policy information from local governments and international statistics. Four major scenario pathways, 1) Base (Baseline: current legislation), 2) OTB/OTB(On the book/On the way : existing control measure/planed control measure), 3) BOTW_GHG(Beyond on the way : OTW with GHG reduction plan), 4) BOTW_NH3 (OTW with additional NH3 reduction measure) were developed to represent air quality improvement pathways in consideration of both Korean and Chinese efforts. Strict ambient PM2.5 standards from Seoul metropolitan Air quality Improvement Plan(SAIP) seems too enthusiastic without linking air quality control efforts of China. Step-by-step emission controls and following air quality, control cost, health impact from each scenario will be presented at the conference. This subject is supported by Korea Ministry of Environment as "Climate Change Correspondence Program". And This work was supported under the framework of national strategy project on fine particulate matters by Ministry of Science, ICT and Future Planning.

Measuring and modelling the quality of 40 post-disaster mental health and psychosocial support programmes

PubMed Central

Thormar, Sigridur B.; Juen, Barbara; Ajdukovic, Dean; Newlove-Eriksson, Lindy; Olff, Miranda

2018-01-01

Disasters can have an enormous impact on the health and well-being of those affected. Internationally, governments and service providers are often challenged to address complex psychosocial problems. Ideally, the potentially broad range of support activities include a coherent, high-quality mental health and psychosocial support (MHPSS) programme. We present a theory-driven quantitative analysis of the quality of 40 MHPSS programmes, mostly implemented in European disaster settings. The objective is to measure quality domains recognized as relevant in the literature and to empirically test associations. During the EU project “Operationalizing Psychosocial Support in Crisis” (OPSIC) an evaluation survey was designed and developed for this purpose and completed by 40 MHPSS programme coordinators involved in different mass emergencies and disasters. We analysed the survey data in two steps. Firstly, we used the data to operationalize quality domains of a MHPSS programme, tested constructs and assessed their internal consistency reliability. A total of 26 out of 44 survey items clustered into three of the four domains identified within the theoretical framework: “planning and delivery system” (Cronbach’s alpha 0.82); “general evaluation criteria” (Cronbach’s alpha 0.82); and “essential psychosocial principles” (Cronbach’s alpha 0.75). “Measures and interventions applied”, theoretically a potential fourth domain, could not be confirmed to empirically cluster together. Secondly, several models with associations between domains and measures and interventions were tested and compared. The model with the best fit suggests that in MHPSS programmes with a higher planning and delivery systems score, a larger number of measures and interventions from evidence-informed guidelines are applied. In such programmes, coordinators are more positive about general evaluation criteria and the realization of essential psychosocial principles. Moreover, the analyses showed that some measures and interventions are more likely to be applied in programmes with more evolved planning and delivery systems, yet for most measures and interventions the likelihood of being applied is not linked to planning and delivery system status, nor to coordinator perceptions concerning psychosocial principles and evaluation criteria. Further research is necessary to validate and expand the findings and to learn more about success factors and obstacles for MHPSS programme implementation. PMID:29489888

Collaborating for care: initial experience of embedded case managers across five medical homes.

PubMed

Treadwell, Janet; Giardino, Angelo

2014-01-01

The purpose of this intervention was to answer the following question: Does an embedded nurse case manager from a health plan performing embedded care coordination and supporting a quality improvement project impact medical home service use, role satisfaction, and per member per month expense? The setting for this study was primary care medical home practices with a minimum of 1,000 lives, contracted with a health plan delivering Medicaid and Children's Health Insurance coverage. Five medical home practice sites were selected for the intervention. The study began with case manager training and project permission in 5 medical homes, followed by implementation of care coordination with health plan clients. The nurse case manager performed care coordination functions for clients and initiated a Lean Six Sigma quality improvement project at the medical home site. The analysis strategy was to compare each medical home with itself before and after the intervention, as well as to obtain satisfaction information from medical home staff and care coordinators. Reductions in expense, as demonstrated by decreased per member per month claim cost, admissions per thousand, and reduced variation in days per thousand, were documented. Quality projects attained significant improvements in 4 out of 5 sites, and practice staff as well as case managers described satisfaction with the embedded nurse case manager role. These findings support medical homes as being an effective delivery model of the Affordable Care Act. Case managers who practice in primary care sites can make a significant difference in patient outcomes and practice efficiencies. Embedded case managers have the ability to impact the population being served through modeling and supporting interprofessional relationships and case management expertise. Use of motivational interviewing, assessment skills, advocacy, and joint care planning engage patients in their own care, whereas quality initiatives bring efficiencies and effectiveness to overall operations. There is need for research to be conducted across a larger number of practice sites and diverse populations to substantiate the effect of embedded case management in medical home.

The eighth NASA total quality management accomplishments report, 1990

NASA Technical Reports Server (NTRS)

1990-01-01

The eighth annual accomplishments report provides numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. NASA's continuous improvement efforts can provide insight for others to succeed in their own endeavors. The report covers: top management leadership and support, strategic planning, focus on the customer, employee training and recognition, employee empowerment and teamwork, measurement and analysis, and quality assurance.

Project Quality Assurance Plan for research and development services provided by Oak Ridge National Laboratory in support of the Westinghouse Materials Company of Ohio Operable Unit 1 Stabilization Development and Treatability Studies Program

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

Gilliam, T.M.

1991-05-01

This Project Quality Assurance Plan (PQAP) sets forth the quality assurance (QA) requirements that are applied to those elements of the Westinghouse Materials Company of Ohio (WMCO) Operable Unit 1 support at Oak Ridge National Laboratory (ORNL) project that involve research and development (R D) performed at ORNL. This is in compliance with the applicable criteria of 10 CFR Part 50, Appendix B, ANSI/ASME NQA-1, as specified by Department of Energy (DOE) Oak Ridge Operations (ORO) Order 5700.6B. For this application, NQA-1 is the core QA Program requirements document. QA policy, normally found in the requirements document, is contained herein.more » The requirements of this PQAP apply to project activities that affect the quality and reliability/credibility of research, development, and investigative data and documentation. These activities include the functions of attaining quality objectives and assuring that an appropriate QA program scope is established. The scope of activities affecting quality includes organization; personnel training and qualifications; design control; procurement; material handling and storage; operating procedures; testing, surveillance, and auditing; R D investigative activities and documentation; deficiencies; corrective actions; and QA record keeping. 12 figs.« less

Margaret E. O'Kane on healthcare accreditation. Interview by Wanda Bishop and Kevin C. Park.

PubMed

O'Kane, M E

2001-01-01

Since 1990, Margaret E. O'Kane has served as president of the National Committee for Quality Assurance (NCQA), an independent, not-for-profit organization whose mission is to improve the quality of healthcare everywhere. Under O'Kane's leadership, NCQA has developed broad support among the employer and health plan communities; today many Fortune 100 companies will do business only with NCQA-accredited health plans. About three quarters of the nation's largest employers use Health Plan Employer Data and Information Set (HEDIS) data to evaluate the plans that serve their employees. O'Kane was named Health Person of the Year in 1996 by the journal Medicine & Health. She also received a 1997 Founder's Award from the American College of Medical Quality, recognizing NCQA's efforts to improve managed care quality. In 1999, O'Kane was elected a member of the Institute of Medicine. In 2000, she received the Centers for Disease Control and Prevention (CDC) Champion of Prevention award, the agency's highest honor. CDC names a Champion of Prevention infrequently and only when an individual has made a truly notable contribution to advancing preventive healthcare. O'Kane began her career in healthcare as a respiratory therapist and has a master's degree in health administration and planning from Johns Hopkins University.

Quality of Diagnosis and Treatment Plans After Using the 'Diagnostic Guideline for Anxiety and Challenging Behaviours' in People with Intellectual Disabilities: A Comparative Multiple Case Study Design.

PubMed

Pruijssers, Addy; van Meijel, Berno; Maaskant, Marian; Keeman, Noortje; van Achterberg, Theo

2016-07-01

People with intellectual disabilities often have a multitude of concurrent problems due to the combination of cognitive impairments, psychiatric disorders (particularly anxiety) and related challenging behaviours. Diagnoses in people with intellectual disabilities are complicated. This study evaluates the quality of the diagnoses and treatment plans after using a guideline that was developed to support professionals in their diagnostic tasks. A comparative multiple case study with an experimental and control condition, applying deductive analyses of diagnoses and treatment plans. The analyses revealed that the number of diagnostic statements and planned treatment actions in the experimental group was significantly larger and more differentiated than in the control condition. In the control group, consequential harm and protective factors were hardly mentioned in diagnoses and treatment plans. Working with the 'Diagnostic Guideline for Anxiety and CB' leads to improved diagnoses and treatment plans compared with care as usual. © 2015 John Wiley & Sons Ltd.

76 FR 14835 - Approval and Promulgation of Air Quality Implementation Plan; Missouri; Proposed Disapproval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-18

... the state's conclusion should be supported by an adequate technical analysis. EPA recommended the...)(2)(D)(i)(I) must be supported by an adequate technical analysis.\\5\\ EPA recommended the various..., the state did not further evaluate or demonstrate with a technical analysis that these measures...

76 FR 43167 - Approval and Promulgation of Air Quality Implementation Plan; North Carolina; Disapproval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

... stated that the state's conclusion should be supported by an adequate technical analysis. Second, EPA... revision must be supported by an adequate technical analysis, including, but not limited to, information... disapproval where the Agency states: ``* * * without an adequate technical analysis EPA does not believe that...

76 FR 14831 - Approval and Promulgation of Air Quality Implementation Plan; Kansas; Proposed Disapproval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-18

... State's conclusion should be supported by an adequate technical analysis. EPA recommended the various...) must be supported by an adequate technical analysis.\\5\\ EPA recommended the various types of... evaluate or demonstrate with a technical analysis that these measures address the requirements of 110(a)(2...

76 FR 43159 - Approval and Promulgation of Air Quality Implementation Plan; Georgia; Disapproval of Interstate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

... stated that the state's conclusion should be supported by an adequate technical analysis. Second, EPA...'' provisions, the state's SIP revision must be supported by an adequate technical analysis, including, but not..., proposed disapproval where the Agency states: ``* * * without an adequate technical analysis EPA does not...

76 FR 43128 - Approval and Promulgation of Air Quality Implementation Plan; Alabama; Disapproval of Interstate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

..., if so, address the impact. The state's conclusion must be supported by an adequate technical analysis...'' provisions, the state's SIP revision must be supported by an adequate technical analysis, including, but not... disapproval where the Agency states: ``* * *without an adequate technical analysis EPA does not believe that...

The interplanetary Pioneers. Volume 2: System design and development

NASA Technical Reports Server (NTRS)

Corliss, W. R.

1972-01-01

The Pioneer systems, subsystems, and ground support activities are described. Details are given on the launch trajectory and solar orbit plans, spacecraft design approach and evolution, scientific instrument, test and ground support equipment, Delta launch vehicle, tracking and communication, and data processing equipment. Pioneer specifications, and reliability and quality assurance are also included.

The importance of work or productive activity in life care planning and case management.

PubMed

Reid, Christine; Riddick-Grisham, Susan

2015-01-01

The importance of work or productive activity for the well-being, community integration, and quality of life of people living with disabilities is addressed, with implications for life care planning and case management. The role of work or productive activity in our society, and consequences of deprivation if rehabilitation services do not address vocational effects of disabilities, is explored. A continuum of productivity options is introduced; types of vocational rehabilitation assessment processes and interventions are described. The role of vocational rehabilitation services in life care planning and case management is discussed, focusing on quality of life for people living with disabilities. Rehabilitation and health care professionals should understand the importance of work or other productive activity, and support the development of appropriate plans to address those needs among people who have disabilities.

Best Practices for Optimizing DoD Contractor Safety and Occupational Health Program Performance

DTIC Science & Technology

2012-12-01

such as Accident Prevention Plan (APP), Activity Hazard Analysis (AHA), Quality Assurance Surveillance Plans (QASP), etc. Contract administration...technology support, medical , and maintenance of equipment and facilities. The DoD Guidebook for the Acquisition of Services, provides acquisition...OSHA regulations and perform in accordance with an applicable accident prevention program that complies with State and Federal requirements. The

From Strategic Planning to Meaningful Learning: Diverse Perspectives on the Development of Web-Based Teaching and Learning in Higher Education

ERIC Educational Resources Information Center

Lofstrom, Erika; Nevgi, Anne

2007-01-01

This paper reports the results of a study on strategic planning and implementation of information and communication technology (ICT) in teaching and describes the level of quality awareness in web-based teaching at the University of Helsinki. Questionnaire survey data obtained from deans and institutional leaders, ICT support staff, teachers and…

The Quality and Effects of Secondary Transition Plans on Special Education Graduates' Postsecondary Outcomes and Their Effects on Secondary Transition

ERIC Educational Resources Information Center

Miller, Vickie

2013-01-01

The purpose of the study was to determine whether or not the implementation of special education graduates' secondary transition plans by a team of supporters such as teachers, parents, administrators, and postsecondary mentors were well-constructed and in alignment with the graduates' high school curriculum and intended postsecondary goals, as…

Support Structures for Facilitators of Student Personal Development Planning: Lessons from Two Departmental Case Studies

ERIC Educational Resources Information Center

Hulme, Claire; Lisewski, Bernard

2010-01-01

In the UK, following guidelines set out by the Quality Assurance Agency, personal development planning (PDP) is now operational across all higher education (HE) awards. Like many policy initiatives, PDP requires change, and vital to its implementation are those who facilitate PDP at the grassroots level. Staff given the task of implementing PDP…

Improving Implementation of Function-Based Interventions: Self-Monitoring, Data Collection, and Data Review

ERIC Educational Resources Information Center

Pinkelman, Sarah E.; Horner, Robert H.

2017-01-01

The success of function-based interventions depends not just on the quality of procedures but also on the extent to which procedures are implemented as planned. Too often in schools, effort is committed to functional assessment and behavior support plan design, only to be followed by weak implementation. This study used a multiple baseline across…

A fast inverse treatment planning strategy facilitating optimized catheter selection in image-guided high-dose-rate interstitial gynecologic brachytherapy.

PubMed

Guthier, Christian V; Damato, Antonio L; Hesser, Juergen W; Viswanathan, Akila N; Cormack, Robert A

2017-12-01

Interstitial high-dose rate (HDR) brachytherapy is an important therapeutic strategy for the treatment of locally advanced gynecologic (GYN) cancers. The outcome of this therapy is determined by the quality of dose distribution achieved. This paper focuses on a novel yet simple heuristic for catheter selection for GYN HDR brachytherapy and their comparison against state of the art optimization strategies. The proposed technique is intended to act as a decision-supporting tool to select a favorable needle configuration. The presented heuristic for catheter optimization is based on a shrinkage-type algorithm (SACO). It is compared against state of the art planning in a retrospective study of 20 patients who previously received image-guided interstitial HDR brachytherapy using a Syed Neblett template. From those plans, template orientation and position are estimated via a rigid registration of the template with the actual catheter trajectories. All potential straight trajectories intersecting the contoured clinical target volume (CTV) are considered for catheter optimization. Retrospectively generated plans and clinical plans are compared with respect to dosimetric performance and optimization time. All plans were generated with one single run of the optimizer lasting 0.6-97.4 s. Compared to manual optimization, SACO yields a statistically significant (P ≤ 0.05) improved target coverage while at the same time fulfilling all dosimetric constraints for organs at risk (OARs). Comparing inverse planning strategies, dosimetric evaluation for SACO and "hybrid inverse planning and optimization" (HIPO), as gold standard, shows no statistically significant difference (P > 0.05). However, SACO provides the potential to reduce the number of used catheters without compromising plan quality. The proposed heuristic for needle selection provides fast catheter selection with optimization times suited for intraoperative treatment planning. Compared to manual optimization, the proposed methodology results in fewer catheters without a clinically significant loss in plan quality. The proposed approach can be used as a decision support tool that guides the user to find the ideal number and configuration of catheters. © 2017 American Association of Physicists in Medicine.

I have my own lease-So why the service plan again? Perspectives on service planning in supportive housing.

PubMed

Choy-Brown, Mimi; Hamovitch, Emily K; Cuervo, Carolina; Stanhope, Victoria

2016-12-01

This study aimed to understand multiple stakeholder perspectives implementing a recovery-oriented approach to service planning in supportive housing programs serving people with lived experience of mental illnesses. Multiple stakeholders (N = 57) were recruited to participate in focus groups (N = 8), including 4 with tenants, 2 with service coordinators, 1 with supervisors, and 1 with leadership. Supportive housing programs were purposively sampled from a recovery-oriented organization serving 1,500 people annually. Stakeholders' experiences with service planning and implementing a recovery-oriented approach to service planning were explored. The authors conducted inductive thematic analyses combined with a conceptual matrix, which yielded themes across and within multiple stakeholder focus groups. Three themes emerged: (a) an institutional reminder-service planning experiences elicited negative emotions and served to remind people of experiences in institutional settings, (b) one-size-fits-all service planning-stakeholders perceived the use of quality assurance tools within the planning process as rigid to others' interests beyond their own, and (c) rules and regulations-reconciling funder requirements (e.g., completion dates) while also tailoring services to tenants' particular situations challenged providers. Even in a recovery-oriented organization, findings suggest that service planning in supportive housing has limitations in responding to each tenant's iterative recovery process. Further, in this context where people can make their home, stakeholders questioned whether the very presence of ongoing service planning activities is problematic. However, tenant-service coordinator relationships predicated on mutual respect and esteem overcame some service planning limitations. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Are Resources Important? (Testimony of Eric Alan Hanushek, March 11, 1996).

ERIC Educational Resources Information Center

Hanushek, Eric Alan

1997-01-01

E. A. Hanushek analyzed the possibility that the St. Louis (Missouri) school district could operate a quality school system with the resources it would get under the state's transition plan that would phase out state financial support for school desegregation. The witness projected no adverse effect on the quality of education in the city. (SLD)

A Comparison of Factors that Influence the Quality of PEPs in Title I Schools

ERIC Educational Resources Information Center

Williams, Connie Jean

2009-01-01

The purpose of this study was to investigate the relationship between school-based organizational structures that support teachers' development of Personalized Education Plans (PEPs) and their quality as written for third through fifth grade students in each of two Title I schools. A causal comparative design was implemented. Teachers' responses…

System for Urban Stormwater Treatment and Analysis IntegratioN (SUSTAIN)

EPA Pesticide Factsheets

SUSTAIN is a decision support system that assists stormwater management professionals with developing and implementing plans for flow and pollution control measures to protect source waters and meet water quality goals.

Analytic innovations for air quality modeling

EPA Science Inventory

The presentation provides an overview of ongoing research activities at the U.S. EPA, focusing on improving long-term emission projections and the development of decision support systems for coordinated environmental, climate and energy planning.

Planning Ahead: Advanced Heart Failure

MedlinePlus

... transition is made from quantity of life to quality of life, hospice care provides comfort and support to advanced heart failure patients and their families. Hospice care services are often provided in the home by a ...

Update: Providing Quality Family Planning Services - Recommendations from CDC and the U.S. Office of Population Affairs, 2017.

PubMed

Gavin, Loretta; Pazol, Karen; Ahrens, Katherine

2017-12-22

In April 2014, CDC published "Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs" (QFP), which describes the scope of services that should be offered in a family planning visit and how to provide those services (e.g., periodicity of screening, which persons are in need of services, etc.) (1). The sections in QFP include the following: Determining the Client's Need for Services; Contraceptive Services; Pregnancy Testing and Counseling; Clients Who Want to Become Pregnant; Basic Infertility Services; Preconception Health Services; Sexually Transmitted Disease Services; and Related Preventive Health Services. In addition, the QFP includes an appendix entitled Screening Services for Which Evidence Does Not Support Screening.

Show Me My Health Plans: Using a Decision Aid to Improve Decisions in the Federal Health Insurance Marketplace

PubMed Central

Politi, Mary C.; Kuzemchak, Marie D.; Liu, Jingxia; Barker, Abigail R.; Peters, Ellen; Ubel, Peter A.; Kaphingst, Kimberly A.; McBride, Timothy; Kreuter, Matthew W.; Shacham, Enbal; Philpott, Sydney E.

2017-01-01

Introduction Since the Affordable Care Act was passed, more than 12 million individuals have enrolled in the health insurance marketplace. Without support, many struggle to make an informed plan choice that meets their health and financial needs. Methods We designed and evaluated a decision aid, Show Me My Health Plans (SMHP), that provides education, preference assessment, and an annual out-of-pocket cost calculator with plan recommendations produced by a tailored, risk-adjusted algorithm incorporating age, gender, and health status. We evaluated whether SMHP compared to HealthCare.gov improved health insurance decision quality and the match between plan choice, needs, and preferences among 328 Missourians enrolling in the marketplace. Results Participants who used SMHP had higher health insurance knowledge (LS-Mean = 78 vs. 62; P < 0.001), decision self-efficacy (LS-Mean = 83 vs. 75; P < 0.002), confidence in their choice (LS-Mean = 3.5 vs. 2.9; P < 0.001), and improved health insurance literacy (odds ratio = 2.52, P <0.001) compared to participants using HealthCare.gov. Those using SMHP were 10.3 times more likely to select a silver- or gold-tier plan (P < 0.0001). Discussion SMHP can improve health insurance decision quality and the odds that consumers select an insurance plan with coverage likely needed to meet their health needs. This study represents a unique context through which to apply principles of decision support to improve health insurance choices. PMID:28804780

Statistical process control: a practical application for hospitals.

PubMed

VanderVeen, L M

1992-01-01

A six-step plan based on using statistics was designed to improve quality in the central processing and distribution department of a 223-bed hospital in Oakland, CA. This article describes how the plan was implemented sequentially, starting with the crucial first step of obtaining administrative support. The QI project succeeded in overcoming beginners' fear of statistics and in training both managers and staff to use inspection checklists, Pareto charts, cause-and-effect diagrams, and control charts. The best outcome of the program was the increased commitment to quality improvement by the members of the department.

Improved Specimen-Referral System and Increased Access to Quality Laboratory Services in Ethiopia: The Role of the Public-Private Partnership.

PubMed

Kebede, Yenew; Fonjungo, Peter N; Tibesso, Gudeta; Shrivastava, Ritu; Nkengasong, John N; Kenyon, Thomas; Kebede, Amha; Gadde, Renuka; Ayana, Gonfa

2016-04-15

Nonstandardized specimen-transport logistics, lack of laboratory personnel to transport specimens, lack of standard specimen containers, and long turnaround time (TAT) hindered access to quality laboratory services. The objective of the Becton, Dickinson, and Company (BD)-US President's Emergency Plan for AIDS Relief (PEPFAR) Public-Private Partnership (PPP) was to support country-specific programs to develop integrated laboratory systems, services, and quality improvement strategies, with an emphasis on strengthening the specimen-referral system (SRS). In 2007, through the Centers for Disease Control and Prevention (CDC), the Ethiopian Public Health Institute (EPHI) joined with the BD-PEPFAR PPP to strengthen laboratory systems. A joint planning and assessment committee identified gaps in the SRS for prioritization and intervention and piloted the system in Addis Ababa and Amhara Region. The PPP established standardized, streamlined specimen logistics, using the Ethiopian Postal Service Enterprise to support a laboratory network in which 554 facilities referred specimens to 160 laboratories. The PPP supported procuring 400 standard specimen containers and the training of 586 laboratory personnel and 81 postal workers. The average TAT was reduced from 7 days (range, 2-14 days) to 2 days (range, 1-3 days) in Addis Ababa and from 10 days (range, 6-21 days) to 5 days (range, 2-6 days) in Amhara Region. This study highlights the feasibility and untapped potential of PPPs to strengthen laboratory systems. This planned and structured approach to improving specimen referral enhanced access to quality laboratory services. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Development and pilot testing of a mobile health solution for asthma self-management: asthma action plan smartphone application pilot study.

PubMed

Licskai, Christopher; Sands, Todd W; Ferrone, Madonna

2013-01-01

Collaborative self-management is a core recommendation of national asthma guidelines; the written action plan is the knowledge tool that supports this objective. Mobile health technologies have the potential to enhance the effectiveness of the action plan as a knowledge translation tool. To design, develop and pilot a mobile health system to support asthma self-management. The present study was a prospective, single-centre, nonrandomized, pilot preintervention-postintervention analysis. System design and development were guided by an expert steering committee. The network included an agnostic web browser-based asthma action plan smartphone application (SPA). Subjects securely transmitted symptoms and peak flow data daily, and received automated control assessment, treatment advice and environmental alerts. Twenty-two adult subjects (mean age 47 years, 82% women) completed the study. Biophysical data were received on 84% of subject days (subject day = 1 subject × 1 day). Subjects viewed their action plan current zone of control on 54% and current air quality on 61% of subject days, 86% followed self-management advice and 50% acted to reduce exposure risks. A large majority affirmed ease of use, clarity and timeliness, and 95% desired SPA use after the study. At baseline, 91% had at least one symptom criterion for uncontrolled asthma and 64% had ≥2, compared with 45% (P=0.006) and 27% (P=0.022) at study close. Mean Asthma Quality of Life Questionnaire score improved from 4.3 to 4.8 (P=0.047). A dynamic, real-time, interactive, mobile health system with an integrated asthma action plan SPA can support knowledge translation at the patient and provider levels.

MO-FG-CAMPUS-TeP3-04: Deliverable Robust Optimization in IMPT Using Quadratic Objective Function

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

Shan, J; Liu, W; Bues, M

Purpose: To find and evaluate the way of applying deliverable MU constraints into robust spot intensity optimization in Intensity-Modulated- Proton-Therapy (IMPT) to prevent plan quality and robustness from degrading due to machine deliverable MU-constraints. Methods: Currently, the influence of the deliverable MU-constraints is retrospectively evaluated by post-processing immediately following optimization. In this study, we propose a new method based on the quasi-Newton-like L-BFGS-B algorithm with which we turn deliverable MU-constraints on and off alternatively during optimization. Seven patients with two different machine settings (small and large spot size) were planned with both conventional and new methods. For each patient, threemore » kinds of plans were generated — conventional non-deliverable plan (plan A), conventional deliverable plan with post-processing (plan B), and new deliverable plan (plan C). We performed this study with both realistic (small) and artificial (large) deliverable MU-constraints. Results: With small minimum MU-constraints considered, new method achieved a slightly better plan quality than conventional method (D95% CTV normalized to the prescription dose: 0.994[0.992∼0.996] (Plan C) vs 0.992[0.986∼0.996] (Plan B)). With large minimum MU constraints considered, results show that the new method maintains plan quality while plan quality from the conventional method is degraded greatly (D95% CTV normalized to the prescription dose: 0.987[0.978∼0.994] (Plan C) vs 0.797[0.641∼1.000] (Plan B)). Meanwhile, plan robustness of these two method’s results is comparable. (For all 7 patients, CTV DVH band gap at D95% normalized to the prescription dose: 0.015[0.005∼0.043] (Plan C) vs 0.012[0.006∼0.038] (Plan B) with small MU-constraints and 0.019[0.009∼0.039] (Plan C) vs 0.030[0.015∼0.041] (Plan B) with large MU-constraints) Conclusion: Positive correlation has been found between plan quality degeneration and magnitude of deliverable minimal MU. Compared to conventional post-processing method, our new method of incorporating deliverable minimal MU-constraints directly into plan optimization, can produce machine-deliverable plans with better plan qualities and non-compromised plan robustness. This research was supported by the National Cancer Institute Career Developmental Award K25CA168984, by the Fraternal Order of Eagles Cancer Research Fund Career Development Award, by The Lawrence W. and Marilyn W. Matteson Fund for Cancer Research, by Mayo Arizona State University Seed Grant and by The Kemper Marley Foundation.« less

SU-E-T-216: TPS QC Supporting Program by a Third-Party Evaluation Agency in Japan.

PubMed

Fukata, K; Minemura, T; Kurokawa, C; Miyagishi, T; Itami, J

2012-06-01

To equalize the quality of radiation therapy in Japan by supporting quality control of radiation treatment planning system. Center for Cancer Control and Information Service in National Cancer Center supports the QA-QC of the cancer core hospitals in Japan as a third-party evaluation agency. Recently, a program for assessing the quality of treatment planning system (TPS) began as a part of our QA-QC supporting activities. In this program, a questionnaire about TPS was sent to 45 prefectural cancer core hospitals in Japan. The object of this questionnaire is to assess the proper commissioning, implement and applications of TPSs. The contents of the questionnaire are as follows; 1) calculate MUs which deliver 1000 cGy to the point of SSD = 100 cm, 10 cm depth with field sizes ranging from 5×5 to 30 × 30 cm 2 , and obtain doses at several depths for the calculated MUs, 2) calculate MUs which deliver 1000 cGy to the point of SSD = 100 cm, 10 cm depth for wedge fields whose angles are from 15 to 60 degrees, and obtain doses at several depths with the MUs, 3) calculate MU which deliver 1000 cGy to the point of STD = 100 cm, 10 cm depth with 10×10 cm 2 field size and obtain doses at several depths with the MU. In this program, 179 beam data from 44 facilities were collected. Data were compared in terms of dose per MU, output factor, wedge factor and TMR. It was found that 90% of the data agreed within 2%. The quality of the treatment planning system was investigated through the questionnaire including the information of essential beam data. We compared 179 beam data in TPSs sent from 44 facilities and 90% of the data showed good agreement. © 2012 American Association of Physicists in Medicine.

Quality of clinical and economic evidence in dossier formulary submissions.

PubMed

Colmenero, Fernando; Sullivan, Sean D; Palmer, Jennifer A; Brauer, Carmen A; Bungay, Kathleen; Watkins, John; Neumann, Peter J

2007-07-01

To investigate the quality and completeness of clinical and economic data in dossiers submitted by drug companies to a health plan using Academy of Managed Care Pharmacy guidelines (the Format) for formulary submissions. We reviewed the quality of economic analyses in dossiers submitted to Premera Blue Cross Health Plan (Mountlake Terrace, Washington; enrollment 1.6 million) between January 2002 and September 2005. For dossiers submitted in 2003, we examined the clinical studies included. Dossiers were audited with a data collection form to judge the types of clinical studies used to support labeled and off-label indications, and the quality and transparency of economic analyses. We compared economic analyses for high-cost (30-day treatment cost > $1000) versus low-cost products, and for "innovative" versus "me-too" drugs. Evidence to support off-label indications often was included in 2003 dossiers, but the information was less extensive and of poorer quality than data for labeled indications. Of 115 dossiers submitted between 2002 and 2005, 53 (46%) included economic analyses. The economic analyses had low levels of compliance with standards: only 43% performed sensitivity analysis; 38% stated the study perspective; 37% discussed relevant treatment alternatives; 20% stated assumptions clearly; and 18% mentioned caveats to conclusions. Economic analyses of high-cost products and innovative products had higher compliance with recommended practices. Drug companies are submitting dossiers of evidence to formulary committees. Dossiers often included clinical data to support off-label indications, but concerns persist about their quality. About half of dossiers included economic analyses, but these analyses had relatively low levels of compliance with recommended practices.

77 FR 46361 - Partial Approval and Disapproval of Air Quality Implementation Plans; Nevada; Infrastructure...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-03

... as explicit or implicit reapproval of any existing provisions that relate to these four substantive... information concerning funding and personnel supporting the functions of the three air pollution control...

Tribal Air Programs in the Pacific Southwest (Region 9)

EPA Pesticide Factsheets

The Region 9 Air Division can assist the 148 tribes in Region 9 with air quality planning, permitting, rulemaking, enforcement/compliance, indoor air, monitoring and related technical support, air grants, and climate change.

Supporting Adults with Autism Spectrum Disorders: Lessons from Six Decades of International Research

ERIC Educational Resources Information Center

Poon, Kenneth K.

2012-01-01

Research focusing on the intervention and support of children with autism spectrum disorders (ASD) has grown exponentially but this increase research has not been mirrored for adults with ASD. With the aims of informing intervention planning, improving quality of life, and areas for future research, 18 peer-reviewed research articles reporting the…

76 FR 4579 - Approval and Promulgation of Air Quality Implementation Plan; New Jersey and New York...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-26

... supported by an adequate technical analysis. EPA recommended the various types of information that could be...) must be supported by an adequate technical analysis. In the 2009 Guidance, EPA recommended the various...) because the State did not evaluate or demonstrate with a technical analysis that the emissions reduction...

76 FR 4584 - Approval and Promulgation of Air Quality Implementation Plans; Georgia; Disapproval of Interstate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-26

... conclusion must be supported by an adequate technical analysis. Second, EPA recommended the various types of... requirement of section 110(a)(2)(D)(i)(I) must be supported by an adequate technical analysis. Additionally... evaluate or demonstrate with a technical analysis that this measure and their intention to rely to the...

People: Creativity and Quality with Technology. Proceedings of the CAUSE National Conference (St. Louis, Missouri, December 1-4, 1981).

ERIC Educational Resources Information Center

Walsh, R. Brian, Ed.; Thomas, Charles R., Ed.

Proceedings of the 1981 CAUSE conference include both professional and vendor presentations. Track 1, on decision support systems, examines such areas as system design, the EDUCOM Financial Planning Model System (EFPM), the evolution of support systems, and a Mississippi approach. Track 2, "Managing the Information Systems Resource,"…

22. VIEW OF THE BASEMENT FLOOR PLAN. THE BASEMENT TUNNELS ...

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

22. VIEW OF THE BASEMENT FLOOR PLAN. THE BASEMENT TUNNELS WERE DESIGNED AS FALLOUT SHELTERS AND USED FOR STORAGE. THE ORIGINAL DRAWING HAS BEEN ARCHIVED ON MICROFILM. THE DRAWING WAS REPRODUCED AT THE BEST QUALITY POSSIBLE. LETTERS AND NUMBERS IN THE CIRCLES INDICATE FOOTER AND/OR COLUMN LOCATIONS. - Rocky Flats Plant, General Manufacturing, Support, Records-Central Computing, Southern portion of Plant, Golden, Jefferson County, CO

Religiousness and Spiritual Support Among Advanced Cancer Patients and Associations With End-of-Life Treatment Preferences and Quality of Life

PubMed Central

Balboni, Tracy A.; Vanderwerker, Lauren C.; Block, Susan D.; Paulk, M. Elizabeth; Lathan, Christopher S.; Peteet, John R.; Prigerson, Holly G.

2008-01-01

Purpose Religion and spirituality play a role in coping with illness for many cancer patients. This study examined religiousness and spiritual support in advanced cancer patients of diverse racial/ethnic backgrounds and associations with quality of life (QOL), treatment preferences, and advance care planning. Methods The Coping With Cancer study is a federally funded, multi-institutional investigation examining factors associated with advanced cancer patient and caregiver well-being. Patients with an advanced cancer diagnosis and failure of first-line chemotherapy were interviewed at baseline regarding religiousness, spiritual support, QOL, treatment preferences, and advance care planning. Results Most (88%) of the study population (N = 230) considered religion to be at least somewhat important. Nearly half (47%) reported that their spiritual needs were minimally or not at all supported by a religious community, and 72% reported that their spiritual needs were supported minimally or not at all by the medical system. Spiritual support by religious communities or the medical system was significantly associated with patient QOL (P = .0003). Religiousness was significantly associated with wanting all measures to extend life (odds ratio, 1.96; 95% CI, 1.08 to 3.57). Conclusion Many advanced cancer patients' spiritual needs are not supported by religious communities or the medical system, and spiritual support is associated with better QOL. Religious individuals more frequently want aggressive measures to extend life. PMID:17290065

The importance of work or productive activity in life care planning and case management

PubMed Central

Reid, Christine; Riddick-Grisham, Susan

2015-01-01

Abstract INTRODUCTION: The importance of work or productive activity for the well-being, community integration, and quality of life of people living with disabilities is addressed, with implications for life care planning and case management. BACKGROUND: The role of work or productive activity in our society, and consequences of deprivation if rehabilitation services do not address vocational effects of disabilities, is explored. A continuum of productivity options is introduced; types of vocational rehabilitation assessment processes and interventions are described. PURPOSE: The role of vocational rehabilitation services in life care planning and case management is discussed, focusing on quality of life for people living with disabilities. CONCLUSION: Rehabilitation and health care professionals should understand the importance of work or other productive activity, and support the development of appropriate plans to address those needs among people who have disabilities. PMID:26409330

Family planning providers' perspectives on family planning service delivery in Ibadan and Kaduna, Nigeria: a qualitative study.

PubMed

Hebert, Luciana Estelle; Schwandt, Hilary Megan; Boulay, Marc; Skinner, Joanna

2013-01-01

In Nigeria, fertility continues to be high and contraceptive prevalence remains low. This study was conducted in order to understand the perceptions of, experiences with and challenges of delivering family planning services in two urban areas of Nigeria from the perspectives of family planning service providers. A qualitative study using 59 in-depth interviews was conducted among family planning providers working in hospitals, primary health centres, clinics, pharmacies and patent medicine vendors in Ibadan and Kaduna, Nigeria. Providers support a mix of individuals and organisations involved in family planning provision, including the government of Nigeria. The Nigerian government's role can take a variety of forms, including providing promotional materials for family planning facilities as well as facilitating training and educational opportunities for providers, since many providers lack basic training in family planning provision. Providers often describe their motivation to provide in terms of the health benefits offered by family planning methods. Few providers engage in any marketing of their services and many providers exclude youth and unmarried individuals from their services. The family planning provider community supports a diverse network of providers, but needs further training and support in order to improve the quality of care and market their services. Adolescents, unmarried individuals and women seeking post-abortion care are vulnerable populations that providers need to be better educated about and trained in how to serve. The perspectives of providers should be considered when designing family planning interventions in urban areas of Nigeria.

Use of telescience for biomedical research during space flight

NASA Technical Reports Server (NTRS)

Huntoon, Carolyn L.; Schneider, Howard J.; Karamanos, Gayle M.

1991-01-01

When the U.S. first embarked on a manned space flight program, NASA's use of medical telescience was focused on crew health monitoring. In recent years, medical telescience use has been expanded to include support of basic research in space medicine. It enables ground support personnel to assist on-board crews in the performance of experiments and improves the quality and quantity of data return. NASA is continuing to develop its telescience capabilities. Future plans include telemedicine that will enable physicians on Earth to support crewmembers during flight and telescience that will enable investigators at their home institutions to support and conduct in-flight medical research. NASA's use of telescience for crew safety and biomedical research from Project Mercury to the present is described and NASA's plans for the future are presented.

Best practice in clinical audit document.

PubMed

2016-12-01

A guide to best practice in clinical audit has been published by the Healthcare Quality Improvement Partnership. It outlines updated criteria for best practice to support clinicians and clinical audit staff with planning, designing and carrying out audits.

Improvements and enhancements to LOSPLAN 2009 : summary report.

DOT National Transportation Integrated Search

2011-03-01

LOSPLAN is software that supports the Quality/Level of Service (Q/LOS) Handbook. The Handbook was developed by the Florida Department of Transportation Systems Planning Office with the intention that engineers, planners, and decision makers would use...

The Italian Dementia National Plan. Commentary.

PubMed

Di Fiandra, Teresa; Canevelli, Marco; Di Pucchio, Alessandra; Vanacore, Nicola

2015-01-01

The Italian Dementia National Plan was formulated in October 2014 by the Italian Ministry of Health in close cooperation with the regions, the National Institute of Health and the three major national associations of patients and carers. The main purpose of this strategy was to provide directive indications for promoting and improving interventions in the dementia field, not limiting to specialist and therapeutic actions, but particularly focusing on the support of patients and families throughout the pathways of care. Four main objectives are indicated: 1) promote health- and social-care interventions and policies; 2) create/strengthen the integrated network of services for dementia based on an integrated approach; 3) implement strategies for promoting appropriateness and quality of care; and 4) improve the quality of life of persons with dementia and their families by supporting empowerment and stigma reduction. These objectives and the pertaining actions are described in the present paper.

NASA In Situ Data Needs to Support the Operational Calibration and Validation of Ocean Color Satellite Data Products

NASA Technical Reports Server (NTRS)

Werdel, P. Jeremy

2012-01-01

Calibrating ocean color satellite instruments and validating their data products requires temporal and spatial abundances of high quality in situ oceanographic data. The Consortium for Ocean Leadership Ocean Observing Initiative (OOl) is currently implementing a distributed array of in-water sensors that could provide a significant contribution to future ocean color activities. This workshop will scope the optimal way to use and possibly supplement the planned OOl infrastructure to maximize its utility and relevance for calibration and validation activities that support existing and planned NASA ocean color missions. Here, I present the current state of the art of NASA validation of ocean color data products, with attention to autonomous time-series (e.g., the AERONET -OC network of above-water radiometers), and outline NASA needs for data quality assurance metrics and adherence to community-vetted data collection protocols

Argentine adaptation of the Quality of Life Indicators guide for organizations that support people with autistic spectrum disorders.

PubMed

Cuesta Gómez, José L; Manzone, Luisa A

2018-04-01

This article describes the adaptation process of the Quality of Life Indicators guide for organizations that support people with autistic spectrum disorders which has taken place in Argentina (Cuesta, J. L., 2009) using the Delphi method, and with the participation of a group of autism-related experts from different fields and domestic institutions. The result is an instrument based on a quality-of-life model which is adjusted to the Argentine setting, helps planning and assessing centers and programs for people with autistic spectrum disorders, and responds to the increasing number of specific services which cover the needs of this population. Sociedad Argentina de Pediatría.

Integrated Hydrographical Basin Management. Study Case - Crasna River Basin

NASA Astrophysics Data System (ADS)

Visescu, Mircea; Beilicci, Erika; Beilicci, Robert

2017-10-01

Hydrographical basins are important from hydrological, economic and ecological points of view. They receive and channel the runoff from rainfall and snowmelt which, when adequate managed, can provide fresh water necessary for water supply, irrigation, food industry, animal husbandry, hydrotechnical arrangements and recreation. Hydrographical basin planning and management follows the efficient use of available water resources in order to satisfy environmental, economic and social necessities and constraints. This can be facilitated by a decision support system that links hydrological, meteorological, engineering, water quality, agriculture, environmental, and other information in an integrated framework. In the last few decades different modelling tools for resolving problems regarding water quantity and quality were developed, respectively water resources management. Watershed models have been developed to the understanding of water cycle and pollution dynamics, and used to evaluate the impacts of hydrotechnical arrangements and land use management options on water quantity, quality, mitigation measures and possible global changes. Models have been used for planning monitoring network and to develop plans for intervention in case of hydrological disasters: floods, flash floods, drought and pollution. MIKE HYDRO Basin is a multi-purpose, map-centric decision support tool for integrated hydrographical basin analysis, planning and management. MIKE HYDRO Basin is designed for analyzing water sharing issues at international, national and local hydrographical basin level. MIKE HYDRO Basin uses a simplified mathematical representation of the hydrographical basin including the configuration of river and reservoir systems, catchment hydrology and existing and potential water user schemes with their various demands including a rigorous irrigation scheme module. This paper analyzes the importance and principles of integrated hydrographical basin management and develop a case study for Crasna river basin, with the use of MIKE HYDRO Basin advanced hydroinformatic tool for integrated hydrographical basin analysis, planning and management.

Partial Meal Replacement Plan and Quality of the Diet at 1 Year: Action for Health in Diabetes (Look AHEAD) Trial.

PubMed

Raynor, Hollie A; Anderson, Andrea M; Miller, Gary D; Reeves, Rebecca; Delahanty, Linda M; Vitolins, Mara Z; Harper, Patricia; Mobley, Connie; Konersman, Kati; Mayer-Davis, Elizabeth

2015-05-01

Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a partial meal replacement plan in the Intensive Lifestyle Intervention. To compare dietary intake and percent meeting fat-related and food group dietary recommendations in Intensive Lifestyle Intervention and Diabetes Support and Education groups at 12 months. A randomized controlled trial comparing Intensive Lifestyle Intervention with Diabetes Support and Education at 0 and 12 months. From 16 US sites, the first 50% of participants (aged 45 to 76 years, overweight or obese, with type 2 diabetes) were invited to complete dietary assessments. Complete 0- and 12-month dietary assessments (collected between 2001 and 2004) were available for 2,397 participants (46.6% of total participants), with 1,186 randomized to Diabetes Support and Education group and 1,211 randomized to Intensive Lifestyle Intervention group. A food frequency questionnaire assessed intake: energy; percent energy from protein, fat, carbohydrate, polyunsaturated fatty acids, and saturated fats; trans-fatty acids; cholesterol; fiber; weekly meal replacements; and daily servings from food groups from the Food Guide Pyramid. Mixed-factor analyses of covariance, using Proc MIXED with a repeated statement, with age, sex, race/ethnicity, education, and income controlled. Unadjusted χ² tests compared percent meeting fat-related and food group recommendations at 12 months. At 12 months, Intensive Lifestyle Intervention participants had a significantly lower fat and cholesterol intake and greater fiber intake than Diabetes Support and Education participants. Intensive Lifestyle Intervention participants consumed more servings per day of fruits; vegetables; and milk, yogurt, and cheese; and fewer servings per day of fats, oils, and sweets than Diabetes Support and Education participants. A greater percentage of Intensive Lifestyle Intervention participants than Diabetes Support and Education participants met fat-related and most food group recommendations. Within Intensive Lifestyle Intervention, a greater percentage of participants consuming two or more meal replacements per day than participants consuming less than one meal replacement per day met most fat-related and food group recommendations. The partial meal replacement plan consumed by Intensive Lifestyle Intervention participants was related to superior diet quality. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Listening to the Patient: Women Veterans' Insights About Health Care Needs, Access, and Quality in Rural Areas.

PubMed

Brooks, Elizabeth; Dailey, Nancy K; Bair, Byron D; Shore, Jay H

2016-09-01

Many work to ensure that women veterans receive appropriate and timely health care, yet the needs of those living in rural areas are often ignored. This is a critical oversight given the multitude of reports documenting rural access problems and health disparities. Lacking this, we are unable to plan for and evaluate appropriate care for this specific group. In this project, we spoke with rural women veterans to document service needs and quality of care from their perspective. Rural women veterans' views about health care access and quality were ascertained in a series of five, semistructured focus groups (n = 35) and completion of a demographic questionnaire. Content analysis documented focus-group themes. Participants said that local dental, mental health, and gender-specific care options were needed, as well as alternative healing options. Community-based support for women veterans and interaction with female peers were absent. Participants' support for telehealth was mixed, as were requests for gender-specific care. Personal experiences in the military impacted participants' current service utilization. Action by both Veterans Affairs and the local community is vital to improving the health of women veterans. Service planning should consider additional Veterans Affairs contracts, mobile health vans, peer support, and enhanced outreach. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Laboratory automation of high-quality and efficient ligand-binding assays for biotherapeutic drug development.

PubMed

Wang, Jin; Patel, Vimal; Burns, Daniel; Laycock, John; Pandya, Kinnari; Tsoi, Jennifer; DeSilva, Binodh; Ma, Mark; Lee, Jean

2013-07-01

Regulated bioanalytical laboratories that run ligand-binding assays in support of biotherapeutics development face ever-increasing demand to support more projects with increased efficiency. Laboratory automation is a tool that has the potential to improve both quality and efficiency in a bioanalytical laboratory. The success of laboratory automation requires thoughtful evaluation of program needs and fit-for-purpose strategies, followed by pragmatic implementation plans and continuous user support. In this article, we present the development of fit-for-purpose automation of total walk-away and flexible modular modes. We shared the sustaining experience of vendor collaboration and team work to educate, promote and track the use of automation. The implementation of laboratory automation improves assay performance, data quality, process efficiency and method transfer to CRO in a regulated bioanalytical laboratory environment.

24. VIEW OF THE SECOND FLOOR PLAN. ENRICHED URANIUM AND ...

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

24. VIEW OF THE SECOND FLOOR PLAN. ENRICHED URANIUM AND STAINLESS STEEL WEAPONS COMPONENT PRODUCTION-RELATED ACTIVITIES OCCURRED PRIMARILY ON THE SECOND FLOOR. THE ORIGINAL DRAWING HAS BEEN ARCHIVED ON MICROFILM. THE DRAWING WAS REPRODUCED AT THE BEST QUALITY POSSIBLE. LETTERS AND NUMBERS IN THE CIRCLES INDICATE FOOTER AND/OR COLUMN LOCATIONS. - Rocky Flats Plant, General Manufacturing, Support, Records-Central Computing, Southern portion of Plant, Golden, Jefferson County, CO

23. VIEW OF THE FIRST FLOOR PLAN. THE FIRST FLOOR ...

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

23. VIEW OF THE FIRST FLOOR PLAN. THE FIRST FLOOR HOUSED ADMINISTRATIVE OFFICES, THE CENTRAL COMPUTING, UTILITY SYSTEMS, ANALYTICAL LABORATORIES, AND MAINTENANCE SHOPS. THE ORIGINAL DRAWING HAS BEEN ARCHIVED ON MICROFILM. THE DRAWING WAS REPRODUCED AT THE BEST QUALITY POSSIBLE. LETTERS AND NUMBERS IN THE CIRCLES INDICATE FOOTER AND/OR COLUMN LOCATIONS. - Rocky Flats Plant, General Manufacturing, Support, Records-Central Computing, Southern portion of Plant, Golden, Jefferson County, CO

Florida First Start Program: Program Planning and Implementation Guide.

ERIC Educational Resources Information Center

Florida State Dept. of Education, Tallahassee. Office of Early Intervention and School Readiness.

This guide is designed to facilitate the implementation of the Florida First Start (FFS) program, created to help at-risk children from birth to 3 years of age have the best possible start in life and to support parents in their roles as their children's first teachers. Emphasis is on providing early, high-quality education and support services.…

Family Support: Fostering Leadership and Partnership to Improve Access and Quality. Building State Early Childhood Comprehensive Systems Series, Number 14

ERIC Educational Resources Information Center

Thompson, Lisa; Uyeda, Kimberly

2004-01-01

The federal Maternal and Child Health Bureau (MCHB) has launched a five-year initiative that will support state efforts to build comprehensive early childhood service systems. This initiative--the State Early Childhood Comprehensive Systems (SECCS) Initiative--provides planning and implementation grants to the state and territory Maternal and…

OPTIMIZING BMP PLACEMENT AT WATERSHED-SCALE USING SUSTAIN

EPA Science Inventory

Watershed and stormwater managers need modeling tools to evaluate alternative plans for environmental quality restoration and protection needs in urban and developing areas. A watershed-scale decision-support system, based on cost optimization, provides an essential tool to suppo...

U.S. EPA's Watershed Management Research Activities

EPA Science Inventory

Watershed and stormwater managers need modeling tools to evaluate alternative plans for environmental quality restoration and protection needs in urban and developing areas. A watershed-scale decision-support system, based on cost optimization, provides an essential tool to suppo...

Project consistency with transportation plans and air quality conformity workshops : technical report.

DOT National Transportation Integrated Search

2015-04-01

This implementation project supports streamlined project delivery, one of the goals outlined by the Texas : Department of Transportation (TxDOT) leadership to achieve an efficient and effective transportation system : in Texas. The project benefits T...

EPA-ORD MEASUREMENT SCIENCE SUPPORT FOR HOMELAND SECURITY

EPA Science Inventory

This presentation will describe the organization and the research and development activities of the ORD National Exposure Measurements Center and will focus on the Center's planned role in providing analytical method development, statistical sampling and design guidance, quality ...

Reciprocal peer review for quality improvement: an ethnographic case study of the Improving Lung Cancer Outcomes Project.

PubMed

Aveling, Emma-Louise; Martin, Graham; Jiménez García, Senai; Martin, Lisa; Herbert, Georgia; Armstrong, Natalie; Dixon-Woods, Mary; Woolhouse, Ian

2012-12-01

Peer review offers a promising way of promoting improvement in health systems, but the optimal model is not yet clear. We aimed to describe a specific peer review model-reciprocal peer-to-peer review (RP2PR)-to identify the features that appeared to support optimal functioning. We conducted an ethnographic study involving observations, interviews and documentary analysis of the Improving Lung Cancer Outcomes Project, which involved 30 paired multidisciplinary lung cancer teams participating in facilitated reciprocal site visits. Analysis was based on the constant comparative method. Fundamental features of the model include multidisciplinary participation, a focus on discussion and observation of teams in action, rather than paperwork; facilitated reflection and discussion on data and observations; support to develop focused improvement plans. Five key features were identified as important in optimising this model: peers and pairing methods; minimising logistic burden; structure of visits; independent facilitation; and credibility of the process. Facilitated RP2PR was generally a positive experience for participants, but implementing improvement plans was challenging and required substantial support. RP2PR appears to be optimised when it is well organised; a safe environment for learning is created; credibility is maximised; implementation and impact are supported. RP2PR is seen as credible and legitimate by lung cancer teams and can act as a powerful stimulus to produce focused quality improvement plans and to support implementation. Our findings have identified how RP2PR functioned and may be optimised to provide a constructive, open space for identifying opportunities for improvement and solutions.

Data Quality Campaign Comments on ESSA Proposed Regulations on Accountability, State Plans, and Data Reporting

ERIC Educational Resources Information Center

Data Quality Campaign, 2016

2016-01-01

The Every Student Succeeds Act (ESSA) preserves the most positive legacy of the No Child Left Behind era--more accurate and transparent data about the performance of all students--and helps states take their efforts to use data in support of student learning to the next level. The Data Quality Campaign (DQC) appreciates the opportunity to provide…

Water quality monitoring strategies - A review and future perspectives.

PubMed

Behmel, S; Damour, M; Ludwig, R; Rodriguez, M J

2016-11-15

The reliable assessment of water quality through water quality monitoring programs (WQMPs) is crucial in order for decision-makers to understand, interpret and use this information in support of their management activities aiming at protecting the resource. The challenge of water quality monitoring has been widely addressed in the literature since the 1940s. However, there is still no generally accepted, holistic and practical strategy to support all phases of WQMPs. The purpose of this paper is to report on the use cases a watershed manager has to address to plan or optimize a WQMP from the challenge of identifying monitoring objectives; selecting sampling sites and water quality parameters; identifying sampling frequencies; considering logistics and resources to the implementation of actions based on information acquired through the WQMP. An inventory and critique of the information, approaches and tools placed at the disposal of watershed managers was proposed to evaluate how the existing information could be integrated in a holistic, user-friendly and evolvable solution. Given the differences in regulatory requirements, water quality standards, geographical and geological differences, land-use variations, and other site specificities, a one-in-all solution is not possible. However, we advance that an intelligent decision support system (IDSS) based on expert knowledge that integrates existing approaches and past research can guide a watershed manager through the process according to his/her site-specific requirements. It is also necessary to tap into local knowledge and to identify the knowledge needs of all the stakeholders through participative approaches based on geographical information systems and adaptive survey-based questionnaires. We believe that future research should focus on developing such participative approaches and further investigate the benefits of IDSS's that can be updated quickly and make it possible for a watershed manager to obtain a timely, holistic view and support for every aspect of planning and optimizing a WQMP. Copyright © 2016 Elsevier B.V. All rights reserved.

A Statistical Estimate of the Validity and Reliability of a Rubric Developed by Connecticut's State Education Resource Center to Evaluate the Quality of Individualized Education Programs for Students with Disabilities

ERIC Educational Resources Information Center

Mearman, Kimberly A.

2013-01-01

Because of the critical function of the IEP in the planning and implementation of effective instruction for students with disabilities, educators need a reference to determine the standards of a quality IEP and a process by which to compare an IEP to those standards. A rubric can support educators in examining the quality of IEPs. This study used…

Waterbird habitat in California's Central Valley basins under climate, urbanization, and water management scenarios

USGS Publications Warehouse

Matchett, Elliott L.; Fleskes, Joseph

2018-01-01

California's Central Valley provides critical, but threatened habitat and food resources for migrating and wintering waterfowl, shorebirds, and other waterbirds. The Central Valley is comprised of nine basins that were defined by the Central Valley Joint Venture (CVJV) to assist in conservation planning. Basins vary in composition and extent of habitats, which primarily include croplands and wetlands that rely on water supplies shared with other competing human and environmental uses. Changes in climate, urban development, and water supply management are uncertain and could reduce future availability of water supplies supporting waterbird habitats and limit effectiveness of wetland restoration planned by the CVJV to support wintering waterbirds. We modeled 17 plausible scenarios including combinations of three climate projections, three urbanization rates, and five water supply management options to promote agricultural and urban water uses, with and without wetland restoration. Our research examines the reduction in quantity and quality of habitats during the fall migration-wintering period by basin under each scenario, and the efficacy of planned wetland restoration to compensate reductions in flooded areas of wetland habitats. Scenario combinations of projected climate, urbanization, and water supply management options reduced availability of flooded cropland and wetland habitats during fall-winter and degraded the quality of seasonal wetlands (i.e., summer-irrigation for improved forage production), though the extent and frequency of impacts varied by basin. Planned wetland restoration may substantially compensate for scenario-related effects on wetland habitats in each basin. However, results indicate that Colusa, Butte, Sutter, San Joaquin, and Tulare Basins may require additional conservation to support summer-irrigation of seasonal wetlands and winter-flooding of cropland habitats. Still further conservation may be required to provide sufficient areas of flooded seasonal and semi-permanent wetlands in San Joaquin and Tulare Basins during fall-winter. The main objective of this research is to provide decision-support for achieving waterbird conservation goals in the valley and to inform CVJV's regional conservation planning.

A Model for Physician Leadership Development and Succession Planning.

PubMed

Dubinsky, Isser; Feerasta, Nadia; Lash, Rick

2015-01-01

Although the presence of physicians in formal leadership positions has often been limited to roles of department chiefs, MAC chairs, etc., a growing number of organizations are recruiting physicians to other leadership positions (e.g., VP, CEO) where their involvement is being genuinely sought and valued. While physicians have traditionally risen to leadership positions based on clinical excellence or on a rotational basis, truly effective physician leadership that includes competencies such as strategic planning, budgeting, mentoring, network development, etc., is essential to support organizational goals, improve performance and overall efficiency as well as ensuring the quality of care. In this context, the authors have developed a physician leader development and succession planning matrix and supporting toolkit to assist hospitals in identifying and nurturing the next generation of physician leaders.

Tools for surveying and improving the quality of life: people with special needs in focus.

PubMed

Hoyningen-Süess, Ursula; Oberholzer, David; Stalder, René; Brügger, Urs

2012-01-01

This article seeks to describe online tools for surveying and improving quality of life for people with disabilities living in assisted living centers and special education service organizations. Ensuring a decent quality of life for disabled people is an important welfare state goal. Using well-accepted quality of life conceptions, online diagnostic and planning tools were developed during an Institute for Education, University of Zurich, research project. The diagnostic tools measure, evaluate and analyze disabled people's quality of life. The planning tools identify factors that can affect their quality of life and suggest improvements. Instrument validity and reliability are not tested according to the standard statistical procedures. This will be done at a more advanced stage of the project. Instead, the tool is developed, refined and adjusted in cooperation with practitioners who are constantly judging it according to best practice standards. The tools support staff in assisted living centers and special education service organizations. These tools offer comprehensive resources for surveying, quantifying, evaluating, describing and simulating quality of life elements.

Surface mine planning and design implications and theory of a visual environmental quality predictive model

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

Burley, J.B.

1999-07-01

Surface mine planners and designers are searching for scientifically based tools to assist in the pre-mine planning and post-mine development or surface mine sites. In this study, the author presents a science based visual and environmental quality predictive model useful in preparing and assessing landscape treatments for surface mine sites. The equation explains 67 percent of respondent preference, with an overall p-value for the equation >0.0001 and a p-value >0.05 for each regressor. Regressors employed in the equation include an environmental quality index, foreground vegetation, distant nonvegetation, people, vehicles, utilities, foreground flowers, foreground erosion, wildlife, landscape openness, landscape mystery, andmore » noosphericness (a measure of human disturbance). The equation can be explained with an Intrusion/Neutral Modifier/Temporal Enhancement Theory which suggests that human intrusions upon other humans results in landscape of low preference and which also suggests that landscape containing natural and special temporal features such as wildlife and flowers can enhance the value of a landscape scene. This research supports the importance of visual barriers such as berms and vegetation screens during mining operations and supports public perceptions concerning many types of industrial activities. In addition, the equation can be applied to study post-mining landscape development plans to maximize the efficiency and effectiveness of landscape treatments.« less

Data Quality Objectives for Tank Farms Waste Compatibility Program

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

BANNING, D.L.

1999-07-02

There are 177 waste storage tanks containing over 210,000 m{sup 3} (55 million gal) of mixed waste at the Hanford Site. The River Protection Project (RPP) has adopted the data quality objective (DQO) process used by the U.S. Environmental Protection Agency (EPA) (EPA 1994a) and implemented by RPP internal procedure (Banning 1999a) to identify the information and data needed to address safety issues. This DQO document is based on several documents that provide the technical basis for inputs and decision/action levels used to develop the decision rules that evaluate the transfer of wastes. A number of these documents are presentlymore » in the process of being revised. This document will need to be revised if there are changes to the technical criteria in these supporting documents. This DQO process supports various documents, such as sampling and analysis plans and double-shell tank (DST) waste analysis plans. This document identifies the type, quality, and quantity of data needed to determine whether transfer of supernatant can be performed safely. The requirements in this document are designed to prevent the mixing of incompatible waste as defined in Washington Administrative Code (WAC) 173-303-040. Waste transfers which meet the requirements contained in this document and the Double-Shell Tank Waste Analysis Plan (Mulkey 1998) are considered to be compatible, and prevent the mixing of incompatible waste.« less

Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability.

PubMed

Berenson, Robert A; Rice, Thomas

2015-12-01

The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. Payment policy should help temper the current "more is better" attitude of physicians and provider organizations. Incentive neutrality would better support health professionals' intrinsic motivation to act in their patients' best interests to improve overall quality than would pay-for-performance plans targeted to specific areas of clinical care. Public policy can support clinicians' intrinsic motivation through approaches that support systematic feedback to clinicians and provide concrete opportunities to collaborate to improve care. Some programs administered by the Centers for Medicare & Medicaid Services, including Partnership for Patients and Conditions of Participation, deserve more attention; they represent available, but largely ignored, approaches to support providers to improve quality and protect beneficiaries against substandard care. Public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation. Actually achieving improvement, however, will require a reexamination of the role played by financial incentives embedded in payments and the unrealistic expectations placed on marginal incentives in pay-for-performance schemes. © Health Research and Educational Trust.

Information Architecture for Quality Management Support in Hospitals.

PubMed

Rocha, Álvaro; Freixo, Jorge

2015-10-01

Quality Management occupies a strategic role in organizations, and the adoption of computer tools within an aligned information architecture facilitates the challenge of making more with less, promoting the development of a competitive edge and sustainability. A formal Information Architecture (IA) lends organizations an enhanced knowledge but, above all, favours management. This simplifies the reinvention of processes, the reformulation of procedures, bridging and the cooperation amongst the multiple actors of an organization. In the present investigation work we planned the IA for the Quality Management System (QMS) of a Hospital, which allowed us to develop and implement the QUALITUS (QUALITUS, name of the computer application developed to support Quality Management in a Hospital Unit) computer application. This solution translated itself in significant gains for the Hospital Unit under study, accelerating the quality management process and reducing the tasks, the number of documents, the information to be filled in and information errors, amongst others.

A Watershed-scale Design Optimization Model for Stormwater Best Management Practices

EPA Science Inventory

U.S. Environmental Protection Agency developed a decision-support system, System for Urban Stormwater Treatment and Analysis Integration (SUSTAIN), to evaluate alternative plans for stormwater quality management and flow abatement techniques in urban and developing areas. SUSTAI...

Progress in improving provincial plans for nutrition through targeted technical assistance and local advocacy in Vietnam

PubMed Central

Harris, Jody; Nguyen, Phuong H.; To, Quyen; Frongillo, Edward A.; Menon, Purnima

2016-01-01

Vietnam has been decentralizing nutrition planning to provinces, which could help with local relevance and accountability. Assessment in 2009 found a continuing top-down approach, limited human capacity, and difficulty in integrating multiple sectors. Alive and Thrive (A&T) provided targeted assistance and capacity-building for 15 provincial plans for nutrition (PPNs). We aimed to (i) assess PPN content and quality improvements 2009–2014, and (ii) explain processes through which change occurred. Data consisted of interview-based assessments of provincial planning processes, annual PPN assessments, and tracking of A&T involvement. At endline, some provinces produced higher quality plans. Local planning skills improved, but capacity remained insufficient. Awareness of and support for nutrition improved, but some policy and legal environments were contradictory. Objectives were clearer, but use of data for planning remained inconsistent. Provinces became more proactive and creative, but remained constrained by slow approval processes and insufficient funding. Targeted assistance and local advocacy can improve decentralized planning, with success dependent on policy and programming contexts and ability to overcome constraints around capacity, investment, data use and remnants of centralized planning. We recommend strong engagement with planners at the national level to understand how to unblock major constraints; solutions must take into consideration the particular political, financial and administrative context. PMID:27198978

Factors influencing healthcare service quality

PubMed Central

Mosadeghrad, Ali Mohammad

2014-01-01

Background: The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods: Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results: Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion: This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality. PMID:25114946

Innovative Stormwater Quality Tools by SARA for Holistic Watershed Master Planning

NASA Astrophysics Data System (ADS)

Thomas, S. M.; Su, Y. C.; Hummel, P. R.

2016-12-01

Stormwater management strategies such as Best Management Practices (BMP) and Low-Impact Development (LID) have increasingly gained attention in urban runoff control, becoming vital to holistic watershed master plans. These strategies can help address existing water quality impairments and support regulatory compliance, as well as guide planning and management of future development when substantial population growth and urbanization is projected to occur. However, past efforts have been limited to qualitative planning due to the lack of suitable tools to conduct quantitative assessment. The San Antonio River Authority (SARA), with the assistance of Lockwood, Andrews & Newnam, Inc. (LAN) and AQUA TERRA Consultants (a division of RESPEC), developed comprehensive hydrodynamic and water quality models using the Hydrological Simulation Program-FORTRAN (HSPF) for several urban watersheds in the San Antonio River Basin. These models enabled watershed management to look at water quality issues on a more refined temporal and spatial scale than the limited monitoring data. They also provided a means to locate and quantify potential water quality impairments and evaluate the effects of mitigation measures. To support the models, a suite of software tools were developed. including: 1) SARA Timeseries Utility Tool for managing and processing of large model timeseries files, 2) SARA Load Reduction Tool to determine load reductions needed to achieve screening levels for each modeled constituent on a sub-basin basis, and 3) SARA Enhanced BMP Tool to determine the optimal combination of BMP types and units needed to achieve the required load reductions. Using these SARA models and tools, water quality agencies and stormwater professionals can determine the optimal combinations of BMP/LID to accomplish their goals and save substantial stormwater infrastructure and management costs. The tools can also help regulators and permittees evaluate the feasibility of achieving compliance using BMP/LID. The project has gained national attention, being showcased in multiple newsletters, professional magazines, and conference presentations. The project also won the Texas American Council of Engineering Companies (ACEC) Gold Medal Award and the ACEC National Recognition Award in 2016.

Combining administrative data feedback, reflection and action planning to engage primary care professionals in quality improvement: qualitative assessment of short term program outcomes.

PubMed

Vachon, Brigitte; Désorcy, Bruno; Gaboury, Isabelle; Camirand, Michel; Rodrigue, Jean; Quesnel, Louise; Guimond, Claude; Labelle, Martin; Huynh, Ai-Thuy; Grimshaw, Jeremy

2015-09-18

Improving primary care for chronic disease management requires a coherent, integrated approach to quality improvement. Evidence in the continuing professional development (CPD) field suggests the importance of using strategies such as feedback delivery, reflective practice and action planning to facilitate recognition of gaps and service improvement needs. Our study explored the outcomes of a CPD intervention, named the COMPAS Project, which consists of a three-hour workshop composed of three main activities: feedback, critical reflection and action planning. The feedback intervention is delivered face-to-face and presents performance indicators extracted from clinical-administrative databases. This aim of this study was to assess the short term outcomes of this intervention to engage primary care professional in continuous quality improvement (QI). In order to develop an understanding of our intervention and of its short term outcomes, a program evaluation approach was used. Ten COMPAS workshops on diabetes management were directly observed and qualitative data was collected to assess the intervention short term outcomes. Data from both sources were combined to describe the characteristics of action plans developed by professionals. Two independent coders analysed the content of these plans to assess if they promoted engagement in QI and interprofessional collaboration. During the ten workshops held, 26 interprofessional work teams were formed. Twenty-two of them developed a QI project they could implement themselves and that targeted aspects of their own practice they perceived in need of change. Most frequently prioritized strategies for change were improvement of systematic clientele follow-up, medication compliance, care pathway and support to improve adoption of healthier life habits. Twenty-one out of 22 action plans were found to target some level of improvement of interprofessional collaboration in primary care. Our study results demonstrate that the COMPAS intervention enabled professionals to target priorities for practice improvements and to develop action plans that promote interprofessional collaboration. The COMPAS intervention aims to increase capability for continuous QI, readiness to implement process of care changes and team shared goals but available resources, climate and culture for change and leadership, are also important required conditions to successfully implement these practice changes. We think that the proposed approach can be very useful to support and engage primary care professionals in the planning stage of quality improvement projects since it combines key successful ingredients: feedback, reflection and planning of action.

A scientific operations plan for the large space telescope. [ground support system design

NASA Technical Reports Server (NTRS)

West, D. K.

1977-01-01

The paper describes an LST ground system which is compatible with the operational requirements of the LST. The goal of the approach is to minimize the cost of post launch operations without seriously compromising the quality and total throughput of LST science. Attention is given to cost constraints and guidelines, the telemetry operations processing systems (TELOPS), the image processing facility, ground system planning and data flow, and scientific interfaces.

Incorporating discrete event simulation into quality improvement efforts in health care systems.

PubMed

Rutberg, Matthew Harris; Wenczel, Sharon; Devaney, John; Goldlust, Eric Jonathan; Day, Theodore Eugene

2015-01-01

Quality improvement (QI) efforts are an indispensable aspect of health care delivery, particularly in an environment of increasing financial and regulatory pressures. The ability to test predictions of proposed changes to flow, policy, staffing, and other process-level changes using discrete event simulation (DES) has shown significant promise and is well reported in the literature. This article describes how to incorporate DES into QI departments and programs in order to support QI efforts, develop high-fidelity simulation models, conduct experiments, make recommendations, and support adoption of results. The authors describe how DES-enabled QI teams can partner with clinical services and administration to plan, conduct, and sustain QI investigations. © 2013 by the American College of Medical Quality.

Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

PubMed

Scott, Colleen; Clarke, Kristie E N; Grevendonk, Jan; Dolan, Samantha B; Ahmed, Hussein Osman; Kamau, Peter; Ademba, Peter Aswani; Osadebe, Lynda; Bonsu, George; Opare, Joseph; Diamenu, Stanley; Amenuvegbe, Gregory; Quaye, Pamela; Osei-Sarpong, Fred; Abotsi, Francis; Ankrah, Joseph Dwomor; MacNeil, Adam

2017-11-10

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya = 50%, Ghana = 53%) and poor data concordance between child registers and facility tally sheets (Kenya = 0%, Ghana = 3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.

Adolescent cancer patients' perceived quality of cancer care: The roles of patient engagement and supporting independence.

PubMed

Siembida, Elizabeth J; Kadan-Lottick, Nina S; Moss, Kerry; Bellizzi, Keith M

2018-04-10

A lack of focus on variation in engagement among cancer populations of differing developmental stages led us to examine the associations between patient engagement, the patient-provider relationship, cognitive development, readiness to transition to adulthood (transitional readiness) and perceived quality of care. A sample of 101 adolescent cancer patients (diagnosed 10-20 years) completed survey items concerning patient engagement, dimensions of the patient-provider relationship, cognitive development, transitional readiness, and demographic characteristics using an iPad/tablet during a routine clinic visit. Patient engagement was not significantly associated with perceived quality of care (b = .02, 95% CI: -0.06, 0.11). Instead, adolescents with providers that supported their independence (b = .34, 95% CI: 0.17, 0.52) were significantly more likely to perceive higher quality care. Supportive patient-provider relationships are an integral part of adolescents' perceptions of quality of care. Adolescents are still gaining important skills for navigating the medical system, and the patient-provider relationship may provide an important scaffolding relationship to help adolescents build independence in their treatment experience. Identifying potential mechanisms through which adolescents can provide their opinion, ask questions, and participate in their treatment plan will help in supporting adolescent independence and improve quality of care. Published by Elsevier B.V.

Water, energy, and biogeochemical budgets investigation at Panola Mountain research watershed, Stockbridge, Georgia; a research plan

USGS Publications Warehouse

Huntington, T.G.; Hooper, R.P.; Peters, N.E.; Bullen, T.D.; Kendall, Carol

1993-01-01

The Panola Mountain Research Watershed (PMRW), located in the Panola Mountain State Conservation Park near Stockbridge, Georgia has been selected as a core research watershed under the Water, Energy and Biogeochemical Budgets (WEBB) research initiative of the U.S. Geological Survey (USGS) Global Climate Change Program. This research plan describes ongoing and planned research activities at PMRW from 1984 to 1994. Since 1984, PMRW has been studied as a geochemical process research site under the U.S. Acid Precipitation Thrust Program. Research conducted under this Thrust Program focused on the estimation of dry atmospheric deposition, short-term temporal variability of streamwater chemistry, sulfate adsorption characteristics of the soils, groundwater chemistry, throughfall chemistry, and streamwater quality. The Acid Precipitation Thrust Program continues (1993) to support data collection and a water-quality laboratory. Proposed research to be supported by the WEBB program is organized in 3 interrelated categories: streamflow generation and water-quality evolution, weathering and geochemical evolution, and regulation of soil-water chemistry. Proposed research on streamflow generation and water-quality evolution will focus on subsurface water movement, its influence in streamflow generation, and the associated chemical changes of the water that take place along its flowpath. Proposed research on weathering and geochemical evolution will identify the sources of cations observed in the streamwater at Panola Mountain and quantify the changes in cation source during storms. Proposed research on regulation of soil-water chemistry will focus on the poorly understood processes that regulate soil-water and groundwater chemistry. (USGS)

Experience gained from the application of basic quality assurance procedures in a Greek university engineering department

NASA Astrophysics Data System (ADS)

Stamatelos, A. M.

2010-06-01

During the last decade, significant funding has become available to Greek public universities to support the convergence to the common European space of higher education. In a number of departments, this funding was wisely invested in the development of a quality culture, covering not only the educational process, but also the services offered by the department's administration and technical support staff. This paper presents the design and implementation of a quality-oriented studies' reform plan in the Mechanical Engineering Department, University of Thessaly in the period 2002-2008. Based on the successful experience from its application, a significant part of the personnel and students have become acquainted with basic quality assurance procedures and performance evaluation. Experience and lessons learnt from this effort are reported and discussed in this paper.

Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review.

PubMed

Zakiyah, Neily; van Asselt, Antoinette D I; Roijmans, Frank; Postma, Maarten J

2016-01-01

A significant number of women in low and middle income countries (L-MICs) who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions from the published literatures and assess their implication for policy and future research. A systematic review was performed in several electronic databases i.e Medline (Pubmed), Embase, Popline, The National Bureau of Economic Research (NBER), EBSCOHost, and The Cochrane Library. Articles reporting full economic evaluations of strategies to improve family planning interventions in one or more L-MICs, published between 1995 until 2015 were eligible for inclusion. Data was synthesized and analyzed using a narrative approach and the reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. From 920 references screened, 9 studies were eligible for inclusion. Six references assessed cost effectiveness of improving family planning interventions in one or more L-MICs, while the rest assessed costs and consequences of integrating family planning and HIV services, concerning sub-Saharan Africa. Assembled evidence suggested that improving family planning interventions is cost effective in a variety of L-MICs as measured against accepted international cost effectiveness benchmarks. In areas with high HIV prevalence, integrating family planning and HIV services can be efficient and cost effective; however the evidence is only supported by a very limited number of studies. The major drivers of cost effectiveness were cost of increasing coverage, effectiveness of the interventions and country-specific factors. Improving family planning interventions in low and middle income countries appears to be cost-effective. Additional economic evaluation studies with improved reporting quality are necessary to generate further evidence on costs, cost-effectiveness, and affordability, and to support increased funding and investments in family planning programs.

Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review

PubMed Central

Zakiyah, Neily; van Asselt, Antoinette D. I.; Roijmans, Frank; Postma, Maarten J.

2016-01-01

Background A significant number of women in low and middle income countries (L-MICs) who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions from the published literatures and assess their implication for policy and future research. Study design A systematic review was performed in several electronic databases i.e Medline (Pubmed), Embase, Popline, The National Bureau of Economic Research (NBER), EBSCOHost, and The Cochrane Library. Articles reporting full economic evaluations of strategies to improve family planning interventions in one or more L-MICs, published between 1995 until 2015 were eligible for inclusion. Data was synthesized and analyzed using a narrative approach and the reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results From 920 references screened, 9 studies were eligible for inclusion. Six references assessed cost effectiveness of improving family planning interventions in one or more L-MICs, while the rest assessed costs and consequences of integrating family planning and HIV services, concerning sub-Saharan Africa. Assembled evidence suggested that improving family planning interventions is cost effective in a variety of L-MICs as measured against accepted international cost effectiveness benchmarks. In areas with high HIV prevalence, integrating family planning and HIV services can be efficient and cost effective; however the evidence is only supported by a very limited number of studies. The major drivers of cost effectiveness were cost of increasing coverage, effectiveness of the interventions and country-specific factors. Conclusion Improving family planning interventions in low and middle income countries appears to be cost-effective. Additional economic evaluation studies with improved reporting quality are necessary to generate further evidence on costs, cost-effectiveness, and affordability, and to support increased funding and investments in family planning programs. PMID:27992552

A patient centered care plan in the EHR: improving collaboration and engagement.

PubMed

Chunchu, Kavitha; Mauksch, Larry; Charles, Carol; Ross, Valerie; Pauwels, Judith

2012-09-01

Patients attempting to manage their chronic conditions require ongoing support in changing and adopting self-management behaviors. However, patient values, health goals, and action plans are not well represented in the electronic health record (EHR) impeding the ability of the team (MA and providers) to provide respectful, ongoing self-management support. We evaluated whether a team approach to using an EHR based patient centered care plan (PCCP) improved collaborative self-management planning. An experimental, prospective cohort study was conducted in a family medicine residency clinic. The experimental group included 7 physicians and a medical assistant who received 2 hr of PCCP training. The control group consisted of 7 physicians and a medical assistant. EHR charts were analyzed for evidence of 8 behavior change elements. Follow-up interviews with experimental group patients and physicians and the medical assistant assessed their experiences. We found that PCCP charts had more documented behavior change elements than control charts in all 8 domains (p < .001). Experimental group physicians valued the PCCP model and suggested ways to improve its use. Patient feedback demonstrated support for the model. A PCCP can help team members to engage patients with chronic illnesses in goal setting and action planning to support self-management. An EHR design that stores patient values, health goals, and action plans may strengthen continuity and quality of care between patients and primary care team members. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Apply creative thinking of decision support in electrical nursing record.

PubMed

Hao, Angelica Te-Hui; Hsu, Chien-Yeh; Li-Fang, Huang; Jian, Wen-Shan; Wu, Li-Bin; Kao, Ching-Chiu; Lu, Mei-Show; Chang, Her-Kung

2006-01-01

The nursing process consists of five interrelated steps: assessment, diagnosis, planning, intervention, and evaluation. In the nursing process, the nurse collects a great deal of data and information. The amount of data and information may exceed the amount the nurse can process efficiently and correctly. Thus, the nurse needs assistance to become proficient in the planning of nursing care, due to the difficulty of simultaneously processing a large set of information. Computer systems are viewed as tools to expand the capabilities of the nurse's mind. Using computer technology to support clinicians' decision making may provide high-quality, patient-centered, and efficient healthcare. Although some existing nursing information systems aid in the nursing process, they only provide the most fundamental decision support--i.e., standard care plans associated with common nursing diagnoses. Such a computerized decision support system helps the nurse develop a care plan step-by-step. But it does not assist the nurse in the decision-making process. The decision process about how to generate nursing diagnoses from data and how to individualize the care plans still reminds of the nurse. The purpose of this study is to develop a pilot structure in electronic nursing record system integrated with international nursing standard for improving the proficiency and accuracy of plan of care in clinical pathway process. The proposed pilot systems not only assist both student nurses and nurses who are novice in nursing practice, but also experts who need to work in a practice area which they are not familiar with.

76 FR 6376 - Approval of Air Quality Implementation Plans; Indiana and Ohio; Disapproval of Interstate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-04

... impact. EPA stated that the State's conclusion should be supported by an adequate technical analysis. EPA... technical analysis, no such analysis was provided by IDEM justifying that these measures are sufficient to... a State's [[Page 6379

Decision Tools for Transportation Infrastructure Reinvestment: User Guidelines for Microcomputer Decision Support System (DSS)

DOT National Transportation Integrated Search

1988-07-01

This report is intended to improve the quality of decisions about reinvestments, : and modest new investments, in highway transportation infrastructure. Decisions : of this type comprise the majority of planning actions taken in the field of : public...

77 FR 5255 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-02

... Education activities. AHRQ is the lead agency charged with supporting research designed to improve the... results from comparative effectiveness research studies. The planned assessment approaches will promote... DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Agency...

Exploring Systems That Support Good Clinical Care in Indigenous Primary Health-care Services: A Retrospective Analysis of Longitudinal Systems Assessment Tool Data from High-Improving Services.

PubMed

Woods, Cindy; Carlisle, Karen; Larkins, Sarah; Thompson, Sandra Claire; Tsey, Komla; Matthews, Veronica; Bailie, Ross

2017-01-01

Continuous Quality Improvement is a process for raising the quality of primary health care (PHC) across Indigenous PHC services. In addition to clinical auditing using plan, do, study, and act cycles, engaging staff in a process of reflecting on systems to support quality care is vital. The One21seventy Systems Assessment Tool (SAT) supports staff to assess systems performance in terms of five key components. This study examines quantitative and qualitative SAT data from five high-improving Indigenous PHC services in northern Australia to understand the systems used to support quality care. High-improving services selected for the study were determined by calculating quality of care indices for Indigenous health services participating in the Audit and Best Practice in Chronic Disease National Research Partnership. Services that reported continuing high improvement in quality of care delivered across two or more audit tools in three or more audits were selected for the study. Precollected SAT data (from annual team SAT meetings) are presented longitudinally using radar plots for quantitative scores for each component, and content analysis is used to describe strengths and weaknesses of performance in each systems' component. High-improving services were able to demonstrate strong processes for assessing system performance and consistent improvement in systems to support quality care across components. Key strengths in the quality support systems included adequate and orientated workforce, appropriate health system supports, and engagement with other organizations and community, while the weaknesses included lack of service infrastructure, recruitment, retention, and support for staff and additional costs. Qualitative data revealed clear voices from health service staff expressing concerns with performance, and subsequent SAT data provided evidence of changes made to address concerns. Learning from the processes and strengths of high-improving services may be useful as we work with services striving to improve the quality of care provided in other areas.

A non-linear optimization programming model for air quality planning including co-benefits for GHG emissions.

PubMed

Turrini, Enrico; Carnevale, Claudio; Finzi, Giovanna; Volta, Marialuisa

2018-04-15

This paper introduces the MAQ (Multi-dimensional Air Quality) model aimed at defining cost-effective air quality plans at different scales (urban to national) and assessing the co-benefits for GHG emissions. The model implements and solves a non-linear multi-objective, multi-pollutant decision problem where the decision variables are the application levels of emission abatement measures allowing the reduction of energy consumption, end-of pipe technologies and fuel switch options. The objectives of the decision problem are the minimization of tropospheric secondary pollution exposure and of internal costs. The model assesses CO 2 equivalent emissions in order to support decision makers in the selection of win-win policies. The methodology is tested on Lombardy region, a heavily polluted area in northern Italy. Copyright © 2017 Elsevier B.V. All rights reserved.

Spreading improvements for advanced COPD care through a Canadian Collaborative.

PubMed

Rocker, Graeme M; Amar, Claudia; Laframboise, Wendy L; Burns, Jane; Verma, Jennifer Y

2017-01-01

A year-long pan-Canadian quality improvement collaborative (QIC) led by the Canadian Foundation for Healthcare Improvement (CFHI) supported the spread of the successful Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ to 19 teams in the 10 Canadian provinces. We describe QIC results, addressing two main questions: 1) Can the results of the Nova Scotia INSPIRED model be replicated elsewhere in Canada? 2) How did the teams implement and evaluate their versions of the INSPIRED program? Collaborative faculty selected measures that were evidence-based, relatively simple to collect, and relevant to local context. Chosen process and outcome measures are related to four quality domains: 1) patient- and family-centeredness, 2) coordination, 3) efficiency, and 4) appropriateness. Evaluation of a complex intervention followed a mixed-methods approach. Most participants were nurse managers and/or COPD educators. Only 8% were physicians. Fifteen teams incorporated all core INSPIRED interventions. All teams carried out evaluation. Thirteen teams actively involved patients and families in customized, direct care planning, eg, asking them to complete evaluative surveys and/or conducting interviews. Patients consistently reported greater self-confidence in symptom management, a return to daily activities, and improvements to quality of life. Twelve teams collected data on care transitions using the validated three-item Care Transitions Measure (CTM-3). Twelve teams used the Lung Information Needs Questionnaire (LINQ). Admissions, emergency room visits, and patient-related costs fell substantially for two teams described in detail (combined enrollment 208 patients). Most teams reported gaining deeper knowledge around complexities of COPD care, optimizing patient care through action plans, self-management support, psychosocial support, advance care planning, and coordinating community partnerships. Quality-of-care gains are achievable in the short term among different teams across diverse geographical and social contexts. A well-designed, adequately funded public-private partnership can deliver widespread beneficial outcomes for the health care system and for those living with advanced COPD.

The Best Laid Plans: An Examination of School Plan Quality and Implementation in a School Improvement Initiative

ERIC Educational Resources Information Center

Strunk, Katharine O.; Marsh, Julie A.; Bush-Mecenas, Susan C.; Duque, Matthew R.

2016-01-01

Purpose: A common strategy used in school improvement efforts is a mandated process of formal planning, yet little is known about the quality of plans or the relationship between plan quality and implementation. This mixed-methods article investigates plan quality, factors associated with plan quality, and the relationship between plan quality and…

The Addiction Benefits Scorecard: A Framework to Promote Health Insurer Accountability and Support Consumer Engagement.

PubMed

Danovitch, Itai; Kan, David

2017-01-01

Health care insurance plans covering treatment for substance use disorders (SUD) offer a wide range of benefits. Distinctions between health plan benefits are confusing, and consumers making selections may not adequately understand the characteristics or significance of the choices they have. The California Society of Addiction Medicine sought to help consumers make informed decisions about plan selections by providing education on the standard of care for SUD and presenting findings from an expert analysis of selected health plans. We developed an assessment framework, based on criteria endorsed by the American Society of Addiction Medicine, to rate the quality of SUD treatment benefits offered by a sample of insurance plans. We convened an expert panel of physicians to rate 16 policies of 10 insurance providers across seven categories. Data from published resources for 2014 insurance plans were extracted, categorized, and rated. The framework and ratings were summarized in a consumer-facing white paper. We found significant heterogeneity in benefits across comparable plans, as well as variation in the characterization and clarity of published services. This article presents findings and implications of the project. There is a pressing need to define requirements for SUD benefits and to hold health plans accountable for offering quality services in accordance with those benefits.

Advanced manufacturing development of a composite empennage component for L-1011 aircraft

NASA Technical Reports Server (NTRS)

Alva, T.; Henkel, J.; Johnson, R.; Carll, B.; Jackson, A.; Mosesian, B.; Brozovic, R.; Obrien, R.; Eudaily, R.

1982-01-01

This is the final report of technical work conducted during the fourth phase of a multiphase program having the objective of the design, development and flight evaluation of an advanced composite empennage component manufactured in a production environment at a cost competitive with those of its metal counterpart, and at a weight savings of at least 20 percent. The empennage component selected for this program is the vertical fin box of the L-1011 aircraft. The box structure extends from the fuselage production joint to the tip rib and includes front and rear spars. During Phase 4 of the program, production quality tooling was designed and manufactured to produce three sets of covers, ribs, spars, miscellaneous parts, and subassemblies to assemble three complete ACVF units. Recurring and nonrecurring cost data were compiled and documented in the updated producibility/design to cost plan. Nondestruct inspections, quality control tests, and quality acceptance tests were performed in accordance with the quality assurance plan and the structural integrity control plan. Records were maintained to provide traceability of material and parts throughout the manufacturing development phase. It was also determined that additional tooling would not be required to support the current and projected L-1011 production rate.

A Web-Based Decision Support System for Assessing Regional Water-Quality Conditions and Management Actions

USGS Publications Warehouse

Booth, N.L.; Everman, E.J.; Kuo, I.-L.; Sprague, L.; Murphy, L.

2011-01-01

The U.S. Geological Survey National Water Quality Assessment Program has completed a number of water-quality prediction models for nitrogen and phosphorus for the conterminous United States as well as for regional areas of the nation. In addition to estimating water-quality conditions at unmonitored streams, the calibrated SPAtially Referenced Regressions On Watershed attributes (SPARROW) models can be used to produce estimates of yield, flow-weighted concentration, or load of constituents in water under various land-use condition, change, or resource management scenarios. A web-based decision support infrastructure has been developed to provide access to SPARROW simulation results on stream water-quality conditions and to offer sophisticated scenario testing capabilities for research and water-quality planning via a graphical user interface with familiar controls. The SPARROW decision support system (DSS) is delivered through a web browser over an Internet connection, making it widely accessible to the public in a format that allows users to easily display water-quality conditions and to describe, test, and share modeled scenarios of future conditions. SPARROW models currently supported by the DSS are based on the modified digital versions of the 1:500,000-scale River Reach File (RF1) and 1:100,000-scale National Hydrography Dataset (medium-resolution, NHDPlus) stream networks. ?? 2011 American Water Resources Association. This article is a U.S. Government work and is in the public domain in the USA.

Quality of Life and Unmet Need in People with Psychosis in the London Borough of Haringey, UK

PubMed Central

Lambri, Maria; Chakraborty, Apu; Leavey, Gerard; King, Michael

2012-01-01

Objectives. Deinstitutionalization of long-term psychiatric patients produced various community-based residential care facilities. However, inner-city areas have many patients with severe mental illness (SMI) as well as deprivation, unemployment, and crime. This makes meeting their community needs complex. We undertook a needs assessment of service provision and consonance between service users' evaluation of need and by care workers. Design. Cross-sectional study with random sample of SMI service users in four housing settings: rehabilitation units; high-supported; medium-supported; low-supported housing. Setting. London Borough of Haringey. Outcome Measures. 110 SMI service users and 110 keyworkers were interviewed, using Camberwell Assessment of Need; SF-36; Lancashire Quality-of-Life profile; demographic and clinical information. Results. People in “low-support” and “high-support” housing had similar symptom scores, though low support had significantly lower quality of life. Quality of life was positively predicted by self-reported mental-health score and negatively predicted by unmet-need score in whole sample and in medium-support residents. Residents' and care-workers' assessments of need differed considerably. Conclusions. Although patients' housing needs were broadly met, those in low-supported housing fared least well. Attendance to self-reported mental health and unmet social needs to quality of life underpins planning of residential services for those with SMI. Social and personal needs of people in supported housing may be underestimated and overlooked; service providers need to prioritise these if concept of “recovery” is to advance. PMID:23213300

Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System.

PubMed

Bose-Brill, Seuli; Feeney, Michelle; Prater, Laura; Miles, Laura; Corbett, Angela; Koesters, Stephen

2018-06-26

Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. A total of 19.5% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39). Among eligible patients aged between 50 and 60 years at the intervention site, advance care planning documentation rates increased by 37% (27/96 to 37/96). Advance care planning documentation rates increased 34% among high users (27/67 to 36/67). Advance care planning previsit planning using a secure electronic health record-supported patient portal framework yielded improvement in the presence of advance care planning documentation, with highest improvement in active patient portal users and patients aged between 50 and 60 years. Targeted previsit patient portal advance care planning delivery in these populations can potentially improve the quality of care in these populations. ©Seuli Bose-Brill, Michelle Feeney, Laura Prater, Laura Miles, Angela Corbett, Stephen Koesters. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.06.2018.

The role of biogeochemical hotspots, landscape heterogeneity, and hydrological connectivity for minimizing forestry effects on water quality.

PubMed

Laudon, Hjalmar; Kuglerová, Lenka; Sponseller, Ryan A; Futter, Martyn; Nordin, Annika; Bishop, Kevin; Lundmark, Tomas; Egnell, Gustaf; Ågren, Anneli M

2016-02-01

Protecting water quality in forested regions is increasingly important as pressures from land-use, long-range transport of air pollutants, and climate change intensify. Maintaining forest industry without jeopardizing sustainability of surface water quality therefore requires new tools and approaches. Here, we show how forest management can be optimized by incorporating landscape sensitivity and hydrological connectivity into a framework that promotes the protection of water quality. We discuss how this approach can be operationalized into a hydromapping tool to support forestry operations that minimize water quality impacts. We specifically focus on how hydromapping can be used to support three fundamental aspects of land management planning including how to (i) locate areas where different forestry practices can be conducted with minimal water quality impact; (ii) guide the off-road driving of forestry machines to minimize soil damage; and (iii) optimize the design of riparian buffer zones. While this work has a boreal perspective, these concepts and approaches have broad-scale applicability.

External quality assurance for HIV point-of-care testing in Africa: A collaborative country-partner approach to strengthen diagnostic services

PubMed Central

2016-01-01

It is important to consider the role of diagnostics and the critical need for quality diagnostics services in resource-limited settings. Accurate diagnostic tests play a key role in patient management and the prevention and control of most infectious diseases. As countries plan for implementation of HIV early infant diagnosis and viral load point-of-care testing, the London School of Hygiene & Tropical Medicine has worked with countries and partners with an interest in external quality assurance to support quality point-of-care testing on the continent. Through a series of collaborative consultations and workshops, the London School of Hygiene & Tropical Medicine has gathered lessons learned, tools, and resources and developed quality assurance models that will support point-of-care testing. The London School of Hygiene & Tropical Medicine is committed to the continued advancement of laboratory diagnostics in Africa and quality laboratory services and point-of-care testing. PMID:28879132

Reengineering health care: management systems for survivors.

PubMed

Griffith, J R

1994-01-01

To survive in the coming era, health care organizations must support the powerful concepts of continuous quality improvement with better internal management systems that include: (1) new processes for making decisions from mission to clinical guidelines; (2) hoshin planning, which emphasizes strong financial management and innovation to meet customer needs; (3) new organizations that make cross-disciplinary teams as important as traditional clinical support services; and (4) expanded information covering several new dimensions, including enhanced analytic capability, and supporting both traditional organization and cross-disciplinary teams.

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

NASA Technical Reports Server (NTRS)

Tavana, Madjid

2005-01-01

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

Bottom-up perspectives of extreme event and climate change threats to water quality: Drinking water utilities in California

NASA Astrophysics Data System (ADS)

Ekstrom, J.; Klasic, M.; Fencl, A.; Lubell, M.; Bedsworth, L. W.; Baker, E.

2016-12-01

Extreme events impact water quality, which pose serious challenges for drinking water systems. Such extreme events, including wildfire, storm surge, and other weather-related extremes, are projected to increase under a changing climate. It remains unclear what climate change information can support water managers in preparing for more extreme events. Exploring this topic requires understanding the larger question: What is the role of scientific information in adapting to climate change? We present two parts of a three-year study geared to understand whether, where, why and in what way climate information (or the lack of) is used or needed to support long term water quality planning for extreme events. In 2015 we surveyed California drinking water utilities and found a wide range of extreme event/water quality issues, perspectives on the severity of climate change threats, drought impacts and trusted information sources relating to water quality concerns. Approximately 70% of 259 respondents had recently experienced extreme weather-related events that worsen or trigger water quality. Survey results informed development of a case study analysis to gain a more in-depth understanding of what type of - or when - extreme events information could support climate adaptation. Projections of extreme events are often not in a form that is useable for water quality planning. Relative to supply-related projections, water quality has received much less scientific attention, leaving it an assumed scientific information gap and need for management. The question remains whether filling this gap would help adaptation, whom it would help, and in what way. Based on interviews with water systems in Summer 2016, our case study analyses reinforce that extreme events threaten water quality in many ways; largely as secondary impacts of climate change. Secondary impacts involve disinfection byproducts, increasing salinity in the Delta, and the use of lower quality sources. The most common barriers impeding effective adaptation were not related to information. Instead, respondents frequently expressed the obstacles of external institutions not coordinating with their needs. This demonstrates why climate adaptation must simultaneously occur at multiple levels of governance in order for water systems to successfully advance.

40 CFR 130.6 - Water quality management plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Water quality management plans. 130.6... QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM... and certified and approved updates to those plans. Continuing water quality planning shall be based...

Spatial Coverage Planning for Exploration Robots

NASA Technical Reports Server (NTRS)

Gaines, Daniel; Estlin, Tara; Chouinard, Caroline

2007-01-01

A report discusses an algorithm for an onboard planning and execution technology to support the exploration and characterization of geological features by autonomous rovers. A rover that is capable of deciding which observations are more important relieves the engineering team from much of the burden of attempting to make accurate predictions of what the available rover resources will be in the future. Instead, the science and engineering teams can uplink a set of observation requests that may potentially oversubscribe resources and let the rover use observation priorities and its current assessment of available resources to make decisions about which observations to perform and when to perform them. The algorithm gives the rover the ability to model spatial coverage quality based on data from different scientific instruments, to assess the impact of terrain on coverage quality, to incorporate user-defined priorities among subregions of the terrain to be covered, and to update coverage quality rankings of observations when terrain knowledge changes. When the rover is exploring large geographical features such as craters, channels, or boundaries between two different regions, an important factor in assessing the quality of a mission plan is how the set of chosen observations spatially cover the area of interest. The algorithm allows the rover to evaluate which observation to perform and to what extent the candidate observation will increase the spatial coverage of the plan.

Five-Year Plan (FY04-FY-08) for the Manufacturing Technology (ManTech) Program. Supplement to the FY03 - FY07 Plan

DTIC Science & Technology

2003-07-01

magnetorheological (MRF) finishing to reduce surface roughness in half the time of previous processes . Improved image quality directly supports improved...affordably polish the inside surface of small tight free form optics to a finish on the order of 3 angstroms. • Demonstrate cycle time reduction...processes and controls for steel, titanium, and superalloys. FY2007: • Demonstrate an improved superfine finishing for optical components to

300 Area TEDF NPDES Permit Compliance Monitoring Plan

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

Loll, C.M.

1994-10-13

This monitoring plan describes the activities and methods that will be employed at the 300 Area Treated Effluent Disposal Facility (TEDF) in order to ensure compliance with the National Discharge Elimination System (NPDES) permit. Included in this document are a brief description of the project, the specifics of the sampling effort, including the physical location and frequency of sampling, the support required for sampling, and the Quality Assurance (QA) protocols to be followed in the sampling procedures.

30 CFR 582.28 - Environmental protection measures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 582.28 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE... evaluation of the approved Delineation, Testing, or Mining Plan. The Director's review of the air quality... to be inadequate to support an environmental evaluation of a proposed Delineation, Testing, or Mining...

30 CFR 582.28 - Environmental protection measures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Section 582.28 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE... evaluation of the approved Delineation, Testing, or Mining Plan. The Director's review of the air quality... to be inadequate to support an environmental evaluation of a proposed Delineation, Testing, or Mining...

30 CFR 582.28 - Environmental protection measures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Section 582.28 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE... evaluation of the approved Delineation, Testing, or Mining Plan. The Director's review of the air quality... to be inadequate to support an environmental evaluation of a proposed Delineation, Testing, or Mining...

Integrated Watershed Management using the Watershed Management Optimization Support Tool (WMOST)

EPA Science Inventory

Integrated watershed management is an effective planning strategy to balance tradeoffs between competing water uses within a watershed. WMOST is an Excel-based decision tool to aid planners in making cost effective decisions that meet water quantity and quality regulations. WMOST...

Computing and Systems Applied in Support of Coordinated Energy, Environmental, and Climate Planning

EPA Science Inventory

This talk focuses on how Dr. Loughlin is applying Computing and Systems models, tools and methods to more fully understand the linkages among energy systems, environmental quality, and climate change. Dr. Loughlin will highlight recent and ongoing research activities, including: ...

Utilizing a TDRS satellite for direct broadcast satellite-radio propagation experiments and demonstrations

NASA Technical Reports Server (NTRS)

Hollansworth, James E.

1993-01-01

The NASA/VOA Direct Broadcast Satellite-Radio (DBS-R) Program will be using a NASA Tracking Data Relay Satellite (TDRS) satellite at 62 deg. West longitude to conduct live satellite S-band propagation experiments and demonstrations of satellite sound broadcasting over the next two years (1993-1994). The NASA/VOA DBS-R program has applied intensive effort to garner domestic and international support for the DBS-R concept. An S-band DBS-R allocation was achieved for Region 2 at WARC-92 held in Spain. With this allocation, the DBS-R program now needs to conduct S-band propagation experiments and systems demonstrations that will assist in the development of planning approaches for the use of Broadcast Satellite Service (Sound) frequency bands prior to the planning conference called for by WARC-92. These activities will also support receiver concept development applied to qualities ranging from AM to Monophonic FM, Stereophonic FM, Monophonic CD, and Stereophonic CD quality.

Underground Test Area Activity Preemptive Review Guidance Nevada National Security Site, Nevada, Revision 0

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

Farnham, Irene; Rehfeldt, Kenneth

Preemptive reviews (PERs) of Underground Test Area (UGTA) Activity corrective action unit (CAU) studies are an important and long-maintained quality improvement process. The CAU-specific PER committees provide internal technical review of ongoing work throughout the CAU lifecycle. The reviews, identified in the UGTA Quality Assurance Plan (QAP) (Sections 1.3.5.1 and 3.2), assure work is comprehensive, accurate, in keeping with the state of the art, and consistent with CAU goals. PER committees review various products, including data, documents, software/codes, analyses, and models. PER committees may also review technical briefings including Federal Facility Agreement and Consent Order (FFACO)-required presentations to the Nevadamore » Division of Environmental Protection (NDEP) and presentations supporting key technical decisions (e.g., investigation plans and approaches). PER committees provide technical recommendations to support regulatory decisions that are the responsibility of the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office (NNSA/NFO) and NDEP.« less

Renewable Energy Zones for the Africa Clean Energy Corridor

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

Wu, Grace C.; Deshmukh, Ranjit; Ndhlukula, Kudakwashe

Multi-criteria Analysis for Planning Renewable Energy (MapRE) is a study approach developed by the Lawrence Berkeley National Laboratory with the support of the International Renewable Energy Agency (IRENA). The approach combines geospatial, statistical, energy engineering, and economic methods to comprehensively identify and value high-quality wind, solar PV, and solar CSP resources for grid integration based on techno-economic criteria, generation profiles (for wind), and socio-environmental impacts. The Renewable Energy Zones for the Africa Clean Energy Corridor study sought to identify and comprehensively value high-quality wind, solar photovoltaic (PV), and concentrating solar power (CSP) resources in 21 countries in the East andmore » Southern Africa Power Pools to support the prioritization of areas for development through a multi-criteria planning process. These countries include Angola, Botswana, Burundi, Djibouti, Democratic Republic of Congo, Egypt, Ethiopia, Kenya, Lesotho, Libya, Malawi, Mozambique, Namibia, Rwanda, South Africa, Sudan, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. The study includes the methodology and the key results including renewable energy potential for each region.« less

Land-use planning for nearshore ecosystem services—the Puget Sound Ecosystem Portfolio Model

USGS Publications Warehouse

Byrd, Kristin

2011-01-01

The 2,500 miles of shoreline and nearshore areas of Puget Sound, Washington, provide multiple benefits to people—"ecosystem services"—including important fishing, shellfishing, and recreation industries. To help resource managers plan for expected growth in coming decades, the U.S. Geological Survey Western Geographic Science Center has developed the Puget Sound Ecosystem Portfolio Model (PSEPM). Scenarios of urban growth and shoreline modifications serve as model inputs to develop alternative futures of important nearshore features such as water quality and beach habitats. Model results will support regional long-term planning decisions for the Puget Sound region.

Integrated management of depression: improving system quality and creating effective interfaces.

PubMed

Myette, Thomas L

2008-04-01

Depression is a chronic recurrent condition and is a leading cause of work disability. Improving occupational outcomes for depression will require an integrated approach that incorporates best practices from the clinical, community, and workplace systems. This article briefly reviews recent quality improvement initiatives and promising practices in each system and then shifts to the importance of systems integration. An integrated chronic care model uses a sophisticated case management process to support essential relationships, facilitate key plans, and efficiently link the three systems to optimize clinical, economic, and occupational outcomes. An expanded role for employers and their agents in the management of depression and other chronic diseases is seen as fundamental to maintaining a healthy and productive workforce. To improve occupational outcomes for depression by integrating best practices from the clinical, community, and workplace systems. After a brief review of quality improvement initiatives and promising practices in each system, an integrated chronic care model is introduced. A case management process that links critical systems, supports essential relationships, and facilitates key plans is expected to result in improvements in clinical, economic, and occupational outcomes. Employers should be more engaged with clinical and community partners in the prevention and control of depression in affected employees.

Palliative care for people with advanced liver disease: A feasibility trial of a supportive care liver nurse specialist.

PubMed

Kimbell, Barbara; Murray, Scott A; Byrne, Heidi; Baird, Andrea; Hayes, Peter C; MacGilchrist, Alastair; Finucane, Anne; Brookes Young, Patricia; O'Carroll, Ronan E; Weir, Christopher J; Kendall, Marilyn; Boyd, Kirsty

2018-05-01

Liver disease is an increasing cause of death worldwide but palliative care is largely absent for these patients. We conducted a feasibility trial of a complex intervention delivered by a supportive care liver nurse specialist to improve care coordination, anticipatory care planning and quality of life for people with advanced liver disease and their carers. Patients received a 6-month intervention (alongside usual care) from a specially trained liver nurse specialist. The nurse supported patients/carers to live as well as possible with the condition and acted as a resource to facilitate care by community professionals. A mixed-method evaluation was conducted. Case note analysis and questionnaires examined resource use, care planning processes and quality-of-life outcomes over time. Interviews with patients, carers and professionals explored acceptability, effectiveness, feasibility and the intervention. Patients with advanced liver disease who had an unplanned hospital admission with decompensated cirrhosis were recruited from an inpatient liver unit. The intervention was delivered to patients once they had returned home. We recruited 47 patients, 27 family carers and 13 case-linked professionals. The intervention was acceptable to all participants. They welcomed access to additional expert advice, support and continuity of care. The intervention greatly increased the number of electronic summary care plans shared by primary care and hospitals. The Palliative care Outcome Scale and EuroQol-5D-5L questionnaire were suitable outcome measurement tools. This nurse-led intervention proved acceptable and feasible. We have refined the recruitment processes and outcome measures for a future randomised controlled trial.

Examining the process of driving cessation in later life.

PubMed

Musselwhite, Charles B A; Shergold, Ian

2013-06-01

Driving cessation for many older people is associated with a poorer quality of life and can lead to health problems such as depression. This paper aims to reveal the process of giving-up driving, examining in particular triggers for giving-up driving, how information on alternative modes of transport is sought and how new transport and travel behaviour is integrated into older people's lives. It examines the challenges faced and how these are overcome and what impact the process has on self-reported quality of life, as articulated by the participants themselves. To this end, twenty-one individuals from three locations in the United Kingdom (UK) were followed over a period of 10 months, through five waves of data collection. Each participant took part in three interviews, a focus group and completed a diary of travel behaviour. Findings suggest that although a similar pattern was found between the trigger and life post-car, not all older people go through the stages of giving-up driving in the same way. Instead, a range of responses are seen, from contemplation of gradually reducing driving, through to stopping abruptly, with the route taken having consequences for the eventual outcome for any individual. Triggers for contemplating driving cessation could be varied and often involved health and social factors. Importantly, people who engaged in pre-planning reported a relatively higher quality of life beyond the car, whilst for those who were more reactive and engaged in little or no pre-planning a poorer quality of life resulted. In addition (and in conjunction with planning), other factors, such as flexibility in travel destinations, the role of family and friends, and wider support networks are also seen as important. With such evidence of the importance of pre-planning it is suggested that more could be done to support giving-up driving and encouraging contemplation at a younger age to mitigate the negative effects experienced by some.

Improving state Medicaid contracts and plan practices for children with special needs.

PubMed

Fox, H B; McManus, M A

1998-01-01

The rapid transition of state Medicaid beneficiaries into fully capitated managed care plans requires a special focus on children with chronic or disabling conditions, who often depend on numerous pediatric physicians and other specialty services for health care and related services. Because managed care arrangements for this population are growing in popularity nationwide, it is important that states craft managed care contracts to address the unique needs of children with complex physical, developmental, and mental health problems. Based on the research reported in this article, in-depth interviews with state Medicaid agency staff, interviews with medical directors and administrators of managed care plans serving Medicaid recipients, and input from experts in pediatrics and managed care, a set of recommendations is made for tailoring managed care contracts to meet the needs of this vulnerable group of children. Six contracting elements that should be adopted by state Medicaid agencies include (1) clarifying the specificity of pediatric benefits, (2) defining appropriate pediatric provider capacity requirements, (3) developing a medical necessity standard specific to children, (4) identifying pediatric quality-of-care measures, (5) setting appropriate pediatric capitation rates, and (6) creating incentives for high-quality pediatric care. Nine approaches that should be adopted by managed care practices interested in providing high-quality care for children with special needs also are identified. These include (1) ensuring that assigned primary care providers have appropriate training and experience, (2) offering support systems for primary care practices, (3) providing specialty consultation for primary care providers, (4) establishing arrangements for the comanagement of primary and specialty pediatric services, (5) arranging for comprehensive care coordination, (6) establishing flexible service authorization policies, (7) implementing provider profiling systems that adjust for pediatric case mix, (8) creating financial incentives for serving children with special needs, and (9) encouraging family involvement in plan operations. Implementing these changes to managed care contracting could have a major impact on the quality and comprehensiveness of health care received by children with special needs. Successful implementation, however, requires strong support from both state Medicaid agencies and the managed care plans dedicated to serving this population.

Formal Methods Specification and Verification Guidebook for Software and Computer Systems. Volume 1; Planning and Technology Insertion

NASA Technical Reports Server (NTRS)

1995-01-01

The Formal Methods Specification and Verification Guidebook for Software and Computer Systems describes a set of techniques called Formal Methods (FM), and outlines their use in the specification and verification of computer systems and software. Development of increasingly complex systems has created a need for improved specification and verification techniques. NASA's Safety and Mission Quality Office has supported the investigation of techniques such as FM, which are now an accepted method for enhancing the quality of aerospace applications. The guidebook provides information for managers and practitioners who are interested in integrating FM into an existing systems development process. Information includes technical and administrative considerations that must be addressed when establishing the use of FM on a specific project. The guidebook is intended to aid decision makers in the successful application of FM to the development of high-quality systems at reasonable cost. This is the first volume of a planned two-volume set. The current volume focuses on administrative and planning considerations for the successful application of FM.

SPIDERplan: A tool to support decision-making in radiation therapy treatment plan assessment.

PubMed

Ventura, Tiago; Lopes, Maria do Carmo; Ferreira, Brigida Costa; Khouri, Leila

2016-01-01

In this work, a graphical method for radiotherapy treatment plan assessment and comparison, named SPIDERplan, is proposed. It aims to support plan approval allowing independent and consistent comparisons of different treatment techniques, algorithms or treatment planning systems. Optimized plans from modern radiotherapy are not easy to evaluate and compare because of their inherent multicriterial nature. The clinical decision on the best treatment plan is mostly based on subjective options. SPIDERplan combines a graphical analysis with a scoring index. Customized radar plots based on the categorization of structures into groups and on the determination of individual structures scores are generated. To each group and structure, an angular amplitude is assigned expressing the clinical importance defined by the radiation oncologist. Completing the graphical evaluation, a global plan score, based on the structures score and their clinical weights, is determined. After a necessary clinical validation of the group weights, SPIDERplan efficacy, to compare and rank different plans, was tested through a planning exercise where plans had been generated for a nasal cavity case using different treatment planning systems. SPIDERplan method was applied to the dose metrics achieved by the nasal cavity test plans. The generated diagrams and scores successfully ranked the plans according to the prescribed dose objectives and constraints and the radiation oncologist priorities, after a necessary clinical validation process. SPIDERplan enables a fast and consistent evaluation of plan quality considering all targets and organs at risk.

Reforming funding for chronic illness: Medicare-CDM.

PubMed

Swerissen, Hal; Taylor, Michael J

2008-02-01

Chronic diseases are a major challenge for the Australian health care system in terms of both the provision of quality care and expenditure, and these challenges will only increase in the future. Various programs have been instituted under the Medicare system to provide increased funding for chronic care, but essentially these programs still follow the traditional fee-for-service model. This paper proposes a realignment and extension of current Medicare chronic disease management programs into a framework that provides general practitioners and other health professionals with the necessary "tools" for high quality care planning and ongoing management, and incorporating international models of outcome-linked funding. The integration of social support services with the Medicare system is also a necessary step in providing high quality care for patients with complex needs requiring additional support.

Visual Decision Support Tool for Supporting Asset ...

EPA Pesticide Factsheets

Abstract:Managing urban water infrastructures faces the challenge of jointly dealing with assets of diverse types, useful life, cost, ages and condition. Service quality and sustainability require sound long-term planning, well aligned with tactical and operational planning and management. In summary, the objective of an integrated approach to infrastructure asset management is to assist utilities answer the following questions:•Who are we at present?•What service do we deliver?•What do we own?•Where do we want to be in the long-term?•How do we get there?The AWARE-P approach (www.aware-p.org) offers a coherent methodological framework and a valuable portfolio of software tools. It is designed to assist water supply and wastewater utility decision-makers in their analyses and planning processes. It is based on a Plan-Do-Check-Act process and is in accordance with the key principles of the International Standards Organization (ISO) 55000 standards on asset management. It is compatible with, and complementary to WERF’s SIMPLE framework. The software assists in strategic, tactical, and operational planning, through a non-intrusive, web-based, collaborative environment where objectives and metrics drive IAM planning. It is aimed at industry professionals and managers, as well as at the consultants and technical experts that support them. It is easy to use and maximizes the value of information from multiple existing data sources, both in da

Progress in improving provincial plans for nutrition through targeted technical assistance and local advocacy in Vietnam.

PubMed

Harris, Jody; Nguyen, Phuong H; To, Quyen; Frongillo, Edward A; Menon, Purnima

2016-12-01

Vietnam has been decentralizing nutrition planning to provinces, which could help with local relevance and accountability. Assessment in 2009 found a continuing top-down approach, limited human capacity, and difficulty in integrating multiple sectors. Alive and Thrive (A&T) provided targeted assistance and capacity-building for 15 provincial plans for nutrition (PPNs). We aimed to (i) assess PPN content and quality improvements 2009-2014, and (ii) explain processes through which change occurred. Data consisted of interview-based assessments of provincial planning processes, annual PPN assessments, and tracking of A&T involvement. At endline, some provinces produced higher quality plans. Local planning skills improved, but capacity remained insufficient. Awareness of and support for nutrition improved, but some policy and legal environments were contradictory. Objectives were clearer, but use of data for planning remained inconsistent. Provinces became more proactive and creative, but remained constrained by slow approval processes and insufficient funding. Targeted assistance and local advocacy can improve decentralized planning, with success dependent on policy and programming contexts and ability to overcome constraints around capacity, investment, data use and remnants of centralized planning. We recommend strong engagement with planners at the national level to understand how to unblock major constraints; solutions must take into consideration the particular political, financial and administrative context. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Problem Solving for Volatilizing Situation in Nursing: Developing Thinking Process Supporting System using NursingNAVI® Contents.

PubMed

Tsuru, Satoko; Wako, Fumiko; Omori, Miho; Sudo, Kumiko

2015-01-01

We have identified three foci of the nursing observation and nursing action respectively. Using these frameworks, we have developed the structured knowledge model for a number of diseases and medical interventions. We developed this structure based NursingNAVI® contents collaborated with some quality centered hospitals. Authors analysed the nursing care documentations of post-gastrectomy patients in light of the standardized nursing care plan in the "NursingNAVI®" developed by ourselves and revealed the "failure to observe" and "failure to document", which leaded to the volatility of the patients' data, conditions and some situation. This phenomenon should have been avoided if nurses had employed a standardized nursing care plan. So, we developed thinking process support system for planning, delivering, recording and evaluating in daily nursing using NursingNAVI® contents. A hospital decided to use NursingNAVI® contents in HIS. It was suggested that the system has availability for nursing OJT and time reduction of planning and recording without volatilizing situation.

Why is quality estimation judgment fast? Comparison of gaze control strategies in quality and difference estimation tasks

NASA Astrophysics Data System (ADS)

Radun, Jenni; Leisti, Tuomas; Virtanen, Toni; Nyman, Göte; Häkkinen, Jukka

2014-11-01

To understand the viewing strategies employed in a quality estimation task, we compared two visual tasks-quality estimation and difference estimation. The estimation was done for a pair of natural images having small global changes in quality. Two groups of observers estimated the same set of images, but with different instructions. One group estimated the difference in quality and the other the difference between image pairs. The results demonstrated the use of different visual strategies in the tasks. The quality estimation was found to include more visual planning during the first fixation than the difference estimation, but afterward needed only a few long fixations on the semantically important areas of the image. The difference estimation used many short fixations. Salient image areas were mainly attended to when these areas were also semantically important. The results support the hypothesis that these tasks' general characteristics (evaluation time, number of fixations, area fixated on) show differences in processing, but also suggest that examining only single fixations when comparing tasks is too narrow a view. When planning a subjective experiment, one must remember that a small change in the instructions might lead to a noticeable change in viewing strategy.

SU-F-J-105: Towards a Novel Treatment Planning Pipeline Delivering Pareto- Optimal Plans While Enabling Inter- and Intrafraction Plan Adaptation

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

Kontaxis, C; Bol, G; Lagendijk, J

2016-06-15

Purpose: To develop a new IMRT treatment planning methodology suitable for the new generation of MR-linear accelerator machines. The pipeline is able to deliver Pareto-optimal plans and can be utilized for conventional treatments as well as for inter- and intrafraction plan adaptation based on real-time MR-data. Methods: A Pareto-optimal plan is generated using the automated multicriterial optimization approach Erasmus-iCycle. The resulting dose distribution is used as input to the second part of the pipeline, an iterative process which generates deliverable segments that target the latest anatomical state and gradually converges to the prescribed dose. This process continues until a certainmore » percentage of the dose has been delivered. Under a conventional treatment, a Segment Weight Optimization (SWO) is then performed to ensure convergence to the prescribed dose. In the case of inter- and intrafraction adaptation, post-processing steps like SWO cannot be employed due to the changing anatomy. This is instead addressed by transferring the missing/excess dose to the input of the subsequent fraction. In this work, the resulting plans were delivered on a Delta4 phantom as a final Quality Assurance test. Results: A conventional static SWO IMRT plan was generated for two prostate cases. The sequencer faithfully reproduced the input dose for all volumes of interest. For the two cases the mean relative dose difference of the PTV between the ideal input and sequenced dose was 0.1% and −0.02% respectively. Both plans were delivered on a Delta4 phantom and passed the clinical Quality Assurance procedures by achieving 100% pass rate at a 3%/3mm gamma analysis. Conclusion: We have developed a new sequencing methodology capable of online plan adaptation. In this work, we extended the pipeline to support Pareto-optimal input and clinically validated that it can accurately achieve these ideal distributions, while its flexible design enables inter- and intrafraction plan adaptation. This research is financially supported by Elekta AB, Stockholm, Sweden.« less

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

NONE

In the Bear Creek Valley Watershed Remedial Investigation, the Boneyard/Burnyard was identified as the source of the largest releases of uranium into groundwater and surface water in Bear Creek Valley. The proposed action for remediation of this site is selective excavation and removal of source material and capping of the remainder of the site. The schedule for this action has been accelerated so that this is the first remedial action planned to be implemented in the Bear Creek Valley Record of Decision. Additional data needs to support design of the remedial action were identified at a data quality objectives meetingmore » held for this project. Sampling at the Boneyard/Burnyard will be conducted through the use of a phased approach. Initial or primary samples will be used to make in-the-field decisions about where to locate follow-up or secondary samples. On the basis of the results of surface water, soil, and groundwater analysis, up to six test pits will be dug. The test pits will be used to provide detailed descriptions of source materials and bulk samples. This document sets forth the requirements and procedures to protect the personnel involved in this project. This document also contains the health and safety plan, quality assurance project plan, waste management plan, data management plan, implementation plan, and best management practices plan for this project as appendices.« less

Earth Observing System (EOS)/Advanced Microwave Sounding Unit-A (AMSU-A) software assurance plan

NASA Technical Reports Server (NTRS)

Schwantje, Robert; Smith, Claude

1994-01-01

This document defines the responsibilities of Software Quality Assurance (SOA) for the development of the flight software installed in EOS/AMSU-A instruments, and the ground support software used in the test and integration of the EOS/AMSU-A instruments.

0-6758 : maintaining project consistency with transportation plans through the project life cycle with an emphasis on maintaining air quality conformity.

DOT National Transportation Integrated Search

2014-03-01

Streamlined project delivery is a federally : mandated goal that the Texas Department of : Transportation (TxDOT) leadership supports to : achieve a more efficient and effective : transportation system in Texas. : Federal and state transportation pla...

A Method for Comparative Analysis of Recovery Potential in Impaired Waters Restoration Planning

EPA Science Inventory

Common decision support tools and a growing body of knowledge about ecological recovery can help inform and guide large state and federal restoration programs affecting thousands of impaired waters. Under the federal Clean Water Act (CWA), waters not meeting state Water Quality ...

75 FR 60471 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... support for working families and improving the quality of child care to promote healthy development... child care programs authorized under the Child Care and Development Block Grant (CCDBG) Act and section...; identifies and implements operational planning objectives and initiatives related to child care; provides...

Embedding systematic quality assessments in supportive supervision at primary healthcare level: application of an electronic Tool to Improve Quality of Healthcare in Tanzania.

PubMed

Mboya, Dominick; Mshana, Christopher; Kessy, Flora; Alba, Sandra; Lengeler, Christian; Renggli, Sabine; Vander Plaetse, Bart; Mohamed, Mohamed A; Schulze, Alexander

2016-10-13

Assessing quality of health services, for example through supportive supervision, is essential for strengthening healthcare delivery. Most systematic health facility assessment mechanisms, however, are not suitable for routine supervision. The objective of this study is to describe a quality assessment methodology using an electronic format that can be embedded in supervision activities and conducted by council health staff. An electronic Tool to Improve Quality of Healthcare (e-TIQH) was developed to assess the quality of primary healthcare provision. The e-TIQH contains six sub-tools, each covering one quality dimension: infrastructure and equipment of the facility, its management and administration, job expectations, clinical skills of the staff, staff motivation and client satisfaction. As part of supportive supervision, council health staff conduct quality assessments in all primary healthcare facilities in a given council, including observation of clinical consultations and exit interviews with clients. Using a hand-held device, assessors enter data and view results in real time through automated data analysis, permitting immediate feedback to health workers. Based on the results, quality gaps and potential measures to address them are jointly discussed and actions plans developed. For illustrative purposes, preliminary findings from e-TIQH application are presented from eight councils of Tanzania for the period 2011-2013, with a quality score <75 % classed as 'unsatisfactory'. Staff motivation (<50 % in all councils) and job expectations (≤50 %) scored lowest of all quality dimensions at baseline. Clinical practice was unsatisfactory in six councils, with more mixed results for availability of infrastructure and equipment, and for administration and management. In contrast, client satisfaction scored surprisingly high. Over time, each council showed a significant overall increase of 3-7 % in mean score, with the most pronounced improvements in staff motivation and job expectations. Given its comprehensiveness, convenient handling and automated statistical reports, e-TIQH enables council health staff to conduct systematic quality assessments. Therefore e-TIQH may not only contribute to objectively identifying quality gaps, but also to more evidence-based supervision. E-TIQH also provides important information for resource planning. Institutional and financial challenges for implementing e-TIQH on a broader scale need to be addressed.

Innovative Tools for Water Quality/Quantity Management: New York City's Operations Support Tool

NASA Astrophysics Data System (ADS)

Wang, L.; Schaake, J. C.; Day, G. N.; Porter, J.; Sheer, D. P.; Pyke, G.

2011-12-01

The New York City Department of Environmental Protection (DEP) manages New York City's water supply, which is comprised of over 20 reservoirs and supplies more than 1 billion gallons of water per day to over 9 million customers. Recently, DEP has initiated design of an Operations Support Tool (OST), a state-of-the-art decision support system to provide computational and predictive support for water supply operations and planning. This presentation describes the technical structure of OST, including the underlying water supply and water quality models, data sources and database management, reservoir inflow forecasts, and the functionalities required to meet the needs of a diverse group of end users. OST is a major upgrade of DEP's current water supply - water quality model, developed to evaluate alternatives for controlling turbidity in NYC's Catskill reservoirs. While the current model relies on historical hydrologic and meteorological data, OST can be driven by forecasted future conditions. It will receive a variety of near-real-time data from a number of sources. OST will support two major types of simulations: long-term, for evaluating policy or infrastructure changes over an extended period of time; and short-term "position analysis" (PA) simulations, consisting of multiple short simulations, all starting from the same initial conditions. Typically, the starting conditions for a PA run will represent those for the current day and traces of forecasted hydrology will drive the model for the duration of the simulation period. The result of these simulations will be a distribution of future system states based on system operating rules and the range of input ensemble streamflow predictions. DEP managers will analyze the output distributions and make operation decisions using risk-based metrics such as probability of refill. Currently, in the developmental stages of OST, forecasts are based on antecedent hydrologic conditions and are statistical in nature. The statistical algorithm is a relatively simple and versatile, but lacks short-term skill critical for water quality and spill management. To improve short-term skill, OST will ultimately operate with meteorologically driven hydrologic forecasts provided by the National Weather Service (NWS). OST functionalities will support a wide range of DEP uses, including short term operational projections, outage planning and emergency management, operating rule development, and water supply planning. A core use of OST will be to inform reservoir management strategies to control and mitigate turbidity events while ensuring water supply reliability. OST will also allow DEP to manage its complex reservoir system to meet multiple objectives, including ecological flows, tailwater fisheries and recreational releases, and peak flow mitigation for downstream communities.

Remote sensing, geographical information systems, and spatial modeling for analyzing public transit services

NASA Astrophysics Data System (ADS)

Wu, Changshan

Public transit service is a promising transportation mode because of its potential to address urban sustainability. Current ridership of public transit, however, is very low in most urban regions, particularly those in the United States. This woeful transit ridership can be attributed to many factors, among which poor service quality is key. Given this, there is a need for transit planning and analysis to improve service quality. Traditionally, spatially aggregate data are utilized in transit analysis and planning. Examples include data associated with the census, zip codes, states, etc. Few studies, however, address the influences of spatially aggregate data on transit planning results. In this research, previous studies in transit planning that use spatially aggregate data are reviewed. Next, problems associated with the utilization of aggregate data, the so-called modifiable areal unit problem (MAUP), are detailed and the need for fine resolution data to support public transit planning is argued. Fine resolution data is generated using intelligent interpolation techniques with the help of remote sensing imagery. In particular, impervious surface fraction, an important socio-economic indicator, is estimated through a fully constrained linear spectral mixture model using Landsat Enhanced Thematic Mapper Plus (ETM+) data within the metropolitan area of Columbus, Ohio in the United States. Four endmembers, low albedo, high albedo, vegetation, and soil are selected to model heterogeneous urban land cover. Impervious surface fraction is estimated by analyzing low and high albedo endmembers. With the derived impervious surface fraction, three spatial interpolation methods, spatial regression, dasymetric mapping, and cokriging, are developed to interpolate detailed population density. Results suggest that cokriging applied to impervious surface is a better alternative for estimating fine resolution population density. With the derived fine resolution data, a multiple route maximal covering/shortest path (MRMCSP) model is proposed to address the tradeoff between public transit service quality and access coverage in an established bus-based transit system. Results show that it is possible to improve current transit service quality by eliminating redundant or underutilized service stops. This research illustrates that fine resolution data can be efficiently generated to support urban planning, management and analysis. Further, this detailed data may necessitate the development of new spatial optimization models for use in analysis.

Process auditing in long term care facilities.

PubMed

Hewitt, S M; LeSage, J; Roberts, K L; Ellor, J R

1985-01-01

The ECC tool development and audit experiences indicated that there is promise in developing a process audit tool to monitor quality of care in nursing homes; moreover, the tool selected required only one hour per resident. Focusing on the care process and resident needs provided useful information for care providers at the unit level as well as for administrative personnel. Besides incorporating a more interdisciplinary focus, the revised tool needs to define support services most appropriate for nursing homes, includes items related to discharge planning and increases measurement of significant others' involvement in the care process. Future emphasis at the ECC will focus on developing intervention plans to maintain strengths and correct deficiencies identified in the audits. Various strategies to bring about desired changes in the quality of care will be evaluated through regular, periodic monitoring. Having a valid and reliable measure of quality of care as a tool will be an important step forward for LTC facilities.

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China

PubMed Central

Richards, Esther; Zhang, Weihong; Hu, Lina; Wu, Shangchun; Tolhurst, Rachel

2017-01-01

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers’ perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces—Zhejiang, Hubei and Yunnan—were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources. PMID:29045434

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China.

PubMed

Jiang, Hong; Xu, Jieshuang; Richards, Esther; Qian, Xu; Zhang, Weihong; Hu, Lina; Wu, Shangchun; Tolhurst, Rachel

2017-01-01

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers' perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces-Zhejiang, Hubei and Yunnan-were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources.

Potential of integrated continuous surveys and quality management to support monitoring, evaluation, and the scale-up of health interventions in developing countries.

PubMed

Rowe, Alexander K

2009-06-01

Well-funded initiatives are challenging developing countries to increase health intervention coverage and show impact. Despite substantial resources, however, major obstacles include weak health systems, a lack of reasonably accurate monitoring data, and inadequate use of data for managing programs. This report discusses how integrated continuous surveys and quality management (I-Q), which are well-recognized approaches in wealthy countries, could support intervention scale-up, monitoring and evaluation, quality control for commodities, capacity building, and implementation research in low-resource settings. Integrated continuous surveys are similar to existing national cross-sectional surveys of households and health facilities, except data are collected over several years by permanent teams, and most results are reported monthly at the national, province, and district levels. Quality management involves conceptualizing work as processes, involving all workers in quality improvement, monitoring quality, and teams that improve quality with "plan-do-study-act" cycles. Implementing and evaluating I-Q in a low-income country would provide critical information on the value of this approach.

The individual supported living (ISL) manual: a planning and review instrument for individual supported living arrangements for adults with intellectual and developmental disabilities.

PubMed

Cocks, E; Thoresen, S; Williamson, M; Boaden, R

2014-07-01

Following the closure of large residential facilities over the past several decades, emphasis on community living for adults with developmental disabilities has strengthened. However, the concept of community living is ambiguous. The term is often associated with congregation of people with disabilities in ordinary houses 'in' the community. Group homes, the most common contemporary formal expression of 'community living', may use ordinary houses and accommodate a small number of residents comparable to a large family. Individual supported living (ISL) arrangements around a single person with a disability using person-centred principles are occurring with increasing frequency. The ISL manual was developed over 4 years in two sequential research projects to produce a quality framework articulating ISL and operationalising the framework into a review and planning instrument for ISL arrangements. The ISL manual was developed in three stages and overseen by a reference group of key stakeholders purposively recruited as well-versed in ISL. The first stage operationalised the quality framework over two half-day workshops with a group of key informants. Participants identified indicators and sources of evidence for each attribute of the quality framework. The quality framework, indicators, and sources of evidence were compiled into an initial evaluation instrument of nine themes consisting of 27 attributes. This was piloted in two rounds to enhance the utility of the instrument and develop the final manual which contained eight themes and 21 attributes. A comprehensive literature search was carried out to identify relevant empirical ISL studies. The literature search identified four empirical studies that incorporated ISL over the preceding 3 years. A previous literature search from the first research project that produced the quality framework spanned 27 years and identified five empirical studies. We concluded that the empirical base for developing evidence for the nature and outcomes of ISL arrangements was sparse. The ISL manual and scoring booklet developed in the current research project includes six illustrative case studies of ISL, instructions for potential users to review living arrangements or set up a new arrangement, and the review framework consisting of descriptions of themes and attributes, indicators, and sources of evidence. The dearth of empirical studies of ISL arrangements for people with developmental disabilities, despite increased policy emphasis on individualised options, underscores the importance of planning and review tools to promote quality outcomes. The ISL manual can assist adults with developmental disabilities, families, carers, and service providers to plan and review ISL arrangements. Further research will enhance the properties of this instrument and establish the relationship between quality of ISL arrangements and outcomes such as quality of life, and participation and inclusion. © 2013 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Crane Cell Testing Support of NASA/Goddard Space Flight Center: An Update

NASA Technical Reports Server (NTRS)

Strawn, Mike; David, Jerry; Rao, Gopalakrishna M.

2001-01-01

The objectives presented in this viewgraph presentation include: 1) Verify the quality and reliability of aerospace battery cells and batteries for NASA flight programs; 2) Disseminate the data to develop a plan for in-orbit battery management and to design a cell/battery for future NASA spacecraft; and 3) Establish a cell test data base for rechargeable cell/batteries. In summary: quality EPT Ni-H2, EPT Super NiCd and SAFT NiCd cells have been demonstrated for aerospace applications; the data has been provided to NASA Centers and other agencies for their use and application; developed plan and used in NASA in-orbit battery management. Database on rechargeable cell/batteries is now available for customer use.

Aligning incentives in health care: physician practice and health system partnership.

PubMed

Levin, L Scott; Gustave, Lori

2013-06-01

The key to successfully aligning hospitals and physicians is financial integration and joint incentives for academic, quality, and clinical productivity. Many physician practices and health systems are moving toward closer integration, but mainly through consolidation and employment strategies. We describe a fully integrated physician and hospital relationship including an overview of an aligned funds flow process that affords the department support for clinical services and teaching, research, and administrative activity. We also describe a physician compensation model that provides incentive not only for increased clinical performance, but also quality and academic objectives. The content of this article was acquired through our own experience in managing the Department of Orthopaedic Surgery at the University of Pennsylvania Health System including the health system's funds flow process. Based on input from both health system leaders and the faculty, the department's compensation plan was totally redesigned to create a line-of-sight plan that credits clinical performance and academic productivity. Our model is multifactorial and provides sustainable support for the department and a compensation plan that is competitive within the local market and nationally. The health system's funds flow process has enhanced alignment of the faculty and hospitals by providing compensation for nonclinical time and assists the department's growth strategies by providing funding for new faculty and gain-sharing of improved hospital margin. The implementation of the compensation plan increased productivity by 8% in its first year with no additional resources. Academic productivity in that same year was arguably at or above any other year in the department's history in terms of accepted publications, national presentations, and research grants awarded. A model of complete integration between an academic department and a health system is achievable through a systematic process of mission-based support.

A knowledge-based patient assessment system: conceptual and technical design.

PubMed Central

Reilly, C. A.; Zielstorff, R. D.; Fox, R. L.; O'Connell, E. M.; Carroll, D. L.; Conley, K. A.; Fitzgerald, P.; Eng, T. K.; Martin, A.; Zidik, C. M.; Segal, M.

2000-01-01

This paper describes the design of an inpatient patient assessment application that captures nursing assessment data using a wireless laptop computer. The primary aim of this system is to capture structured information for facilitating decision support and quality monitoring. The system also aims to improve efficiency of recording patient assessments, reduce costs, and improve discharge planning and early identification of patient learning needs. Object-oriented methods were used to elicit functional requirements and to model the proposed system. A tools-based development approach is being used to facilitate rapid development and easy modification of assessment items and rules for decision support. Criteria for evaluation include perceived utility by clinician users, validity of decision support rules, time spent recording assessments, and perceived utility of aggregate reports for quality monitoring. PMID:11079970

A knowledge-based patient assessment system: conceptual and technical design.

PubMed

Reilly, C A; Zielstorff, R D; Fox, R L; O'Connell, E M; Carroll, D L; Conley, K A; Fitzgerald, P; Eng, T K; Martin, A; Zidik, C M; Segal, M

2000-01-01

This paper describes the design of an inpatient patient assessment application that captures nursing assessment data using a wireless laptop computer. The primary aim of this system is to capture structured information for facilitating decision support and quality monitoring. The system also aims to improve efficiency of recording patient assessments, reduce costs, and improve discharge planning and early identification of patient learning needs. Object-oriented methods were used to elicit functional requirements and to model the proposed system. A tools-based development approach is being used to facilitate rapid development and easy modification of assessment items and rules for decision support. Criteria for evaluation include perceived utility by clinician users, validity of decision support rules, time spent recording assessments, and perceived utility of aggregate reports for quality monitoring.

Managers' Support for Employee Wellness Programs: An Integrative Review.

PubMed

Passey, Deborah G; Brown, Meagan C; Hammerback, Kristen; Harris, Jeffrey R; Hannon, Peggy A

2018-01-01

The aim of this integrative literature review is to synthesize the existing evidence regarding managers' support for employee wellness programs. The search utilized multiple electronic databases and libraries. Inclusion criteria comprised peer-reviewed research published in English, between 1990 and 2016, and examining managers' support in the context of a worksite intervention. The final sample included 21 articles for analysis. Two researchers extracted and described results from each of the included articles using a content analysis. Two researchers independently rated the quality of the included articles. Researchers synthesized data into a summary table by study design, sample, data collected, key findings, and quality rating. Factors that may influence managers' support include their organization's management structure, senior leadership support, their expected roles, training on health topics, and their beliefs and attitudes toward wellness programs and employee health. Managers' support may influence the organizational culture, employees' perception of support, and employees' behaviors. When designing interventions, health promotion practitioners and researchers should consider strategies that target senior, middle, and line managers' support. Interventions need to include explicit measures of managers' support as part of the evaluation plan.

Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan

PubMed Central

Teich, Jonathan M.; Osheroff, Jerome A.; Pifer, Eric A.; Sittig, Dean F.; Jenders, Robert A.

2005-01-01

Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system capabilities, including basic and advanced sets of CDS interventions and knowledge, supporting database elements, operational features to improve usability and measure performance, and management and governance structures; (2) uniform standards, vocabularies, and centralized knowledge structures and services that could reduce rework by vendors and care providers, improve dissemination of well-constructed CDS interventions, promote generally applicable research in CDS methods, and accelerate the movement of new medical knowledge from research to practice; and (3) appropriate financial and legal incentives to promote adoption. PMID:15802474

Implementing and using quality measures for children's health care: perspectives on the state of the practice.

PubMed

Shaller, Dale

2004-01-01

The objective of this study was to identify issues, obstacles, and priorities related to implementing and using child health care quality measures from the perspectives of 4 groups: 1) funders of quality-measurement development and implementation; 2) developers of quality measures; 3) users of quality measures (including Medicaid and the State Children's Health Insurance Program, employer coalitions, and consumer groups); and 4) health plans and providers (in their role as both subjects and users of quality measures). A series of semistructured interviews was conducted with approximately 40 opinion leaders drawn from these 4 groups. The interviews were conducted by telephone between September and December of 2001. Major topic areas covered in the interviews were similar across the groups. Topic areas included 1) strategic vision and/or objectives for funding, developing, or using quality measures for children's health care; 2) a brief summary of the specific quality measures funded, developed, or used; 3) issues and challenges facing funders and developers of measures; 4) major successes achieved; 5) obstacles to implementation and use of measures; and 6) priority needs for future funding. Leaders from all 4 groups acknowledge the importance of developing a robust set of quality measures that can serve multiple objectives and multiple audiences. Standardization of measures is viewed as a critical feature related to all objectives. An assessment of specific quality measures funded, developed, or used by strategic objective shows a high correlation between the uses intended by funders and developers and the actual applications of the various users. The most commonly cited measures across all groups are the Consumer Assessment of Health Plans Survey and Health Plan Employer Data and Information Set, followed by the Child and Adolescent Health Measurement Initiative and special topic studies to support quality-improvement applications (eg, asthma, diabetes, etc). The major issues and challenges cited in common among funders and developers are 1) the lack of trained capacity in the field to conduct needed research and development, and 2) the difficulty in generating sustained interest and support among funders because of the complexity of quality-measurement issues, competing funding priorities in the face of limited funds available to allocate, and the lack of clear and compelling evidence that quality measurement and improvement actually result in better outcomes for children. The 3 most common successes cited across all 4 groups are 1) the growing consensus and collaboration among diverse stakeholder groups involved in measurement development and implementation; 2) the increasing collection and use of specific measures; and 3) early documentation of tangible results in terms of improved quality of care. Specific measurement tools cited as successes by funders and developers include the Medicaid Health Plan Employer Data and Information Set, Consumer Assessment of Health Plans Survey, the Child and Adolescent Health Measurement Initiative, and Rand QA Tools. The most important obstacle reported across all groups is the lack of a strong and compelling "business case" that clearly demonstrates the benefits of quality measurement relative to the costs of implementation. Strongly related to this barrier is the cost of implementing and using measures without a sustainable source of financing as well as the absence of strong public awareness and political support for children's health care quality measurement. Another major barrier cited is the lack of coordination among funders, which prevents the field from developing a unified approach to addressing the numerous technical, political, and administrative issues also cited at length by the leaders interviewed. The 5 top needs for future funding identified across all 4 groups follow directly from the major obstacles that they reported: 1) develop the business case for children's health care quality measurement and improvement based on rigorous cost-bigorous cost-benefit analysis and documentation of quantifiable successes; 2) develop new measures to fill the gaps in critical areas (including adolescent health care, behavioral health, and chronic conditions) that can be applied at the hospital and ambulatory care provider levels; 3) invest in building needed research capacity, a trained pool of users of quality measures, and the capacity among providers to understand and use quality-improvement methods and tools; 4) invest in developing an information infrastructure that will support the efficient collection and use of measures for multiple purposes, including clinical practice, quality measurement, and quality improvement; and 5) develop increased public awareness and support for quality measurement based on improved strategies for communicating with consumers, purchasers, providers, and policy makers. Several implications are suggested by these perspectives for the future direction of quality measurement in children's health care. First, to meet the funding needs identified, many funders must improve coordination to reduce the noise and fragmentation generated by numerous competing or redundant activities. Improved coordination among funders will help assure maximum impact and the efficient use of scarce resources. Second, the importance attached to standardization of measures by both users and developers may conflict at times with the need for innovation and flexibility. Child health quality leaders will need to manage this tension between standardization and innovation to maintain an appropriate balance between the benefits of both. Finally, many of the obstacles identified are not unique to children's health care. Child health quality leaders will need to determine to what extent their efforts to overcome these obstacles can be successfully undertaken independently as opposed to in concert with groups concerned about other populations and sectors in the health care system.

Study findings on evaluation of integrated family planning programme performance.

PubMed

1980-01-01

In 1976 the United Nations's Economic and Social Commission for Asia and the Pacific launched a comparative study on integrated family planning programs in a number of countries in the region. In November 1979 the study directors from the participating countries meet in Bangkok to discuss the current status of the studies in their countries. The Korean and Malaysian studies were completed, the Bangladesh study was in the data collecting phase, and the Pakistani research design phase was completed. The meeting participants focused their attention on the findings and policy implications of the 2 completed studies and also discussed a number of theorectical and methodological issues which grew out of their research experience. The Malaysian study indicated that group structure, financial resources, and the frequency and quality of worker-client contact were the most significant variables determining program effectiveness. In the Korean Study, leadership, financial resources, and the frequency and quality of contact between agencies were the key variables in determining program effectiveness. In the Malaysian study there was a positive correlation between maternal and child health service performance measures and family planning service performance measures. This finding supported the contention that these 2 types of service provision are not in conflict with each other but instead serve to reinforce each other. Policy implications of the Korean study were 1) family planning should be an integral part of all community activities; 2) family planning workers should be adequately supported by financial and supply allocations; and 3) adequate record keeping and information exchange procedures should be incorporated in the programs.

Supporting students undertaking the Specialist Practitioner Qualification in District Nursing.

PubMed

Ginger, Tracey; Ritchie, Georgina

2017-11-02

The ever-evolving role of the Specialist Practitioner Qualified District Nurse (SPQDN) presents an increasing number of challenges for Practice Teachers and mentors in preparing SPQDN students for the elevated level clinical and transformational leadership necessary to ensure high-quality patient care. The daily challenges of clinical practice within the community nursing setting in addition to undertaking educational interventions in the clinical arena demand that a structured approach to supervision and mentorship is crucial. Employing learning plans to assess individual students learning needs, prepare plans for educational developments and interventions and evaluate a student's progress can be a helpful tool in aiding the learning journey for both the SPQDN student and Practice Teacher or mentor. This article examines how and why a structured learning plan may be used in supporting learning and competency in achieving the necessary level of practice to meet the requirements of the SPQDN.

Does human resource management improve family planning service quality? Analysis from the Kenya Service Provision Assessment 2010.

PubMed

Thatte, Nandita; Choi, Yoonjoung

2015-04-01

Human resource (HR) management is a priority for health systems strengthening in developing countries, yet few studies have empirically examined associations with service quality. The purpose of this study was to assess the relationship between HR management and family planning (FP) service quality. Data came from the 2010 Kenya Service Provision Assessment, a nationally representative health facility assessment. In total, 912 FP consultations from 301 facilities were analysed. Four indices were created to measure quality on reproductive history taking, physical examination, sexually transmitted infections prevention and pill/injectable specific counselling. HR management variables included training in the past year, any and supportive (i.e. with feedback, technical updates and discussion) in-person supervision in the past 6 months and having a written job description. Multivariate linear regression analyses were conducted to estimate coefficients of HR management variables on each of the four quality indices, adjusting for background characteristics of clients, provider and facilities. The level of service quality ranged from 16 to 53 out of a maximum score of 100 across the indices. Fifty-two per cent of consultations were done by providers who received supportive in-person supervision in the previous 6 months. In 23% and 38% of consultations, the provider was trained in the past year and had a written job description, respectively. Multivariate analyses indicated that having a written job description was associated with higher service quality in history taking, physical examination and the pill/injectable specific counselling. Other HR management variables were not significantly associated with service quality. Having a written job description was significantly associated with higher service quality and may be a useful tool for strengthening management practices. The details of such job descriptions and the quality of other management indicators should be explored to better understand the relationship between HR management and FP service quality. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

The Role of Personality and Social Support in Health-Related Quality of Life in Chronic Kidney Disease Patients.

PubMed

Ibrahim, Norhayati; Teo, Sharlene S L; Che Din, Normah; Abdul Gafor, Abdul Halim; Ismail, Rozmi

2015-01-01

Chronic kidney disease (CKD) is commonly associated with various negative health outcomes. The aim of this study was to examine the influence of personality and social support on health-related quality of life in patients with chronic kidney disease. Health-related quality of life (HRQoL) is the quality of life studied in relation to health, and it provides important information of patients' coping with their health issues. Participants comprised of 200 patients experiencing various stages of chronic kidney disease. All participants completed the Short-Form 36 (SF-36), Big Five Inventory (BFI) and the Medical Outcomes Study (MOS) Social Support questionnaires. Participants consisted of 108 males (54.0%) and 92 females (46.0%) with the mean age of 59.3 years (SD 14.5). Results showed that higher levels of extraversion and lower perceived affectionate social support were associated with higher physical HRQoL, whereas higher levels of neuroticism were associated with poorer mental HRQoL. The current study found that certain personality traits, namely extraversion and neuroticism, were found to be associated with HRQoL. In addition, affectionate social support was also associated with higher HRQoL. Therefore, special attention should be paid to the personality of CKD patients, as well as the type of social support that they have, in planning interventions to improve their health outcomes.

The Role of Personality and Social Support in Health-Related Quality of Life in Chronic Kidney Disease Patients

PubMed Central

Che Din, Normah; Abdul Gafor, Abdul Halim; Ismail, Rozmi

2015-01-01

Background Chronic kidney disease (CKD) is commonly associated with various negative health outcomes. The aim of this study was to examine the influence of personality and social support on health-related quality of life in patients with chronic kidney disease. Health-related quality of life (HRQoL) is the quality of life studied in relation to health, and it provides important information of patients’ coping with their health issues. Method Participants comprised of 200 patients experiencing various stages of chronic kidney disease. All participants completed the Short-Form 36 (SF-36), Big Five Inventory (BFI) and the Medical Outcomes Study (MOS) Social Support questionnaires. Results Participants consisted of 108 males (54.0%) and 92 females (46.0%) with the mean age of 59.3 years (SD 14.5). Results showed that higher levels of extraversion and lower perceived affectionate social support were associated with higher physical HRQoL, whereas higher levels of neuroticism were associated with poorer mental HRQoL. Conclusion The current study found that certain personality traits, namely extraversion and neuroticism, were found to be associated with HRQoL. In addition, affectionate social support was also associated with higher HRQoL. Therefore, special attention should be paid to the personality of CKD patients, as well as the type of social support that they have, in planning interventions to improve their health outcomes. PMID:26131714

Strategic Planning. Alliance Action Information Sheets

ERIC Educational Resources Information Center

Technical Assistance ALLIANCE for Parent Centers, 2005

2005-01-01

Executive Directors of parent centers have very challenging careers. For example, they need to ensure that high quality services are developed and provided; funds are raised; bills are paid on time; staff are hired, trained and supported; boards are recruited and effective; community awareness is high; and reports are accurate and submitted on…

Using Knowledge Management to Revise Software-Testing Processes

ERIC Educational Resources Information Center

Nogeste, Kersti; Walker, Derek H. T.

2006-01-01

Purpose: This paper aims to use a knowledge management (KM) approach to effectively revise a utility retailer's software testing process. This paper presents a case study of how the utility organisation's customer services IT production support group improved their test planning skills through applying the American Productivity and Quality Center…

78 FR 17633 - Notice of Request for Extension of a Currently Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... DEPARTMENT OF AGRICULTURE Rural Housing Service Notice of Request for Extension of a Currently... Support Staff, Housing and Community Facilities Programs, U.S. Department of Agriculture, Stop 0761, 1400... on the quality of the human environment during agency planning and decision-making processes. For...

76 FR 43136 - Approval and Promulgation of Air Quality Implementation Plan; Kentucky; Disapproval of Interstate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

... supported by an adequate technical analysis. Second, EPA recommended the various types of information that... technical analysis, including, but not limited to, information concerning emissions in the state...: ``* * * without an adequate technical analysis EPA does not believe that states can sufficiently address the...

76 FR 2853 - Approval and Promulgation of Air Quality Implementation Plans; Delaware; Infrastructure State...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-18

... technical analysis submitted for parallel-processing by DNREC on December 9, 2010, to address significant... technical analysis submitted by DNREC for parallel-processing on December 9, 2010, to satisfy the... consists of a technical analysis that provides detailed support for Delaware's position that it has...

76 FR 74000 - Approval and Promulgation of Implementation Plans and Designation of Areas for Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-30

... (BRNA or BR), revisions to the Louisiana SIP that meet the Reasonably Available Control Technology (RACT... show that the area continues to attain the 1997 8-hour ozone standard. EPA also determined that the BR... expressed overall support for EPA's [[Page 74001

MICHTOX: A MASS BALANCE AND BIOACCUMULATION MODEL FOR TOXIC CHEMICALS IN LAKE MICHIGAN

EPA Science Inventory

MICHTOX is a toxic chemical mass balance and bioaccumulation model for Lake Michigan. It was developed for USEPA's Region V in support of the Lake Michigan Lake-wide Management Plan (LaMP) to provide guidance on expected water quality improvements in response to critical pollutan...

Program Evaluation for USAID/Guinea Basic Education Program Portfolio

ERIC Educational Resources Information Center

Midling, Michael; Filion, Louise; David-Gnahoui, Emmanuel M.; Gassama-Mbaye, Mbarou; Diallo, Amadou Tidjane; Diallo, Abdoul Karim

2006-01-01

In support of its strategic objective of a quality basic education provided to a larger percentage of Guinean children with an emphasis on girls and rural children, the United States Agency for International Development established the following intermediate results: (1) Improved sectoral strategic planning, management, and decision-making in…

Unpacking Clinical Supervision in Transitional and Permanent Supportive Housing: Scrutiny or Support?

PubMed

Choy-Brown, Mimi; Stanhope, Victoria; Tiderington, Emmy; Padgett, Deborah K

2016-07-01

Behavioral health organizations use clinical supervision to ensure professional development and practice quality. This qualitative study examined 35 service coordinators' perspectives on supervision in two distinct supportive housing program types (permanent and transitional). Thematic analysis of in-depth interviews yielded three contrast themes: support versus scrutiny, planned versus impromptu time, and housing first versus treatment first. Supervisory content and format resulted in differential perceptions of supervision, thereby influencing opportunities for learning. These findings suggest that unpacking discrete elements of supervision enactment in usual care settings can inform implementation of recovery-oriented practice.

Unpacking clinical supervision in transitional and permanent supportive housing: Scrutiny or support?

PubMed Central

Choy-Brown, Mimi; Stanhope, Victoria; Tiderington, Emmy; Padgett, Deborah K.

2015-01-01

Behavioral health organizations use clinical supervision to ensure professional development and practice quality. This qualitative study examined 35 service coordinators' perspectives on supervision in two distinct supportive housing program types (permanent and transitional). Thematic analysis of in-depth interviews yielded three contrast themes: support versus scrutiny, planned versus impromptu time, and Housing First versus Treatment First. Supervisory content and format resulted in differential perceptions of supervision, thereby influencing opportunities for learning. These findings suggest that unpacking discrete elements of supervision enactment in usual care settings can inform implementation of recovery-oriented practice. PMID:26066866

COPD self-management supportive care: chaos and complexity theory.

PubMed

Cornforth, Amber

This paper uses the emergent theories of chaos and complexity to explore the self-management supportive care of chronic obstructive pulmonary disease (COPD) patients within the evolving primary care setting. It discusses the concept of self-management support, the complexity of the primary care context and consultations, smoking cessation, and the impact of acute exacerbations and action planning. The author hopes that this paper will enable the acquisition of new insight and better understanding in this clinical area, as well as support meaningful learning and facilitate more thoughtful, effective and high quality patient-centred care within the context of primary care.

Purchaser strategies to influence quality of care: from rhetoric to global applications.

PubMed

McNamara, P

2006-06-01

The potential of purchasers to influence the quality and safety of care has captured the attention of health sector leaders worldwide. Quality based purchasing explicitly seeks to hold providers accountable for the quality and safety of care. Three strategies are available to purchasers: (1) selective contracting based on quality; (2) payment differentials based on quality; and (3) sponsorship of comparative provider report cards. Examples are given to illustrate each of the three strategies. Governments, employers, social insurance funds, community based insurance organizations, health plans, donors, and other buyers of health services are encouraged to explore and debate these purchaser strategies within the context of an overarching national or local quality framework. Public and private funders of operations research are encouraged to support and disseminate evaluations of purchaser efforts to improve quality. This paper is designed to highlight and frame purchasers' strategies explicitly crafted to enhance the quality and safety of care. The ultimate aim is to encourage thoughtful discussion about whether or not one or more purchaser strategy might support a particular country's goals to improve care. Experiences from both developed and developing countries are included to facilitate the exchange of ideas and provide the broadest of perspectives.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick

2013-09-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. CAU 105 comprises the following five corrective action sites (CASs): -02-23-04 Atmospheric Test Site - Whitney Closure In Place -02-23-05 Atmospheric Test Site T-2A Closure In Place -02-23-06 Atmospheric Test Site T-2B Clean Closure -02-23-08 Atmospheric Test Site T-2 Closure In Place -02-23-09 Atmospheric Test Site - Turk Closure In Place The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that nomore » further corrective action is needed for CAU 105 based on the implementation of the corrective actions. Corrective action investigation (CAI) activities were performed from October 22, 2012, through May 23, 2013, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices.« less

Experience of parenthood, couple relationship, social support, and child-rearing goals in planned lesbian mother families.

PubMed

Bos, Henny M W; van Balen, Frank; van Den Boom, Dymphna C

2004-05-01

The phenomenon of planned lesbian families (i.e., two-mother families in which the child was born to the lesbian relationship) is relatively new and very little research has been conducted among those families. The overall aim of this research was to examine whether planned lesbian mother families differ from heterosexual families on factors that are assumed to influence the parent-child relationship, such as experience of parenthood, child-rearing goals, couple relationship, and social support. A hundred lesbian two-mother families were compared with 100 heterosexual families having naturally conceived children. A variety of measures were used to collect the data, including questionnaires and a diary of activities kept by the parents. Lesbian parents are no less competent or more burdened than heterosexual parents. Both lesbian and heterosexual parents consider it important to develop qualities of independence in their child. However, 'conformity' as a child-rearing goal is less important to lesbian mothers. Furthermore, lesbian social mothers feel more often than fathers in heterosexual families that they must justify the quality of their parenthood. There are few differences between lesbian couples and heterosexual couples, except that lesbian mothers appear less attuned to traditional child-rearing goals and lesbian social mothers appear more to defend their position as mother.

Visual Sample Plan Version 7.0 User's Guide

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

Matzke, Brett D.; Newburn, Lisa LN; Hathaway, John E.

2014-03-01

User's guide for VSP 7.0 This user's guide describes Visual Sample Plan (VSP) Version 7.0 and provides instructions for using the software. VSP selects the appropriate number and location of environmental samples to ensure that the results of statistical tests performed to provide input to risk decisions have the required confidence and performance. VSP Version 7.0 provides sample-size equations or algorithms needed by specific statistical tests appropriate for specific environmental sampling objectives. It also provides data quality assessment and statistical analysis functions to support evaluation of the data and determine whether the data support decisions regarding sites suspected of contamination.more » The easy-to-use program is highly visual and graphic. VSP runs on personal computers with Microsoft Windows operating systems (XP, Vista, Windows 7, and Windows 8). Designed primarily for project managers and users without expertise in statistics, VSP is applicable to two- and three-dimensional populations to be sampled (e.g., rooms and buildings, surface soil, a defined layer of subsurface soil, water bodies, and other similar applications) for studies of environmental quality. VSP is also applicable for designing sampling plans for assessing chem/rad/bio threat and hazard identification within rooms and buildings, and for designing geophysical surveys for unexploded ordnance (UXO) identification.« less

Integrating evidence-based interventions into client care plans.

PubMed

Doran, Diane; Carryer, Jennifer; Paterson, Jane; Goering, Paula; Nagle, Lynn; Kushniruk, Andre; Bajnok, Irmajean; Clark, Carrie; Srivastava, Rani

2009-01-01

Within the mental health care system, there is an opportunity to improve patient safety and the overall quality of care by integrating clinical practice guidelines with the care planning process through the use of information technology. Electronic assessment tools such as the Resident Assessment Inventory - Mental Health (RAI-MH) are widely used to identify the health care needs and outcomes of clients. In this knowledge translation initiative, an electronic care planning tool was enhanced to include evidence-based clinical interventions from schizophrenia guidelines. This paper describes the development of a mental health decision support prototype, a field test by clinicians, and user experiences with the application.

Bradley vs. Gore: how media covered proposals for health insurance reform in the context of the 2000 presidential campaign.

PubMed

Mebane, Felicia

2003-01-01

This study examines how often national media reported key aspects of Senator Bill Bradley's and Vice President Al Gore's proposals for health insurance reform during the 2000 Democratic primary campaign. The results show that news media reported on Bradley's plan and major features of his plan significantly more often than Gore's. Additionally, few reports contained explicit comparisons that explained which plan would have covered more people or cost more. Public health and media professionals need to work together to improve the quality of information the public depends on to develop views about and support for the uninsured.

SeaSketch: Implementation of a Decision-Support Platform for a Channel Islands National Marine Sanctuary Multi-sector Working Group

NASA Astrophysics Data System (ADS)

Goldberg, G.; McClintock, W.

2016-12-01

Effective interagency and cross-sector coordination is essential to ecosystem based management which depends on processes characterized by collaboration and science-based information. Many technological barriers that exist in the development of science-based management plans are closely tied to process challenges, such as the sharing of data and information or the inclusion of parties with varied levels of technical experience. The Channel Islands National Marine Sanctuary has convened a diverse working group to develop recommendations for the management of marine shipping in and around the Santa Barbara Channel, as well as recommendations regarding research needs and outreach strategies. Working group members take a multi-issue approach with four distinct goals related to the reduction of ship strikes on whales, emissions and air quality, conflicting ocean uses, and issues of navigational safety. Members range from industry representatives, scientists, and multiple local and federal government entities. The recommended management plans will be based in the best-available science, and will build off of previous efforts, making this an interesting case study of adaptive management. In addition to support from the Sanctuary and professional facilitators, the group is using a decision-support platform, SeaSketch (safepassage.seasketch.org). SeaSketch is a web-based GIS that supports collaborative science-based marine spatial planning (MSP). Each feature supports a step of the MSP process, from data gathering, identification of data needs, the design of spatial plans, evaluation of those plans with analytics, and map-based forums that facilitate data-driven discussions. Working group members are able to access these tools to explore management options and collaborate remotely, in addition to using the platform during in-person meetings and webinars. Empowering diverse audiences to engage in the design of science-based plans is of key importance to developing ecosystem-based management plans where multi-sector participation and inter-agency coordination are critical.

SeaSketch: Implementation of a Decision-Support Platform for a Channel Islands National Marine Sanctuary Multi-sector Working Group

NASA Astrophysics Data System (ADS)

Goldberg, G.; McClintock, W.

2016-02-01

Effective interagency and cross-sector coordination is essential to ecosystem based management which depends on processes characterized by collaboration and science-based information. Many technological barriers that exist in the development of science-based management plans are closely tied to process challenges, such as the sharing of data and information or the inclusion of parties with varied levels of technical experience. The Channel Islands National Marine Sanctuary has convened a diverse working group to develop recommendations for the management of marine shipping in and around the Santa Barbara Channel, as well as recommendations regarding research needs and outreach strategies. Working group members take a multi-issue approach with four distinct goals related to the reduction of ship strikes on whales, emissions and air quality, conflicting ocean uses, and issues of navigational safety. Members range from industry representatives, scientists, and multiple local and federal government entities. The recommended management plans will be based in the best-available science, and will build off of previous efforts, making this an interesting case study of adaptive management. In addition to support from the Sanctuary and professional facilitators, the group is using a decision-support platform, SeaSketch (safepassage.seasketch.org). SeaSketch is a web-based GIS that supports collaborative science-based marine spatial planning (MSP). Each feature supports a step of the MSP process, from data gathering, identification of data needs, the design of spatial plans, evaluation of those plans with analytics, and map-based forums that facilitate data-driven discussions. Working group members are able to access these tools to explore management options and collaborate remotely, in addition to using the platform during in-person meetings and webinars. Empowering diverse audiences to engage in the design of science-based plans is of key importance to developing ecosystem-based management plans where multi-sector participation and inter-agency coordination are critical.

An International Coordinated Effort to Further the Documentation & Development of Quality Assurance, Quality Control, and Best Practices for Oceanographic Observations

NASA Astrophysics Data System (ADS)

Bushnell, M.; Waldmann, C.; Hermes, J.; Tamburri, M.

2017-12-01

Many oceanographic observation groups create and maintain QA, QC, and best practices (BP) to ensure efficient and accurate data collection and quantify quality. Several entities - IOOS® QARTOD, AtlantOS, ACT, WMO/IOC JCOMM OCG - have joined forces to document existing practices, identify gaps, and support development of emerging techniques. While each group has a slightly different focus, many underlying QA/QC/BP needs can be quite common. QARTOD focuses upon real-time data QC, and has produced manuals that address QC tests for eleven ocean variables. AtlantOS is a research and innovation project working towards the integration of ocean-observing activities across all disciplines in the Atlantic Basin. ACT brings together research institutions, resource managers, and private companies to foster the development and adoption of effective and reliable sensors for coastal, freshwater, and ocean environments. JCOMM promotes broad international coordination of oceanographic and marine meteorological observations and data management and services. Leveraging existing efforts of these organizations is an efficient way to consolidate available information, develop new practices, and evaluate the use of ISO standards to judge the quality of measurements. ISO standards may offer accepted support for a framework for an ocean data quality management system, similar to the meteorological standards defined by WMO (https://www.wmo.int/pages/prog/arep/gaw/qassurance.html). We will first cooperatively develop a plan to create a QA/QC/BP manual. The resulting plan will describe the need for such a manual, the extent of the manual, the process used to engage the community in creating it, the maintenance of the resultant document, and how these things will be done. It will also investigate standards for metadata. The plan will subsequently be used to develop the QA/QC/BP manual, providing guidance which advances the standards adopted by IOOS, AtlantOS, JCOMM, and others.

Creating a national culture of quality: the Tanzania experience.

PubMed

Mwidunda, Patrick E; Eliakimu, Eliudi

2015-07-01

Although quality improvement has been a priority for Tanzania's health sector since the 1970s, few effective quality improvement initiatives were implemented, due to limited expertise, political commitment and resources. More recently, as the HIV epidemic gained momentum within the country, an influx of funding and of international organizations with quality improvement expertise accelerated the implementation of quality improvement projects, as well as efforts to institutionalize quality improvement at the national level. The support of US President's Emergency Plan for AIDS Relief (PEPFAR) and other donors, and the increasing numbers of HIV-implementing partners focused on quality management, and quality improvement strategies catalysed the development of HIV-specific quality improvement initiatives first, and then of national quality improvement frameworks. The diversity of quality improvement approaches championed by various donors and partners also presented important challenges to harmonization and institutionalization of quality improvement programmes.

The ends of uncertainty: Air quality science and planning in Central California

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

Fine, James

Air quality planning in Central California is complicated and controversial despite millions of dollars invested to improve scientific understanding. This research describes and critiques the use of photochemical air quality simulation modeling studies in planning to attain standards for ground-level ozone in the San Francisco Bay Area and the San Joaquin Valley during the 1990's. Data are gathered through documents and interviews with planners, modelers, and policy-makers at public agencies and with representatives from the regulated and environmental communities. Interactions amongst organizations are diagramed to identify significant nodes of interaction. Dominant policy coalitions are described through narratives distinguished by theirmore » uses of and responses to uncertainty, their exposures to risks, and their responses to the principles of conservatism, civil duty, and caution. Policy narratives are delineated using aggregated respondent statements to describe and understand advocacy coalitions. I found that models impacted the planning process significantly, but were used not purely for their scientific capabilities. Modeling results provided justification for decisions based on other constraints and political considerations. Uncertainties were utilized opportunistically by stakeholders instead of managed explicitly. Ultimately, the process supported the partisan views of those in control of the modeling. Based on these findings, as well as a review of model uncertainty analysis capabilities, I recommend modifying the planning process to allow for the development and incorporation of uncertainty information, while addressing the need for inclusive and meaningful public participation. By documenting an actual air quality planning process these findings provide insights about the potential for using new scientific information and understanding to achieve environmental goals, most notably the analysis of uncertainties in modeling applications. Concurrently, needed uncertainty information is identified and capabilities to produce it are assessed. Practices to facilitate incorporation of uncertainty information are suggested based on research findings, as well as theory from the literatures of the policy sciences, decision sciences, science and technology studies, consensus-based and communicative planning, and modeling.« less

Modeling Study on Air Quality Improvement due to Mobile Source Emission control Plan in Seoul Metropolitan Area

NASA Astrophysics Data System (ADS)

Kim, Y. J.; Sunwoo, Y.; Hwang, I.; Song, S.; Sin, J.; Kim, D.

2015-12-01

A very high population and corresponding high number of vehicles in the Seoul Metropolitan Area (SMA) are aggravating the air quality of this region. The Korean government continues to make concerted efforts to improve air quality. One of the major policies that the Ministry of Environment of Korea enforced is "The Special Act for Improvement of Air Quality in SMA" and "The 1st Air Quality Management Plan of SMA". Mobile Source emission controls are an important part of the policy. Thus, it is timely to evaluate the air quality improvement due to the controls. Therefore, we performed a quantitative analysis of the difference in air quality using the Community Multiscale Air Quality (CMAQ) model and December, 2011 was set as the target period to capture the impact of the above control plans. We considered four fuel-type vehicle emission scenarios and compared the air quality improvement differences between them. The scenarios are as follows: no-control, gasoline vehicle control only, diesel vehicle control only, and control of both; utilizing the revised mobile source emissions from the Clean Air Policy Support System (CAPSS), which is the national emission inventory reflecting current policy.In order to improve the accuracy of the modeling data, we developed new temporal allocation coefficients based on traffic volume observation data and spatially reallocated the mobile source emissions using vehicle flow survey data. Furthermore, we calculated the PM10 and PM2.5 emissions of gasoline vehicles which is omitted in CAPSS.The results of the air quality modeling shows that vehicle control plans for both gasoline and diesel lead to a decrease of 0.65ppb~8.75ppb and 0.02㎍/㎥~7.09㎍/㎥ in NO2 and PM10 monthly average concentrations, respectively. The large percentage decreases mainly appear near the center of the metropolis. However, the largest NO2 decrease percentages are found in the northeast region of Gyeonggi-do, which is the province that surrounds the capital of Seoul. Comparing the results between the different scenarios, diesel vehicle control impact dominates relative to the impact of gasoline control. The diesel-only reduction plan shows that NO2 and PM10 improved by 2.93ppb and 3.32㎍/㎥, respectively.

Ernest Orlando Lawrence Berkeley National Laboratory institutional plan, FY 1996--2001

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

NONE

1995-11-01

The FY 1996--2001 Institutional Plan provides an overview of the Ernest Orlando Lawrence Berkeley National Laboratory mission, strategic plan, core business areas, critical success factors, and the resource requirements to fulfill its mission in support of national needs in fundamental science and technology, energy resources, and environmental quality. The Laboratory Strategic Plan section identifies long-range conditions that will influence the Laboratory, as well as potential research trends and management implications. The Core Business Areas section identifies those initiatives that are potential new research programs representing major long-term opportunities for the Laboratory, and the resources required for their implementation. It alsomore » summarizes current programs and potential changes in research program activity, science and technology partnerships, and university and science education. The Critical Success Factors section reviews human resources; work force diversity; environment, safety, and health programs; management practices; site and facility needs; and communications and trust. The Resource Projections are estimates of required budgetary authority for the Laboratory`s ongoing research programs. The Institutional Plan is a management report for integration with the Department of Energy`s strategic planning activities, developed through an annual planning process. The plan identifies technical and administrative directions in the context of the national energy policy and research needs and the Department of Energy`s program planning initiatives. Preparation of the plan is coordinated by the Office of Planning and Communications from information contributed by the Laboratory`s scientific and support divisions.« less

Knowledge enabled plan of care and documentation prototype.

PubMed

DaDamio, Rebecca; Gugerty, Brian; Kennedy, Rosemary

2006-01-01

There exist significant challenges in integrating the plan of care into documentation and point of care operational processes. A plan of care is often a static artifact that meets regulatory standards with limited influence on supporting goal-directed care delivery processes. Although this prototype is applicable to many clinical disciplines, we will highlight nursing processes in demonstrating a knowledge-driven computerized solution that fully integrates the plan of care within documentation. The knowledge-driven solution reflects evidenced-based practice; is an effective tool for managing problems, orders/interventions, and the patient's progress towards expected outcomes; meets regulatory standards; and drives quality and process improvement. The knowledge infrastructure consists of fully represented terminology, structured clinical expressions utilizing the controlled terminology and clinical knowledge representing evidence-based practice.

An Overview of NASA's IM&S Verification and Validation Process Plan and Specification for Space Exploration

NASA Technical Reports Server (NTRS)

Gravitz, Robert M.; Hale, Joseph

2006-01-01

NASA's Exploration Systems Mission Directorate (ESMD) is implementing a management approach for modeling and simulation (M&S) that will provide decision-makers information on the model's fidelity, credibility, and quality. This information will allow the decision-maker to understand the risks involved in using a model's results in the decision-making process. This presentation will discuss NASA's approach for verification and validation (V&V) of its models or simulations supporting space exploration. This presentation will describe NASA's V&V process and the associated M&S verification and validation (V&V) activities required to support the decision-making process. The M&S V&V Plan and V&V Report templates for ESMD will also be illustrated.

Quality-assurance plan for water-resources activities of the U. S. Geological Survey in Montana--1991

USGS Publications Warehouse

Moreland, Joe A.

1991-01-01

As the Nation's principal earth-science information agency, the U.S. Geological Survey has developed a worldwide reputation for collecting accurate data and producing factual, impartial interpretive reports. To ensure continued confidence in the pro- ducts, the Water Resources Division of the U.S. Geological Survey has implemented a policy that all scientific work will be performed in accordance with a centrally managed quality-assurance program. The formal policy for quality assurance within the Montana District was established and documented in USGS Open-File Report 91-194. This report has been revised to reflect changes in personnel and organi- zational structure that have occurred since 1991. Quality assurance is formalized by describing organization and operational responsibilities, the quality-assurance policy, and the quality- assurance responsibilities for performing District functions. The District conducts its work through offices in Helena, Billings, Kalispell, and Fort Peck. Data-collection programs and interpretive studies are conducted by three operating sections and four support units. Discipline specialists provide technical advice and assistance. Management advisors provide guidance on various personnel issues and support functions.

Quality-assurance plan for water-resources activities of the U.S. Geological Survey in Montana--1995

USGS Publications Warehouse

Moreland, Joe A.

1995-01-01

As the Nation's principal earth-science information agency, the U.S. Geological Survey has developed a worldwide reputation for collecting accurate data and producing factual, impartial interpretive reports. To ensure continued confidence in the pro- ducts, the Water Resources Division of the U.S. Geological Survey has implemented a policy that all scientific work will be performed in accordance with a centrally managed quality-assurance program. The formal policy for quality assurance within the Montana District was established and documented in USGS Open-File Report 91-194. This report has been revised to reflect changes in personnel and organi- zational structure that have occurred since 1991. Quality assurance is formalized by describing organization and operational responsibilities, the quality-assurance policy, and the quality- assurance responsibilities for performing District functions. The District conducts its work through offices in Helena, Billings, Kalispell, and Fort Peck. Data-collection programs and interpretive studies are conducted by three operating sections and four support units. Discipline specialists provide technical advice and assistance. Management advisors provide guidance on various personnel issues and support functions.

Awakening consumer stewardship of health benefits: prevalence and differentiation of new health plan models.

PubMed

Rosenthal, Meredith; Milstein, Arnold

2004-08-01

Despite widespread publicity of consumer-directed health plans, little is known about their prevalence and the extent to which their designs adequately reflect and support consumerism. We examined three types of consumer-directed health plans: health reimbursement accounts (HRAs), premium-tiered, and point-of-care tiered benefit plans. We sought to measure the extent to which these plans had diffused, as well as to provide a critical look at the ways in which these plans support consumerism. Consumerism in this context refers to efforts to enable informed consumer choice and consumers' involvement in managing their health. We also wished to determine whether mainstream health plans-health maintenance organization (HMO), point of service (POS), and preferred provider organization (PPO) models-were being influenced by consumerism. Our study uses national survey data collected by Mercer Human Resource Consulting from 680 national and regional commercial health benefit plans on HMO, PPO, POS, and consumer-directed products. We defined consumer-directed products as health benefit plans that provided (1) consumer incentives to select more economical health care options, including self-care and no care, and (2) information and support to inform such selections. We asked health plans that offered consumer-directed products about 2003 enrollment, basic design features, and the availability of decision support. We also asked mainstream health plans about their activities that supported consumerism (e.g., proactive outreach to inform or influence enrollee behavior, such as self-management or preventive care, reminders sent to patients with identified medical conditions.) We analyzed survey responses for all four product lines in order to identify those plans that offer health reimbursement accounts (HRAs), premium-tiered, or point-of-care tiered models as well as efforts of mainstream health plans to engage informed consumer decision making. The majority of enrollees in consumer-directed health plans are in tiered models (primarily point-of-care tiered networks) rather than HRAs. Tiers are predominantly determined based on both cost and quality criteria. Enrollment in HRAs has grown substantially, in part because of the entry of mainstream managed care plans into the consumer-directed market. Health reimbursement accounts, tiered networks, and traditional managed care plans vary in their capacity to support consumers in managing their health risks and selection of provider and treatment options, with HRAs providing the most and mainstream plans the least. While enrollment in consumer-directed health plans continues to grow steadily, it remains a tiny fraction of all employer-sponsored coverage. Decision support in these plans, a critical link to help consumers make more informed choices, is also still limited. This lack may be of concern in light of the fact that only a minority of such plans report that they monitor claims to protect against underuse. Tiered benefit models appear to be more readily accepted by the market than HRAs. If they are to succeed in optimizing consumers' utility from health benefit spending, careful attention needs to be paid to how well these models inform consumers about the consequences of their selections.

GSFC Supplier Surveillance

NASA Technical Reports Server (NTRS)

Kelly, Michael P.

2011-01-01

Topics covered include: Develop Program/Project Quality Assurance Surveillance Plans The work activities performed by the developer and/or his suppliers are subject to evaluation and audit by government-designated representatives. CSO supports project by selecting on-site supplier representative s by one of several methods: (1) a Defense Contract Management Agency (DCMA) person via a Letter Of Delegation (LOD), (2) an independent assurance contractor (IAC) via a contract Audits, Assessments, and Assurance (A3) Contract Code 300 Mission Assurance Support Contract (MASC)

An airborne remote sensing system for urban air quality

NASA Technical Reports Server (NTRS)

Duncan, L. J.; Friedman, E. J.; Keitz, E. L.; Ward, E. A.

1974-01-01

Several NASA sponsored remote sensors and possible airborne platforms were evaluated. Outputs of dispersion models for SO2 and CO pollution in the Washington, D.C. area were used with ground station data to establish the expected performance and limitations of the remote sensors. Aircraft/sensor support requirements are discussed. A method of optimum flight plan determination was made. Cost trade offs were performed. Conclusions about the implementation of various instrument packages as parts of a comprehensive air quality monitoring system in Washington are presented.

An evaluation of a family planning mobile job aid for community health workers in Tanzania.

PubMed

Braun, Rebecca; Lasway, Christine; Agarwal, Smisha; L'Engle, Kelly; Layer, Erica; Silas, Lucy; Mwakibete, Anna; Kudrati, Mustafa

2016-07-01

The global rapid growth in mobile technology provides unique opportunities to support community health workers (CHWs) in providing family planning (FP) services. FHI 360, Pathfinder International and D-tree International developed an evidence-based mobile job aid to support CHW counseling, screening, service provision and referrals, with mobile forms for client and service data, and text-message reporting and reminders. The purpose of this study is to evaluate the acceptability and potential benefits to service quality from the perspective of CHWs and their clients. The mobile job aid was piloted in Dar es Salaam, Tanzania. Data collection tools included a demographic survey of all 25 CHWs trained to use the mobile job aid, in-depth interviews with 20 of the CHWs after 3 months and a survey of 176 clients who received FP services from a CHW using the mobile job aid after 6 months. Both CHWs and their clients reported that the mobile job aid was a highly acceptable FP support tool. CHWs perceived benefits to service quality, including timelier and more convenient care; better quality of information; increased method choice; and improved privacy, confidentiality and trust with clients. Most clients discussed multiple FP methods with CHWs; only 1 in 10 clients reported discussion of all 9 methods. This research suggests that mobile phones can be effective tools to support CHWs with FP counseling, screening and referrals, data collection and reporting, and communication. Challenges remain to support informed contraceptive choice. Future research should focus on implementation, including scale-up and sustainability. Mobile job aids can uniquely enhance FP service provision at the community level through adherence to standard protocols, real-time feedback and technical assistance, and provision of confidential care. This study can inform future efforts to support and expand the role of CHWs in increasing FP access and informed contraceptive choice. Copyright © 2016 Elsevier Inc. All rights reserved.

3D Printout Models vs. 3D-Rendered Images: Which Is Better for Preoperative Planning?

PubMed

Zheng, Yi-xiong; Yu, Di-fei; Zhao, Jian-gang; Wu, Yu-lian; Zheng, Bin

2016-01-01

Correct interpretation of a patient's anatomy and changes that occurs secondary to a disease process are crucial in the preoperative process to ensure optimal surgical treatment. In this study, we presented 3 different pancreatic cancer cases to surgical residents in the form of 3D-rendered images and 3D-printed models to investigate which modality resulted in the most appropriate preoperative plan. We selected 3 cases that would require significantly different preoperative plans based on key features identifiable in the preoperative computed tomography imaging. 3D volume rendering and 3D printing were performed respectively to create 2 different training ways. A total of 30, year 1 surgical residents were randomly divided into 2 groups. Besides traditional 2D computed tomography images, residents in group A (n = 15) reviewed 3D computer models, whereas in group B, residents (n = 15) reviewed 3D-printed models. Both groups subsequently completed an examination, designed in-house, to assess the appropriateness of their preoperative plan and provide a numerical score of the quality of the surgical plan. Residents in group B showed significantly higher quality of the surgical plan scores compared with residents in group A (76.4 ± 10.5 vs. 66.5 ± 11.2, p = 0.018). This difference was due in large part to a significant difference in knowledge of key surgical steps (22.1 ± 2.9 vs. 17.4 ± 4.2, p = 0.004) between each group. All participants reported a high level of satisfaction with the exercise. Results from this study support our hypothesis that 3D-printed models improve the quality of surgical trainee's preoperative plans. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

30 CFR 28.31 - Quality control plans; contents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Quality control plans; contents. 28.31 Section... PROTECTION FOR TRAILING CABLES IN COAL MINES Quality Control § 28.31 Quality control plans; contents. (a) Each quality control plan shall contain provisions for the management of quality, including: (1...

40 CFR 130.6 - Water quality management plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Water quality management plans. 130.6... QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM... when they are needed to address water quality problems. (1) Total maximum daily loads. TMDLs in...

78 FR 30770 - Approval and Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-23

... Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards Revision AGENCY... Illinois state implementation plan (SIP) to reflect current National Ambient Air Quality Standards (NAAQS... Implementation Plan at 35 Illinois Administrative Code part 243, which updates National Ambient Air Quality...

Awakening Consumer Stewardship of Health Benefits: Prevalence and Differentiation of New Health Plan Models

PubMed Central

Rosenthal, Meredith; Milstein, Arnold

2004-01-01

Context Despite widespread publicity of consumer-directed health plans, little is known about their prevalence and the extent to which their designs adequately reflect and support consumerism. Objective We examined three types of consumer-directed health plans: health reimbursement accounts (HRAs), premium-tiered, and point-of-care tiered benefit plans. We sought to measure the extent to which these plans had diffused, as well as to provide a critical look at the ways in which these plans support consumerism. Consumerism in this context refers to efforts to enable informed consumer choice and consumers' involvement in managing their health. We also wished to determine whether mainstream health plans—health maintenance organization (HMO), point of service (POS), and preferred provider organization (PPO) models—were being influenced by consumerism. Data Sources/Study Setting Our study uses national survey data collected by Mercer Human Resource Consulting from 680 national and regional commercial health benefit plans on HMO, PPO, POS, and consumer-directed products. Study Design We defined consumer-directed products as health benefit plans that provided (1) consumer incentives to select more economical health care options, including self-care and no care, and (2) information and support to inform such selections. We asked health plans that offered consumer-directed products about 2003 enrollment, basic design features, and the availability of decision support. We also asked mainstream health plans about their activities that supported consumerism (e.g., proactive outreach to inform or influence enrollee behavior, such as self-management or preventive care, reminders sent to patients with identified medical conditions.) Data Collection/Extraction Methods We analyzed survey responses for all four product lines in order to identify those plans that offer health reimbursement accounts (HRAs), premium-tiered, or point-of-care tiered models as well as efforts of mainstream health plans to engage informed consumer decision making. Principal Findings The majority of enrollees in consumer-directed health plans are in tiered models (primarily point-of-care tiered networks) rather than HRAs. Tiers are predominantly determined based on both cost and quality criteria. Enrollment in HRAs has grown substantially, in part because of the entry of mainstream managed care plans into the consumer-directed market. Health reimbursement accounts, tiered networks, and traditional managed care plans vary in their capacity to support consumers in managing their health risks and selection of provider and treatment options, with HRAs providing the most and mainstream plans the least. Conclusions While enrollment in consumer-directed health plans continues to grow steadily, it remains a tiny fraction of all employer-sponsored coverage. Decision support in these plans, a critical link to help consumers make more informed choices, is also still limited. This lack may be of concern in light of the fact that only a minority of such plans report that they monitor claims to protect against underuse. Tiered benefit models appear to be more readily accepted by the market than HRAs. If they are to succeed in optimizing consumers' utility from health benefit spending, careful attention needs to be paid to how well these models inform consumers about the consequences of their selections. PMID:15230911

48 CFR 37.604 - Quality assurance surveillance plans.

Code of Federal Regulations, 2013 CFR

2013-10-01

... surveillance plans. 37.604 Section 37.604 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION... assurance surveillance plans. Requirements for quality assurance and quality assurance surveillance plans are in Subpart 46.4. The Government may either prepare the quality assurance surveillance plan or...

48 CFR 37.604 - Quality assurance surveillance plans.

Code of Federal Regulations, 2014 CFR

2014-10-01

... surveillance plans. 37.604 Section 37.604 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION... assurance surveillance plans. Requirements for quality assurance and quality assurance surveillance plans are in Subpart 46.4. The Government may either prepare the quality assurance surveillance plan or...

48 CFR 37.604 - Quality assurance surveillance plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... surveillance plans. 37.604 Section 37.604 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION... assurance surveillance plans. Requirements for quality assurance and quality assurance surveillance plans are in Subpart 46.4. The Government may either prepare the quality assurance surveillance plan or...

48 CFR 37.604 - Quality assurance surveillance plans.

Code of Federal Regulations, 2012 CFR

2012-10-01

... surveillance plans. 37.604 Section 37.604 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION... assurance surveillance plans. Requirements for quality assurance and quality assurance surveillance plans are in Subpart 46.4. The Government may either prepare the quality assurance surveillance plan or...

48 CFR 37.604 - Quality assurance surveillance plans.

Code of Federal Regulations, 2011 CFR

2011-10-01

... surveillance plans. 37.604 Section 37.604 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION... assurance surveillance plans. Requirements for quality assurance and quality assurance surveillance plans are in Subpart 46.4. The Government may either prepare the quality assurance surveillance plan or...

A multicentre randomised controlled trial of reciprocal lung cancer peer review and supported quality improvement: results from the improving lung cancer outcomes project

PubMed Central

Russell, G K; Jimenez, S; Martin, L; Stanley, R; Peake, M D; Woolhouse, I

2014-01-01

Background: Results from the National Lung Cancer Audit demonstrate unexplained variation in outcomes. Peer review with supported quality improvement has been shown to reduce variation in other areas of health care but has not been formally tested in cancer multidisciplinary teams. The aim of the current study is to assess the impact of reciprocal peer-to-peer review visits with supported quality improvement and collaborative working on lung cancer process and outcome measures. Methods: English lung cancer teams were randomised to usual care or facilitated reciprocal peer review visits followed by 12 months of supported quality improvement. The primary outcome was change in the following national audit indicators; mulitdisciplinary team discussion, histological confirmation, active treatment, surgical resection, small-cell chemotherapy and specialist nurse review. Patient experience was measured using a new lung cancer patient questionnaire in the intervention group. Results: Thirty teams (31 trusts) entered the intervention group and 29 of these submitted a total of 67 quality improvement plans. Active treatment increased in the intervention group (n=31) by 5.2% compared with 1.2% in the control group (n=48, mean difference 4.1%, 95% CI −0.1 to 8.2%, P=0.055). The remaining audit indicators improved similarly in all groups. Mean patient experience scores in the intervention group did not change significantly during the study but a significant improvement was seen in the scores for the five teams with the worst baseline scores (0.86 to 0.22, P<0.001). Conclusions: Reciprocal peer review with supported quality improvement was feasible and effective in stimulating quality improvement activity but resulted in only modest improvements in lung cancer treatment rates and patient experience. PMID:24651386

A Web-Based Decision Support System for Assessing Regional Water-Quality Conditions and Management Actions

NASA Astrophysics Data System (ADS)

Booth, N. L.; Everman, E.; Kuo, I.; Sprague, L.; Murphy, L.

2011-12-01

A new web-based decision support system has been developed as part of the U.S. Geological Survey (USGS) National Water Quality Assessment Program's (NAWQA) effort to provide ready access to Spatially Referenced Regressions On Watershed attributes (SPARROW) results of stream water-quality conditions and to offer sophisticated scenario testing capabilities for research and water-quality planning via an intuitive graphical user interface with a map-based display. The SPARROW Decision Support System (DSS) is delivered through a web browser over an Internet connection, making it widely accessible to the public in a format that allows users to easily display water-quality conditions, distribution of nutrient sources, nutrient delivery to downstream waterbodies, and simulations of altered nutrient inputs including atmospheric and agricultural sources. The DSS offers other features for analysis including various background map layers, model output exports, and the ability to save and share prediction scenarios. SPARROW models currently supported by the DSS are based on the modified digital versions of the 1:500,000-scale River Reach File (RF1) and 1:100,000-scale National Hydrography Dataset (medium-resolution, NHDPlus) stream networks. The underlying modeling framework and server infrastructure illustrate innovations in the information technology and geosciences fields for delivering SPARROW model predictions over the web by performing intensive model computations and map visualizations of the predicted conditions within the stream network.

Quality and Certification of Electronic Health Records

PubMed Central

Hoerbst, A.; Ammenwerth, E.

2010-01-01

Background Numerous projects, initiatives, and programs are dedicated to the development of Electronic Health Records (EHR) worldwide. Increasingly more of these plans have recently been brought from a scientific environment to real life applications. In this context, quality is a crucial factor with regard to the acceptance and utility of Electronic Health Records. However, the dissemination of the existing quality approaches is often rather limited. Objectives The present paper aims at the description and comparison of the current major quality certification approaches to EHRs. Methods A literature analysis was carried out in order to identify the relevant publications with regard to EHR quality certification. PubMed, ACM Digital Library, IEEExplore, CiteSeer, and Google (Scholar) were used to collect relevant sources. The documents that were obtained were analyzed using techniques of qualitative content analysis. Results The analysis discusses and compares the quality approaches of CCHIT, EuroRec, IHE, openEHR, and EN13606. These approaches differ with regard to their focus, support of service-oriented EHRs, process of (re-)certification and testing, number of systems certified and tested, supporting organizations, and regional relevance. Discussion The analyzed approaches show differences with regard to their structure and processes. System vendors can exploit these approaches in order to improve and certify their information systems. Health care organizations can use these approaches to support selection processes or to assess the quality of their own information systems. PMID:23616834

STEM for All Children: Preschool Teachers Supporting Engagement of Children With Special Needs in Physical Science Learning Centers

ERIC Educational Resources Information Center

Donegan-Ritter, Mary

2017-01-01

Early childhood STEM activities are part of developmentally appropriate practices that are the foundation of quality preschool experiences for all young children (Copple & Bredekamp, 2009). However, young children with developmental delays or disabilities require planning and specialized practices that allow them to participate and engage…

76 FR 43175 - Approval of Air Quality Implementation Plans; Indiana and Ohio; Disapproval of Interstate...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-20

... impact. EPA stated that the state's conclusion should be supported by an adequate technical analysis. EPA... by an adequate technical analysis. IDEM did not provide a technical analysis in its submittal, but... technical analysis and justification necessary to make that demonstration. Indiana did not provide any...

Emergency Medical Operations at Kennedy Space Center in Support of Space Shuttle

NASA Technical Reports Server (NTRS)

Myers, K. Jeffrey; Tipton, David A.; Woodard, Daniel; Long, Irene D.

1992-01-01

The unique environment of the Kennedy Space Center includes a wide variety of industrial processes culminating in launch and spaceflight. Many are potentially hazardous to the work force and the astronauts. Technology, planning, training, and quality control are utilized to prevent contingencies and expedite response should a contingency occur.

75 FR 43062 - Approval and Promulgation of Air Quality Implementation Plans; Texas; Revisions to Emissions...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-23

... ozone precursor gases during the winter and summer months, respectively. The revisions also allow for... dioxide, ozone, lead (Pb), particulate matter (PM), and sulfur dioxide (SO 2 ). A SIP is a set of air... supporting information such as emissions inventories, monitoring networks, and modeling demonstrations. Each...

Long-Term Care and Life Planning Preferences for Older Gays and Lesbians

ERIC Educational Resources Information Center

Rivera, Edgar; Wilson, Steven R.; Jennings, Lisa K.

2011-01-01

This study explored the needs and preferences of older gay and lesbian adults regarding their care in later life. Using a phenomenological case study approach, 15 participants were interviewed regarding their anticipated practical needs, including housing and finances, and their psychological needs, such as support and quality of life. Fearing…

NED-2: A decision support system for integrated forest ecosystem management

Treesearch

Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; H. Michael Rauscher; Donald E. Nute; Walter D. Potter; Frederick Maier; Jin Wang; Mayukh Dass; Hajime Uchiyama; Astrid Glende; Robin E. Hoffman

2005-01-01

NED-2 is a Windows-based system designed to improve project-level planning and decision making by providing useful and scientifically sound information to natural resource managers. Resources currently addressed include visual quality, ecology, forest health, timber, water, and wildlife. NED-2 expands on previous versions of NED applications by integrating treatment...

NED-2: a decision support system for integrated forest ecosystem management

Treesearch

Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; H. Michael Rauscher; Donald E. Nute; Walter D. Potter; Frederick Maier; Jin Wang; Mayukh Dass; Hajime Uchiyama; Astrid Glende; Robin E. Hoffman

2005-01-01

NED-2 is a Windows-based system designed to improve project-level planning and decision making by providing useful and scientifically sound information to natural resource managers. Resources currently addressed include visual quality, ecology, forest health, timber, water, and wildlife. NED-2 expands on previous versions of NED applications by integrating treatment...

The On-Site, Programmatic Approach to Staff Development.

ERIC Educational Resources Information Center

Collins, Charles C.; Case, Chester H.

At present, community college in-service professional development programs are not top quality. Little, if any, budgetary support is allocated for them, and responsibility for planning and carrying them out is allocated to no one in particular. The few on-site in-service professional development programs now in operation exhibit common elements…

Financial planning on a comprehensive scale.

PubMed

Mishra, Simita

2013-04-01

Hospitals and health systems that wish to explore the shift to comprehensive care management should: Assess the investments in infrastructure necessary to support comprehensive care management, Gauge the financial implications and set quality and financial goals, Monitor performance using metrics such as patient satisfaction, avoidable admissions, out-of-group referrals, and average length of stay.

78 FR 78720 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Disapproval of State...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-27

..., where ArcelorMittal is located. Emission inventories and modeling parameters had improved, and through...; therefore, this corrective action has no impact on the approved SIP or the modeling conducted to support it... gas combustion that were used in the modeling to demonstrate attainment. The flares were not...

Emergency medical operations at Kennedy Space Center in support of space shuttle

NASA Technical Reports Server (NTRS)

Myers, K. J.; Tipton, D. A.; Woodard, D.; Long, I. D.

1992-01-01

The unique environment of the Kennedy Space Center includes a wide variety of industrial processes culminating in launch and spaceflight. Many are potentially hazardous to the work force and the astronauts. Technology, planning, training, and quality control are utilized to prevent contingencies and expedite response should a contingency occur.

3 CFR 13653 - Executive Order 13653 of November 1, 2013. Preparing the United States for the Impacts of Climate...

Code of Federal Regulations, 2014 CFR

2014-01-01

... Council on Environmental Quality (CEQ), the Office of Science and Technology Policy (OSTP), and the... National Science and Technology Council and those that support the implementation of Presidential Policy... integration of climate science in policies and planning of government agencies and the private sector...

75 FR 32419 - Notice of Solicitation of Applications for Stakeholder Representative Members of the Missouri...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-08

... of a work plan and associated budget requests. Administrative Support. To the extent authorized by.... Irrigation; f. Major Tributaries; g. Navigation; h. Recreation; i. Water Quality; and j. Waterways Industries... to the overall balance of representation on MRRIC. All applicants will be notified in writing as to...

Design and evaluation of an imaging informatics system for analytics-based decision support in radiation therapy

NASA Astrophysics Data System (ADS)

Deshpande, Ruchi; DeMarco, John; Liu, Brent J.

2015-03-01

We have developed a comprehensive DICOM RT specific database of retrospective treatment planning data for radiation therapy of head and neck cancer. Further, we have designed and built an imaging informatics module that utilizes this database to perform data mining. The end-goal of this data mining system is to provide radiation therapy decision support for incoming head and neck cancer patients, by identifying best practices from previous patients who had the most similar tumor geometries. Since the performance of such systems often depends on the size and quality of the retrospective database, we have also placed an emphasis on developing infrastructure and strategies to encourage data sharing and participation from multiple institutions. The infrastructure and decision support algorithm have both been tested and evaluated with 51 sets of retrospective treatment planning data of head and neck cancer patients. We will present the overall design and architecture of our system, an overview of our decision support mechanism as well as the results of our evaluation.

78 FR 21281 - Approval and Promulgation of Implementation Plans; State of Missouri; Infrastructure SIP...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-10

...EPA is proposing action on four Missouri State Implementation Plan (SIP) submissions. First, EPA is proposing to approve portions of two SIP submissions from the State of Missouri addressing the applicable requirements of Clean Air Act (CAA) for the 1997 and 2006 National Ambient Air Quality Standards (NAAQS) for fine particulate matter (PM2.5). The CAA requires that each state adopt and submit a SIP to support implementation, maintenance, and enforcement of each new or revised NAAQS promulgated by EPA. These SIPs are commonly referred to as ``infrastructure'' SIPs. The infrastructure requirements are designed to ensure that the structural components of each state's air quality management program are adequate to meet the state's responsibilities under the CAA. EPA is also proposing to approve two additional SIP submissions from Missouri, one addressing the Prevention of Significant Deterioration (PSD) program in Missouri, and another addressing the requirements applicable to any board or body which approves permits or enforcement orders of the CAA, both of which support requirements associated with infrastructure SIPs.

Telehealth to improve asthma control in pregnancy: A randomized controlled trial.

PubMed

Zairina, Elida; Abramson, Michael J; McDonald, Christine F; Li, Jonathan; Dharmasiri, Thanuja; Stewart, Kay; Walker, Susan P; Paul, Eldho; George, Johnson

2016-07-01

Poorly controlled asthma during pregnancy is hazardous for both mother and foetus. Better asthma control may be achieved if patients are involved in regular self-monitoring of symptoms and self-management according to a written asthma action plan. Telehealth applications to optimize asthma management and outcomes in pregnant women have not yet been evaluated. This study evaluated the efficacy of a telehealth programme supported by a handheld respiratory device in improving asthma control during pregnancy. Pregnant women with asthma (n = 72) from two antenatal clinics in Melbourne, Australia, were randomized to one of two groups: (i) intervention-involving a telehealth programme (management of asthma with supportive telehealth of respiratory function in pregnancy (MASTERY(©) )) supported by a handheld respiratory device and an Android smart phone application (Breathe-easy(©) ) and written asthma action plan or (ii) control-usual care. The primary outcome was change in asthma control at 3 and 6 months (prenatal). Secondary outcomes included changes in quality of life and lung function, and perinatal/neonatal outcomes. At baseline, participants' mean (± standard deviation) age was 31.4 ± 4.5 years and gestational age 16.7 ± 3.1 weeks. At 6 months, the MASTERY group had better asthma control (P = 0.02) and asthma-related quality of life (P = 0.002) compared with usual care. There were no significant differences between groups in lung function, unscheduled health-care visits, days off work/study, oral corticosteroid use, or perinatal outcomes. Differences between groups were not significant at 3 months. Telehealth interventions supporting self-management are feasible and could potentially improve asthma control and asthma-related quality of life during pregnancy. © 2016 Asian Pacific Society of Respirology.

The Utility of the OMI HCHO and NO2 Data Products in Air Quality Decision- Making Activities

NASA Technical Reports Server (NTRS)

Duncan, Bryan N.

2010-01-01

We will present three related air quality applications of the OMI HCHO (formaldehyde) and NO2 (nitrogen dioxide) data products, which we us to support mission planning of an OMI-like instrument for the proposed GEO-CAPE satellite that has as one of its objectives to study air quality from space. First, we will discuss a novel and practical application of the data products to the "weight of evidence" in the air quality decision-making process (e.g., State Implementation Plan (SIP)) for a city, region, or state to demonstrate that it is making progress toward attainment of the National Ambient Air Quality Standard (NAAQS) for ozone. Any trend, or lack thereof, in the observed OMI HCHO/NO2, which we use as an air quality indicator, may support that an emission control strategy implemented to reduce ozone is or is not occurring for a metropolitan area. Second, we will discuss how we use variations in the OMI HCHO product as a proxy for variability in the biogenic hydrocarbon, isoprene, which is an important player for the formation of high levels of ozone and the dominant source of HCHO in the eastern U.S. Third, we will discuss the variability of NO2 in the U.S. as indicated by the OMI NO2 product. In addition, we will show the impact of the 2005 hurricanes on pollutant emissions, including those associated with the intensive oil extraction and refining activities, in the Gulf of Mexico region using the OMI NO2 product. The variability of HCHO and NO2 as indicated by OMI helps us to understand changes in the OMI HCHO/NO2 and the implications for ozone formation.

Tank 241-AY-101 Privatization Push Mode Core Sampling and Analysis Plan

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

TEMPLETON, A.M.

2000-01-12

This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for samples obtained from tank 241-AY-101. The purpose of this sampling event is to obtain information about the characteristics of the contents of 241-AY-101 required to satisfy Data Quality Objectives For RPP Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For High-Level Waste Feed Batch X(HLW DQO) (Nguyen 1999a), Data Quality Objectives For TWRS Privatization Phase I : Confirm Tank T Is An Appropriate Feed Source For Low-Activity Waste Feed Batch X (LAW DQO) (Nguyen 1999b), Low Activitymore » Waste and High-Level Waste Feed Data Quality Objectives (L and H DQO) (Patello et al. 1999), and Characterization Data Needs for Development, Design, and Operation of Retrieval Equipment Developed through the Data Quality Objective Process (Equipment DQO) (Bloom 1996). Special instructions regarding support to the LAW and HLW DQOs are provided by Baldwin (1999). Push mode core samples will be obtained from risers 15G and 150 to provide sufficient material for the chemical analyses and tests required to satisfy these data quality objectives. The 222-S Laboratory will extrude core samples; composite the liquids and solids; perform chemical analyses on composite and segment samples; archive half-segment samples; and provide subsamples to the Process Chemistry Laboratory. The Process Chemistry Laboratory will prepare test plans and perform process tests to evaluate the behavior of the 241-AY-101 waste undergoing the retrieval and treatment scenarios defined in the applicable DQOs. Requirements for analyses of samples originating in the process tests will be documented in the corresponding test plans and are not within the scope of this SAP.« less

Tank 241-AY-101 Privatization Push Mode Core Sampling and Analysis Plan

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

TEMPLETON, A.M.

2000-05-19

This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for samples obtained from tank 241-AY-101. The purpose of this sampling event is to obtain information about the characteristics of the contents of 241-AY-101 required to satisfy ''Data Quality Objectives For RPP Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For High-Level Waste Feed Batch X(HLW DQO)' (Nguyen 1999a), ''Data Quality Objectives For TWRS Privatization Phase I: Confirm Tank T Is An Appropriate Feed Source For Low-Activity Waste Feed Butch X (LAW DQO) (Nguyen 1999b)'', ''Low Activity Wastemore » and High-Level Waste Feed Data Quality Objectives (L&H DQO)'' (Patello et al. 1999), and ''Characterization Data Needs for Development, Design, and Operation of Retrieval Equipment Developed through the Data Quality Objective Process (Equipment DQO)'' (Bloom 1996). Special instructions regarding support to the LAW and HLW DQOs are provided by Baldwin (1999). Push mode core samples will be obtained from risers 15G and 150 to provide sufficient material for the chemical analyses and tests required to satisfy these data quality objectives. The 222-S Laboratory will extrude core samples; composite the liquids and solids; perform chemical analyses on composite and segment samples; archive half-segment samples; and provide sub-samples to the Process Chemistry Laboratory. The Process Chemistry Laboratory will prepare test plans and perform process tests to evaluate the behavior of the 241-AY-101 waste undergoing the retrieval and treatment scenarios defined in the applicable DQOs. Requirements for analyses of samples originating in the process tests will be documented in the corresponding test plans and are not within the scope of this SAP.« less

Hurricane Sandy science plan: coastal topographic and bathymetric data to support hurricane impact assessment and response

USGS Publications Warehouse

Stronko, Jakob M.

2013-01-01

Hurricane Sandy devastated some of the most heavily populated eastern coastal areas of the Nation. With a storm surge peaking at more than 19 feet, the powerful landscape-altering destruction of Hurricane Sandy is a stark reminder of why the Nation must become more resilient to coastal hazards. In response to this natural disaster, the U.S. Geological Survey (USGS) received a total of $41.2 million in supplemental appropriations from the Department of the Interior (DOI) to support response, recovery, and rebuilding efforts. These funds support a science plan that will provide critical scientific information necessary to inform management decisions for recovery of coastal communities, and aid in preparation for future natural hazards. This science plan is designed to coordinate continuing USGS activities with stakeholders and other agencies to improve data collection and analysis that will guide recovery and restoration efforts. The science plan is split into five distinct themes: • Coastal topography and bathymetry • Impacts to coastal beaches and barriers • Impacts of storm surge, including disturbed estuarine and bay hydrology • Impacts on environmental quality and persisting contaminant exposures • Impacts to coastal ecosystems, habitats, and fish and wildlife This fact sheet focuses on coastal topography and bathymetry. This fact sheet focuses on coastal topography and bathymetry.

A new plan quality index for nasopharyngeal cancer SIB IMRT.

PubMed

Jin, X; Yi, J; Zhou, Y; Yan, H; Han, C; Xie, C

2014-02-01

A new plan quality index integrating dosimetric and radiobiological indices was proposed to facilitate the evaluation and comparison of simultaneous integrated boost (SIB) intensity modulated radiotherapy (IMRT) plans for nasopharyngeal cancer (NPC) patients. Ten NPC patients treated by SIB-IMRT were enrolled in the study. Custom software was developed to read dose-volume histogram (DVH) curves from the treatment planning system (TPS). A plan filtering matrix was introduced to filter plans that fail to satisfy treatment protocol. Target plan quality indices and organ at risk (OAR) plan quality indices were calculated for qualified plans. A unique composite plan quality index (CPQI) was proposed based on the relative weight of these indices to evaluate and compare competing plans. Plan ranking results were compared with detailed statistical analysis, radiation oncology quality system (ROQS) scoring results and physician's evaluation results to verify the accuracy of this new plan quality index. The average CPQI values for plans with OAR priority of low, normal, high, and PTV only were 0.22 ± 0.08, 0.49 ± 0.077, 0.71 ± 0.062, and -0.21 ± 0.16, respectively. There were significant differences among these plan quality indices (One-way ANOVA test, p < 0.01). This was consistent with statistical analysis, ROQS results and physician's ranking results in which 90% OAR high plans were selected. Plan filtering matrix was able to speed up the plan evaluation process. The new matrix plan quality index CPQI showed good consistence with physician ranking results. It is a promising index for NPC SIB-IMRT plan evaluation. Copyright © 2013 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Data management plans: the missing perspective.

PubMed

Williams, Mary; Bagwell, Jacqueline; Nahm Zozus, Meredith

2017-07-01

The National Institutes of Health requires data sharing plans for projects with over five hundred thousand dollars in direct costs in a single year and has recently released a new guidance on rigor and reproducibility in grant applications. The National Science Foundation outright requires Data Management Plans (DMPs) as part of applications for funding. However, there is no general and definitive list of topics that should be covered in a DMP for a research project. We identified and reviewed DMP requirements from research funders. Forty-three DMP topics were identified. The review uncovered inconsistent requirements for written DMPs as well as high variability in required or suggested DMP topics among funder requirements. DMP requirements were found to emphasize post-publication data sharing rather than upstream activities that impact data quality, provide traceability or support reproducibility. With the emphasis equalized, the forty-three identified topics can aid Data Managers in systematically generating comprehensive DMPs that support research project planning and funding application evaluation as well as data management conduct and post-publication data sharing. Copyright © 2017. Published by Elsevier Inc.

Technology in education: A guidebook for developing a science and math education support program

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

Wagner, C.L.

1992-09-01

Education is vital to survival and success in an increasingly technical world, and the quality of education is the responsibility of everyone students, teachers, parents, industry, and government. Any technical organization wanting to contribute to that success through its local education system can do so easily and effectively through careful planning. This report details that planning process and includes methods to (1) identify the interests, strengths, and resources of the technical organization; (2) identify the needs of the local education system; (3) interface with local school system administration, principals, and teachers; and (4) develop a unique plan to match themore » organization's strengths and resources with the needs of the school system. Following these getting started'' activities is the actual program that the Engineering Technology Division implemented in a local elementary school, including the curriculum, topics, and actual lesson plans used by technical personnel in the classroom. Finally, there are enrichment activities for teachers and students, suggestions for measuring the success of an education support program, and an overview of student responses to questions about the overall program.« less

Technology in education: A guidebook for developing a science and math education support program

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

Wagner, C.L.

1992-09-01

Education is vital to survival and success in an increasingly technical world, and the quality of education is the responsibility of everyone students, teachers, parents, industry, and government. Any technical organization wanting to contribute to that success through its local education system can do so easily and effectively through careful planning. This report details that planning process and includes methods to (1) identify the interests, strengths, and resources of the technical organization; (2) identify the needs of the local education system; (3) interface with local school system administration, principals, and teachers; and (4) develop a unique plan to match themore » organization`s strengths and resources with the needs of the school system. Following these ``getting started`` activities is the actual program that the Engineering Technology Division implemented in a local elementary school, including the curriculum, topics, and actual lesson plans used by technical personnel in the classroom. Finally, there are enrichment activities for teachers and students, suggestions for measuring the success of an education support program, and an overview of student responses to questions about the overall program.« less

40 CFR 130.6 - Water quality management plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Water quality management plans. 130.6 Section 130.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM...

40 CFR 130.6 - Water quality management plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 23 2013-07-01 2013-07-01 false Water quality management plans. 130.6 Section 130.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM...

40 CFR 130.6 - Water quality management plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 22 2014-07-01 2013-07-01 true Water quality management plans. 130.6 Section 130.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM...

Visualization of risk structures for interactive planning of image guided radiofrequency ablation of liver tumors

NASA Astrophysics Data System (ADS)

Rieder, Christian; Schwier, Michael; Weihusen, Andreas; Zidowitz, Stephan; Peitgen, Heinz-Otto

2009-02-01

Image guided radiofrequency ablation (RFA) is becoming a standard procedure as a minimally invasive method for tumor treatment in the clinical routine. The visualization of pathological tissue and potential risk structures like vessels or important organs gives essential support in image guided pre-interventional RFA planning. In this work our aim is to present novel visualization techniques for interactive RFA planning to support the physician with spatial information of pathological structures as well as the finding of trajectories without harming vitally important tissue. Furthermore, we illustrate three-dimensional applicator models of different manufactures combined with corresponding ablation areas in homogenous tissue, as specified by the manufacturers, to enhance the estimated amount of cell destruction caused by ablation. The visualization techniques are embedded in a workflow oriented application, designed for the use in the clinical routine. To allow a high-quality volume rendering we integrated a visualization method using the fuzzy c-means algorithm. This method automatically defines a transfer function for volume visualization of vessels without the need of a segmentation mask. However, insufficient visualization results of the displayed vessels caused by low data quality can be improved using local vessel segmentation in the vicinity of the lesion. We also provide an interactive segmentation technique of liver tumors for the volumetric measurement and for the visualization of pathological tissue combined with anatomical structures. In order to support coagulation estimation with respect to the heat-sink effect of the cooling blood flow which decreases thermal ablation, a numerical simulation of the heat distribution is provided.

Promoting Good Clinical Laboratory Practices and Laboratory Accreditation to Support Clinical Trials in Sub-Saharan Africa

PubMed Central

Shott, Joseph P.; Saye, Renion; Diakité, Moussa L.; Sanogo, Sintry; Dembele, Moussa B.; Keita, Sekouba; Nagel, Mary C.; Ellis, Ruth D.; Aebig, Joan A.; Diallo, Dapa A.; Doumbo, Ogobara K.

2012-01-01

Laboratory capacity in the developing world frequently lacks quality management systems (QMS) such as good clinical laboratory practices, proper safety precautions, and adequate facilities; impacting the ability to conduct biomedical research where it is needed most. As the regulatory climate changes globally, higher quality laboratory support is needed to protect study volunteers and to accurately assess biological parameters. The University of Bamako and its partners have undertaken a comprehensive QMS plan to improve quality and productivity using the Clinical and Laboratory Standards Institute standards and guidelines. The clinical laboratory passed the College of American Pathologists inspection in April 2010, and received full accreditation in June 2010. Our efforts to implement high-quality standards have been valuable for evaluating safety and immunogenicity of malaria vaccine candidates in Mali. Other disease-specific research groups in resource-limited settings may benefit by incorporating similar training initiatives, QMS methods, and continual improvement practices to ensure best practices. PMID:22492138

Factors Affecting Medical Service Quality.

PubMed

Mosadeghrad, Ali Mohammad

2014-02-01

A better understanding of factors influencing quality of medical service can pinpoint better strategies for quality assurance in medical services. This study aimed to identify factors affecting the quality of medical services provided by Iranian physicians. Exploratory in-depth individual interviews were conducted with sixty-four physicians working in various medical institutions in Iran. Individual, organizational and environmental factors enhance or inhibit the quality of medical services. Quality of medical services depends on the personal factors of the physician and patient, and factors pertaining to the healthcare setting and the broader environment. Differences in internal and external factors such as availability of resources, patient cooperation and collaboration among providers affect the quality of medical services and patient outcomes. Supportive leadership, proper planning, education and training and effective management of resources and processes improve the quality of medical services. This article contributes to healthcare theory and practice by developing a conceptual framework for understanding factors that influence medical services quality.

Holistic needs assessment and care plans for women with gynaecological cancer: do they improve cancer-specific health-related quality of life? A randomised controlled trial using mixed methods.

PubMed

Sandsund, Catherine; Towers, Richard; Thomas, Karen; Tigue, Ruth; Lalji, Amyn; Fernandes, Andreia; Doyle, Natalie; Jordan, Jake; Gage, Heather; Shaw, Clare

2017-08-28

Holistic needs assessment (HNA) and care planning are proposed to address unmet needs of people treated for cancer. We tested whether HNA and care planning by an allied health professional improved cancer-specific quality of life for women following curative treatment for stage I-III gynaecological cancer. Consecutive women were invited to participate in a randomised controlled study (HNA and care planning vs usual care) at a UK cancer centre. Data were collected by questionnaire at baseline, 3 and 6 months. The outcomes were 6-month change in European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-C30 (version 3), global score (primary) and, in EORTC subscales, generic quality of life and self-efficacy (secondary). The study was blinded for data management and analysis. Differences in outcomes were compared between groups. Health service utilisation and quality-adjusted life years (QALY) (from Short Form-6) were gathered for a cost-effectiveness analysis. Thematic analysis was used to interpret data from an exit interview. 150 women consented (75 per group); 10 undertook interviews. For 124 participants (61 intervention, 63 controls) with complete data, no statistically significant differences were seen between groups in the primary endpoint. The majority of those interviewed reported important personal gains they attributed to the intervention, which reflected trends to improvement seen in EORTC functional and symptom scales. Economic analysis suggests a 62% probability of cost-effectiveness at a £30 000/QALY threshold. Care plan development with an allied health professional is cost-effective, acceptable and useful for some women treated for stage I-III gynaecological cancer. We recommend its introduction early in the pathway to support person-centred care. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

SU-E-T-60: A Plan Quality Index in IMRT QA That Is Independent of the Acceptance Criteria

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

Kim, D; Kang, S; Kim, T

2015-06-15

Purpose: In IMRT QA, plan quality evaluation is made based on pass rate under preset acceptance criteria, mostly using gamma-values. This method is convenient but, its Result highly depends on what the acceptance criteria are and suffers from the lack of sensitivity in judging how good the plan is. In this study, we introduced a simple but effective plan quality index of IMRT QA based on dose difference only to supplement such shortcomings, and investigated its validity. Methods: The proposed index is a single value which is calculated mainly based on point-by-point comparison between planned and measured dose distributions, andmore » it becomes “1” in an ideal case. A systematic evaluation was performed with one-dimensional test dose distributions. For 3 hypothetical dose profiles, various displacements (in both dose and space) were introduced, the proposed index was calculated for each case, and the behavior of obtained indices was analyzed and compared with that of gamma evaluation. In addition, the feasibility of the index was assessed with clinical IMRT/VMAT/SBRT QA cases for different sites (prostate, head & neck, liver, lung, spine, and abdomen). Results: The proposed index showed more robust correlation with the amount of induced displacement compared to the gamma evaluation method. No matter what the acceptance criteria are (e.g., whether 3%/3mm or 2%/2mm), it was possible to clearly rank every case with the proposed index while it was difficult to do with the gamma evaluation method. Conclusion: IMRT plan quality can be evaluated quantitatively by the proposed index. It is considered that the proposed index would provide useful information for better judging the level of goodness of each plan and its Result is independent of the acceptance criteria. This work was supported by the Radiation Technology R&D program (No. 2013M2A2A7043498) and the Mid-career Researcher Program (2014R1A2A1A10050270) through the National Research Foundation of Korea funded by the Ministry of Science, ICT&Future Planning.« less

42 CFR 84.41 - Quality control plans; contents.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Quality control plans; contents. 84.41 Section 84... AND HEALTH RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Quality Control § 84.41 Quality control plans; contents. (a) Each quality control plan shall contain provisions for the...

42 CFR 84.41 - Quality control plans; contents.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Quality control plans; contents. 84.41 Section 84... AND HEALTH RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Quality Control § 84.41 Quality control plans; contents. (a) Each quality control plan shall contain provisions for the...

42 CFR 84.41 - Quality control plans; contents.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Quality control plans; contents. 84.41 Section 84... AND HEALTH RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Quality Control § 84.41 Quality control plans; contents. (a) Each quality control plan shall contain provisions for the...

42 CFR 84.41 - Quality control plans; contents.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Quality control plans; contents. 84.41 Section 84... AND HEALTH RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Quality Control § 84.41 Quality control plans; contents. (a) Each quality control plan shall contain provisions for the...

42 CFR 84.41 - Quality control plans; contents.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 1 2011-10-01 2011-10-01 false Quality control plans; contents. 84.41 Section 84... AND HEALTH RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Quality Control § 84.41 Quality control plans; contents. (a) Each quality control plan shall contain provisions for the...

30 CFR 28.32 - Proposed quality control plans; approval by MSHA.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Proposed quality control plans; approval by...-CIRCUIT PROTECTION FOR TRAILING CABLES IN COAL MINES Quality Control § 28.32 Proposed quality control plans; approval by MSHA. (a) Each proposed quality control plan submitted in accordance with this...

30 CFR 28.30 - Quality control plans; filing requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Quality control plans; filing requirements. 28... PROTECTION FOR TRAILING CABLES IN COAL MINES Quality Control § 28.30 Quality control plans; filing... part, each applicant shall file with MSHA a proposed quality control plan which shall be designed to...

30 CFR 28.30 - Quality control plans; filing requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Quality control plans; filing requirements. 28... PROTECTION FOR TRAILING CABLES IN COAL MINES Quality Control § 28.30 Quality control plans; filing... part, each applicant shall file with MSHA a proposed quality control plan which shall be designed to...

30 CFR 28.30 - Quality control plans; filing requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROTECTION FOR TRAILING CABLES IN COAL MINES Quality Control § 28.30 Quality control plans; filing... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Quality control plans; filing requirements. 28... part, each applicant shall file with MSHA a proposed quality control plan which shall be designed to...

30 CFR 28.32 - Proposed quality control plans; approval by MSHA.

Code of Federal Regulations, 2012 CFR

2012-07-01

...-CIRCUIT PROTECTION FOR TRAILING CABLES IN COAL MINES Quality Control § 28.32 Proposed quality control plans; approval by MSHA. (a) Each proposed quality control plan submitted in accordance with this... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Proposed quality control plans; approval by...

30 CFR 28.32 - Proposed quality control plans; approval by MSHA.

Code of Federal Regulations, 2013 CFR

2013-07-01

...-CIRCUIT PROTECTION FOR TRAILING CABLES IN COAL MINES Quality Control § 28.32 Proposed quality control plans; approval by MSHA. (a) Each proposed quality control plan submitted in accordance with this... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Proposed quality control plans; approval by...

30 CFR 28.30 - Quality control plans; filing requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROTECTION FOR TRAILING CABLES IN COAL MINES Quality Control § 28.30 Quality control plans; filing... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Quality control plans; filing requirements. 28... part, each applicant shall file with MSHA a proposed quality control plan which shall be designed to...

30 CFR 28.30 - Quality control plans; filing requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROTECTION FOR TRAILING CABLES IN COAL MINES Quality Control § 28.30 Quality control plans; filing... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Quality control plans; filing requirements. 28... part, each applicant shall file with MSHA a proposed quality control plan which shall be designed to...

30 CFR 28.32 - Proposed quality control plans; approval by MSHA.

Code of Federal Regulations, 2014 CFR

2014-07-01

...-CIRCUIT PROTECTION FOR TRAILING CABLES IN COAL MINES Quality Control § 28.32 Proposed quality control plans; approval by MSHA. (a) Each proposed quality control plan submitted in accordance with this... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Proposed quality control plans; approval by...

Towards a catchment-scale macro-ecological model to support integrated catchment management in Europe

NASA Astrophysics Data System (ADS)

Lerner, R. N.; Lerner, D. N.; Surridge, B.; Paetzold, A.; Harris, B.; Anderson, C. W.

2005-12-01

In Europe, the Water Framework Directive (WFD) is providing a powerful regulatory driver to adopt integrated catchment management, and so pressurizing researchers to build suitable supporting tools. The WFD requires agencies to drive towards `good ecological quality' by 2015. After the initial step of characterising water bodies and the pressures on them, the next substantive step is the preparation of river basin management plans and proposed programmes of measures by 2009. Ecological quality is a complex concept and poorly defined, unless it is taken as a simple measure such as the abundance of a particular species of organism. There is clearly substantial work to do to build a practical but sound definition of ecological quality; practical in the sense of being easy to measure and explain to stakeholders, and sound in the sense that it reflects ecological complexity within catchments, the variability between catchments, and the conflicts demands for goods and services that human society places upon the ecological system. However ecological quality is defined, it will be driven by four interacting groups of factors. These represent the physical, chemical, ecological and socio-economic environments within and encompassing the catchment. Some of these groupings are better understood than others, for example hydrological processes and the transport of solutes are reasonably understood, even though they remain research areas in their own right. There are much larger gaps in our understanding at the interfaces, i.e. predicting how, for example, hydrological processes such as flow and river morphology influence ecological quality. Overall, it is clear we are not yet in a position to build deterministic models of the overall ecological behaviour of catchment. But we need predictive tools to support catchment management agencies in preparing robust plans. This poster describes our current exploration of soft modelling options to build a comprehensive macro-ecological model of UK catchments. This is taking place within the Catchment Science Centre, a joint venture between the University of Sheffield and the Environment Agency.

Use of plan quality degradation to evaluate tradeoffs in delivery efficiency and clinical plan metrics arising from IMRT optimizer and sequencer compromises

PubMed Central

Wilkie, Joel R.; Matuszak, Martha M.; Feng, Mary; Moran, Jean M.; Fraass, Benedick A.

2013-01-01

Purpose: Plan degradation resulting from compromises made to enhance delivery efficiency is an important consideration for intensity modulated radiation therapy (IMRT) treatment plans. IMRT optimization and/or multileaf collimator (MLC) sequencing schemes can be modified to generate more efficient treatment delivery, but the effect those modifications have on plan quality is often difficult to quantify. In this work, the authors present a method for quantitative assessment of overall plan quality degradation due to tradeoffs between delivery efficiency and treatment plan quality, illustrated using comparisons between plans developed allowing different numbers of intensity levels in IMRT optimization and/or MLC sequencing for static segmental MLC IMRT plans. Methods: A plan quality degradation method to evaluate delivery efficiency and plan quality tradeoffs was developed and used to assess planning for 14 prostate and 12 head and neck patients treated with static IMRT. Plan quality was evaluated using a physician's predetermined “quality degradation” factors for relevant clinical plan metrics associated with the plan optimization strategy. Delivery efficiency and plan quality were assessed for a range of optimization and sequencing limitations. The “optimal” (baseline) plan for each case was derived using a clinical cost function with an unlimited number of intensity levels. These plans were sequenced with a clinical MLC leaf sequencer which uses >100 segments, assuring delivered intensities to be within 1% of the optimized intensity pattern. Each patient's optimal plan was also sequenced limiting the number of intensity levels (20, 10, and 5), and then separately optimized with these same numbers of intensity levels. Delivery time was measured for all plans, and direct evaluation of the tradeoffs between delivery time and plan degradation was performed. Results: When considering tradeoffs, the optimal number of intensity levels depends on the treatment site and on the stage in the process at which the levels are limited. The cost of improved delivery efficiency, in terms of plan quality degradation, increased as the number of intensity levels in the sequencer or optimizer decreased. The degradation was more substantial for the head and neck cases relative to the prostate cases, particularly when fewer than 20 intensity levels were used. Plan quality degradation was less severe when the number of intensity levels was limited in the optimizer rather than the sequencer. Conclusions: Analysis of plan quality degradation allows for a quantitative assessment of the compromises in clinical plan quality as delivery efficiency is improved, in order to determine the optimal delivery settings. The technique is based on physician-determined quality degradation factors and can be extended to other clinical situations where investigation of various tradeoffs is warranted. PMID:23822412

Treatment outcomes and patient-reported quality of life after orthognathic surgery with computer-assisted 2- or 3-dimensional planning: A randomized double-blind active-controlled clinical trial.

PubMed

Bengtsson, Martin; Wall, Gert; Larsson, Pernilla; Becktor, Jonas P; Rasmusson, Lars

2018-06-01

Thorough treatment planning is essential for a good clinical outcome in orthognathic treatment. The planning is often digital. Both 2-dimensional (2D) and 3-dimensional (3D) software options are available. The aim of this randomized 2-arm parallel double-blinded active-controlled clinical trial was to compare the outcomes of computer-based 2D and 3D planning techniques according to patient-reported health related quality of life. The hypothesis was that a 3D technique would give a better treatment outcome compared with a 2D technique. Orthognathic treatment for 62 subjects, aged 18 to 28 years, with severe Class III malocclusion was planned with both 2D and 3D techniques. After treatment planning but before surgery, the patients were randomly allocated via blind collection of 1 enveloped card for each subject in a 1:1 ratio to the test (3D) or the control (2D) group. Thus, the intervention was according to which planning technique was used. The primary outcome was patient-reported outcome measures. The secondary outcome was relationship between patient-reported outcome measures and cephalometric accuracy. Questionnaires on the patient's health-related quality of life (HRQoL) were distributed preoperatively and 12 months after surgical treatment. The questionnaires were coded, meaning blinding throughout the analysis. Differences between groups were tested with the Fisher permutation test. The HRQoL was also compared with measurements of cephalometric accuracy for the 2 groups. Three subjects were lost to clinical follow-up, leaving 57 included. Of these, 55 subjects completed the questionnaires, 28 in the 2D and 27 in the 3D groups. No statistically significant difference regarding HRQoL was found between the studied planning techniques: the Oral Health Impact Profile total showed -3.69 (95% confidence interval, -19.68 to 12.30). Consistent results on HRQoL and cephalometric accuracy showed a difference between pretreatment and posttreatment that increased in both groups but to a higher level in the 3D group. A difference between pretreatment and posttreatment HRQoL was shown for both groups, indicating increased quality of life after treatment. This supports recent findings comparing 3D and 2D planning techniques. No serious harm was observed during the study. Improvements of HRQoL were shown after treatment independent of which planning technique, 2D or 3D, was used. No statistically significant difference was found between the planning techniques. This trial was not registered. The protocol was not published before trial commencement. This project was supported by personal grants to Martin Bengtsson from the Scandinavian Association of Oral and Maxillofacial Surgeons (25000 SEK), the Southern Region of the Swedish Dental Association (50000 SEK), and the Swedish Association of Oral and Maxillofacial Surgeons (25000 SEK). The sponsors had no influence on the study design, analysis of the data, or the writing of the article. Copyright © 2018 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

A scientific operations plan for the NASA space telescope. [ground support systems, project planning

NASA Technical Reports Server (NTRS)

West, D. K.; Costa, S. R.

1975-01-01

A ground system is described which is compatible with the operational requirements of the space telescope. The goal of the ground system is to minimize the cost of post launch operations without seriously compromising the quality and total throughput of space telescope science, or jeopardizing the safety of the space telescope in orbit. The resulting system is able to accomplish this goal through optimum use of existing and planned resources and institutional facilities. Cost is also reduced and efficiency in operation increased by drawing on existing experience in interfacing guest astronomers with spacecraft as well as mission control experience obtained in the operation of present astronomical spacecraft.

Patient-centred assessment of social support, health status and quality of life in patients with acute coronary syndrome.

PubMed

de Jong-Watt, Wynne; Sherifi, Ines

2011-01-01

Measurement of health status (HS) and social support are becoming increasingly accepted as tools to guide clinical decision-making and patient-centred practice. To assess self-reported HS, cardiac-health related quality of life and social support in subjects with a diagnosis of acute coronary syndrome (ACS). The study used a quantitative descriptive design. 36 subjects with a diagnosis of ACS were selected from patients admitted to medical units at a teaching hospital in Toronto, Ontario. One-time, semi-structured interviews were conducted using valid and reliable cardiac-specific HS and social support measures. Analysis indicated that subjects with higher perceived social support and patients with higher income reported greater treatment satisfaction and C-HROL. Subjects with severe angina reported a higher perceived level of social support than those with more moderate physical limitation due to angina. Patients' social environment and HS significantly impact their satisfaction with treatment. Patient-centred measures assist in clinical decision-making, patient-centred care planning and patient involvement in their care.

Strategic plan for science-U.S. Geological Survey, Ohio Water Science Center, 2010-15

USGS Publications Warehouse

,

2010-01-01

This Science Plan identifies specific scientific and technical programmatic issues of current importance to Ohio and the Nation. An examination of those issues yielded a set of five major focus areas with associated science goals and strategies that the Ohio Water Science Center will emphasize in its program during 2010-15. A primary goal of the Science Plan is to establish a relevant multidisciplinary scientific and technical program that generates high-quality products that meet or exceed the expectations of our partners while supporting the goals and initiatives of the U.S. Geological Survey. The Science Plan will be used to set the direction of new and existing programs and will influence future training and hiring decisions by the Ohio Water Science Center.

U.S. Geological Survey quality-assurance plan for continuous water-quality monitoring in Kansas, 2014

USGS Publications Warehouse

Bennett, Trudy J.; Graham, Jennifer L.; Foster, Guy M.; Stone, Mandy L.; Juracek, Kyle E.; Rasmussen, Teresa J.; Putnam, James E.

2014-01-01

A quality-assurance plan for use in conducting continuous water-quality monitoring activities has been developed for the Kansas Water Science Center in accordance with guidelines set forth by the U.S. Geological Survey. This quality-assurance plan documents the standards, policies, and procedures used by the U.S. Geological Survey in Kansas for activities related to the collection, processing, storage, analysis, and release of continuous water-quality monitoring data. The policies and procedures that are documented in this quality-assurance plan for continuous water-quality monitoring activities complement quality-assurance plans for surface-water and groundwater activities in Kansas.

Quality-assurance plan for water-quality activities in the U.S. Geological Survey Washington Water Science Center

USGS Publications Warehouse

Conn, Kathleen E.; Huffman, Raegan L.; Barton, Cynthia

2017-05-08

In accordance with guidelines set forth by the Office of Water Quality in the Water Mission Area of the U.S. Geological Survey, a quality-assurance plan has been created for use by the Washington Water Science Center (WAWSC) in conducting water-quality activities. This qualityassurance plan documents the standards, policies, and procedures used by the WAWSC for activities related to the collection, processing, storage, analysis, and publication of water-quality data. The policies and procedures documented in this quality-assurance plan for water-quality activities complement the quality-assurance plans for surface-water and groundwater activities at the WAWSC.

Routine outcome measurement in mental health service consumers: who should provide support for the self-assessments?

PubMed

Gelkopf, Marc; Pagorek-Eshel, Shira; Trauer, Tom; Roe, David

2015-06-01

This study examined whether mental health community service users completed outcome self-reports differently when assessments were supervised by internal vs. external staff. The examination of potential differences between the two has useful implications for mental health systems that take upon themselves the challenge of Routine Outcome Measurement (ROM), as it might impact allocation of public resources and managed care program planning. 73 consumers completed the Manchester Short Assessment of Quality of Life (MANSA), a shortened version of the Recovery Assessment Scale (RAS), and a functioning questionnaire. Questionnaires were administered, once using support provided by internal staff and once using support provided by external professional staff, with a one-month time interval and in random order. A MANOVA Repeated Measures showed no differences in outcomes of quality of life and recovery between internal and external support. Functioning scores were higher for the internal support when the internal assessments were performed first. Overall, except for the differences in functioning assessment, outcome scores were not determined by the supporting agency. This might indicate that when measuring quality of life and recovery, different supporting methods can be used to gather outcome measures and internal staff might be a good default agency to do this. Differences found in functioning assessment are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Support for comprehensive reuse

NASA Technical Reports Server (NTRS)

Basili, V. R.; Rombach, H. D.

1991-01-01

Reuse of products, processes, and other knowledge will be the key to enable the software industry to achieve the dramatic improvement in productivity and quality required to satisfy the anticipated growing demands. Although experience shows that certain kinds of reuse can be successful, general success has been elusive. A software life-cycle technology which allows comprehensive reuse of all kinds of software-related experience could provide the means to achieving the desired order-of-magnitude improvements. A comprehensive framework of models, model-based characterization schemes, and support mechanisms for better understanding, evaluating, planning, and supporting all aspects of reuse are introduced.

360-degree physician performance assessment.

PubMed

Dubinsky, Isser; Jennings, Kelly; Greengarten, Moshe; Brans, Amy

2010-01-01

Few jurisdictions have a robust common approach to assessing the quantitative and qualitative dimensions of physician performance. In this article, we examine the need for 360-degree physician performance assessment and review the literature supporting comprehensive physician assessment. An evidence-based, "best practice" approach to the development of a 360-degree physician performance assessment framework is presented, including an overview of a tool kit to support implementation. The focus of the framework is to support physician career planning and to enhance the quality of patient care. Finally, the legal considerations related to implementing 360-degree physician performance assessment are explored.

Medical technology companies broaden role to support the financial success of clinics.

PubMed

Johansson, Soren

2003-01-01

Market challenges continue to mount for hospitals and clinics, causing an unparalleled focus on profitability and return on investment for services. To support these challenges, technology suppliers that were once content to deliver and install equipment have become partners with the institutions they serve. Savvy technology companies are offering an extensive array of services that assist facilities in the planning, cost justification, implementation and ongoing support of their technology. The result is a marriage of progress and profit, resulting in solutions that enhance both the quality of care and the bottom line.

Patient-specific dosimetric endpoints based treatment plan quality control in radiotherapy.

PubMed

Song, Ting; Staub, David; Chen, Mingli; Lu, Weiguo; Tian, Zhen; Jia, Xun; Li, Yongbao; Zhou, Linghong; Jiang, Steve B; Gu, Xuejun

2015-11-07

In intensity modulated radiotherapy (IMRT), the optimal plan for each patient is specific due to unique patient anatomy. To achieve such a plan, patient-specific dosimetric goals reflecting each patient's unique anatomy should be defined and adopted in the treatment planning procedure for plan quality control. This study is to develop such a personalized treatment plan quality control tool by predicting patient-specific dosimetric endpoints (DEs). The incorporation of patient specific DEs is realized by a multi-OAR geometry-dosimetry model, capable of predicting optimal DEs based on the individual patient's geometry. The overall quality of a treatment plan is then judged with a numerical treatment plan quality indicator and characterized as optimal or suboptimal. Taking advantage of clinically available prostate volumetric modulated arc therapy (VMAT) treatment plans, we built and evaluated our proposed plan quality control tool. Using our developed tool, six of twenty evaluated plans were identified as sub-optimal plans. After plan re-optimization, these suboptimal plans achieved better OAR dose sparing without sacrificing the PTV coverage, and the dosimetric endpoints of the re-optimized plans agreed well with the model predicted values, which validate the predictability of the proposed tool. In conclusion, the developed tool is able to accurately predict optimally achievable DEs of multiple OARs, identify suboptimal plans, and guide plan optimization. It is a useful tool for achieving patient-specific treatment plan quality control.

Microbiological, Geochemical and Hydrologic Processes Controlling Uranium Mobility: An Integrated Field-Scale Subsurface Research Challenge Site at Rifle, Colorado, Quality Assurance Project Plan

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

Fix, N. J.

The U.S. Department of Energy (DOE) is cleaning up and/or monitoring large, dilute plumes contaminated by metals, such as uranium and chromium, whose mobility and solubility change with redox status. Field-scale experiments with acetate as the electron donor have stimulated metal-reducing bacteria to effectively remove uranium [U(VI)] from groundwater at the Uranium Mill Tailings Site in Rifle, Colorado. The Pacific Northwest National Laboratory and a multidisciplinary team of national laboratory and academic collaborators has embarked on a research proposed for the Rifle site, the object of which is to gain a comprehensive and mechanistic understanding of the microbial factors andmore » associated geochemistry controlling uranium mobility so that DOE can confidently remediate uranium plumes as well as support stewardship of uranium-contaminated sites. This Quality Assurance Project Plan provides the quality assurance requirements and processes that will be followed by the Rifle Integrated Field-Scale Subsurface Research Challenge Project.« less

Quality Assurance Program Plan for SFR Metallic Fuel Data Qualification

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

Benoit, Timothy; Hlotke, John Daniel; Yacout, Abdellatif

2017-07-05

This document contains an evaluation of the applicability of the current Quality Assurance Standards from the American Society of Mechanical Engineers Standard NQA-1 (NQA-1) criteria and identifies and describes the quality assurance process(es) by which attributes of historical, analytical, and other data associated with sodium-cooled fast reactor [SFR] metallic fuel and/or related reactor fuel designs and constituency will be evaluated. This process is being instituted to facilitate validation of data to the extent that such data may be used to support future licensing efforts associated with advanced reactor designs. The initial data to be evaluated under this program were generatedmore » during the US Integral Fast Reactor program between 1984-1994, where the data includes, but is not limited to, research and development data and associated documents, test plans and associated protocols, operations and test data, technical reports, and information associated with past United States Nuclear Regulatory Commission reviews of SFR designs.« less

Physical Property Analysis and Report for Sediments at 100-BC-5 Operable Unit, Boreholes C7505, C7506, C7507, and C7665

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

Lindberg, Michael J.

2010-09-28

Between October 14, 2009 and February 22, 2010 sediment samples were received from 100-BC Decision Unit for geochemical studies. This is an analytical data report for sediments received from CHPRC at the 100 BC 5 OU. The analyses for this project were performed at the 325 building located in the 300 Area of the Hanford Site. The analyses were performed according to Pacific Northwest National Laboratory (PNNL) approved procedures and/or nationally recognized test procedures. The data sets include the sample identification numbers, analytical results, estimated quantification limits (EQL), and quality control data. The preparatory and analytical quality control requirements, calibrationmore » requirements, acceptance criteria, and failure actions are defined in the on-line QA plan 'Conducting Analytical Work in Support of Regulatory Programs' (CAW). This QA plan implements the Hanford Analytical Services Quality Assurance Requirements Documents (HASQARD) for PNNL.« less

Compatibility Grab Sampling and Analysis Plan for FY 2000

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

SASAKI, L.M.

1999-12-29

This sampling and analysis plan (SAP) identifies characterization objectives pertaining to sample collection, laboratory analytical evaluation, and reporting requirements for grab samples obtained to address waste compatibility. It is written in accordance with requirements identified in Data Quality Objectives for Tank Farms Waste Compatibility Program (Mulkey et al. 1999) and Tank Farm Waste Transfer Compatibility Program (Fowler 1999). In addition to analyses to support Compatibility, the Waste Feed Delivery program has requested that tank samples obtained for Compatibility also be analyzed to confirm the high-level waste and/or low-activity waste envelope(s) for the tank waste (Baldwin 1999). The analytical requirements tomore » confirm waste envelopes are identified in Data Quality Objectives for TWRS Privatization Phase I: Confirm Tank T is an Appropriate Feed Source for Low-Activity Waste Feed Batch X (Nguyen 1999a) and Data Quality Objectives for RPP Privatization Phase I: Confirm Tank T is an Appropriate Feed Source for High-Level Waste Feed Batch X (Nguyen 1999b).« less

Quality-Assurance Plan for Water-Quality Activities of the U.S. Geological Survey Montana Water Science Center

USGS Publications Warehouse

Lambing, John H.

2006-01-01

In accordance with guidelines set forth by the Office of Water Quality in the Water Resources Discipline of the U.S. Geological Survey (USGS), a quality-assurance plan has been created for use by the USGS Montana Water Science Center in conducting water-quality activities. This quality-assurance plan documents the standards, policies, and procedures used by the USGS Montana Water Science Center for activities related to the collection, processing, storage, analysis, and publication of water-quality data. The policies and procedures presented in this quality-assurance plan for water-quality activities complement the quality-assurance plans for surface-water and ground-water activities and suspended-sediment analysis.

CHARACTERIZATION REPORT FOR STRONTIUM TITANATE IN SWSA 7 AND ADJACENT PARCELS IN SUPPORT OF THE NATIONAL PRIORITIES LIST SITE BOUNDARY DEFINITION PROGRAM OAK RIDGE, TENNESSEE

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

David A. King

2011-10-10

The U.S. Department of Energy (DOE) Oak Ridge Office requested support from the Oak Ridge Institute for Science and Education (ORISE) contract to delineate the extent of strontium titanate (SrTiO3) contamination in and around Solid Waste Storage Area (SWSA) 7 as part of the Oak Ridge National Priorities List Site boundary definition program. The study area is presented in Fig. 1.1 relative to the Oak Ridge Reservation (ORR). The investigation was executed according to Sampling and Analysis Plan/Quality Assurance Project Plan (SAP/QAPP) (DOE 2011) to supplement previous investigations noted below and to determine what areas, if any, have been adverselymore » impacted by site operations.« less

Quality-Assurance Plan for Water-Quality Activities in the USGS Ohio Water Science Center

USGS Publications Warehouse

Francy, Donna S.; Shaffer, Kimberly H.

2008-01-01

In accordance with guidelines set forth by the Office of Water Quality in the Water Resources Discipline of the U.S. Geological Survey, a quality-assurance plan has been written for use by the Ohio Water Science Center in conducting water-quality activities. This quality-assurance plan documents the standards, policies, and procedures used by the Ohio Water Science Center for activities related to the collection, processing, storage, analysis, and publication of water-quality data. The policies and procedures documented in this quality-assurance plan for water-quality activities are meant to complement the Ohio Water Science Center quality-assurance plans for water-quality monitors, the microbiology laboratory, and surface-water and ground-water activities.

Involvement of Individuals in the Development of Technical Solutions and Rules of Management for Building Renovation Projects: A Case Study of Latvia

NASA Astrophysics Data System (ADS)

Pukite, I.; Grekis, A.; Geipele, I.; Zeltins, N.

2017-08-01

In March 2016, the Latvian government approved a new support program for increasing energy efficiency in residential apartment buildings. For the support of renovation of apartment buildings in the period from 2016 to 2023, 166 470 588 EUR will be available. Different persons, such as energy auditors, designers, architects, project managers and builders, will be involved in the process of planning, development and implementation of building renovation. At the development stage of the building renovation project, special attention should be devoted to the first stage - energy audit and technical project development. The problem arises due to the fact that each of these individuals, during the development of technical building documentation, does not work as a completely unified system. The implementation of construction project planning and organisational management system is one of the most important factors to guarantee that the quality of building renovation project is ensured in accordance with the laws and regulatory standards. The paper studies mutual cooperation, professionalism and the role of information feedback of personnel involved in the planning stage of building renovation, which is an essential prerequisite for the renovation process in order to achieve high quality of work and reduce the energy performance indicator. The present research includes the analysis of different technical solutions and their impact on energy efficiency. Mutual harmonisation of technical specifications is also investigated.

Development of the breastfeeding quality improvement in hospitals learning collaborative in New York state.

PubMed

Fitzpatrick, Eileen; Dennison, Barbara A; Welge, Sara Bonam; Hisgen, Stephanie; Boyce, Patricia Simino; Waniewski, Patricia A

2013-06-01

Exclusive breastfeeding is a public health priority. A strong body of evidence links maternity care practices, based on the Ten Steps to Successful Breastfeeding, to increased breastfeeding initiation, duration and exclusivity. Despite having written breastfeeding policies, New York (NY) hospitals vary widely in reported maternity care practices and in prevalence rates of breastfeeding, especially exclusive breastfeeding, during the birth hospitalization. To improve hospital maternity care practices, breastfeeding support, and the percentage of infants exclusively breastfeeding, the NY State Department of Health developed the Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative. The BQIH Learning Collaborative was the first to use the Institute for Health Care Improvement's Breakthrough Series methodology to specifically focus on increasing hospital breastfeeding support. The evidence-based maternity care practices from the Ten Steps to Successful Breastfeeding provided the basis for the Change Package and Data Measurement Plan. The present article describes the development of the BQIH Learning Collaborative. The engagement of breastfeeding experts, partners, and stakeholders in refining the Learning Collaborative design and content, in defining the strategies and interventions (Change Package) that drive hospital systems change, and in developing the Data Measurement Plan to assess progress in meeting the Learning Collaborative goals and hospital aims is illustrated. The BQIH Learning Collaborative is a model program that was implemented in a group of NY hospitals with plans to spread to additional hospitals in NY and across the country.

Quality assurance of the SCOPE 1 trial in oesophageal radiotherapy.

PubMed

Wills, Lucy; Maggs, Rhydian; Lewis, Geraint; Jones, Gareth; Nixon, Lisette; Staffurth, John; Crosby, Tom

2017-11-15

SCOPE 1 was the first UK based multi-centre trial involving radiotherapy of the oesophagus. A comprehensive radiotherapy trials quality assurance programme was launched with two main aims: 1. To assist centres, where needed, to adapt their radiotherapy techniques in order to achieve protocol compliance and thereby enable their participation in the trial. 2. To support the trial's clinical outcomes by ensuring the consistent planning and delivery of radiotherapy across all participating centres. A detailed information package was provided and centres were required to complete a benchmark case in which the delineated target volumes and organs at risk, dose distribution and completion of a plan assessment form were assessed prior to recruiting patients into the trial. Upon recruiting, the quality assurance (QA) programme continued to monitor the outlining and planning of radiotherapy treatments. Completion of a questionnaire was requested in order to gather information about each centre's equipment and techniques relating to their trial participation and to assess the impact of the trial nationally on standard practice for radiotherapy of the oesophagus. During the trial, advice was available for individual planning issues, and was circulated amongst the SCOPE 1 community in response to common areas of concern using bulletins. 36 centres were supported through QA processes to enable their participation in SCOPE1. We discuss the issues which have arisen throughout this process and present details of the benchmark case solutions, centre questionnaires and on-trial protocol compliance. The range of submitted benchmark case GTV volumes was 29.8-67.8cm 3 ; and PTV volumes 221.9-513.3 cm 3 . For the dose distributions associated with these volumes, the percentage volume of the lungs receiving 20Gy (V20Gy) ranged from 20.4 to 33.5%. Similarly, heart V40Gy ranged from 16.1 to 33.0%. Incidence of incorrect outlining of OAR volumes increased from 50% of centres at benchmark case, to 64% on trial. Sixty-five percent of centres, who returned the trial questionnaire, stated that their standard practice had changed as a result of their participation in the SCOPE1 trial. The SCOPE 1 QA programme outcomes lend support to the trial's clinical conclusions. The range of patient planning outcomes for the benchmark case indicated, at the outset of the trial, the significant degree of variation present in UK oesophageal radiotherapy planning outcomes, despite the presence of a protocol. This supports the case for increasingly detailed definition of practice by means of consensus protocols, training and peer review. The incidence of minor inconsistencies of technique highlights the potential for improved QA systems and the need for sufficient resource for this to be addressed within future trials. As indicated in questionnaire responses, the QA exercise as a whole has contributed to greater consistency of oesophageal radiotherapy in the UK via the adoption into standard practice of elements of the protocol. The SCOPE1 trial is an International Standard Randomized Controlled Trial, ISRCTN47718479 .

Improving Quality and Reducing Waste in Allied Health Workplace Education Programs: A Pragmatic Operational Education Framework Approach.

PubMed

Golder, Janet; Farlie, Melanie K; Sevenhuysen, Samantha

2016-01-01

Efficient utilisation of education resources is required for the delivery of effective learning opportunities for allied health professionals. This study aimed to develop an education framework to support delivery of high-quality education within existing education resources. This study was conducted in a large metropolitan health service. Homogenous and purposive sampling methods were utilised in Phase 1 (n=43) and 2 (n=14) consultation stages. Participants included 25 allied health professionals, 22 managers, 1 educator, and 3 executives. Field notes taken during 43 semi-structured interviews and 4 focus groups were member-checked, and semantic thematic analysis methods were utilised. Framework design was informed by existing published framework development guides. The framework model contains governance, planning, delivery, and evaluation and research elements and identifies performance indicators, practice examples, and support tools for a range of stakeholders. Themes integrated into framework content include improving quality of education and training provided and delivery efficiency, greater understanding of education role requirements, and workforce support for education-specific knowledge and skill development. This framework supports efficient delivery of allied health workforce education and training to the highest standard, whilst pragmatically considering current allied health education workforce demands.

Data Requirement (DR) MA-03: Payload missions integration. [Spacelab payloads

NASA Technical Reports Server (NTRS)

1985-01-01

Project management and payload integration requirements definition activities are reported. Mission peculiar equipment; systems integration; ground operations analysis and requirement definition; safety and quality assurance; and support systems development are examined for payloads planned for the following missions: EOM-1; SL-2; Sl-3 Astro-1; MSL-2; EASE/ACCESS; MPESS; and the middeck ADSF flight.

77 FR 15996 - Science Advisory Board (SAB); Notice of Open Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-19

... Atmospheric Administration (NOAA) science programs are of the highest quality and provide optimal support to resource management. Time and Date: The meeting will be held Thursday, April 5, 2012 from 9 a.m. to 5:15 p... limited to a total time of five (5) minutes. Individuals or groups planning to make a verbal presentation...

78 FR 15664 - Approval and Promulgation of Air Quality Implementation Plans; New Mexico; Interstate Transport...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-12

... technical analysis supporting New Mexico's conclusion as recommended by EPA's guidance memorandum that... modeling technical analyses are available, but EPA does not believe that modeling is necessarily required...)(2)(D)(i)(I) for the 2006 PM 2.5 NAAQS in several ways. It takes into account the technical analysis...

Crane Cell Testing Support of Nasa/goddard Space Flight Center: an Update

NASA Technical Reports Server (NTRS)

Strawn, Mike; David, Jerry; Rao, Gopalakrishna M.

2001-01-01

The objective of this paper is to verify the quality and reliability of aerospace battery cells and batteries for NASA flight programs, disseminate the data - to develop a plan for in-orbit battery management - to design a cell/battery for future NASA spacecraft and establish a cell test data base for rechargeable cell/batteries.

Case Study in the Power of Collaboration: Planning Process for the Kansas Educational Leadership Institute

ERIC Educational Resources Information Center

Devin, Mary

2013-01-01

This article reports on the collaborative efforts undertaken for systematic statewide support for the recruitment, development, and retention of quality leaders in schools and school districts in Kansas, USA. The author presents the case of a strong sense of "collaboration" that made the difference and stimulated movement from vision…

78 FR 6733 - Approval and Promulgation of Air Quality Implementation Plans; Minnesota; Flint Hills Resources...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-31

... corresponding to a new boiler were included in the modeling analysis performed for this SIP revision request... different from those used in the dispersion modeling supporting the August 29, 2011 SIP revision request... decoking process uses steam, air, heat, and water to periodically remove coke buildup from process heater...

76 FR 43898 - Approval and Promulgation of State Implementation Plan Revisions; Infrastructure Requirements for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-22

...: The commenter supported EPA's efforts to require ozone monitoring in Utah's Uinta Basin. However, the... air quality in the basin is not in compliance with the ozone standard,'' to designate the Uinta Basin... commenter refers to. For a discussion of other monitoring data in the Uinta Basin, see the response to...

Healthcare information systems: data mining methods in the creation of a clinical recommender system

NASA Astrophysics Data System (ADS)

Duan, L.; Street, W. N.; Xu, E.

2011-05-01

Recommender systems have been extensively studied to present items, such as movies, music and books that are likely of interest to the user. Researchers have indicated that integrated medical information systems are becoming an essential part of the modern healthcare systems. Such systems have evolved to an integrated enterprise-wide system. In particular, such systems are considered as a type of enterprise information systems or ERP system addressing healthcare industry sector needs. As part of efforts, nursing care plan recommender systems can provide clinical decision support, nursing education, clinical quality control, and serve as a complement to existing practice guidelines. We propose to use correlations among nursing diagnoses, outcomes and interventions to create a recommender system for constructing nursing care plans. In the current study, we used nursing diagnosis data to develop the methodology. Our system utilises a prefix-tree structure common in itemset mining to construct a ranked list of suggested care plan items based on previously-entered items. Unlike common commercial systems, our system makes sequential recommendations based on user interaction, modifying a ranked list of suggested items at each step in care plan construction. We rank items based on traditional association-rule measures such as support and confidence, as well as a novel measure that anticipates which selections might improve the quality of future rankings. Since the multi-step nature of our recommendations presents problems for traditional evaluation measures, we also present a new evaluation method based on average ranking position and use it to test the effectiveness of different recommendation strategies.

Protocol for monitoring metals in Ozark National Scenic Riverways, Missouri: Version 1.0

USGS Publications Warehouse

Schmitt, Christopher J.; Brumbaugh, William G.; Besser, John M.; Hinck, Jo Ellen; Bowles, David E.; Morrison, Lloyd W.; Williams, Michael H.

2008-01-01

The National Park Service is developing a monitoring plan for the Ozark National Scenic Riverways in southeastern Missouri. Because of concerns about the release of lead, zinc, and other metals from lead-zinc mining to streams, the monitoring plan will include mining-related metals. After considering a variety of alternatives, the plan will consist of measuring the concentrations of cadmium, cobalt, lead, nickel, and zinc in composite samples of crayfish (Orconectes luteus or alternate species) and Asian clam (Corbicula fluminea) collected periodically from selected sites. This document, which comprises a protocol narrative and supporting standard operating procedures, describes the methods to be employed prior to, during, and after collection of the organisms, along with procedures for their chemical analysis and quality assurance; statistical analysis, interpretation, and reporting of the data; and for modifying the protocol narrative and supporting standard operating procedures. A list of supplies and equipment, data forms, and sample labels are also included. An example based on data from a pilot study is presented.

Building partnerships for healthy environments: research, leadership and education.

PubMed

Thompson, Susan; Kent, Jennifer; Lyons, Claudine

2014-12-01

As populations across the globe face an increasing health burden from rising rates of obesity, diabetes and other lifestyle-related diseases, health professionals are collaborating with urban planners to influence city design that supports healthy ways of living. This paper details the establishment and operation of an innovative, interdisciplinary collaboration that brings together urban planning and health. Situated in a built environment faculty at one of Australia's most prestigious universities, the Healthy Built Environments Program (HBEP) partners planning academics, a health non-government organisation, local councils and private planning consultants in a state government health department funded consortium. The HBEP focuses on three strategic areas: research, workforce development and education, and leadership and advocacy. Interdisciplinary research includes a comprehensive literature review that establishes Australian-based evidence to support the development, prioritisation and implementation of healthy built environment policies and practices. Another ongoing study examines the design features, social interventions and locational qualities that positively benefit human health. Formal courses, workshops, public lectures and e-learning develop professional capacity, as well as skills in interdisciplinary practice to support productive collaborations between health professionals and planners. The third area involves working with government and non-government agencies, and the private sector and the community, to advocate closer links between health and the built environment. Our paper presents an overview of the HBEP's major achievements. We conclude with a critical review of the challenges, revealing lessons in bringing health and planning closer together to create health-supportive cities for the 21st century.

An ounce of prevention. Is family planning disappearing from the healthcare picture?

PubMed

Hirshbein, N

1992-04-01

Despite family planning's enormous health and social benefits, US support for family planning is dwindling. Not only does family planning improve the health quality of life of children and their parents, it is also a cost-effective measure, saving an average of $4.40 in health and social services costs for each public dollar invested in the program. But over the past few years, political and financial neglect have brought the public family planning infrastructure near collapse. Combined federal and state spending on family planning amounts to less than 1% of public health care funds. In 1990, Medicaid represented the largest source of funds for family planning. But since Medicaid is tied to welfare eligibility, a woman must already have a child in order to qualify for Medicaid and its family planning benefits. Direct state funding for family planning services was the 2nd largest source. Several states, however, provided no funding whatsoever for family planning. The 3rd largest source was the Title X program, a federal program devoted exclusively to family planning. It provides services to some 4 million teens and low-income women nationwide. Over the past decade, Title X has received no significant increase in funding, and inflation has reduced its purchasing power by 2/3. As a result, Title X serves less women. Meanwhile, the number of unintended pregnancies continues to increase. The US already has the highest rate of unintended pregnancies in the developed world. This is partly a result of society's ambivalence towards sex, which makes it difficult to discuss -- much less promote -- family planning. Lack of support for family planning can also be traced to the vigorous efforts of the anti-birth control lobby, which has successfully defeated attempts to increase funding.

Business planning for university health science programs: a case study.

PubMed

Austin, Michael; Milos, Nadine; Raborn, G Wayne

2002-02-01

Many publicly funded education programs and organizations have developed business plans to enhance accountability. In the case of the Department of Dentistry at the University of Alberta, the main impetus for business planning was a persistent deficit in the annual operating fund since a merger of a stand-alone dental faculty with the Faculty of Medicine. The main challenges were to balance revenues with expenditures, to reduce expenditures without compromising quality of teaching, service delivery and research, to maintain adequate funding to ensure future competitiveness, and to repay the accumulated debt owed to the university. The business plan comprises key strategies in the areas of education, clinical practice and service, and research. One of the strategies for education was to start a BSc program in dental hygiene, which was accomplished in September 2000. In clinical practice, a key strategy was implementation of a clinic operations fee, which also occurred in September 2000. This student fee helps to offset the cost of clinical practice. In research, a key strategy has been to strengthen our emphasis on prevention technologies. In completing the business plan, we learned the importance of identifying clear goals and ensuring that the goals are reasonable and achievable; gaining access to high-quality data to support planning; and nurturing existing positive relationships with external stakeholders such as the provincial government and professional associations.

Quality-assurance and data-management plan for water-quality activities in the Kansas Water Science Center, 2014

USGS Publications Warehouse

Rasmussen, Teresa J.; Bennett, Trudy J.; Foster, Guy M.; Graham, Jennifer L.; Putnam, James E.

2014-01-01

As the Nation’s largest water, earth, and biological science and civilian mapping information agency, the U.S. Geological Survey is relied on to collect high-quality data, and produce factual and impartial interpretive reports. This quality-assurance and data-management plan provides guidance for water-quality activities conducted by the Kansas Water Science Center. Policies and procedures are documented for activities related to planning, collecting, storing, documenting, tracking, verifying, approving, archiving, and disseminating water-quality data. The policies and procedures described in this plan complement quality-assurance plans for continuous water-quality monitoring, surface-water, and groundwater activities in Kansas.

An Overview of Transition Planning for Students Who Are Deafblind.

PubMed

Zatta, Mary; McGinnity, Betsy

2016-01-01

Children who are deafblind are one of the lowest-incidence yet most diverse groups receiving services mandated by the Individuals With Disabilities Education Improvement Act. Despite this population's diversity, the development of communication skills is critical for all children who are deafblind, and is the foundation on which good transition planning can be built. The authors describe key research findings and other professional literature on transition planning and services guided by the quality of life principle. The role of the individualized education program and case law in transition planning is discussed. Through a person-centered approach to transition planning, a coordinated set of activities designed to support the young adult in moving from school to postschool settings and activities is identified. The authors conclude that effective transition efforts will involve extensive collaboration among school and agency professionals, families, and the young adult who is deafblind.

SU-F-P-64: The Impact of Plan Complexity Parameters On the Plan Quality and Deliverability of Volumetric Modulated Arc Therapy with Canonical Correlation Analysis

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

Jin, X; Yi, J; Xie, C

Purpose: To evaluate the impact of complexity indices on the plan quality and deliverability of volumetric modulated arc therapy (VMAT), and to determine the most significant parameters in the generation of an ideal VMAT plan. Methods: A multi-dimensional exploratory statistical method, canonical correlation analysis (CCA) was adopted to study the correlations between VMAT parameters of complexity, quality and deliverability, as well as their contribution weights with 32 two-arc VMAT nasopharyngeal cancer (NPC) patients and 31 one-arc VMAT prostate cancer patients. Results: The MU per arc (MU/Arc) and MU per control point (MU/CP) of NPC were 337.8±25.2 and 3.7±0.3, respectively, whichmore » were significantly lower than those of prostate cancer patients (MU/Arc : 506.9±95.4, MU/CP : 5.6±1.1). The plan complexity indices indicated that two-arc VMAT plans were more complex than one-arc VMAT plans. Plan quality comparison confirmed that one-arc VMAT plans had a high quality than two-arc VMAT plans. CCA results implied that plan complexity parameters were highly correlated with plan quality with the first two canonical correlations of 0.96, 0.88 (both p<0.001) and significantly correlated with deliverability with the first canonical correlation of 0.79 (p<0.001), plan quality and deliverability was also correlated with the first canonical correlation of 0.71 (p=0.02). Complexity parameters of MU/CP, segment area (SA) per CP, percent of MU/CP less 3 and planning target volume (PTV) were weighted heavily in correlation with plan quality and deliveability . Similar results obtained from individual NPC and prostate CCA analysis. Conclusion: Relationship between complexity, quality, and deliverability parameters were investigated with CCA. MU, SA related parameters and PTV volume were found to have strong effect on the plan quality and deliverability. The presented correlation among different quantified parameters could be used to improve the plan quality and the efficiency of the radiotherapy process when creating a complex VMAT plan.« less

Evaluation of NASA Data Products for RPO Applications

NASA Technical Reports Server (NTRS)

Frisbie, Troy; Knowlton, Kelly; Andrews, Jane

2005-01-01

This presentation summarizes preliminary investigations at SSC by NASA's ASD in Air Quality including decision support tools, partner plans, working groups, and committees. An overview of follow-on short-term and long-term objectives is also provided. A table of potential NASA sensors for use with air quality applications is included, along with specifications for MODIS 04 and 06 products. This presentation was originally given by Rich Piorot of the Vermont Department of Environmental Conservation - Air Quality as part of a round-table discussion during "Exploring Collaborative Opportunities in Air Quality Monitoring, Modelling and Communication Workshop" in Boulder, CO, on March 21-22, 2005; verbal consent for this presentation to be provided to Mr. Piorot was given by the NASA SSC ASD Air Quality Program Manager on March 14, 2005.

Mathematical Modeling of Food Supply for Long Term Space Missions Using Advanced Life Support

NASA Technical Reports Server (NTRS)

Cruthirds, John E.

2003-01-01

A habitat for long duration missions which utilizes Advanced Life Support (ALS), the Bioregenerative Planetary Life Support Systems Test Complex (BIO-Plex), is currently being built at JSC. In this system all consumables will be recycled and reused. In support of this effort, a menu is being planned utilizing ALS crops that will meet nutritional and psychological requirements. The need exists in the food system to identify specific physical quantities that define life support systems from an analysis and modeling perspective. Once these quantities are defined, they need to be fed into a mathematical model that takes into consideration other systems in the BIO-Plex. This model, if successful, will be used to understand the impacts of changes in the food system on the other systems and vice versa. The Equivalent System Mass (ESM) metric has been used to describe systems and subsystems, including the food system options, in terms of the single parameter, mass. There is concern that this approach might not adequately address the important issues of food quality and psychological impact on crew morale of a supply of fiesh food items. In fact, the mass of food can also depend on the quality of the food. This summer faculty fellow project will involve creating an appropriate mathematical model for the food plan developed by the Food Processing System for BIO-Plex. The desired outcome of this work will be a quantitative model that can be applied to the various options of supplying food on long-term space missions.

The Medicare Health Outcomes Survey program: overview, context, and near-term prospects.

PubMed

Jones, Nathaniel; Jones, Stephanie L; Miller, Nancy A

2004-07-12

In 1996, the Centers for Medicare & Medicaid Services (CMS) initiated the Medicare Health Outcomes Survey (HOS). It is the first national survey to measure the quality of life and functional health status of Medicare beneficiaries enrolled in managed care. The program seeks to gather valid and reliable health status data in Medicare managed care for use in quality improvement activities, public reporting, plan accountability and improving health outcomes based on competition. The context that led to the development of the HOS was formed by the convergence of the following factors: 1) a recognized need to monitor the performance of managed care plans, 2) technical expertise and advancement in the areas of quality measurement and health outcomes assessment, 3) the existence of a tested functional health status assessment tool (SF-36)1, which was valid for an elderly population, 4) CMS leadership, and 5) political interest in quality improvement. Since 1998, there have been six baseline surveys and four follow up surveys. CMS, working with its partners, performs the following tasks as part of the HOS program: 1) Supports the technical/scientific development of the HOS measure, 2) Certifies survey vendors, 3) Collects Health Plan Employer Data and Information Set(HEDIS)2 HOS data, 4) Cleans, scores, and disseminates annual rounds of HOS data, public use files and reports to CMS, Quality Improvement Organizations (QIOs), Medicare+Choice Organizations (M+COs), and other stakeholders, 5) Trains M+COs and QIOs in the use of functional status measures and best practices for improving care, 6) Provides technical assistance to CMS, QIOs, M+COs and other data users, and 7) Conducts analyses using HOS data to support CMS and HHS priorities.CMS has recently sponsored an evaluation of the HOS program, which will provide the information necessary to enhance the future administration of the program. Information collected to date reveals that the HOS program is a valuable tool that provides a rich set of data that is useful for quality monitoring and improvement efforts. To enhance the future of the HOS program, many stakeholders recommend the implementation of incentives to encourage the use of the data, while others identify the need to monitor the health status of plan disenrollees.Overall, the HOS program represents an important vehicle for collecting outcomes data from Medicare beneficiaries. The new Medicare Prescription Drug, Improvement, and Modernization Act (2003) mandates the collection and use of data for outcomes measurement. Consequently, it is important to improve HOS to most effectively meet the mandate.

Plan-provider integration, premiums, and quality in the Medicare Advantage market.

PubMed

Frakt, Austin B; Pizer, Steven D; Feldman, Roger

2013-12-01

To investigate how integration between Medicare Advantage plans and health care providers is related to plan premiums and quality ratings. We used public data from the Centers for Medicare and Medicaid Services (CMS) and the Area Resource File and private data from one large insurer. Premiums and quality ratings are from 2009 CMS administrative files and some control variables are historical. We estimated ordinary least-squares models for premiums and plan quality ratings, with state fixed effects and firm random effects. The key independent variable was an indicator of plan-provider integration. With the exception of Medigap premium data, all data were publicly available. We ascertained plan-provider integration through examination of plans' websites and governance documents. We found that integrated plan-providers charge higher premiums, controlling for quality. Such plans also have higher quality ratings. We found no evidence that integration is associated with more generous benefits. Current policy encourages plan-provider integration, although potential effects on health insurance products and markets are uncertain. Policy makers and regulators may want to closely monitor changes in premiums and quality after integration and consider whether quality improvement (if any) justifies premium increases (if they occur). © Health Research and Educational Trust.

Integrating ecosystem-service tradeoffs into land-use decisions

PubMed Central

Goldstein, Joshua H.; Caldarone, Giorgio; Duarte, Thomas Kaeo; Ennaanay, Driss; Hannahs, Neil; Mendoza, Guillermo; Polasky, Stephen; Wolny, Stacie; Daily, Gretchen C.

2012-01-01

Recent high-profile efforts have called for integrating ecosystem-service values into important societal decisions, but there are few demonstrations of this approach in practice. We quantified ecosystem-service values to help the largest private landowner in Hawaii, Kamehameha Schools, design a land-use development plan that balances multiple private and public values on its North Shore land holdings (Island of O’ahu) of ∼10,600 ha. We used the InVEST software tool to evaluate the environmental and financial implications of seven planning scenarios encompassing contrasting land-use combinations including biofuel feedstocks, food crops, forestry, livestock, and residential development. All scenarios had positive financial return relative to the status quo of negative return. However, tradeoffs existed between carbon storage and water quality as well as between environmental improvement and financial return. Based on this analysis and community input, Kamehameha Schools is implementing a plan to support diversified agriculture and forestry. This plan generates a positive financial return ($10.9 million) and improved carbon storage (0.5% increase relative to status quo) with negative relative effects on water quality (15.4% increase in potential nitrogen export relative to status quo). The effects on water quality could be mitigated partially (reduced to a 4.9% increase in potential nitrogen export) by establishing vegetation buffers on agricultural fields. This plan contributes to policy goals for climate change mitigation, food security, and diversifying rural economic opportunities. More broadly, our approach illustrates how information can help guide local land-use decisions that involve tradeoffs between private and public interests. PMID:22529388

Integrating ecosystem-service tradeoffs into land-use decisions.

PubMed

Goldstein, Joshua H; Caldarone, Giorgio; Duarte, Thomas Kaeo; Ennaanay, Driss; Hannahs, Neil; Mendoza, Guillermo; Polasky, Stephen; Wolny, Stacie; Daily, Gretchen C

2012-05-08

Recent high-profile efforts have called for integrating ecosystem-service values into important societal decisions, but there are few demonstrations of this approach in practice. We quantified ecosystem-service values to help the largest private landowner in Hawaii, Kamehameha Schools, design a land-use development plan that balances multiple private and public values on its North Shore land holdings (Island of O'ahu) of ∼10,600 ha. We used the InVEST software tool to evaluate the environmental and financial implications of seven planning scenarios encompassing contrasting land-use combinations including biofuel feedstocks, food crops, forestry, livestock, and residential development. All scenarios had positive financial return relative to the status quo of negative return. However, tradeoffs existed between carbon storage and water quality as well as between environmental improvement and financial return. Based on this analysis and community input, Kamehameha Schools is implementing a plan to support diversified agriculture and forestry. This plan generates a positive financial return ($10.9 million) and improved carbon storage (0.5% increase relative to status quo) with negative relative effects on water quality (15.4% increase in potential nitrogen export relative to status quo). The effects on water quality could be mitigated partially (reduced to a 4.9% increase in potential nitrogen export) by establishing vegetation buffers on agricultural fields. This plan contributes to policy goals for climate change mitigation, food security, and diversifying rural economic opportunities. More broadly, our approach illustrates how information can help guide local land-use decisions that involve tradeoffs between private and public interests.

40 CFR 130.9 - Designation and de-designation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... QUALITY PLANNING AND MANAGEMENT § 130.9 Designation and de-designation. (a) Designation. Areawide planning... specified in Water Quality Management (WQM) plans. Areawide planning agencies shall monitor DMA activities... continue water quality planning activities within the designated boundaries. (c) Impact of de-designation...

Developing a caries risk registry to support caries risk assessment and management for children: A quality improvement initiative.

PubMed

Ruff, Jesley C; Herndon, Jill Boylston; Horton, Roger A; Lynch, Julie; Mathwig, Dawn C; Leonard, Audra; Aravamudhan, Krishna

2017-10-27

Health registries are commonly used in medicine to support public health activities and are increasingly used in quality improvement (QI) initiatives. Illustrations of dental registries and their QI applications are lacking. Within dentistry, caries risk assessment implementation and documentation are vital to optimal patient care. The purpose of this article is to describe the processes used to develop a caries risk assessment registry as a QI initiative to support clinical caries risk assessment, caries prevention, and disease management for children. Developmental steps reflected Agency for Healthcare Research and Quality recommendations for planning QI registries and included engaging "champions," defining the project, identifying registry features, defining performance dashboard indicators, and pilot testing with participant feedback. We followed Standards for Quality Improvement Reporting Excellence guidelines. Registry eligibility is patients aged 0-17 years. QI tools include prompts to register eligible patients; decision support tools grounded in evidence-based guidelines; and performance dashboard reports delivered at the provider and aggregated levels at regular intervals. The registry was successfully piloted in two practices with documented caries risk assessment increasing from 57 percent to 92 percent and positive feedback regarding the potential to improve dental practice patient centeredness, patient engagement and education, and quality of care. The caries risk assessment registry demonstrates how dental registries may be used in QI efforts to promote joint patient and provider engagement, foster shared decision making, and systematically collect patient information to generate timely and actionable data to improve care quality and patient outcomes at the individual and population levels. © 2017 American Association of Public Health Dentistry.

Observations and lessons learnt from more than a decade of water safety planning in South-East Asia.

PubMed

Sutherland, David

2017-09-01

In many countries of the World Health Organization (WHO) South-East Asia Region, drinking water is not used directly from the tap and faecal contamination of water sources is prevalent. As reflected in Sustainable Development Goal 6, access to safer drinking water is one of the most successful ways of preventing disease. The WHO Water Safety Framework promotes the use of water safety plans (WSPs), which are structured tools that help identify and mitigate potential risks throughout a water-supply system, from the water source to the point of use. WSPs not only help prevent outbreaks of acute and chronic waterborne diseases but also improve water-supply management and performance. During the past 12 years, through the direct and indirect work of a water quality partnership supported by the Australian Government, more than 5000 urban and rural WSPs have been implemented in the region. An impact assessment based on pre- and post-WSP surveys suggests that WSPs have improved system operations and management, infrastructure and performance; leveraged donor funds; increased stakeholder communication and collaboration; increased testing of water quality; and increased monitoring of consumer satisfaction. These achievements, and their sustainability, are being achieved through national legislation and regulatory frameworks for water supply, including quality standards for drinking water; national training tools and extensive training of sector professionals and creation of WSP experts; model WSPs; WSP auditing systems; and the institution of longterm training and support. More than a decade of water safety planning using the WSP approach has shown that supplying safe drinking water at the tap throughout the WHO South-East Asia Region is a realistic goal.

SU-F-T-402: The Effect of Extremely Narrow MLC Leaf Width On the Plan Quality of VMAT for Prostate Cancer

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

Kim, J; Park, S; Kim, J

2016-06-15

Purpose: To investigate the effect of multi-leaf collimators (MLCs) with leaf width of 1.25 mm on the plan quality of volumetric modulated arc therapy (VMAT) for prostate cancer. Methods: A total of 20 patients with prostate cancer were retrospectively selected. Using a high definition MLC (HD MLC), primary and boost VMAT plans with two full arcs were generated for each patient (original plan). After that, by shifting patient CT images by 1.25 mm in the cranio-caudal direction between the 1st and the 2nd arc, we simulated fluences made with MLCs with leaf width of 1.25 mm. After shifting, primary andmore » boost plans were generated for each patient (shifted plan). A sum plan was generated by summation of the primary and boost plan for each patient. Dose-volumetric parameters were calculated and compared. Results: Both homogeneity index (HI) and conformity index (CI) of the shifted plans were better than those of the original plans in primary plans (HI = 0.044 vs. 0.040 with p < 0.001 and CI = 1.056 vs. 1.044 with p = 0.006). Similarly, the shifted plans for boost target volume showed better homogeneity and conformity than did the original plans (HI = 0.042 vs. 0.037 with p = 0.006 and CI = 1.015 vs. 1.009 with p < 0.001). The total body volumes of the original plans irradiated by the prescription dose were larger than those of the shifted plans in sum plans (60.9 cc vs. 49.0 cc with p = 0.007). Conclusion: Use of extremely narrow MLCs could increase dose homogeneity and conformity of the target volume for prostate VMAT. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. 2015R1C1A1A02036331).« less

Making a business case for small medical practices to maintain quality while addressing racial healthcare disparities.

PubMed

Dunston, Frances J; Eisenberg, Andrew C; Lewis, Evelyn L; Montgomery, John M; Ramos, Diana; Elster, Arthur

2008-11-01

Various reports have documented variations in quality of care that occur among racial and ethnic populations, even after accounting for socioeconomic factors and health insurance status. Although quality improvement initiatives are often touted as the answer to healthcare disparities, researchers have questioned whether a business case exists that supports this notion. We assess various barriers and incentives for using quality improvement to address racial and ethnic healthcare disparities in small-to-medium-sized practices. We believe that although both indirect and direct cost incentives may exist, a favorable business case for small private practices cannot be made unless there are additional financial incentives. The business community can work with health plans to provide these incentives.

7 CFR 634.23 - Water quality plan.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 6 2012-01-01 2012-01-01 false Water quality plan. 634.23 Section 634.23 Agriculture... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.23 Water quality plan. (a) The participant's water quality plan, developed with technical assistance by the NRCS or its...

7 CFR 634.23 - Water quality plan.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 6 2013-01-01 2013-01-01 false Water quality plan. 634.23 Section 634.23 Agriculture... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.23 Water quality plan. (a) The participant's water quality plan, developed with technical assistance by the NRCS or its...

7 CFR 634.23 - Water quality plan.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 6 2014-01-01 2014-01-01 false Water quality plan. 634.23 Section 634.23 Agriculture... AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.23 Water quality plan. (a) The participant's water quality plan, developed with technical assistance by the NRCS or its...

42 CFR 441.474 - Quality assurance and improvement plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assurance and improvement plan. 441.474... SERVICES Optional Self-Directed Personal Assistance Services Program § 441.474 Quality assurance and improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State...

42 CFR 441.474 - Quality assurance and improvement plan.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Quality assurance and improvement plan. 441.474... SERVICES Optional Self-Directed Personal Assistance Services Program § 441.474 Quality assurance and improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State...

42 CFR 441.474 - Quality assurance and improvement plan.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Quality assurance and improvement plan. 441.474... SERVICES Optional Self-Directed Personal Assistance Services Program § 441.474 Quality assurance and improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State...

42 CFR 441.474 - Quality assurance and improvement plan.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Quality assurance and improvement plan. 441.474... SERVICES Optional Self-Directed Personal Assistance Services Program § 441.474 Quality assurance and improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State...

42 CFR 441.474 - Quality assurance and improvement plan.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Quality assurance and improvement plan. 441.474... SERVICES Optional Self-Directed Personal Assistance Services Program § 441.474 Quality assurance and improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State...

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

Matthews, Patrick K.

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 550: Smoky Contamination Area, Nevada National Security Site, Nevada. CAU 550 includes 19 corrective action sites (CASs), which consist of one weapons-related atmospheric test (Smoky), three safety experiments (Ceres, Oberon, Titania), and 15 debris sites (Table ES-1). The CASs were sorted into the following study groups based on release potential and technical similarities: • Study Group 1, Atmospheric Test • Study Group 2, Safety Experiments • Study Group 3, Washes • Study Group 4, Debris The purpose of this document is to provide justificationmore » and documentation supporting the conclusion that no further corrective action is needed for CAU 550 based on implementation of the corrective actions listed in Table ES-1. Corrective action investigation (CAI) activities were performed between August 2012 and October 2013 as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 550: Smoky Contamination Area; and in accordance with the Soils Activity Quality Assurance Plan. The approach for the CAI was to investigate and make data quality objective (DQO) decisions based on the types of releases present. The purpose of the CAI was to fulfill data needs as defined during the DQO process. The CAU 550 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in fulfilling the DQO data needs.« less

78 FR 10589 - Revision of Air Quality Implementation Plan; California; Sacramento Metropolitan Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-14

... Quality Implementation Plan; California; Sacramento Metropolitan Air Quality Management District... Sacramento Metropolitan Air Quality Management District (SMAQMD or District) portion of the California State... sources within the areas covered by the plan as necessary to assure that the National Ambient Air Quality...

77 FR 73320 - Approval of Air Quality Implementation Plans; California; South Coast Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-10

... Quality Implementation Plans; California; South Coast Air Quality Management District; Prevention of... Implementation Plan (SIP) revision for the South Coast Air Quality Management District (SCAQMD or District... in a August 15, 2012 letter from the South Coast Air Quality Management District regarding specific...

Strengthening decentralized primary healthcare planning in Nigeria using a quality improvement model: how contexts and actors affect implementation.

PubMed

Eboreime, Ejemai Amaize; Nxumalo, Nonhlanhla; Ramaswamy, Rohit; Eyles, John

2018-05-08

Quality improvement models have been applied across various levels of health systems with varying success leading to scepticisms about effectiveness. Health systems are complex, influenced by contexts and characterized by numerous interests. Thus, a shift in focus from examining whether improvement models work, to understanding why, when and where they work most effectively is essential. Nigeria introduced DIVA (Diagnose-Intervene-Verify-Adjust) as a model to strengthen decentralized PHC planning. However, implementation has been poorly sustained. This article explores the role of actors and context in implementation and sustainability of DIVA in two local government areas (LGAs) in Nigeria. We employed an integrated mixed method approach in which qualitative data was used in conjunction with quantitative to understand effects of actors and contexts on implementation outcomes. We analysed policy documents and conducted interviews with PHC managers. Then using the Model for Understanding Success in Quality (MUSIQ), we measured contextual factors affecting implementation of DIVA in the selected LGAs. The LGAs scored 117.42 and 104.67 out of 168 points on the MUSIQ scale, respectively, indicating contextual barriers exist. Both have strong DIVA team attributes, but these could not independently ensure quality implementation. Although external support accounted for the greatest contextual disparities, the utmost implementation challenges relate to subnational government leadership, management, financial and technical support. Although higher levels of government may set visionary goals for PHC, interventions are potentially skewed towards donor interests at lower (implementation) levels. Thus, subnational political will is a key determinant of quality implementation. Consequently, advocacy for responsible and accountable political governance is essential in comparable decentralized contexts.

Revision 2 of the Enbridge Quality Assurance Project Plan

EPA Pesticide Factsheets

This Quality Assurance Project Plan (QAPP) presents Revision 2 of the organization, objectives, planned activities, and specific quality assurance/quality control (QA/QC) procedures associated with the Enbridge Marshall Pipeline Release Project.

SU-C-BRB-01: Automated Dose Deformation for Re-Irradiation

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

Lim, S; Kainz, K; Li, X

Purpose: An objective of retreatment planning is to minimize dose to previously irradiated tissues. Conventional retreatment planning is based largely on best-guess superposition of the previous treatment’s isodose lines. In this study, we report a rigorous, automated retreatment planning process to minimize dose to previously irradiated organs at risk (OAR). Methods: Data for representative patients previously treated using helical tomotherapy and later retreated in the vicinity of the original disease site were retrospectively analyzed in an automated fashion using a prototype treatment planning system equipped with a retreatment planning module (Accuray, Inc.). The initial plan’s CT, structures, and planned dosemore » were input along with the retreatment CT and structure set. Using a deformable registration algorithm implemented in the module, the initially planned dose and structures were warped onto the retreatment CT. An integrated third-party sourced software (MIM, Inc.) was used to evaluate registration quality and to contour overlapping regions between isodose lines and OARs, providing additional constraints during retreatment planning. The resulting plan and the conventionally generated retreatment plan were compared. Results: Jacobian maps showed good quality registration between the initial plan and retreatment CTs. For a right orbit case, the dose deformation facilitated delineating the regions of the eyes and optic chiasm originally receiving 13 to 42 Gy. Using these regions as dose constraints, the new retreatment plan resulted in V50 reduction of 28% for the right eye and 8% for the optic chiasm, relative to the conventional plan. Meanwhile, differences in the PTV dose coverage were clinically insignificant. Conclusion: Automated retreatment planning with dose deformation and definition of previously-irradiated regions allowed for additional planning constraints to be defined to minimize re-irradiation of OARs. For serial organs that do not recover from radiation damage, this method provides a more precise and quantitative means to limit cumulative dose. This research is partially supported by Accuray, Inc.« less

Study protocol: a mixed methods study to assess mental health recovery, shared decision-making and quality of life (Plan4Recovery).

PubMed

Coffey, Michael; Hannigan, Ben; Meudell, Alan; Hunt, Julian; Fitzsimmons, Deb

2016-08-17

Recovery in mental health care is complex, highly individual and can be facilitated by a range of professional and non-professional support. In this study we will examine how recovery from mental health problems is promoted in non-medical settings. We hypothesise a relationship between involvement in decisions about care, social support and recovery and quality of life outcomes. We will use standardised validated instruments of involvement in decision-making, social contacts, recovery and quality of life with a random sample of people accessing non-statutory mental health social care services in Wales. We will add to this important information with detailed one to one case study interviews with people, their family members and their support workers. We will use a series of these interviews to examine how people build recovery over time to help us understand more about their involvement in decisions and the social links they build. We want to see how being involved in decisions about care and the social links people have are related to recovery and quality of life for people with experience of using mental health support services. We want to understand the different perspectives of the people involved in making recovery possible. We will use this information to guide further studies of particular types of social interventions and their use in helping recovery from mental health problems.

Training telescope operators and support astronomers at Paranal

NASA Astrophysics Data System (ADS)

Boffin, Henri M. J.; Gadotti, Dimitri A.; Anderson, Joe; Pino, Andres; de Wit, Willem-Jan; Girard, Julien H. V.

2016-07-01

The operations model of the Paranal Observatory relies on the work of efficient staff to carry out all the daytime and nighttime tasks. This is highly dependent on adequate training. The Paranal Science Operations department (PSO) has a training group that devises a well-defined and continuously evolving training plan for new staff, in addition to broadening and reinforcing courses for the whole department. This paper presents the training activities for and by PSO, including recent astronomical and quality control training for operators, as well as adaptive optics and interferometry training of all staff. We also present some future plans.

40 CFR 35.925-2 - Water quality management plans and agencies.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Water quality management plans and... Water Act § 35.925-2 Water quality management plans and agencies. That the project is consistent with any applicable water quality management (WQM) plan approved under section 208 or section 303(e) of the...

40 CFR 35.2102 - Water quality management planning.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Water quality management planning. 35... Administrator shall first determine that the project is: (a) Included in any water quality management plan being implemented for the area under section 208 of the Act or will be included in any water quality management plan...

China's women leaders promote quality and equity in family planning.

PubMed

He, S

1995-08-01

In China, key policy-makers at the highest levels of government recognize that the success of the family planning (FP) program depends upon improving the status of Chinese women. The highest ranking female government official, Peng Peiyun, a State Councilor and the Minister of the State Family Planning (FP) Commission, has initiated a new policy of improving the quality of service in the FP program. She recognizes that women who are gainfully employed and control their income are less likely to desire large families. One aspect of the effort to improve quality involves training FP personnel in interpersonal communication and counseling skills. The results of a pilot training program show that clients are pleased with the new approach and that use of FP services has increased. The FP Commission is also experimenting with programs which integrate all the needs of women and their families (FP, credit availability, old age support) in rural areas. Traditionally, sons provided for their elderly parents, so families with only one daughter are concerned about old age provision. Thus, national efforts are underway to develop social security systems. In the meantime, women at all levels, from grassroots FP acceptors to FP staff members and researchers are the major contributors to the innovations which will allow China to control its population growth.

Translator Plan: A Coordinated Vision for Fiscal Years 2018-2020

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

Riihimaki, Laura; Comstock, Jennifer; Collis, Scott

In June of 2017, the Translator Group met to develop this coordinated three-year vision plan, incorporating key feedback and aligning to ARM’s mission priorities. This plan responds to a shift in how we determine our priorities, given the new needs of the ARM Facility. In the past, individual Translators have determined priorities in conversation with individual DOE Atmospheric System Research (ASR) working groups. To better support ARM’s Decadal Vision (https://www.arm.gov/publications/programdocs/doe-sc-arm-14-029.pdf), however, the Translator Group is instead developing a coordinated response to needs from our user community to better balance resources and skills among participants. This approach agrees with direction frommore » ARM leadership and the ARM-ASR Coordination Team (AACT). To develop this plan the Translator Group reviewed feedback received from the User Executive Committee (UEC) and the Triennial Review, as well as priorities from ASR working groups and Principal Investigators (PIs), the LES ARM Symbiotic Simulation and Observation (LASSO) project, and new instrumentation and activities as described by the ARM Technical Director. In particular, we are responding to the advice that we were trying to do too much, and should focus on providing additional support to data quality, uncertainty assessment, a timeline for producing core VAPs from ARM Mobile Facility (AMF) campaigns, and supporting key aspects of the Decadal Vision.« less

Sustainable aggregate production planning in the chemical process industry - A benchmark problem and dataset.

PubMed

Brandenburg, Marcus; Hahn, Gerd J

2018-06-01

Process industries typically involve complex manufacturing operations and thus require adequate decision support for aggregate production planning (APP). The need for powerful and efficient approaches to solve complex APP problems persists. Problem-specific solution approaches are advantageous compared to standardized approaches that are designed to provide basic decision support for a broad range of planning problems but inadequate to optimize under consideration of specific settings. This in turn calls for methods to compare different approaches regarding their computational performance and solution quality. In this paper, we present a benchmarking problem for APP in the chemical process industry. The presented problem focuses on (i) sustainable operations planning involving multiple alternative production modes/routings with specific production-related carbon emission and the social dimension of varying operating rates and (ii) integrated campaign planning with production mix/volume on the operational level. The mutual trade-offs between economic, environmental and social factors can be considered as externalized factors (production-related carbon emission and overtime working hours) as well as internalized ones (resulting costs). We provide data for all problem parameters in addition to a detailed verbal problem statement. We refer to Hahn and Brandenburg [1] for a first numerical analysis based on and for future research perspectives arising from this benchmarking problem.

Quality of care in investor-owned vs not-for-profit HMOs.

PubMed

Himmelstein, D U; Woolhandler, S; Hellander, I; Wolfe, S M

1999-07-14

The proportion of health maintenance organization (HMO) members enrolled in investor-owned plans has increased sharply, yet little is known about the quality of these plans compared with not-for-profit HMOs. To compare quality-of-care measures for investor-owned and not-for-profit HMOs. Analysis of the Health Plan Employer Data and Information Set (HEDIS) Version 3.0 from the National Committee for Quality Assurance's Quality Compass 1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned and 81 not-for-profit), representing 56% of the total HMO enrollment in the United States. Rates for 14 HEDIS quality-of-care indicators. Compared with not-for-profit HMOs, investor-owned plans had lower rates for all 14 quality-of-care indicators. Among patients discharged from the hospital after myocardial infarction, 59.2% of members in investor-owned HMOs vs 70.6% in not-for-profit plans received a beta-blocker (P<.001); 35.1% of patients with diabetes mellitus in investor-owned plans vs 47.9% in not-for-profit plans had annual eye examinations (P<.001). Investor-owned plans had lower rates than not-for-profit plans of immunization (63.9% vs 72.3%; P<.001), mammography (69.4% vs 75.1%; P<.001), Papanicolaou tests (69.2% vs 77.1%; P<.001), and psychiatric hospitalization (70.5% vs 77.1%; P<.001). Quality scores were highest for staff- and group-model HMOs. In multivariate analyses, investor ownership was consistently associated with lower quality after controlling for model type, geographic region, and the method each HMO used to collect data. Investor-owned HMOs deliver lower quality of care than not-for-profit plans.

Potential Impact of the National Plan for Future Electric Power Supply on Air Quality in Korea

NASA Astrophysics Data System (ADS)

Shim, C.; Hong, J.

2014-12-01

Korean Ministry of Trade, Industry and Energy (MOTIE) announced the national plan for Korea's future electric power supply (2013 - 2027) in 2013. According to the plan, the national demand for electricity will be increased by 60% compared to that of 2010 and primary energy sources for electric generation will still lean on the fossil fuels such as petroleum, LNG, and coal, which would be a potential threat to air quality of Korea. This study focused on two subjects: (1) How the spatial distribution of the primary air pollutant's emissions (i.e., NOx, SOx, CO, PM) will be changed and (2) How the primary emission changes will influence on the national ambient air quality including ozone in 2027. We used GEOS-Chem model simulation with modification of Korean emissions inventory (Clean Air Policy Support System (CAPSS)) to simulate the current and future air quality in Korea. The national total emissions of CO, NOx, SOx, PM in year 2027 will be increased by 3%, 8%, 13%, 2%, respectively compared to 2010 and there are additional concern that the future location of the power plants will be closer to the Seoul Metropolitan Area (SMA), where there are approximately 20 million population vulnerable to the potentially worsened air quality. While there are slight increase of concentration of CO, NOx, SOx, and PM in 2027, the O3 concentration is expected to be similar to the level of 2010. Those results may imply the characteristics of air pollution in East Asia such as potentially severe O3 titration and poorer O3/CO or O3/NOx ratio. Furthermore, we will discuss on the impact of transboundary pollution transport from China in the future, which is one of the large factors to control the air quality of Korea.

[Healthy design for sustainable communities].

PubMed

Capolongo, S; Battistella, A; Buffoli, M; Oppio, A

2011-01-01

Health, quality of life and sustainable development are strongly interconnected. The quality of living is a complex concept that includes different meanings. The quality of life issue has been studied for a long time, even if its measurement is a more recent matter. It's possible to distinguish two main approaches: the first one, depending on which the quality of life corresponds to the social wellbeing and it can be measured objectively; the second one, that emphasizes the perceptive dimension of quality of life, such as needs, feelings and aspirations. According to the WHO's wide definition of wellbeing, this paper suggests an approach focused on the effects that urban planning and designing can have on the health of citizens. Actually many of the problems of the cities like pollution, inequity, lack of services and accessibility depends on decisions about the development of land and buildings. To have more attractive cities in the future it is important that professionals involved in planning and local authorities focus on the major determinants of health: the physical and social environment in which people live and the nature of their lifestyles. The experience explained in this paper shows as local authorities can support professionals in designing process, producing quick and effective benchmark in order to improve the quality of urban spaces and architecture. More in deep the tool works by a set of performance indicators developed with the purpose to assess the degree of sustainability of building and urban space proposals at the planning stage (and at later stages), against a range of criteria. This evaluation procedure can be considered as a common platform from which different stakeholders can agree goals and work together contributing to increase the benefits of a well-designed built environment.

Federal Funding for Early Childhood Supports and Services: A Guide to Sources and Strategies.

ERIC Educational Resources Information Center

Fisher, Hansine

The need for improved access to quality services for children and their families has resulted in a wide variety of early childhood and out-of-school time initiatives. Recognizing that developing financing plans and finding funding sources are a major challenge for these initiatives, this guide is intended to assist state and local officials, as…

48 CFR 302.7000 - Common HHSAR acronyms and abbreviations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... they are cited only in one HHSAR part, subpart, section, or in reference to a particular topic, are not...) 304.803-70(b). AHRQ Agency for Healthcare Research and Quality 301.270(b). AP Acquisition Plan 301.606....1300(c). PSC Program Support Center (in OS) 301.270(b). R&D research and development 301.607-72(b). RFI...

48 CFR 302.7000 - Common HHSAR acronyms and abbreviations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... they are cited only in one HHSAR part, subpart, section, or in reference to a particular topic, are not...) 304.803-70(b). AHRQ Agency for Healthcare Research and Quality 301.270(b). AP Acquisition Plan 301.606....1300(c). PSC Program Support Center (in OS) 301.270(b). R&D research and development 301.607-72(b). RFI...

48 CFR 302.7000 - Common HHSAR acronyms and abbreviations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... they are cited only in one HHSAR part, subpart, section, or in reference to a particular topic, are not...) 304.803-70(b). AHRQ Agency for Healthcare Research and Quality 301.270(b). AP Acquisition Plan 301.606....1300(c). PSC Program Support Center (in OS) 301.270(b). R&D research and development 301.607-72(b). RFI...

48 CFR 302.7000 - Common HHSAR acronyms and abbreviations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... they are cited only in one HHSAR part, subpart, section, or in reference to a particular topic, are not...) 304.803-70(b). AHRQ Agency for Healthcare Research and Quality 301.270(b). AP Acquisition Plan 301.606....1300(c). PSC Program Support Center (in OS) 301.270(b). R&D research and development 301.607-72(b). RFI...

SU-E-T-616: Plan Quality Assessment of Both Treatment Planning System Dose and Measurement-Based 3D Reconstructed Dose in the Patient

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

Olch, A

2015-06-15

Purpose: Systematic radiotherapy plan quality assessment promotes quality improvement. Software tools can perform this analysis by applying site-specific structure dose metrics. The next step is to similarly evaluate the quality of the dose delivery. This study defines metrics for acceptable doses to targets and normal organs for a particular treatment site and scores each plan accordingly. The input can be the TPS or the measurement-based 3D patient dose. From this analysis, one can determine whether the delivered dose distribution to the patient receives a score which is comparable to the TPS plan score, otherwise replanning may be indicated. Methods: Elevenmore » neuroblastoma patient plans were exported from Eclipse to the Quality Reports program. A scoring algorithm defined a score for each normal and target structure based on dose-volume parameters. Each plan was scored by this algorithm and the percentage of total possible points was obtained. Each plan also underwent IMRT QA measurements with a Mapcheck2 or ArcCheck. These measurements were input into the 3DVH program to compute the patient 3D dose distribution which was analyzed using the same scoring algorithm as the TPS plan. Results: The mean quality score for the TPS plans was 75.37% (std dev=14.15%) compared to 71.95% (std dev=13.45%) for the 3DVH dose distribution. For 3/11 plans, the 3DVH-based quality score was higher than the TPS score, by between 0.5 to 8.4 percentage points. Eight/11 plans scores decreased based on IMRT QA measurements by 1.2 to 18.6 points. Conclusion: Software was used to determine the degree to which the plan quality score differed between the TPS and measurement-based dose. Although the delivery score was generally in good agreement with the planned dose score, there were some that improved while there was one plan whose delivered dose quality was significantly less than planned. This methodology helps evaluate both planned and delivered dose quality. Sun Nuclear Corporation has provded a license for the software described.« less

SU-F-BRD-10: Lung IMRT Planning Using Standardized Beam Bouquet Templates

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

Yuan, L; Wu, Q J.; Yin, F

2014-06-15

Purpose: We investigate the feasibility of choosing from a small set of standardized templates of beam bouquets (i.e., entire beam configuration settings) for lung IMRT planning to improve planning efficiency and quality consistency, and also to facilitate automated planning. Methods: A set of beam bouquet templates is determined by learning from the beam angle settings in 60 clinical lung IMRT plans. A k-medoids cluster analysis method is used to classify the beam angle configuration into clusters. The value of the average silhouette width is used to determine the ideal number of clusters. The beam arrangements in each medoid of themore » resulting clusters are taken as the standardized beam bouquet for the cluster, with the corresponding case taken as the reference case. The resulting set of beam bouquet templates was used to re-plan 20 cases randomly selected from the database and the dosimetric quality of the plans was evaluated against the corresponding clinical plans by a paired t-test. The template for each test case was manually selected by a planner based on the match between the test and reference cases. Results: The dosimetric parameters (mean±S.D. in percentage of prescription dose) of the plans using 6 beam bouquet templates and those of the clinical plans, respectively, and the p-values (in parenthesis) are: lung Dmean: 18.8±7.0, 19.2±7.0 (0.28), esophagus Dmean: 32.0±16.3, 34.4±17.9 (0.01), heart Dmean: 19.2±16.5, 19.4±16.6 (0.74), spinal cord D2%: 47.7±18.8, 52.0±20.3 (0.01), PTV dose homogeneity (D2%-D99%): 17.1±15.4, 20.7±12.2 (0.03).The esophagus Dmean, cord D02 and PTV dose homogeneity are statistically better in the plans using the standardized templates, but the improvements (<5%) may not be clinically significant. The other dosimetric parameters are not statistically different. Conclusion: It's feasible to use a small number of standardized beam bouquet templates (e.g. 6) to generate plans with quality comparable to that of clinical plans. Partially supported by NIH/NCI under grant #R21CA161389 and a master research grant by Varian Medical System.« less

Fuel Cycle Technologies 2014 Achievement Report

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

Hong, Bonnie C.

2015-01-01

The Fuel Cycle Technologies (FCT) program supports the Department of Energy’s (DOE’s) mission to: “Enhance U.S. security and economic growth through transformative science, technology innovation, and market solutions to meet our energy, nuclear security, and environmental challenges.” Goal 1 of DOE’s Strategic Plan is to innovate energy technologies that enhance U.S. economic growth and job creation, energy security, and environmental quality. FCT does this by investing in advanced technologies that could transform the nuclear fuel cycle in the decades to come. Goal 2 of DOE’s Strategic Plan is to strengthen national security by strengthening key science, technology, and engineering capabilities.more » FCT does this by working closely with the National Nuclear Security Administration and the U.S Department of State to develop advanced technologies that support the Nation’s nuclear nonproliferation goals.« less

There's a New Alphabet in Town: ESSA and Its Implications for Students, Schools, and School Nurses.

PubMed

Blackborow, Mary; Clark, Elizabeth; Combe, Laurie; Morgitan, Judith; Tupe, Anna

2018-03-01

The 2015 passage of the Every Student Succeeds Act (ESSA) provides state education agencies with more local control over educational planning, requires development of state accountability plans, and provides opportunities for advocacy surrounding school nursing-sensitive indicators of student success. Federal Title I, II, and IV funds are available for state and local education agency utilization in meeting educational needs of impoverished students and for development of high-quality instructional and support personnel. As Specialized Instructional Support Personnel, school nurses can utilize ESSA Title funding to positively impact chronic absenteeism, school climate, and school nurse staffing. ESSA can be a resource for funding school health services and professional education. This article will assist school nurses in better understanding ESSA and how funding is allocated to states and local education agencies.

Space Applications in Support of Future Urban Development in Armenia

NASA Astrophysics Data System (ADS)

Alhaddad, Bahaaeddin; Reppucci, Antonio; Moreno, Laura

2016-08-01

The fast growing of some cities has produced important changes in the urban sectors not always following sustainability criteria. As results, most urban growth falls outside formal planning controls and many cities suffer poor urban services management, traffic, and congestion, loss of green areas, poor air quality, and noise. The main advantages of satellite-based EO products are to support the decision-making process, and the development and operation of smart services. Satellite-based urban morphology analysis can help to identify the transformation of the urban development and evolution. The pilot presented here is a demonstration in the framework of the collaboration between ESA and ADB, called EOTAP "Earth Observation for a Transforming Asia Pacific". Aim of the pilot is to exploit satellite Earth observation data for sustainable growth and help preparing a series of city development and investment plans.

Quality Evaluation of Nursing Observation Based on a Survey of Nursing Documents Using NursingNAVI.

PubMed

Tsuru, Satoko; Omori, Miho; Inoue, Manami; Wako, Fumiko

2016-01-01

We have identified three foci of the nursing observation and nursing action respectively. Using these frameworks, we have developed the structured knowledge model for a number of diseases and medical interventions. We developed this structure based NursingNAVI^® contents collaborated with some quality centred hospitals. Authors analysed the nursing care documentations of post-gastrectomy patients in light of the standardized nursing care plan in the "NursingNAVI^®" developed by ourselves and revealed the "failure to observe" and "failure to document", which leaded to the volatility of the patients' data, conditions and some situation. This phenomenon should have been avoided if nurses had employed a standardized nursing care plan. So, we developed thinking process support system for planning, delivering, recording and evaluating in daily nursing using NursingNAVI^® contents. It is important to identify the problem of the volatility of the patients' data, conditions and some situation. We developed a survey tool of nursing documents using NursingNAVI^® Content for quality evaluation of nursing observation. We recommended some hospitals to use this survey tool. Fifteen hospitals participated the survey using this tool. It is estimated that the volatilizing situation. A hospital which don't participate this survey, knew the result. So the hospital decided to use NursingNAVI^® contents in HIS. It was suggested that the system has availability for nursing OJT and time reduction of planning and recording without volatilizing situation.

SU-E-J-127: Implementation of An Online Replanning Tool for VMAT Using Flattening Filter-Free Beams

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

Ates, O; Ahunbay, E; Li, X

2015-06-15

Purpose: This is to report the implementation of an online replanning tool based on segment aperture morphing (SAM) for VMAT with flattening filter free (FFF) beams. Methods: Previously reported SAM algorithm modified to accommodate VMAT with FFF beams was implemented in a tool that was interfaced with a treatment planning system (Monaco, Elekta). The tool allows (1) to output the beam parameters of the original VMAT plan from Monaco, and (2) to input the apertures generated from the SAM algorithm into Monaco for the dose calculation on daily CT/CBCT/MRI in the following steps:(1) Quickly generating target contour based on themore » image of the day, using an auto-segmentation tool (ADMIRE, Elekta) with manual editing if necessary; (2) Morphing apertures based on the SAM in the original VMAT plan to account for the interfractional change of the target from the planning to the daily images; (3) Calculating dose distribution for new apertures with the same numbers of MU as in the original plan; (4) Transferring the new plan into a record & verify system (MOSAIQ, Elekta); (5) Performing a pre-delivery QA based on software; (6) Delivering the adaptive plan for the fraction.This workflow was implemented on a 16-CPU (2.6 GHz dual-core) hardware with GPU and was tested for sample cases of prostate, pancreas and lung tumors. Results: The online replanning process can be completed within 10 minutes. The adaptive plans generally have improved the plan quality when compared to the IGRT repositioning plans. The adaptive plans with FFF beams have better normal tissue sparing as compared with those of FF beams. Conclusion: The online replanning tool based on SAM can quickly generate adaptive VMAT plans using FFF beams with improved plan quality than those from the IGRT repositioning plans based on daily CT/CBCT/MRI and can be used clinically. This research was supported by Elekta Inc. (Crawley, UK)« less

Evaluation of dosimetric effect caused by slowing with multi-leaf collimator (MLC) leaves for volumetric modulated arc therapy (VMAT)

PubMed Central

Wang, Iris Z.; Kumaraswamy, Lalith K.; Podgorsak, Matthew B.

2016-01-01

Background This study is to report 1) the sensitivity of intensity modulated radiation therapy (IMRT) QA method for clinical volumetric modulated arc therapy (VMAT) plans with multi-leaf collimator (MLC) leaf errors that will not trigger MLC interlock during beam delivery; 2) the effect of non-beam-hold MLC leaf errors on the quality of VMAT plan dose delivery. Materials and methods. Eleven VMAT plans were selected and modified using an in-house developed software. For each control point of a VMAT arc, MLC leaves with the highest speed (1.87-1.95 cm/s) were set to move at the maximal allowable speed (2.3 cm/s), which resulted in a leaf position difference of less than 2 mm. The modified plans were considered as ‘standard’ plans, and the original plans were treated as the ‘slowing MLC’ plans for simulating ‘standard’ plans with leaves moving at relatively lower speed. The measurement of each ‘slowing MLC’ plan using MapCHECK®2 was compared with calculated planar dose of the ‘standard’ plan with respect to absolute dose Van Dyk distance-to-agreement (DTA) comparisons using 3%/3 mm and 2%/2 mm criteria. Results All ‘slowing MLC’ plans passed the 90% pass rate threshold using 3%/3 mm criteria while one brain and three anal VMAT cases were below 90% with 2%/2 mm criteria. For ten out of eleven cases, DVH comparisons between ‘standard’ and ‘slowing MLC’ plans demonstrated minimal dosimetric changes in targets and organs-at-risk. Conclusions For highly modulated VMAT plans, pass rate threshold (90%) using 3%/3mm criteria is not sensitive in detecting MLC leaf errors that will not trigger the MLC leaf interlock. However, the consequential effects of non-beam hold MLC errors on target and OAR doses are negligible, which supports the reliability of current patient-specific IMRT quality assurance (QA) method for VMAT plans. PMID:27069458

40 CFR 130.1 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., interstate, areawide and regional and local CWA water quality planning and management activities undertaken... Quality Management (WQM) plans developed under sections 208 and 303 of the Act. (b) Planning and... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY PLANNING...

[Quality planning of Family Health Units using Quality Function Deployment (QFD)].

PubMed

Volpato, Luciana Fernandes; Meneghim, Marcelo de Castro; Pereira, Antonio Carlos; Ambrosano, Gláucia Maria Bovi

2010-08-01

Quality is an indispensible requirement in the health field, and its pursuit is necessary in order to meet demands by a population that is aware of its rights, as part of the essence of good work relations, and to decrease technological costs. Quality thus involves all parties to the process (users and professionals), and is no longer merely an attribute of the health service. This study aimed to verify the possibility of quality planning in the Family Health Units, using Quality Function Deployment (QFD). QFD plans quality according to user satisfaction, involving staff professionals and identifying new approaches to improve work processes. Development of the array, called the House of Quality, is this method's most important characteristics. The results show a similarity between the quality demanded by users and the quality planned by professionals. The current study showed that QFD is an efficient tool for quality planning in public health services.

Relating health and climate impacts to grid-scale emissions using adjoint sensitivity modeling for the Climate and Clean Air Coalition

NASA Astrophysics Data System (ADS)

Henze, D. K.; Lacey, F.; Seltzer, M.; Vallack, H.; Kuylenstierna, J.; Bowman, K. W.; Anenberg, S.; Sasser, E.; Lee, C. J.; Martin, R.

2013-12-01

The Climate and Clean Air Coalition (CCAC) was initiated in 2012 to develop, understand and promote measures to reduce short lived climate forcers such as aerosol, ozone and methane. The Coalition now includes over 30 nations, and as a service to these nations is committed to providing a decision support toolkit that allows member nations to explore the benefits of a range of emissions mitigation measures in terms of the combined impacts on air quality and climate and so help in the development of their National Action Plans. Here we will present recent modeling work to support the development of the CCAC National Action Plans toolkit. Adjoint sensitivity analysis is presented as a means of efficiently relating air quality, climate and crop impacts back to changes in emissions from each species, sector and location at the grid-scale resolution of typical global air quality model applications. The GEOS-Chem adjoint model is used to estimate the damages per ton of emissions of PM2.5 related mortality, the impacts of ozone precursors on crops and ozone-related health effects, and the combined impacts of these species on regional surface temperature changes. We show how the benefits-per-emission vary spatially as a function of the surrounding environment, and how this impacts the overall benefit of sector-specific control strategies. We present initial findings for Bangladesh, as well as Mexico, Ghana and Colombia, some of the first countries to join the CCAC, and discuss general issues related to adjoint-based metrics for quantifying air quality and climate co-benefits.

Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps) in a Medicaid managed care plan: study protocol.

PubMed

Ratanawongsa, Neda; Handley, Margaret A; Quan, Judy; Sarkar, Urmimala; Pfeifer, Kelly; Soria, Catalina; Schillinger, Dean

2012-01-26

Health information technology can enhance self-management and quality of life for patients with chronic disease and overcome healthcare barriers for patients with limited English proficiency. After a randomized controlled trial of a multilingual automated telephone self-management support program (ATSM) improved patient-centered dimensions of diabetes care in safety net clinics, we collaborated with a nonprofit Medicaid managed care plan to translate research into practice, offering ATSM as a covered benefit and augmenting ATSM to promote medication activation. This paper describes the protocol of the Self-Management Automated and Real-Time Telephonic Support Project (SMARTSteps). This controlled quasi-experimental trial used a wait-list variant of a stepped wedge design to enroll 362 adult health plan members with diabetes who speak English, Cantonese, or Spanish and receive care at 4 publicly-funded clinics. Through language-stratified randomization, participants were assigned to four intervention statuses: SMARTSteps-ONLY, SMARTSteps-PLUS, or wait-list for either intervention. In addition to usual primary care, intervention participants received 27 weekly calls in their preferred language with rotating queries and response-triggered education about self-care, medication adherence, safety concerns, psychological issues, and preventive services. Health coaches from the health plan called patients with out-of-range responses for collaborative goal setting and action planning. SMARTSteps-PLUS also included health coach calls to promote medication activation, adherence and intensification, if triggered by ATSM-reported non-adherence, refill non-adherence from pharmacy claims, or suboptimal cardiometabolic indicators. Wait-list patients crossed-over to SMARTSteps-ONLY or -PLUS at 6 months. For participants who agreed to structured telephone interviews at baseline and 6 months (n = 252), primary outcomes will be changes in quality of life and functional status with secondary outcomes of 6-month changes in self-management behaviors/efficacy and patient-centered processes of care. We will also evaluate 6-month changes in cardiometabolic (HbA1c, blood pressure, and LDL) and utilization indicators for all participants. Outcomes will provide evidence regarding real-world implementation of ATSM within a Medicaid managed care plan serving safety net settings. The evaluation trial will provide insight into translating and scaling up health information technology interventions for linguistically and culturally diverse vulnerable populations with chronic disease. ClinicalTrials.gov: NCT00683020.

Quasi-experimental trial of diabetes Self-Management Automated and Real-Time Telephonic Support (SMARTSteps) in a Medicaid managed care plan: study protocol

PubMed Central

2012-01-01

Background Health information technology can enhance self-management and quality of life for patients with chronic disease and overcome healthcare barriers for patients with limited English proficiency. After a randomized controlled trial of a multilingual automated telephone self-management support program (ATSM) improved patient-centered dimensions of diabetes care in safety net clinics, we collaborated with a nonprofit Medicaid managed care plan to translate research into practice, offering ATSM as a covered benefit and augmenting ATSM to promote medication activation. This paper describes the protocol of the Self-Management Automated and Real-Time Telephonic Support Project (SMARTSteps). Methods/Design This controlled quasi-experimental trial used a wait-list variant of a stepped wedge design to enroll 362 adult health plan members with diabetes who speak English, Cantonese, or Spanish and receive care at 4 publicly-funded clinics. Through language-stratified randomization, participants were assigned to four intervention statuses: SMARTSteps-ONLY, SMARTSteps-PLUS, or wait-list for either intervention. In addition to usual primary care, intervention participants received 27 weekly calls in their preferred language with rotating queries and response-triggered education about self-care, medication adherence, safety concerns, psychological issues, and preventive services. Health coaches from the health plan called patients with out-of-range responses for collaborative goal setting and action planning. SMARTSteps-PLUS also included health coach calls to promote medication activation, adherence and intensification, if triggered by ATSM-reported non-adherence, refill non-adherence from pharmacy claims, or suboptimal cardiometabolic indicators. Wait-list patients crossed-over to SMARTSteps-ONLY or -PLUS at 6 months. For participants who agreed to structured telephone interviews at baseline and 6 months (n = 252), primary outcomes will be changes in quality of life and functional status with secondary outcomes of 6-month changes in self-management behaviors/efficacy and patient-centered processes of care. We will also evaluate 6-month changes in cardiometabolic (HbA1c, blood pressure, and LDL) and utilization indicators for all participants. Discussion Outcomes will provide evidence regarding real-world implementation of ATSM within a Medicaid managed care plan serving safety net settings. The evaluation trial will provide insight into translating and scaling up health information technology interventions for linguistically and culturally diverse vulnerable populations with chronic disease. Trial Registration ClinicalTrials.gov: NCT00683020 PMID:22280514

NACA documents database project

NASA Technical Reports Server (NTRS)

Smith, Ruth S.

1991-01-01

The plan to get all the National Advisory Committee on Aeronautics (NACA) collection online, with quality records, led to the NACA Documents Data base Project. The project has a two fold purpose: (1) to develop the definitive bibliography of NACA produced and/or held documents; and (2) to make that bibliography and the associated documents available to the aerospace community. This study supports the first objective by providing an analysis of the NACA collection and its bibliographic records, and supports the second objective by defining the NACA archive and recommending methodologies for meeting the project objectives.

Hurricane Sandy science plan: coastal impact assessments

USGS Publications Warehouse

Stronko, Jakob M.

2013-01-01

Hurricane Sandy devastated some of the most heavily populated eastern coastal areas of the Nation. With a storm surge peaking at more than 19 feet, the powerful landscape-altering destruction of Hurricane Sandy is a stark reminder of why the Nation must become more resilient to coastal hazards. In response to this natural disaster, the U.S. Geological Survey (USGS) received a total of $41.2 million in supplemental appropriations from the Department of the Interior (DOI) to support response, recovery, and rebuilding efforts. These funds support a science plan that will provide critical scientific information necessary to inform management decisions for recovery of coastal communities, and aid in preparation for future natural hazards. This science plan is designed to coordinate continuing USGS activities with stakeholders and other agencies to improve data collection and analysis that will guide recovery and restoration efforts. The science plan is split into five distinct themes: coastal topography and bathymetry, impacts to coastal beaches and barriers, impacts of storm surge, including disturbed estuarine and bay hydrology, impacts on environmental quality and persisting contaminant exposures, impacts to coastal ecosystems, habitats, and fish and wildlife. This fact sheet focuses assessing impacts to coastal beaches and barriers.

Multi-objective Optimization for the Robust Performance of Drinking Water Treatment Plants under Climate Change and Climate Extremes

NASA Astrophysics Data System (ADS)

Raseman, W. J.; Kasprzyk, J. R.; Rosario-Ortiz, F.; Summers, R. S.; Stewart, J.; Livneh, B.

2016-12-01

To promote public health, the United States Environmental Protection Agency (US EPA), and similar entities around the world enact strict laws to regulate drinking water quality. These laws, such as the Stage 1 and 2 Disinfectants and Disinfection Byproducts (D/DBP) Rules, come at a cost to water treatment plants (WTPs) which must alter their operations and designs to meet more stringent standards and the regulation of new contaminants of concern. Moreover, external factors such as changing influent water quality due to climate extremes and climate change, may force WTPs to adapt their treatment methods. To grapple with these issues, decision support systems (DSSs) have been developed to aid WTP operation and planning. However, there is a critical need to better address long-term decision making for WTPs. In this poster, we propose a DSS framework for WTPs for long-term planning, which improves upon the current treatment of deep uncertainties within the overall potable water system including the impact of climate on influent water quality and uncertainties in treatment process efficiencies. We present preliminary results exploring how a multi-objective evolutionary algorithm (MOEA) search can be coupled with models of WTP processes to identify high-performing plans for their design and operation. This coupled simulation-optimization technique uses Borg MOEA, an auto-adaptive algorithm, and the Water Treatment Plant Model, a simulation model developed by the US EPA to assist in creating the D/DBP Rules. Additionally, Monte Carlo sampling methods were used to study the impact of uncertainty of influent water quality on WTP decision-making and generate plans for robust WTP performance.

Guidelines for preparing a quality assurance plan for district offices of the U.S. Geological Survey

USGS Publications Warehouse

Schroder, L.J.; Shampine, W.J.

1992-01-01

The U.S. Geological Survey has a policy that requires each District office to prepare a Quality Assurance Plan. This plan is a combination of a District's management principles and quality assurance processes. The guidelines presented in this report provide a framework or expanded outline that a District can use to prepare a plan. Parti- cular emphasis is given to a District's: (1) quality assurance policies; (2) organization and staff responsibilities; and (3) program and project planning. The guidelines address the 'how', 'what', and 'who' questions that need to be answered when a District Quality Assurance Plan is prepared.

Designing Universitas Indonesia Molina EV Bus Dashboard Using ECQFD and TRIZ

NASA Astrophysics Data System (ADS)

Faiq Pradhila, Muhammad; Suzianti, Amalia; Putri Adinda, Prilly

2018-01-01

Universitas Indonesia is involved in the national electric car development program. One of the focus by the research team is to develop the Molina EV Bus which is planned to replace the current operational bus at UI so that it can be more environmental friendly. With UI developing facilities for the disabled, the Molina research team planned to make a new prototype of the Molina EV Bus to contribute to the facilities developed for the disabled. The new prototype is expected to increase the quality of the previous features of the EV Bus, including the dashboard that had been ignored. To support the development of the new prototype, this research was conducted to design a suitable dashboard for the new prototype. Design of the prototype are made using Autodesk Inventor. This research used the integration of ECQFD (Environmentally Conscious Quality Function Deployment) and TRIZ (Theory of Inventive Problem Solving) method. ECQFD was used to translate user needs into quality characteristics based on environmental aspects. TRIZ was used to translate the quality characteristics into technical specifications. This research has generated 3 sustainable, innovative, and user-preferred dashboard design recommendation for the new prototype.

Championship management for healthcare organizations.

PubMed

Griffith, J R

2000-01-01

Stakeholders will put increasing pressure on integrated health systems (IHS) for measured performance, demanding data on quality and patient satisfaction, while simultaneously pressing for lower cost. The changes to Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) and the growing importance of the National Committee on Quality Assurance (NCQA) are simply forerunners of an intensifying trend. Quality of care in particular will face increasing scrutiny. Achieving competitive targets in these areas will also require measures addressing demand and worker satisfaction. "Balanced scorecard" approaches will allow IHS and their accountable work groups to track performance on several dimensions and establish integrated goals or targets. Those with consistently good scores will be labeled "champions." Champions will support the multidimensional measures with improved decision processes. About eight major processes will be central--governance/strategic management, clinical quality, clinical organization, financial planning, planning and marketing, information services, human resources, and plant services. It is possible to map these processes to the criteria of the Joint Commission, NCQA, and Malcolm Baldrige Quality Award. The processes themselves can be measured and common weaknesses identified and corrected. Champions share some common characteristics that seem to arise from the combination of processes and measures. Among these characteristics are service line orientation, extensive partnering with other organizations, and the possibility of outsourcing organizational components.

Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan : ASC software quality engineering practices Version 3.0.

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

Turgeon, Jennifer L.; Minana, Molly A.; Hackney, Patricia

2009-01-01

The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in the US Department of Energy/National Nuclear Security Agency (DOE/NNSA) Quality Criteria, Revision 10 (QC-1) as 'conformance to customer requirements and expectations'. This quality plan defines the SNL ASC Program software quality engineering (SQE) practices and provides a mapping of these practices to the SNL Corporate Process Requirement (CPR) 001.3.6; 'Corporate Software Engineering Excellence'. This plan also identifies ASC management's and themore » software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals. This SNL ASC Software Quality Plan establishes the signatories commitments to improving software products by applying cost-effective SQE practices. This plan enumerates the SQE practices that comprise the development of SNL ASC's software products and explains the project teams opportunities for tailoring and implementing the practices.« less

77 FR 52277 - Approval of Air Quality Implementation Plans; California; South Coast Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-29

... Quality Implementation Plans; California; South Coast Air Quality Management District; Prevention of... rule. SUMMARY: EPA is proposing approval of a permitting rule submitted for the South Coast Air Quality Management District (District) portion of the California State Implementation Plan (SIP). The State is...

78 FR 63878 - Approval and Promulgation of Air Quality Implementation Plans; Virginia; Revised Ambient Air...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

...] Approval and Promulgation of Air Quality Implementation Plans; Virginia; Revised Ambient Air Quality... State Implementation Plan (SIP). The revisions add ambient air quality standards and associated... Ambient Air Quality Standards (NAAQS) for PM 2.5 . EPA is approving these revisions in accordance with the...

78 FR 30829 - Approval and Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-23

... Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards Revision AGENCY... the Illinois State Implementation Plan (SIP) to reflect current national ambient air quality standards...) 692-2450. 4. Mail: Pamela Blakley, Chief, Control Strategies Section, Air Programs Branch (AR-18J), U...

75 FR 19886 - Approval and Promulgation of Air Quality Implementation Plans; Wyoming; Revisions to the Wyoming...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-16

... Promulgation of Air Quality Implementation Plans; Wyoming; Revisions to the Wyoming Air Quality Standards and.... Wyoming has revised its Air Quality Standards and Regulations, specifically Chapter 1, Section 5... Wyoming's State Implementation Plan (SIP). These revisions amend Wyoming's Air Quality Standards and...

Urban ecosystem services for resilience planning and management in New York City.

PubMed

McPhearson, Timon; Hamstead, Zoé A; Kremer, Peleg

2014-05-01

We review the current state of knowledge about urban ecosystem services in New York City (NYC) and how these services are regulated, planned for, and managed. Focusing on ecosystem services that have presented challenges in NYC-including stormwater quality enhancement and flood control, drinking water quality, food provisioning and recreation-we find that mismatches between the scale of production and scale of management occur where service provision is insufficient. Adequate production of locally produced services and services which are more accessible when produced locally is challenging in the context of dense urban development that is characteristic of NYC. Management approaches are needed to address scale mismatches in the production and consumption of ecosystem services. By coordinating along multiple scales of management and promoting best management practices, urban leaders have an opportunity to ensure that nature and ecosystem processes are protected in cities to support the delivery of fundamental urban ecosystem services.