Sample records for utility management options

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

    Treesearch

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

    1997-01-01

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

  2. Trade-off decisions in distribution utility management

    NASA Astrophysics Data System (ADS)

    Slavickas, Rimas Anthony

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

  3. City-scale analysis of water-related energy identifies more cost-effective solutions.

    PubMed

    Lam, Ka Leung; Kenway, Steven J; Lant, Paul A

    2017-02-01

    Energy and greenhouse gas management in urban water systems typically focus on optimising within the direct system boundary of water utilities that covers the centralised water supply and wastewater treatment systems, despite a greater energy influence by the water end use. This work develops a cost curve of water-related energy management options from a city perspective for a hypothetical Australian city. It is compared with that from the water utility perspective. The curves are based on 18 water-related energy management options that have been implemented or evaluated in Australia. In the studied scenario, the cost-effective energy saving potential from a city perspective (292 GWh/year) is far more significant than that from a utility perspective (65 GWh/year). In some cases, for similar capital cost, if regional water planners invested in end use options instead of utility options, a greater energy saving potential at a greater cost-effectiveness could be achieved in urban water systems. For example, upgrading a wastewater treatment plant for biogas recovery at a capital cost of $27.2 million would save 31 GWh/year with a marginal cost saving of $63/MWh, while solar hot water system rebates at a cost of $28.6 million would save 67 GWh/year with a marginal cost saving of $111/MWh. Options related to hot water use such as water-efficient shower heads, water-efficient clothes washers and solar hot water system rebates are among the most cost-effective city-scale opportunities. This study demonstrates the use of cost curves to compare both utility and end use options in a consistent framework. It also illustrates that focusing solely on managing the energy use within the utility would miss substantial non-utility water-related energy saving opportunities. There is a need to broaden the conventional scope of cost curve analysis to include water-related energy and greenhouse gas at the water end use, and to value their management from a city perspective. This would create opportunities where the same capital investment could achieve far greater energy savings and greenhouse gas emissions abatement. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Counseling women with early pregnancy failure: utilizing evidence, preserving preference.

    PubMed

    Wallace, Robin R; Goodman, Suzan; Freedman, Lori R; Dalton, Vanessa K; Harris, Lisa H

    2010-12-01

    To apply principles of shared decision-making to EPF management counseling. To present a patient treatment priority checklist developed from review of available literature on patient priorities for EPF management. Review of evidence for patient preferences; personal, emotional, physical and clinical factors that may influence patient priorities for EPF management; and the clinical factors, resources, and provider bias that may influence current practice. Women have strong and diverse preferences for EPF management and report higher satisfaction when treated according to these preferences. However, estimates of actual treatment patterns suggest that current practice does not reflect the evidence for safety and acceptability of all options, or patient preferences. Multiple practice barriers and biases exist that may be influencing provider counseling about options for EPF management. Choosing management for EPF is a preference-sensitive decision. A patient-centered approach to EPF management should incorporate counseling about all treatment options. Providers can integrate a counseling model into EPF management practice that utilizes principles of shared decision-making and an organized method for eliciting patient preferences, priorities, and concerns about treatment options. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  5. Load Management - Methods to Reduce Electric Utilities Peak Loads.

    DTIC Science & Technology

    1983-08-01

    for electric utilities.1 The largest impact came in 1978 when the Public Utilities Regulatory Policies Act ( PURPA ) was enacted which required state...management option. 7 CHAPTER VII CONCLUSION Since PURPA was enacted in 1978, utilities have been required to investigate methods in which to more effectively

  6. Cooperative Drought Adaptation: Integrating Infrastructure Development, Conservation, and Water Transfers into Adaptive Policy Pathways

    NASA Astrophysics Data System (ADS)

    Zeff, H. B.; Characklis, G. W.; Reed, P. M.; Herman, J. D.

    2015-12-01

    Water supply policies that integrate portfolios of short-term management decisions with long-term infrastructure development enable utilities to adapt to a range of future scenarios. An effective mix of short-term management actions can augment existing infrastructure, potentially forestalling new development. Likewise, coordinated expansion of infrastructure such as regional interconnections and shared treatment capacity can increase the effectiveness of some management actions like water transfers. Highly adaptable decision pathways that mix long-term infrastructure options and short-term management actions require decision triggers capable of incorporating the impact of these time-evolving decisions on growing water supply needs. Here, we adapt risk-based triggers to sequence a set of potential infrastructure options in combination with utility-specific conservation actions and inter-utility water transfers. Individual infrastructure pathways can be augmented with conservation or water transfers to reduce the cost of meeting utility objectives, but they can also include cooperatively developed, shared infrastructure that expands regional capacity to transfer water. This analysis explores the role of cooperation among four water utilities in the 'Research Triangle' region of North Carolina by formulating three distinct categories of adaptive policy pathways: independent action (utility-specific conservation and supply infrastructure only), weak cooperation (utility-specific conservation and infrastructure development with regional transfers), and strong cooperation (utility specific conservation and jointly developed of regional infrastructure that supports transfers). Results suggest that strong cooperation aids the utilities in meeting their individual objections at substantially lower costs and with fewer irreversible infrastructure options.

  7. Environmental assessment of gas management options at the Old Ammässuo landfill (Finland) by means of LCA-modeling (EASEWASTE).

    PubMed

    Manfredi, Simone; Niskanen, Antti; Christensen, Thomas H

    2009-05-01

    The current landfill gas (LFG) management (based on flaring and utilization for heat generation of the collected gas) and three potential future gas management options (LFG flaring, heat generation and combined heat and power generation) for the Old Ammässuo landfill (Espoo, Finland) were evaluated by life-cycle assessment modeling. The evaluation accounts for all resource utilization and emissions to the environment related to the gas generation and management for a life-cycle time horizon of 100 yr. The assessment criteria comprise standard impact categories (global warming, photo-chemical ozone formation, stratospheric ozone depletion, acidification and nutrient enrichment) and toxicity-related impact categories (human toxicity via soil, via water and via air, eco-toxicity in soil and in water chronic). The results of the life-cycle impact assessment show that disperse emissions of LFG from the landfill surface determine the highest potential impacts in terms of global warming, stratospheric ozone depletion, and human toxicity via soil. Conversely, the impact potentials estimated for other categories are numerically-negative when the collected LFG is utilized for energy generation, demonstrating that net environmental savings can be obtained. Such savings are proportional to the amount of gas utilized for energy generation and the gas energy recovery efficiency achieved, which thus have to be regarded as key parameters. As a result, the overall best performance is found for the heat generation option - as it has the highest LFG utilization/energy recovery rates - whereas the worst performance is estimated for the LFG flaring option, as no LFG is here utilized for energy generation. Therefore, to reduce the environmental burdens caused by the current gas management strategy, more LFG should be used for energy generation. This inherently requires a superior LFG capture rate that, in addition, would reduce fugitive emissions of LFG from the landfill surface, bringing further environmental benefits.

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

    PubMed

    Milner-Gulland, E J

    2011-01-25

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

  9. Retrieving residue after overstory removal in true fir, northeastern California

    Treesearch

    Gary O. Fiddler; C. Phillip Weatherspoon

    1986-01-01

    Overstory removal cutting, the most common means of converting old-growth stands to young growth stands in California, can produce excessive residues that pose management problems. Utilization is an attractive option for managing residues. However, the cost of residue retrieval and utilization is often prohibitive. Residue retrieval by a private contractor was studied...

  10. Impact of dentists' years since graduation on management of temporomandibular disorders.

    PubMed

    Reissmann, Daniel R; Behn, Alexandra; Schierz, Oliver; List, Thomas; Heydecke, Guido

    2015-12-01

    The aims were to assess the impact of the number of years since dentists' graduation on appraisement of diagnostic needs and utilization of treatment options for temporomandibular disorders (TMD) and to investigate whether increased knowledge in TMD is sufficiently considered in today's dentist's undergraduate curricula and, therefore, represented in more evidence-based TMD management in dentists with less years since graduation. A questionnaire regarding knowledge and management of TMD was developed and was subsequently applied in a random sample of 400 dentists in a region in Northern Germany. Of the 222 dentists (response rate 55.6 %), participating in the study, the frequency of TMD treatment need in the general population was estimated at 21.5 %, with lower values in dentists with more years passed since graduation. Measures regarding utilization of standardized examination forms, perceptions of insufficient specialization, and referrals of patients to TMD specialists indicated a lower quality and certainty in TMD management in participants with less time since graduation. While the provision of splints was a well-established treatment option in initial TMD management of all participants, additional TMD treatment options were mentioned less often, with lower proportions of participants making use of these options within the first decade since graduation. Evidence-based TMD management is not fully represented in dental practitioners in Germany. This might be due to an insufficient consideration of TMD management in the dentist's undergraduate curricula. Effective interventions to increase dentists' knowledge and to change dentists' practices in TMD management are required.

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

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

    Hornibrook, C.

    1995-12-31

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

  12. Fusion Teaching: Utilizing Course Management Technology to Deliver an Effective Multimodal Pedagogy

    ERIC Educational Resources Information Center

    Childs, Bradley D.; Cochran, Howard H.; Velikova, Marieta

    2013-01-01

    Fusion teaching merges several pedagogies into a coherent whole. Course management technology allows for the digitization and delivery of pedagogies in an effective and exciting manner. Online course management options more easily enable outcome assessment and monitoring for continuous improvement.

  13. Maximizing value in opioid utilization: Is oxycodone immediate release a good option for pain management?

    PubMed

    Pergolizzi, Joseph V; Köknel Talu, Gül; Zmponga, Gianpetrio; Erdine, Serdar; Taylor, Robert; Ayan, Burak; Raffa, Robert B

    2015-01-01

    The modern approach to the management of pain involves optimizing all aspects of the process. This includes utilization of pharmacologic and non-pharmacologic modalities, consideration of patient characteristics, proper matching of the physiology of the pain with the analgesic's mechanism of action (pharmacodynamics, PD), and the onset and duration of action (pharmacokinetics, PK). No single agent or formulation satisfies all of the requirements for all patients. Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) are effective options for inflammatory pain and, as is acetaminophen, for mild pain. Specialized agents are helpful for particular pains, such as for migraine headache. Opioids remain the standard option for severe pain. Although they are generally a safe and effective option, opioids can produce dose-limiting adverse effects and have abuse potential. The goal of pain therapy is thus to achieve the maximum pain relief with the least amount of opioid exposure. Against this background of measured approach to the use of analgesics, an immediate release (IR) oral formulation of the established opioid oxycodone has been developed to provide rapid onset of action and rate of titration, both of which could maximize temporal matching of dose with pain level and reduce total exposure to drug. This article considers the option of an immediate release (IR) oral formulation for the management of pain.

  14. Thermochemical reactor systems and methods

    DOEpatents

    Lipinski, Wojciech; Davidson, Jane Holloway; Chase, Thomas Richard

    2016-11-29

    Thermochemical reactor systems that may be used to produce a fuel, and methods of using the thermochemical reactor systems, utilizing a reactive cylindrical element, an optional energy transfer cylindrical element, an inlet gas management system, and an outlet gas management system.

  15. 42 CFR 456.700 - Scope.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ASSISTANCE PROGRAMS UTILIZATION CONTROL Drug Use Review (DUR) Program and Electronic Claims Management System... outpatient DUR program that includes prospective drug review, retrospective drug use review, and an... optional point-of-sale electronic claims management system for processing claims for covered outpatient...

  16. 75 FR 8352 - Agency Information Collection Activities: Final Collection; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-24

    ... utilization and management prospective insurance liability relative to risk premiums received. DATES: Comments...). SUMMARY: The Export-Import Bank of the United States (Ex-Im Bank), as a part of its continuing effort to... Institution'' as an option; b. Under ``Obligo Types'' we have deleted ``Eximbank Sole Risk'' as an option; c...

  17. Time management problems and discounted utility.

    PubMed

    König, Cornelius J; Kleinmann, Martin

    2007-05-01

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

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

    Kelly, K.; Gonzales, J.

    Many fleet managers have opted to incorporate alternative fuels and advanced vehicles into their lineup. Original equipment manufacturers (OEMs) offer a variety of choices, and there are additional options offered by aftermarket companies. There are also a myriad of ways that existing vehicles can be modified to utilize alternative fuels and other advanced technologies. Vehicle conversions and retrofit packages, along with engine repower options, can offer an ideal way to lower vehicle operating costs. This can result in long term return on investment, in addition to helping fleet managers achieve emissions and environmental goals. This report summarizes the various factorsmore » to consider when pursuing a conversion, retrofit, or repower option.« less

  19. Early pregnancy failure management among family physicians.

    PubMed

    Wallace, Robin; Dehlendorf, Christine; Vittinghoff, Eric; Gold, Katherine J; Dalton, Vanessa K

    2013-03-01

    Family physicians, as primary care providers for reproductive-aged women, frequently initiate or refer patients for management of early pregnancy failure (EPF). Safe and effective options for EPF treatment include expectant management, medical management with misoprostol, and aspiration in the office or operating room. Current practice does not appear to reflect patient preferences or to utilize the most cost-effective treatments. We compared characteristics and practice patterns among family physicians who do and do not provide multiple options for EPF care. We performed a secondary analysis of a national survey of women's health providers to describe demographic and practice characteristics among family physicians who care for women with EPF. We used multivariate logistic regression to identify correlates of providing more than one option for EPF management. The majority of family physicians provide only one option for EPF; expectant management was most frequently used among our survey respondents. Misoprostol and office-based aspiration were rarely used. Providing more than one option for EPF management was associated with more years in practice, smaller county population, larger proportions of Medicaid patients, intrauterine contraception provision, and prior training in office-based aspiration. Family physicians are capable of providing a comprehensive range of options for EPF management in the outpatient setting but few providers currently do so. To create a more patient-centered and cost-effective model of care for EPF, additional resources should be directed at education, skills training, and system change initiatives to prepare family physicians to offer misoprostol and office-based aspiration to women with EPF.

  20. Decision-Support Tools and Databases to Inform Regional Stormwater Utility Development in New England

    EPA Science Inventory

    Development of stormwater utilities requires information on existing stormwater infrastructure and impervious cover as well as costs and benefits of stormwater management options. US EPA has developed a suite of databases and tools that can inform decision-making by regional sto...

  1. U.S. EPA'S PHOTOVOLTAIC DEMAND-SIDE MANAGEMENT PROJECT

    EPA Science Inventory

    The paper discusses an investigation of how photovoltaic (PV) may be used as both a pollution-mitigating energy replacement for fossil fuels and a demand-side management (DSM) option to reduce peak electrical demands of commercial and residential buildings. leven electric utiliti...

  2. 42 CFR 456.700 - Scope.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... ASSISTANCE PROGRAMS UTILIZATION CONTROL Drug Use Review (DUR) Program and Electronic Claims Management System... optional point-of-sale electronic claims management system for processing claims for covered outpatient... 42 Public Health 4 2014-10-01 2014-10-01 false Scope. 456.700 Section 456.700 Public Health...

  3. Air Force Strategy Study 2020-2030

    DTIC Science & Technology

    2011-01-01

    shocks (also known as “black swans”), having 2 │ introduction the potential to radically alter the utility of the capability, as a way of highlighting... utilized by its expeditionary air units.”5 The Air Force must present strategic and operational options along with forces capable of operating and...Emer- gency Management Agency (FEMA) regional staffs, in part representing the service and USNORTHCOM. The imagery analysts’ utility is largely due

  4. Joint Peru/United States report on Peru/United States cooperative energy assessment. Volume 4 of 4 Volumes Annexes 8-11

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

    Not Available

    1979-08-01

    A comprehensive assessment of the biofuel potential of Peru is presented. Topics discussed cover current biofuel utilization practices; evaluation of Peruvian biomass productivity; identification of Peruvian agricultural and forestry resources; assessment of resource development and management concerns; identification of market considerations; description of biofuel technological options; and regional identification of biofuel technology applications. The discussion of current biofuel utilization centers on a qualitative description of the main conversion approaches now being practiced in Peru. Biomass productivity is evaluated in the context of the terrain, soil, and climatic conditions found in Peru. A quantitative description of the energy potential that couldmore » be realized from agricultural and forestry resources of Peru follows. A regional picture is given for the production of agricultural residues and forest resources that could potentially supply energy. The assessment of resource development and management concerns focuses on harvesting, reforestation, training, and the environmental consequences of utilization of forest resources. Market factors assessed include: importation, internal market development, external market development, energy policy and pricing, and transportation. Ten biofuel technology options for Peru were identified: small- to medium-scale gasification, a wood waste inventory, stationary and mobile charcoal production systems, wood distillation, forest resource development and management, electrical cogeneration, anaerobic digestion technology, development of ethanol production capabilities, and agricultural strategies for fuel production.Based upon these biofuel options, nine applications were identified for the Costa Region, eight for the Sierra Region, and ten for the Selva Region.« less

  5. Assessment of Peruvian biofuel resources and alternatives

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

    Harper, J.P.; Smith, W.; Mariani, E.

    1979-08-01

    Comprehensive assessment of the biofuel potential of Peru is based on: determination of current biofuel utilization practices, evauation of Peruvian biomass productivity, identification of Peruvian agricultural and forestry resources, assessment of resource development and management concerns, identification of market considerations, description of biofuel technological options, and identification of regional biofuel technology applications. Discussion of current biofuel utilization centers on a qualitative description of the main conversion approaches currently being practiced in Peru. Biomass productivity evaluations consider the terrain and soil, and climatic conditions found in Peru. The potential energy from Peruvian agricultural and forestry resources is described quantitatively. Potental regionalmore » production of agricultural residues and forest resources that could supply energy are identified. Assessment of resource development and management concerns focuses on harvesting, reforestation, training, and environmental consequences of utilization of forest resources. Market factors assessed include: importation, internal market development, external market development, energy policy and pricing, and transportation. Nine biofuel technology options for Peru are identified: (1) small-to-medium-scale gasification, (2) a wood waste inventory, (3) stationary and mobile charcoal production systems, (4) wood distillation, (5) forest resource development and management, (6) electrical cogeneration, (7) anaerobic digestion technology, (8) development of ethanol production capabilities, and (9) agricultural strategies for fuel production. Applications of these biofuel options are identified for each of the three major regions - nine applications for the Costa Region, eight for the Sierra Region, and ten for the Selva Region.« less

  6. What Fleets Need to Know About Alternative Fuel Vehicle Conversions, Retrofits, and Repowers

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

    Kelly, Kay L.; Gonzales, John

    2017-10-17

    Many fleet managers have opted to incorporate alternative fuels and advanced vehicles into their lineup. Original equipment manufacturers (OEMs) offer a variety of choices, and there are additional options offered by aftermarket companies. There are also a myriad of ways that existing vehicles can be modified to utilize alternative fuels and other advanced technologies. Vehicle conversions and retrofit packages, along with engine repower options, can offer an ideal way to lower vehicle operating costs. This can result in long term return on investment, in addition to helping fleet managers achieve emissions and environmental goals. This report summarizes the various factorsmore » to consider when pursuing a conversion, retrofit, or repower option.« less

  7. Status and potential of terrestrial carbon sequestration in West Virginia

    Treesearch

    Benktesh D. Sharma; Jingxin Wang

    2011-01-01

    Terrestrial ecosystem management offers cost-effective ways to enhance carbon (C) sequestration. This study utilized C stock and C sequestration in forest and agricultural lands, abandoned mine lands, and harvested wood products to estimate the net current annual C sequestration in West Virginia. Several management options within these components were simulated using a...

  8. Utilization of municipal solid and liquid wastes for bioenergy and bioproducts production.

    PubMed

    Chen, Paul; Xie, Qinglong; Addy, Min; Zhou, Wenguang; Liu, Yuhuan; Wang, Yunpu; Cheng, Yanling; Li, Kun; Ruan, Roger

    2016-09-01

    Municipal wastes, be it solid or liquid, are rising due to the global population growth and rapid urbanization and industrialization. Conventional management practice involving recycling, combustion, and treatment/disposal is deemed unsustainable. Solutions must be sought to not only increase the capacity but also improve the sustainability of waste management. Research has demonstrated that the non-recyclable waste materials and bio-solids can be converted into useable heat, electricity, or fuel and chemical through a variety of processes, including gasification, pyrolysis, anaerobic digestion, and landfill gas in addition to combustion, and wastewater streams have the potential to support algae growth and provide other energy recovery options. The present review is intended to assess and analyze the current state of knowledge in the municipal solid wastes and wastewater treatment and utilization technologies and recommend practical solution options and future research and development needs. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. An economic comparison of slash and loblolly pine under various levels of management in the lower Atlantic and gulf coastal plain

    Treesearch

    E. David Dickens; Coleman W. Dangerfield; David J. Moorhead

    2006-01-01

    Nonindustrial private forest (NIPF) landowners have perceived reduced product market availability and increased price uncertainty since late 1997 in the southeastern United States. Lower Atlantic and Gulf Coastal Plain NIPF landowners seek management options utilizing two commonly available pine species, loblolly (Pinus taeda L.) and slash (...

  10. The Colville Study: wood utilization for ecosystem management: preliminary results of study of product potential from small-diameter stands.

    Treesearch

    S. Willits; R. J. Barbour; J. McNeel; R. D. Fight; G. C. Myers; A. Mason

    The Colville Study was developed in 1994 to identify and evaluate a series of management options for achieving ecosystem objectives in dense stands of small-diameter trees while also producing wood products. The Colville National Forest selected the Rocky II Timber Sale as an example of this type of stand that needed management to achieve the following goals: (1)...

  11. Assessment and management of rib fracture pain in geriatric population: an ode to old age.

    PubMed

    Wardhan, Richa

    2013-10-01

    Pain management for traumatic rib fractures has been described in literature, but there is paucity of data when it comes to acute pain management in the elderly, let alone pain resulting from traumatic rib fractures. This article focuses on challenges of assessment of pain in elderly patients and the various options available for pain management including utilization of nerve blocks. Nerve blocks are instrumental in treating rib fracture pain along with utilization of opioids and nonopioids thus formulating a multimodal approach to pain management. The goal is to devise a proper pain management regimen for geriatric patients with rib fractures to decrease the morbidity and mortality associated with it. Developing institutional protocols is one step forward towards quality care for such patients.

  12. Management of obstructive sleep apnea in the indigent population: a deviation of standard of care?

    PubMed

    Hamblin, John S; Sandulache, Vlad C; Alapat, Philip M; Takashima, Masayoshi

    2014-03-01

    Comprehensive management of patients with obstructive sleep apnea (OSA) typically is managed best via a multidisciplinary approach, involving otolaryngologists, sleep psychologists/psychiatrists, pulmonologists, neurologists, oral surgeons, and sleep trained dentists. By utilizing these resources, one could fashion a treatment individualized to the patient, giving rise to the holistic phrase of "personalized medicine." Unfortunately, in situations and environments with limited resources, the treatment options in an otolaryngologist's armamentarium are restricted--typically to continuous positive airway pressure (CPAP) versus sleep surgery. However, a recent patient encounter highlighted here shows how a hospital's reimbursement policy effectively dictated a patient's medical management to sleep surgery. This occurred although the current gold standard for the initial treatment of OSA is CPAP. Changing the course of medical/surgical management by selectively restricting funding is a cause of concern, especially when it promotes patients to choose a treatment option that is not considered the current standard of care.

  13. Does competition by health maintenance organizations affect the adoption of cost-containment measures by fee-for-service plans?

    PubMed

    Joesch, J M; Wickizer, T M; Feldstein, P J

    1998-06-01

    How groups insured by fee-for-service health plans react to increased competition from health maintenance organizations (HMOs) is an unresolved question. We investigated whether groups insured by indemnity plans respond to HMO market competition by changing selected health insurance features, such as deductible amounts, stop loss levels, and coinsurance rates, or by adopting utilization management or preferred provider organization (PPO) benefit options. We collected benefit design data for the years 1985 through 1992 from 95 insured groups in 62 US metropolitan statistical areas. Multivariate hazard analysis showed that groups located in markets with higher rates of change in HMO enrollment were less likely to increase deductibles or stop loss levels. Groups located in markets with higher HMO enrollment were more likely to adopt utilization management or PPO benefit options. A group located in a market with an HMO penetration rate of 20% was 65% more likely to have included a PPO option as part of its insurance benefit plan than a group located in a market with an HMO penetration rate of 15% (p < 0.05). Concern about possible adverse selection effects may deter some fee-for-service groups from changing their health insurance coverage. Under some conditions, however, groups insured under fee-for-service plans do respond to managed care competition by changing their insurance benefits to achieve greater cost containment.

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

    PubMed Central

    2010-01-01

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

  15. 7 CFR 4290.815 - Financings in the form of Debt Securities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... purchase Debt Securities from an Enterprise. (b) Restriction of options obtained by RBIC's management and... Section 4290.815 Agriculture Regulations of the Department of Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE RURAL BUSINESS INVESTMENT COMPANY...

  16. Secure transport and adaptation of MC-EZBC video utilizing H.264-based transport protocols☆

    PubMed Central

    Hellwagner, Hermann; Hofbauer, Heinz; Kuschnig, Robert; Stütz, Thomas; Uhl, Andreas

    2012-01-01

    Universal Multimedia Access (UMA) calls for solutions where content is created once and subsequently adapted to given requirements. With regard to UMA and scalability, which is required often due to a wide variety of end clients, the best suited codecs are wavelet based (like the MC-EZBC) due to their inherent high number of scaling options. However, most transport technologies for delivering videos to end clients are targeted toward the H.264/AVC standard or, if scalability is required, the H.264/SVC. In this paper we will introduce a mapping of the MC-EZBC bitstream to existing H.264/SVC based streaming and scaling protocols. This enables the use of highly scalable wavelet based codecs on the one hand and the utilization of already existing network technologies without accruing high implementation costs on the other hand. Furthermore, we will evaluate different scaling options in order to choose the best option for given requirements. Additionally, we will evaluate different encryption options based on transport and bitstream encryption for use cases where digital rights management is required. PMID:26869746

  17. The extension of the thermal-vacuum test optimization program to multiple flights

    NASA Technical Reports Server (NTRS)

    Williams, R. E.; Byrd, J.

    1981-01-01

    The thermal vacuum test optimization model developed to provide an approach to the optimization of a test program based on prediction of flight performance with a single flight option in mind is extended to consider reflight as in space shuttle missions. The concept of 'utility', developed under the name of 'availability', is used to follow performance through the various options encountered when the capabilities of reflight and retrievability of space shuttle are available. Also, a 'lost value' model is modified to produce a measure of the probability of a mission's success, achieving a desired utility using a minimal cost test strategy. The resulting matrix of probabilities and their associated costs provides a means for project management to evaluate various test and reflight strategies.

  18. Propellant Depots: The Future of Space Exploration

    NASA Astrophysics Data System (ADS)

    Crenwelge, Drew

    NASA is currently exploring several options for mankind's return to the lunar surface and beyond. The selected option must stimulate both commercial and international involvement, support future missions to the Moon and other destinations, and above all, fit within the current budget profile. Contrary to the current Constellation approach, this paper describes the option of using an in-space propellant depot architecture that can refuel or top-off visiting vehicles at EML1, and how it fits within NASA's new space exploration criteria. In addition to receiving and transferring fuel, the propellant depot will also provide cryogenic propellant storage and management that utilizes flight proven technologies in conjunction with technologies currently under development. The propellant depot system, propellant management and acquisition devices, thermodynamic analysis, and key enabling technologies are also discussed. Depot design concepts along with an overview of a future lunar mission sequence are also presented.

  19. Power Buying: Planning For Your Deregulated Future.

    ERIC Educational Resources Information Center

    Robertson, Wayne K.

    1997-01-01

    Colleges and universities can benefit from the coming deregulation of utilities. Deregulation creates opportunity for facility managers to aggressively negotiate agreements, implement changes to the physical plant to make the institution a more attractive customer, and explore new, less expensive energy supply options and alternatives. Some action…

  20. American power conference: Proceedings

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

    Not Available

    1994-01-01

    The first volume of this conference contains papers on the following topics: (1) Controls, monitoring, and expert systems (Harnessing microprocessor revolution for a more competitive power industry; Plant control--Upgrades; Neural network applications); (2) Diversification and globalization (Electric utility diversification/globalization--Panel; Private power in developing countries); (3) Environment and clean air (Clean Air compliance costs; Site selection for power stations and related facilities; Electric utility trace substance emissions; Solid waste disposal and commercial use; Precipitators/fabric filters; and Effect of flow modifications on fisheries and water quality); (4) Generation--Fuel options equipment (Alternate fuels; Advances in fuel cells for electric power applications; Secondary containmentmore » and seismic requirements for petrochemical facilities; Clean coal technology demonstration; Advanced energy systems; Hydropower); (5) Nuclear operations options (Radioactive waste management and disposal; Off normal conditions; Advanced light water reactors--15 years after TMI; Structural dynamic analyses for nuclear power plants); (6) Retrofit, betterment, repowering maintenance (Project management; Improving competitiveness through process re-engineering; Central stations; Water and wastewater treatment); (7) System planning, operation demand maintenance (Transmission system access; Stability; Systems planning); (8) Transmission and distribution (Transformers; Relaying for system protection; Managing EMF effects); and (9) Education (Power engineering). 155 papers have been processed separately for inclusion on the data base.« less

  1. Selection bias between 2 Medicare capitated benefit programs.

    PubMed

    Leutz, Walter; Brody, Kathleen K; Nonnenkamp, Lucy L; Perrin, Nancy A

    2007-04-01

    To assess enrollment selection bias between a standard Medicare health maintenance organization (HMO) and a higher-priced social health maintenance organization (SHMO) offering full prescription drug and unique home-based and community-based benefits and to assess how adverse selection was handled through SHMO finances. Kaiser Permanente Northwest offered the dual-choice option in the greater Portland region from 1985 to 2002. Analysis focused on 3 "choice points" when options were clear and highlighted for beneficiaries. Data collected included age and sex, utilization 1 year before and after the choice points, health status data at enrollment (1999-2002 only), mortality, and cost and revenues. Data were extracted from health plan databases. Hospital, pharmacy, and nursing facility utilization for 1 year before and after the choice points are compared for HMO and SHMO choosers. Health and functional status data are compared from 1999 to 2002. Utilization and mortality data are controlled by age and sex. SHMO joiners evidenced adverse selection, while healthier members tended to stay in the HMO, with leaner benefits. Despite adverse selection, the health plan maintained margins in the SHMO, assisted by frailty-adjusted Medicare payments and member premiums. This high-low option strategy sought to offer the "right care at the right time" and may be a model for managed care organizations to serve aging and disabled beneficiaries under Medicare's new special needs plan option.

  2. Cost-effectiveness of sialendoscopy versus medical management for radioiodine-induced sialadenitis.

    PubMed

    Kowalczyk, David M; Jordan, J Randall; Stringer, Scott P

    2018-03-30

    The medical management and radiographic identification of radioiodine-induced sialadenitis (RAIS) is challenging. This study utilizes a cost-effectiveness analysis to compare upfront sialendoscopy as both a diagnostic and therapeutic option versus multiple modalities of diagnostic radiography along with medical management. Literature review and cost-effectiveness analysis. A literature review was performed to identify the outcomes of medical management, sialendoscopy, diagnostic radiography, and surgical complications. All charges were obtained from the University of Mississippi Budget Office in 2017 US dollars and converted to costs using the 2017 Medicare Cost-to-Charge Ratio for urban medical centers. A cost-effectiveness analysis was used to evaluate the four treatment arms-sialendoscopy, medical management- ultrasound, medical management-computed tomography (CT) sialography, and medical management-magnetic resonance (MR) sialography. Sensitivity analyses were used to evaluate the confidence levels of the economic evaluation. The incremental cost-effectiveness ratio for upfront sialendoscopy versus medical management-ultrasound was $30,402.30, which demonstrates that sialendoscopy is the more cost-effective option given a willingness-to-pay threshold of $50,000. The probability that this decision is correct at a willingness-to-pay of $50,000 is 64.5%. Sialendoscopic improvement was the most sensitive variable requiring a threshold of 0.70. Of the three imaging modalities, ultrasound dominated MR and CT sialography, both of which required a willingness-to-pay of greater than $90,000 to realize a difference. Upfront sialendoscopy is more cost-effective compared to medical management utilizing diagnostic ultrasound assuming a willingness-to-pay threshold of $50,000. There is a clear cost-effectiveness to using ultrasound with medical management over CT and MR sialography in the diagnosis and management of RAIS. NA. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

  3. Joint protection and hand exercises for hand osteoarthritis: an economic evaluation comparing methods for the analysis of factorial trials

    PubMed Central

    Oppong, Raymond; Nicholls, Elaine; Whitehurst, David G. T.; Hill, Susan; Hammond, Alison; Hay, Elaine M.; Dziedzic, Krysia

    2015-01-01

    Objectives. Evidence regarding the cost-effectiveness of joint protection and hand exercises for the management of hand OA is not well established. The primary aim of this study is to assess the cost-effectiveness (cost-utility) of these management options. In addition, given the absence of consensus regarding the conduct of economic evaluation alongside factorial trials, we compare different analytical methodologies. Methods. A trial-based economic evaluation to assess the cost-utility of joint protection only, hand exercises only and joint protection plus hand exercises compared with leaflet and advice was undertaken over a 12 month period from a UK National Health Service perspective. Patient-level mean costs and mean quality-adjusted life years (QALYs) were calculated for each trial arm. Incremental cost-effectiveness ratios (ICERs) were estimated and cost-effectiveness acceptability curves were constructed. The base case analysis used a within-the-table analysis methodology. Two further methods were explored: the at-the-margins approach and a regression-based approach with or without an interaction term. Results. Mean costs (QALYs) were £58.46 (s.d. 0.662) for leaflet and advice, £92.12 (s.d. 0.659) for joint protection, £64.51 (s.d. 0.681) for hand exercises and £112.38 (s.d. 0.658) for joint protection plus hand exercises. In the base case, hand exercises were the cost-effective option, with an ICER of £318 per QALY gained. Hand exercises remained the most cost-effective management strategy when adopting alternative methodological approaches. Conclusion. This is the first trial evaluating the cost-effectiveness of occupational therapy-supported approaches to self-management for hand OA. Our findings showed that hand exercises were the most cost-effective option. PMID:25339642

  4. Comparison of health utility weights among elderly patients receiving breast-conserving surgery plus hormonal therapy with or without radiotherapy

    PubMed Central

    Ali, Askal Ayalew; Xiao, Hong; Tawk, Rima; Campbell, Ellen; Semykina, Anastasia; Montero, Alberto J.; Diaby, Vakaramoko

    2017-01-01

    Background The selection of the most appropriate treatment combinations requires the balancing of benefits and harms of these treatment options as well as the patients’ preferences for the resulting outcomes. Objective This research aimed at estimating and comparing the utility weights between elderly women with early stage hormone receptor positive (HR+) breast cancer receiving a combination of radiotherapy and hormonal therapy after breast conserving surgery (BCS) and those receiving a combination of BCS and hormonal therapy. Methods The Surveillance, Epidemiology, and End Results (SEER) linked with Medicare Health Outcomes Survey (MHOS) was used as the data source. Health utility weights were derived from the VR-12 health-related quality of life instrument using a mapping algorithm. Descriptive statistics of the sample were provided. Two sample t-tests were performed to determine potential differences in mean health utility weights between the two groups after propensity score matching. Results The average age at diagnosis was 72 vs. 76 years for the treated and the untreated groups, respectively. The results showed an inverse relationship between the receipt of radiotherapy and age. Patients who received radiotherapy had, on average, a higher health utility weight (0.70; SD = 0.123) compared with those who did not receive radiotherapy (0.676; SD = 0.130). Only treated patients who had more than two comorbid conditions had significantly higher health utility weights compared with patients who were not treated. Conclusions The mean health utility weights estimated for the radiotherapy and no radiotherapy groups can be used to inform a comparative cost-effectiveness analysis of the treatment options. However, the results of this study may not be generalizable to those who are outside a managed care plan because MHOS data is collected on managed care beneficiaries. PMID:27819160

  5. A Many-Objective Approach to Developing Adaptive Water Supply Portfolios in the 'Research Triangle' Region of North Carolina

    NASA Astrophysics Data System (ADS)

    Zeff, H. B.; Kasprzyk, J. R.; Reed, P. M.; Characklis, G. W.

    2012-12-01

    This study uses many-objective evolutionary optimization to quantify the tradeoffs water utilities face when developing flexible water shortage response plans. Alternatives to infrastructure development, such as temporary demand management programs and inter-utility water transfer agreements, allow local water providers to develop portfolios of water supply options capable of adapting to changing hydrologic conditions and growing water demand. The extent to which these options are implemented will be determined by a number of conflicting operational and financial considerations. An integrated reservoir simulation model including four large water utilities in the 'Research Triangle' region of North Carolina is used to evaluate the potential tradeoffs resulting from regional demands on shared infrastructure, customer concerns, and the financial uncertainty caused by the intermittent and irregular nature of drought. Instead of providing one optimal solution, multi-objective evolutionary algorithms (MOEAs) use the concept of non-dominations to discover a set of portfolio options in which no solution is inferior to any other solution in all objectives. Interactive visual analytics enable water providers to explore these tradeoffs and develop water shortage response plans tailored to their individual circumstances. The simulation model is evaluated under a number of different formulations to help identify and visualize the impacts of water efficiency, revenue/cost variability, consumer effects, and inter-utility cooperation. The different problems are formulated by adding portfolio options and objectives in such a way that the lower dimensional problem formulations are sub-sets of the full formulation. The full formulation considers reservoir reliability, water use restriction frequency, total water transfer allotment, total costs, revenue/cost variability, and additional consumer losses during restrictions. The simulation results highlight the inadequacy of lower order, cost-benefit type analyses to evaluate water management techniques as they move beyond the construction of large storage infrastructure. This work can help water providers develop the analytical tools to evaluate complex, adaptive techniques that are becoming more attractive in an era of growing municipal demand, risking infrastructure costs, and uncertain hydrology.

  6. Short Lumber: Concept and Acceptance

    Treesearch

    Janice K. Wiedenbeck

    1993-01-01

    The primary purpose of this study was to evaluate short length lumber (less than 8 feet long) utilization opportunities within the furniture and cabinet industries. If such a high-value market for short length lumber could be developed, the profit potential for many sawmills would increase and the forest resource management options in many areas would expand. Short...

  7. Inferences from growing trees backwards

    Treesearch

    David W. Green; Kent A. McDonald

    1997-01-01

    The objective of this paper is to illustrate how longitudinal stress wave techniques can be useful in tracking the future quality of a growing tree. Monitoring the quality of selected trees in a plantation forest could provide early input to decisions on the effectiveness of management practices, or future utilization options, for trees in a plantation. There will...

  8. Youth Risk Assessment in Complex Agency Practice

    ERIC Educational Resources Information Center

    Groner, Mark R.; Solomon, Jean

    2007-01-01

    Advancements in the delivery of community-based services and tight utilization management of high-cost treatment options result in youths with serious behavior problems receiving intervention in lower levels of care than was true ten or fifteen years ago. This shift in where services tend to be delivered necessitates enhancement of risk assessment…

  9. A review of the clinical utility of duloxetine in the treatment of diabetic peripheral neuropathic pain

    PubMed Central

    King, Jordan B; Schauerhamer, Marisa B; Bellows, Brandon K

    2015-01-01

    Diabetes mellitus is a world-wide epidemic with many long-term complications, with neuropathy being the most common. In particular, diabetic peripheral neuropathic pain (DPNP), can be one of the most distressing complications associated with diabetes, leading to decreases in physical and mental quality of life. Despite the availability of many efficient medications, DPNP remains a challenge to treat, and the optimal sequencing of pharmacotherapy remains unknown. Currently, there are only three medications approved by the US Food and Drug Administration specifically for the management of DPNP. Duloxetine (DUL), a selective serotonin-norepinephrine reuptake inhibitor, is one of these. With the goal of optimizing pharmacotherapy use in DPNP population, a review of current literature was conducted, and the clinical utility of DUL described. Along with early clinical trials, recently published observational studies and pharmacoeconomic models may be useful in guiding decision making by clinicians and managed care organizations. In real-world practice settings, DUL is associated with decreased or similar opioid utilization, increased medication adherence, and similar health care costs compared with current standard of care. DUL has consistently been found to be a cost-effective option over short time-horizons. Currently, the long-term cost-effectiveness of DUL is unknown. Evidence derived from randomized clinical trials, real-world observations, and economic models support the use of DUL as a first-line treatment option from the perspective of the patient, clinician, and managed care payer. PMID:26309404

  10. A review of the clinical utility of duloxetine in the treatment of diabetic peripheral neuropathic pain.

    PubMed

    King, Jordan B; Schauerhamer, Marisa B; Bellows, Brandon K

    2015-01-01

    Diabetes mellitus is a world-wide epidemic with many long-term complications, with neuropathy being the most common. In particular, diabetic peripheral neuropathic pain (DPNP), can be one of the most distressing complications associated with diabetes, leading to decreases in physical and mental quality of life. Despite the availability of many efficient medications, DPNP remains a challenge to treat, and the optimal sequencing of pharmacotherapy remains unknown. Currently, there are only three medications approved by the US Food and Drug Administration specifically for the management of DPNP. Duloxetine (DUL), a selective serotonin-norepinephrine reuptake inhibitor, is one of these. With the goal of optimizing pharmacotherapy use in DPNP population, a review of current literature was conducted, and the clinical utility of DUL described. Along with early clinical trials, recently published observational studies and pharmacoeconomic models may be useful in guiding decision making by clinicians and managed care organizations. In real-world practice settings, DUL is associated with decreased or similar opioid utilization, increased medication adherence, and similar health care costs compared with current standard of care. DUL has consistently been found to be a cost-effective option over short time-horizons. Currently, the long-term cost-effectiveness of DUL is unknown. Evidence derived from randomized clinical trials, real-world observations, and economic models support the use of DUL as a first-line treatment option from the perspective of the patient, clinician, and managed care payer.

  11. Assessing Pinyon Juniper Feedstock Properties and Utilization Options

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

    Gresham, Garold Linn; Kenney, Kevin Louis

    2015-08-01

    Pinyon-juniper woodlands are a major ecosystem type found in the Southwest and the Intermountain West regions of the United States. These ecosystems are characterized by the presence of several different species of pinyon pine and juniper as the dominant plant cover. Since the 1800s, pinyon-juniper woodlands have rapidly expanded their range at the expense of existing ecosystems. Additionally, existing woodlands have become more dense, potentially increasing fire hazards. Land managers responsible for these areas often desire to reduce pinyonjuniper coverage on their lands for a variety of reasons, including restoration to previous vegetative cover, mitigation of fire risk, and improvementmore » in wildlife habitat. However, the cost of clearing or thinning pinyon-juniper stands can be prohibitive. One reason for this is the lack of utilization options for the resulting biomass that could help recover some of the cost of pinyonjuniper stand management. The goal of this project was to assess the feedstock characteristics of biomass from a pinyon-juniper harvest so that potential applications for the biomass may be evaluated.« less

  12. Life-cycle assessment of selected management options for air pollution control residues from waste incineration.

    PubMed

    Fruergaard, Thilde; Hyks, Jiri; Astrup, Thomas

    2010-09-15

    Based on available technology and emission data seven selected management options for air-pollution-control (APC) residues from waste incineration were evaluated by life-cycle assessment (LCA) using the EASEWASTE model. Scenarios were evaluated with respect to both non-toxicity impact categories (e.g. global warming) and toxicity related impact categories (e.g. ecotoxicity and human toxicity). The assessment addressed treatment and final placement of 1 tonne of APC residue in seven scenarios: 1) direct landfilling without treatment (baseline), 2) backfilling in salt mines, 3) neutralization of waste acid, 4) filler material in asphalt, 5) Ferrox stabilization, 6) vitrification, and 7) melting with automobile shredder residues (ASR). The management scenarios were selected as examples of the wide range of different technologies available worldwide while at the same time using realistic technology data. Results from the LCA were discussed with respect to importance of: energy consumption/substitution, material substitution, leaching, air emissions, time horizon aspects for the assessment, and transportation distances. The LCA modeling showed that thermal processes were associated with the highest loads in the non-toxicity categories (energy consumption), while differences between the remaining alternatives were small and generally considered insignificant. In the toxicity categories, all treatment/utilization options were significantly better than direct landfilling without treatment (lower leaching), although the thermal processes had somewhat higher impacts than the others options (air emissions). Transportation distances did not affect the overall ranking of the management alternatives. Copyright 2010 Elsevier B.V. All rights reserved.

  13. Chronobiology of epilepsy: diagnostic and therapeutic implications of chrono-epileptology.

    PubMed

    Loddenkemper, Tobias; Lockley, Steven W; Kaleyias, Joseph; Kothare, Sanjeev V

    2011-04-01

    The combination of chronobiology and epilepsy offers novel diagnostic and therapeutic management options. Knowledge of the interactions between circadian periodicity, entrainment, sleep patterns, and epilepsy may provide additional diagnostic options beyond sleep deprivation and extended release medication formulations. It may also provide novel insights into the physiologic, biochemical, and genetic regulation processes of epilepsy and the circadian clock, rendering new treatment options. Temporal fluctuations of seizure susceptibility based on sleep homeostasis and circadian phase in selected epilepsies may provide predictability based on mathematical models. Chrono-epileptology offers opportunities for individualized patient-oriented treatment paradigms based on chrono-pharmacology, differential medication dosing, chrono-drug delivery systems, and utilization of "zeitgebers" such as chronobiotics or light-therapy and desynchronization strategies among others.

  14. Distributed utility technology cost, performance, and environmental characteristics

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

    Wan, Y; Adelman, S

    1995-06-01

    Distributed Utility (DU) is an emerging concept in which modular generation and storage technologies sited near customer loads in distribution systems and specifically targeted demand-side management programs are used to supplement conventional central station generation plants to meet customer energy service needs. Research has shown that implementation of the DU concept could provide substantial benefits to utilities. This report summarizes the cost, performance, and environmental and siting characteristics of existing and emerging modular generation and storage technologies that are applicable under the DU concept. It is intended to be a practical reference guide for utility planners and engineers seeking informationmore » on DU technology options. This work was funded by the Office of Utility Technologies of the US Department of Energy.« less

  15. Proceedings: 1989 electric utility franchise conference

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

    Romo, R.G.

    The primary purpose of the Conference was to present and discuss strategic issues related to franchising electric service. The theme for the conference was to both improve the management of existing franchises and the negotiation of new franchises. To promote a better understanding of the planning issues related to this theme, the following sessions were designed: (1) public utility franchising, (2) investor owned utility and community perspectives on franchising, (3) franchise case study presentations, (4) alternatives to franchise renewal: the public acquisition option, and (5) special franchise issues. The Conference combined results from research coupled with actual franchise negotiating experiences,more » and concepts and ideas considered or implemented by utilities, government agencies, consultants and others.« less

  16. Options for small-diameter hardwood utilization: past and present

    Treesearch

    Matthew S. Bumgardner; Bruce G. Hansen; Albert T. Schuler; Philip A. Araman

    2000-01-01

    Effective and maximum value use of small-diameter hardwood timber has long been of interest to forest managers and researchers. In addition to being a significant component of the standing forest base, small-diameter hardwoods often are available after thinning or other tending operations. Although the use of this material is important to achieving healthy and...

  17. Building partnerships to evaluate wood utilization options for improving forest health

    Treesearch

    Kenneth E. Skog; David Green; R. James Barbour; John E. Baumgras; Alexander Clark; Andrew Mason; David A. Meriwether; Gary C. Myers; Gary C. Myers

    1995-01-01

    Silvicultural practices used on national forests are changing as a result of the shift to ecosystem management. As a result, the species mix, size, quality, and quantity of woody material that may be removed are changing. In a combined, multidisciplinary effort, Forest Service research units at the Forest Products Laboratory, Pacific Northwest and Southern Research...

  18. Options for Small-Diameter Hardwood Utilization: Past and Present

    Treesearch

    Matthew S. Bumgardner; Bruce G. Hansen; Albert T. Schuler; Philip A. Araman; Philip A. Araman

    2001-01-01

    Effective and maximum value use of small-diameter hardwood timber has long been of interest to forest managers and researchers. In addition to being a significant component of the standing forest base, small-diameter hardwoods often are available after thinning or other tending operations. Although the use of this material is important to achieving healthy and...

  19. Analysis of Some Potential Manpower Policies for the All-Volunteer Navy. Final Report.

    ERIC Educational Resources Information Center

    Battelle, R. Bard; And Others

    This report describes an analysis of Navy personnel as a subsystem of the Navy, functioning with the overall objective of maintaining Fleet readiness within the constraints of budget and manpower supply limitations. Manpower utilization and management techniques and options were examined and evaluated for their usefulness to an all volunteer Navy…

  20. Production of AM fungus colonized seedlings under organic management; suitablity of hydrolyzed fish vs. blood meal as options for N addition

    USDA-ARS?s Scientific Manuscript database

    The potential benefits of the arbuscular mycorrhizal [AM] symbiosis to crop growth and overall farm sustainability make effective utilization of AM fungus inoculum of particular interest to organic farmers. An important consideration in ensuring the colonization of vegetable seedlings by AM fungi d...

  1. Definitional Hegemony as a Public Relations Strategy: The Rhetoric of the Nuclear Power Industry after Three Mile Island.

    ERIC Educational Resources Information Center

    Dionisopoulos, George N.; Crable, Richard E.

    1988-01-01

    Examines (1) definitional hegemony as one of several rhetorical options available to issue managers; (2) the post-accident rhetorical context of the Three Mile Island nuclear crisis; and (3) the specific strategies utilized to deal with this crisis. Assesses the nuclear industry's public relations efforts. (MS)

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

    NASA Astrophysics Data System (ADS)

    Porter, R. W.

    1982-09-01

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

  3. Tools for automated acoustic monitoring within the R package monitoR

    USGS Publications Warehouse

    Katz, Jonathan; Hafner, Sasha D.; Donovan, Therese

    2016-01-01

    The R package monitoR contains tools for managing an acoustic-monitoring program including survey metadata, template creation and manipulation, automated detection and results management. These tools are scalable for use with small projects as well as larger long-term projects and those with expansive spatial extents. Here, we describe typical workflow when using the tools in monitoR. Typical workflow utilizes a generic sequence of functions, with the option for either binary point matching or spectrogram cross-correlation detectors.

  4. A New Methodology for Modeling National Command Level Decisionmaking in War Games and Simulations.

    DTIC Science & Technology

    1986-07-01

    Conclusions about Utility and Development Options, The Rand Corporation, R-2945-DNA, March 1983. Drucker , Peter F., Management : Tasks, Responsibilities...looks to the worst case can readily find himself paralyzed. Of course, it is also true ’The effort to affect an opponent’s image of oneself is part of...how to manage forces on a continuing basis. So long as the broad features of the NCL-specified plan continue to appear valid, it is the military com

  5. A 26-year-old man with dyspnea and chest pain.

    PubMed

    Mittal, Saurabh; Jain, Akanksha; Arava, Sudheer; Hadda, Vijay; Mohan, Anant; Guleria, Randeep; Madan, Karan

    2017-01-01

    A 26-year-old smoker male presented with a history of sudden onset dyspnea and right-sided chest pain. Chest radiograph revealed large right-sided pneumothorax which was managed with tube thoracostomy. High-resolution computed tomography thorax revealed multiple lung cysts, and for a definite diagnosis, a video-assisted thoracoscopic surgery-guided lung biopsy was performed followed by pleurodesis. This clinicopathologic conference discusses the clinical and radiological differential diagnoses, utility of lung biopsy, and management options for patients with such a clinical presentation.

  6. A 26-year-old man with dyspnea and chest pain

    PubMed Central

    Mittal, Saurabh; Jain, Akanksha; Arava, Sudheer; Hadda, Vijay; Mohan, Anant; Guleria, Randeep; Madan, Karan

    2017-01-01

    A 26-year-old smoker male presented with a history of sudden onset dyspnea and right-sided chest pain. Chest radiograph revealed large right-sided pneumothorax which was managed with tube thoracostomy. High-resolution computed tomography thorax revealed multiple lung cysts, and for a definite diagnosis, a video-assisted thoracoscopic surgery-guided lung biopsy was performed followed by pleurodesis. This clinicopathologic conference discusses the clinical and radiological differential diagnoses, utility of lung biopsy, and management options for patients with such a clinical presentation. PMID:29099006

  7. Mandible Fractures

    PubMed Central

    Pickrell, Brent B.; Serebrakian, Arman T.; Maricevich, Renata S.

    2017-01-01

    Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles. PMID:28496390

  8. Mandible Fractures.

    PubMed

    Pickrell, Brent B; Serebrakian, Arman T; Maricevich, Renata S

    2017-05-01

    Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.

  9. The energy cane alternative

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

    Alexander, A.G.

    This book reviews the conceptual and theoretical background of Saccharum botany, which underlies the growing of cane as a total growth commodity. Management details are provided for energy cane planting, cultivation, harvest, and postharvest operations. Chapters on energy cane utilization stress new developments in lignocellulose conversion plus alternative options for fermentable solids usage. Chapters are also included for the management of alternative grasses to supplement energy cane, and the breeding of new hybrid canes with high biomass attributes at the intergeneric and interspecific levels.

  10. Evaluating options for balancing the water-electricity nexus in California: part 1--securing water availability.

    PubMed

    Tarroja, Brian; AghaKouchak, Amir; Sobhani, Reza; Feldman, David; Jiang, Sunny; Samuelsen, Scott

    2014-11-01

    The technical potential and effectiveness of different water supply options for securing water availability in a large-scale, interconnected water supply system under historical and climate-change augmented inflow and demand conditions were compared. Part 1 of the study focused on determining the scale of the options required to secure water availability and compared the effectiveness of different options. A spatially and temporally resolved model of California's major surface reservoirs was developed, and its sensitivity to urban water conservation, desalination, and water reuse was examined. Potential capacities of the different options were determined. Under historical (baseline) hydrology conditions, many individual options were found to be capable of securing water availability alone. Under climate change augment conditions, a portfolio approach was necessary. The water savings from many individual options other than desalination were insufficient in the latter, however, relying on seawater desalination alone requires extreme capacity installations which have energy, brine disposal, management, and cost implications. The importance of identifying and utilizing points of leverage in the system for choosing where to deploy different options is also demonstrated. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Addressing Climate Change in Long-Term Water Planning Using Robust Decisionmaking

    NASA Astrophysics Data System (ADS)

    Groves, D. G.; Lempert, R.

    2008-12-01

    Addressing climate change in long-term natural resource planning is difficult because future management conditions are deeply uncertain and the range of possible adaptation options are so extensive. These conditions pose challenges to standard optimization decision-support techniques. This talk will describe a methodology called Robust Decisionmaking (RDM) that can complement more traditional analytic approaches by utilizing screening-level water management models to evaluate large numbers of strategies against a wide range of plausible future scenarios. The presentation will describe a recent application of the methodology to evaluate climate adaptation strategies for the Inland Empire Utilities Agency in Southern California. This project found that RDM can provide a useful way for addressing climate change uncertainty and identify robust adaptation strategies.

  12. Feasibility of a small central cogenerated energy facility: Energy management memorandum

    NASA Astrophysics Data System (ADS)

    Porter, R. N.

    1982-10-01

    The thermal economic feasibility of a small cogenerated energy facility designed to serve several industries in the Stockyards area was investigated. Cogeneration options included two dual fuel diesels and two gas turbines, all with waste heat boilers, and five fired boilers. Fuels included natural gas, and for the fired boiler cases, also low sulphur coal and municipal refuse. For coal and refuse, the option of steam only without cogeneration was also assessed. The fired boiler cogeneration systems employed back pressure steam turbines. The refuse fired cases utilized electrical capacities, 8500 to 52,400 lbm/hr and 0 to 9.9 MW (e), respectively. Deficient steam was assumed generated independently in existing equipment. Excess electrical power over that which was displaced was sold to Commonwealth Edison Company under PURPA (Public Utility Regulatory Policies Act). The facility was operated by a mutually owned corporation formed by the cogenerated power users.

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

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

    Schweitzer, M.

    1991-01-01

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

  14. A potential role for N-acetylcysteine in the management of methamphetamine dependence.

    PubMed

    McKetin, Rebecca; Dean, Olivia M; Baker, Amanda L; Carter, Greg; Turner, Alyna; Kelly, Peter J; Berk, Michael

    2017-03-01

    Methamphetamine dependence is a growing problem in Australia and globally. Currently, there are no approved pharmacotherapy options for the management of methamphetamine dependence. N-acetylcysteine is one potential pharmacotherapy option. It has received growing attention as a therapy for managing addictions because of its capacity to restore homeostasis to brain glutamate systems disrupted in addiction and thereby reduce craving and the risk of relapse. N-acetylcysteine also has antioxidant properties that protect against methamphetamine-induced toxicity and it may therefore assist in the management of the neuropsychiatric and neurocognitive effects of methamphetamine. This commentary overviews the actions of N-acetylcysteine and evidence for its efficacy in treating addiction with a particular focus on its potential utility for methamphetamine dependence. We conclude that the preliminary evidence indicates a need for full-scale trials to definitively establish whether N-acetylcysteine has a therapeutic benefit and the nature of this benefit, for managing methamphetamine dependence. [McKetin R, Dean O, Baker A. L, Carter G, Turner A, Kelly P. J, Berk M. A potential role for N-acetylcysteine in the management of methamphetamine dependence. Drug Alcohol Rev 2017;36:153-159]. © 2016 Australasian Professional Society on Alcohol and other Drugs.

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

    Bird, L.; Kaiser, M.

    In the early 1990s, only a handful of utilities offered their customers a choice of purchasing electricity generated from renewable energy sources. Today, more than 750 utilities--or about 25% of all utilities nationally--provide their customers a "green power" option. Through these programs, more than 70 million customers have the ability to purchase renewable energy to meet some portion or all of their electricity needs--or make contributions to support the development of renewable energy resources. Typically, customers pay a premium above standard electricity rates for this service. This report presents year-end 2006 data on utility green pricing programs, and examines trendsmore » in consumer response and program implementation over time. The data in this report, which were obtained via a questionnaire distributed to utility green pricing program managers, can be used by utilities to benchmark the success of their green power programs.« less

  16. 10 CFR 490.307 - Option for Electric Utilities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 3 2011-01-01 2011-01-01 false Option for Electric Utilities. 490.307 Section 490.307... Provider Vehicle Acquisition Mandate § 490.307 Option for Electric Utilities. (a) A covered person or its... regulation by acquiring electric motor vehicles. (b) If a covered person or its affiliate, division, or...

  17. 10 CFR 490.307 - Option for Electric Utilities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 3 2013-01-01 2013-01-01 false Option for Electric Utilities. 490.307 Section 490.307... Provider Vehicle Acquisition Mandate § 490.307 Option for Electric Utilities. (a) A covered person or its... regulation by acquiring electric motor vehicles. (b) If a covered person or its affiliate, division, or...

  18. The effect of salvage logging on surface fuel loads and fuel moisture in beetle-infested lodgepole pine forests

    Treesearch

    Paul R. Hood; Kellen N. Nelson; Charles C. Rhoades; Daniel B. Tinker

    2017-01-01

    Widespread tree mortality from mountain pine beetle (MPB; Dendroctonus ponderosae Hopkins) outbreaks has prompted forest management activities to reduce crown fire hazard in the Rocky Mountain region. However, little is known about how beetle-related salvage logging and biomass utilization options affect woody surface fuel loads and fuel moisture dynamics. We compared...

  19. The Philippine Bases: Continuing Utility in a Changing Strategic Context,

    DTIC Science & Technology

    1980-02-01

    economy. One study has shown that the total impact of such spending (local purchases , construction, wages to Filipinos, and various US private spending...results of research studies in selected areas of national strategy formulation and management of national security resources. Unless otherwise noted...NTENDINI WSJ.......: .3 Background .. . . . . . . . . . . . . . . . . .3 The Forward Strategy Concept ./..:*....**’* 5 The "Failback" Option to Gua

  20. TAP Report - Southwest Idaho Juniper Working Group

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

    Gresham, Garold Linn

    There is explicit need for characterization of the materials for possible commercialization as little characterization data exists. Pinyon-juniper woodlands are a major ecosystem type found in the Southwest and the Intermountain West regions of the United States including Nevada, Idaho and Oregon. These widespread ecosystems are characterized by the presence of several different species of pinyon and juniper as the dominant plant cover. Since the 1800s, pinyon-juniper woodlands have rapidly expanded their range at the expense of existing ecosystems. Additionally, existing woodlands have become denser, progressively creating potential fire hazards as seen in the Soda Fire, which burned more thanmore » 400 sq. miles. Land managers responsible for these areas often desire to reduce pinyon-juniper coverage on their lands for a variety of reasons, as stated in the Working Group objectives. However, the cost of clearing thinning pinyon-juniper stands can be prohibitive. One reason for this is the lack of utilization options for the resulting biomass that could help recover some of the cost of pinyon-juniper stand management. The goal of this TAP effort was to assess the feedstock characteristics of biomass from a juniper harvested from Owyhee County to evaluate possible fuel and conversion utilization options.« less

  1. Integrated Research on the Development of Global Climate Risk Management Strategies - Framework and Initial Results of the Research Project ICA-RUS

    NASA Astrophysics Data System (ADS)

    Emori, Seita; Takahashi, Kiyoshi; Yamagata, Yoshiki; Oki, Taikan; Mori, Shunsuke; Fujigaki, Yuko

    2013-04-01

    With the aim of proposing strategies of global climate risk management, we have launched a five-year research project called ICA-RUS (Integrated Climate Assessment - Risks, Uncertainties and Society). In this project with the phrase "risk management" in its title, we aspire for a comprehensive assessment of climate change risks, explicit consideration of uncertainties, utilization of best available information, and consideration of every possible conditions and options. We also regard the problem as one of decision-making at the human level, which involves social value judgments and adapts to future changes in circumstances. The ICA-RUS project consists of the following five themes: 1) Synthesis of global climate risk management strategies, 2) Optimization of land, water and ecosystem uses for climate risk management, 3) Identification and analysis of critical climate risks, 4) Evaluation of climate risk management options under technological, social and economic uncertainties and 5) Interactions between scientific and social rationalities in climate risk management (see also: http://www.nies.go.jp/ica-rus/en/). For the integration of quantitative knowledge of climate change risks and responses, we apply a tool named AIM/Impact [Policy], which consists of an energy-economic model, a simplified climate model and impact projection modules. At the same time, in order to make use of qualitative knowledge as well, we hold monthly project meetings for the discussion of risk management strategies and publish annual reports based on the quantitative and qualitative information. To enhance the comprehensiveness of the analyses, we maintain an inventory of risks and risk management options. The inventory is revised iteratively through interactive meetings with stakeholders such as policymakers, government officials and industrial representatives.

  2. Adenomyosis and Abnormal Uterine Bleeding (AUB-A)-Pathogenesis, diagnosis, and management.

    PubMed

    Abbott, Jason A

    2017-04-01

    The complex pathogenesis and variable presentation of adenomyosis make it one of the most difficult of the FIGO PALM-COIEN abnormal uterine bleeding group to diagnose and treat. Basic clinical parameters such as prevalence are difficult to accurately assess because histological confirmation is usually employed; however, because of the access to and accuracy and utilization of transvaginal ultrasound and other advanced imaging techniques such as MRI, noninvasive diagnosis is recognized to be highly accurate. The clinical symptoms of pain, abnormal uterine bleeding, and subfertility are the primary presentations of adenomyosis with increasing data supporting a substantial role of this disease in reducing fecundity and interfering with assisted reproductive interventions. Treatments have been aimed at managing symptoms and improving fertility options. Management by hysterectomy is not always desired by women, and with many women having children in their fourth and even fifth decades, it is often not reasonable to consider this radical option. Copyright © 2016. Published by Elsevier Ltd.

  3. Helping Water Utilities Grapple with Climate Change

    NASA Astrophysics Data System (ADS)

    Yates, D.; Gracely, B.; Miller, K.

    2008-12-01

    The Water Research Foundation (WRF), serving the drinking water industry and the National Center for Atmospheric Research (NCAR) are collaborating on an effort to develop and implement locally-relevant, structured processes to help water utilities consider the impacts and adaptation options that climate variability and change might have on their water systems. Adopting a case-study approach, the structured process include 1) a problem definition phase, focused on identifying goals, information needs, utility vulnerabilities and possible adaptation options in the face of climate and hydrologic uncertainty; 2) developing and/or modifying system-specific Integrated Water Resource Management (IWRM) models and conducting sensitivity analysis to identify critical variables; 3) developing probabilistic climate change scenarios focused on exploring uncertainties identified as important in the sensitivity analysis in step 2; and 4) implementing the structured process and examining approaches decision making under uncertainty. Collaborators include seven drinking water utilities and two state agencies: 1) The Inland Empire Utility Agency, CA; 2) The El Dorado Irrigation District, Placerville CA; 2) Portland Water Bureau, Portland OR; 3) Colorado Springs Utilities, Colo Spgs, CO; 4) Cincinnati Water, Cincinnati, OH; 5) Massachusetts Water Resources Authority (MWRA), Boston, MA; 6) Durham Water, Durham, NC; and 7) Palm Beach County Water (PBCW), Palm Beach, FL. The California Department of Water Resources and the Colorado Water Conservation Board were the state agencies that we have collaborated with.

  4. Using Global Climate Data to Inform Long-Term Water Planning Decisions

    NASA Astrophysics Data System (ADS)

    Groves, D. G.; Lempert, R.

    2008-12-01

    Water managers throughout the world are working to consider climate change in their long-term water planning processes. The best available information regarding plausible future hydrologic conditions are largely derived from global circulation models and from paleoclimate data. To date there lacks a single approach for (1) utilizing these data in water management planning tools for analysis and (2) evaluating the myriad of possible adaptation options. This talk will describe several approaches being used at RAND to incorporate global projections of climate change into local, regional, and state-wide long-term water planning. It will draw on current work with the California Department of Water Resources and other local Western water agencies, and a recently completed project with the Inland Empire Utilities Agency. Work to date suggests that climate information can be assimilated into local water planning tools to help identify robust climate adaptation water management strategies.

  5. Network approach for decision making under risk—How do we choose among probabilistic options with the same expected value?

    PubMed Central

    Chen, Yi-Shin

    2018-01-01

    Conventional decision theory suggests that under risk, people choose option(s) by maximizing the expected utility. However, theories deal ambiguously with different options that have the same expected utility. A network approach is proposed by introducing ‘goal’ and ‘time’ factors to reduce the ambiguity in strategies for calculating the time-dependent probability of reaching a goal. As such, a mathematical foundation that explains the irrational behavior of choosing an option with a lower expected utility is revealed, which could imply that humans possess rationality in foresight. PMID:29702665

  6. Network approach for decision making under risk-How do we choose among probabilistic options with the same expected value?

    PubMed

    Pan, Wei; Chen, Yi-Shin

    2018-01-01

    Conventional decision theory suggests that under risk, people choose option(s) by maximizing the expected utility. However, theories deal ambiguously with different options that have the same expected utility. A network approach is proposed by introducing 'goal' and 'time' factors to reduce the ambiguity in strategies for calculating the time-dependent probability of reaching a goal. As such, a mathematical foundation that explains the irrational behavior of choosing an option with a lower expected utility is revealed, which could imply that humans possess rationality in foresight.

  7. Utility-free heuristic models of two-option choice can mimic predictions of utility-stage models under many conditions

    PubMed Central

    Piantadosi, Steven T.; Hayden, Benjamin Y.

    2015-01-01

    Economists often model choices as if decision-makers assign each option a scalar value variable, known as utility, and then select the option with the highest utility. It remains unclear whether as-if utility models describe real mental and neural steps in choice. Although choices alone cannot prove the existence of a utility stage, utility transformations are often taken to provide the most parsimonious or psychologically plausible explanation for choice data. Here, we show that it is possible to mathematically transform a large set of common utility-stage two-option choice models (specifically ones in which dimensions are can be decomposed into additive functions) into a heuristic model (specifically, a dimensional prioritization heuristic) that has no utility computation stage. We then show that under a range of plausible assumptions, both classes of model predict similar neural responses. These results highlight the difficulties in using neuroeconomic data to infer the existence of a value stage in choice. PMID:25914613

  8. Endovascular Management of Central Retinal Arterial Occlusion.

    PubMed

    Agarwal, Nitin; Gala, Nihar B; Baumrind, Benjamin; Hansberry, David R; Thabet, Ahmad M; Gandhi, Chirag D; Prestigiacomo, Charles J

    2016-11-01

    Central retinal artery occlusion (CRAO) is an ophthalmologic emergency due to the sudden cessation of circulation to the inner retinal layer. Without immediate treatment, permanent blindness may ensue. Several treatment options exist, ranging from noninvasive medical management to thrombolysis. Nonetheless, ongoing debate exists regarding the best therapeutic strategy. The authors present the case of a 78-year-old woman with a medical history of hypercholesterolemia and rheumatoid arthritis who experienced complete loss of vision in her left eye. Following ophthalmologic evaluation demonstrating left CRAO, anterior chamber paracentesis was performed. Endovascular intervention was performed via local intra-arterial fibrinolysis with alteplase. Her vision returned to 20/20 following the procedure. In general, conventional therapies have not significantly improved patient outcomes. Several management options exist for CRAO. In general, conservative measures have not been reported to yield better patient outcomes as compared to the natural history of this medical emergency. Endovascular approaches are another option as observed with this case reported. In cases of CRAO, therapeutic strategies such as intra-arterial fibrinolysis utilize a local infusion of reactive tissue plasminogen activator directly at the site of occlusion via catheterization of the ophthalmic artery. Although several case series do show promising results after treating CRAO with intra-arterial fibrinolysis, further studies are required given the reports of complications.

  9. Soak Up the Rain New England Webinar Series: National ...

    EPA Pesticide Factsheets

    Presenters will provide an introduction to the most recent EPA green infrastructure tools to R1 stakeholders; and their use in making decisions about implementing green infrastructure. We will discuss structuring your green infrastructure decision, finding appropriate information and tools, evaluating options and selecting the right Best Management Practices mix for your needs.WMOST (Watershed Management Optimization Support Tool)- for screening a wide range of practices for cost-effectiveness in achieving watershed or water utilities management goals.GIWiz (Green Infrastructure Wizard)- a web application connecting communities to EPA Green Infrastructure tools and resources.Opti-Tool-designed to assist in developing technically sound and optimized cost-effective Stormwater management plans. National Stormwater Calculator- a desktop application for estimating the impact of land cover change and green infrastructure controls on stormwater runoff. DASEES-GI (Decision Analysis for a Sustainable Environment, Economy, and Society) – a framework for linking objectives and measures with green infrastructure methods. Presenters will provide an introduction to the most recent EPA green infrastructure tools to R1 stakeholders; and their use in making decisions about implementing green infrastructure. We will discuss structuring your green infrastructure decision, finding appropriate information and tools, evaluating options and selecting the right Best Management Pr

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

    Bird, Lori; Kaiser, Marshall

    In the early 1990s, only a handful of utilities offered their customers a choice of purchasing electricity generated from renewable energy sources. Today, more than 750 utilities—or about 25% of all utilities nationally—provide their customers a “green power” option. Through these programs, more than 70 million customers have the ability to purchase renewable energy to meet some portion or all of their electricity needs—or make contributions to support the development of renewable energy resources. Typically, customers pay a premium above standard electricity rates for this service. This report presents year-end 2006 data on utility green pricing programs, and examines trendsmore » in consumer response and program implementation over time. The data in this report, which were obtained via a questionnaire distributed to utility green pricing program managers, can be used by utilities to benchmark the success of their green power programs.« less

  11. Wetland Biomass Production: emergent aquatic management options and evaluations. A final subcontract report. [Includes a bibliography containing 686 references on Typha from biological abstracts

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

    Pratt, D.C.; Dubbe, D.R.; Garver, E.G.

    1984-07-01

    The high yield potential and attractive chemical composition of Typha make it a particularly viable energy crop. The Minnesota research effort has demonstrated that total annual biomass yields equivalent to 30 dry tonnes/ha (13 tons/acre) are possible in planted stands. This compares with yields of total plant material between 9 and 16 dry tonnes/ha (4 to 7 tons/acre) in a typical Minnesota corn field. At least 50% of the Typha plant is comprised of a belowground rhizome system containing 40% starch and sugar. This high level of easily fermentable carbohydrate makes rhizomes an attractive feedstock for alcohol production. The abovegroundmore » portion of the plant is largely cellulose, and although it is not easily fermentable, it can be gasified or burned. This report is organized in a manner that focuses on the evaluation of the management options task. Results from stand management research performed at the University of Minnesota during 1982 and 1983 are integrated with findings from an extensive survey of relevant emergent aquatic plant research and utilization. These results and findings are then arranged in sections dealing with key steps and issues that need to be dealt with in the development of a managed emergent aquatic bio-energy system. A brief section evaluating the current status of rhizome harvesting is also included along with an indexed bibliography of the biology, ecology, and utilization of Typha which was completed with support from this SERI subcontract. 686 references, 11 figures, 17 tables.« less

  12. Management of Candida biofilms: state of knowledge and new options for prevention and eradication.

    PubMed

    Bujdáková, Helena

    2016-01-01

    Biofilms formed by Candida species (spp.) on medical devices represent a potential health risk. The focus of current research is searching for new options for the treatment and prevention of biofilm-associated infections using different approaches including modern nanotechnology. This review summarizes current information concerning the most relevant resistance/tolerance mechanisms to conventional drugs and a role of additional factors contributing to these phenomena in Candida spp. (mostly Candida albicans). Additionally, it provides an information update in prevention and eradication of a Candida biofilm including experiences with 'lock' therapy, potential utilization of small molecules in biomedical applications, and perspectives of using photodynamic inactivation in the control of a Candida biofilm.

  13. The Indus basin in the framework of current and future water resources management

    NASA Astrophysics Data System (ADS)

    Laghari, A. N.; Vanham, D.; Rauch, W.

    2012-04-01

    The Indus basin is one of the regions in the world that is faced with major challenges for its water sector, due to population growth, rapid urbanisation and industrialisation, environmental degradation, unregulated utilization of the resources, inefficient water use and poverty, all aggravated by climate change. The Indus Basin is shared by 4 countries - Pakistan, India, Afghanistan and China. With a current population of 237 million people which is projected to increase to 319 million in 2025 and 383 million in 2050, already today water resources are abstracted almost entirely (more than 95% for irrigation). Climate change will result in increased water availability in the short term. However in the long term water availability will decrease. Some current aspects in the basin need to be re-evaluated. During the past decades water abstractions - and especially groundwater extractions - have augmented continuously to support a rice-wheat system where rice is grown during the kharif (wet, summer) season (as well as sugar cane, cotton, maize and other crops) and wheat during the rabi (dry, winter) season. However, the sustainability of this system in its current form is questionable. Additional water for domestic and industrial purposes is required for the future and should be made available by a reduction in irrigation requirements. This paper gives a comprehensive listing and description of available options for current and future sustainable water resources management (WRM) within the basin. Sustainable WRM practices include both water supply management and water demand management options. Water supply management options include: (1) reservoir management as the basin is characterised by a strong seasonal behaviour in water availability (monsoon and meltwater) and water demands; (2) water quality conservation and investment in wastewater infrastructure; (3) the use of alternative water resources like the recycling of wastewater and desalination; (4) land use planning and soil conservation as well as flood management, with a focus on the reduction of erosion and resulting sedimentation as well as the restoration of ecosystem services like wetlands and natural floodplains. Water demand management options include: (1) the management of conjunctive use of surface and groundwater; as well as (2) the rehabilitation and modernization of existing infrastructure. Other demand management options are: (3) the increase of water productivity for agriculture; (4) crop planning and diversification including the critical assessment of agricultural export, especially (basmati) rice; (5) economic instruments and (6) changing food demand patterns and limiting post-harvest losses.

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

    NASA Astrophysics Data System (ADS)

    Alp, E.; Aksoy, M. N.; Koçer, B.

    2013-12-01

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

  15. Large wind turbines: A utility option for the generation of electricity

    NASA Technical Reports Server (NTRS)

    Robbins, W. H.; Thomas, R. L.; Baldwin, D. H.

    1980-01-01

    The wind resource is such that wind energy generation has the potential to save 6-7 quads of energy nationally. Thus, the Federal Government is sponsoring and encouraging the development of cost effective and reliable wind turbines. One element of the Federal Wind Energy Programs, Large Horizontal Axis Wind Turbine Development, is managed by the NASA Lewis Research Center for the Department of Energy. There are several ongoing wind system development projects oriented primarily toward utility application within this program element. In addition, a comprehensive technology program supporting the wind turbine development projects is being conducted. An overview is presented of the NASA activities with emphasis on application of large wind turbines for generation of electricity by utility systems.

  16. Audience response system: a new learning tool for urologic conferences.

    PubMed

    Leung, Cynthia P; Klausner, Adam P; Habibi, Joseph R; King, Ashley B; Feldman, Adam

    2013-12-01

    Audience response systems (ARS) have not been used to gauge knowledge transfer and retention in the setting of large medical conferences. In this study, we explore the utility of an ARS as an educational tool in the setting of a large urology conference. At the 2011 joint meeting of the Mid-Atlantic and New England sections of the American Urological Association, conference attendees were able to use a web-based and cell-phone accessed ARS. At the meeting, six ARS questions were asked during five point-counterpoint debate topics covering areas of prostate cancer, incontinence, pediatrics, stone disease, and renal cancer. Questions were presented by expert representatives from each of the sections; questions were structured as management options for predefined cases. At the beginning and end of each 15-minute session, attendees were asked to use the ARS to select the best management option. In five out of the six questions (83%) more than 10% of responses were changed following the presentation of the point-counterpoint session and a > 25% change in response was noted in two out of the six questions (33%). A statistically significant change was noted for one question relating to management of urolithiasis in pregnancy (p = 0.037). This is the first study which demonstrates the potential utility of an ARS in a large urology conference. With further research it may be possible to use this technology to identify high-yield topics for medical education and improve outcomes during lecture-based educational activities.

  17. How can primary care providers manage pediatric obesity in the real world?

    PubMed

    Hopkins, Kristy F; Decristofaro, Claire; Elliott, Lydia

    2011-06-01

    To provide information regarding evidence-based interventions and clinical practice guidelines as a basis for a clinical toolkit utilizing a step management approach for the primary care provider in managing childhood obesity. Evidence-based literature including original clinical trials, literature reviews, and clinical practice guidelines. Interventions can be stratified based on initial screening of children and adolescents so that selection of treatment options is optimized. For all treatments, lifestyle modifications include attention to diet and activity level. Levels of initial success, as well as maintenance of target body mass index, may be related to the intensity and duration of interventions; involvement of family may increase success rates. For failed lifestyle interventions, or for patients with extreme obesity and/or certain comorbidities, pharmacologic or surgical options should be considered. Many intensive programs have shown success, but the resources required for these approaches may be unavailable to the typical community provider and family. However, using current guidelines, the primary care provider can initiate and manage ongoing interventions in pediatric obesity. A toolkit for primary care implementation and maintenance interventions is provided. ©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.

  18. NOX EMISSION CONTROL OPTIONS FOR COAL-FIRED ELECTRIC UTILITY BOILERS

    EPA Science Inventory

    The paper reviews NOx control options for coal-fired electric utility boilers. (NOTE: Acid Rain NOx regulations, the Ozone Transport Commission's NOx Budget Program, revision of the New Source Performance Standards (NSPS) for NOx emissions from utility sources, and Ozone Transpor...

  19. Developing Spatial Management Options for the Protection of Vulnerable Marine Ecosystems in the South Pacific Ocean Region.

    NASA Astrophysics Data System (ADS)

    Rowden, A. A.; Lundquist, C. J.; Clark, M. R.; Anderson, O. F.; Guinotte, J. M.; Baird, S. J.; Roux, M. J.; Wadhwa, S.

    2016-02-01

    The South Pacific Regional Fisheries Management Organisation (SPRFMO) Convention includes specific provisions to protect vulnerable marine ecosystems (VMEs). The SPRFMO Commission has determined that the interim measures put in place to protect VMEs would be replaced by an improved system of fishable and closed areas. These closures would effectively represent a preliminary spatial management plan, whereby conservation and management measures are implemented that will result in sustainable fisheries and benthic protection. We used the conservation planning tool Zonation to develop spatial management options that balance the protection of VMEs with utilisation of high value areas for fishing. Input data included habitat suitability maps, and uncertainties associated with these model predictions, for eleven VME indicator taxa (4 Scleractinian coral species; 3 other cnidarian groups (Family Stylasteridae, Order Antipatharia, Order Pennatulacea; 2 classes of sponges (Demospongiae, Hexactinellidae), and 2 echninoderm groups (Crinoidea and Brisingida)) at bathyal depths across the entire SPRFMO area (divided into 1 km2 grid cells); New Zealand fishing catch data (for two different time periods and trawl types); naturalness (represented by proxy variable using the number of trawl tows); and a bioregionalisation scheme. Running various scenario models for spatial planning allowed for the cost to fishing to be determined, in terms of the amount of the trawl catch footprint lost if high priority areas for VME indicator taxa are protected. Generally, the cost to fishing was low given the relatively high proportion of suitable habitat for VME indicator taxa protected. The main outcome of the present study is a demonstration of the practical utility of using available data, including modelled data, and the Zonation conservation planning software tool to develop options for the spatial management of the SPRFMO area.

  20. Pharmacologic Therapy in Men's Health: Hypogonadism, Erectile Dysfunction, and Benign Prostatic Hyperplasia.

    PubMed

    Berkseth, Kathryn E; Thirumalai, Arthi; Amory, John K

    2016-07-01

    This article reviews current pharmacologic treatment options for 3 common men's health concerns: hypogonadism, erectile dysfunction (ED), and benign prostatic hyperplasia (BPH). Specific topics addressed include: management of male hypogonadism using testosterone replacement therapy, use of oral phosphodiesterase inhibitors as first-line therapy for men with ED and the utility of intraurethral and intrapenile alprostadil injections for patients who do not respond to oral medications, and the role of alpha1-adrenergic antagonists, 5-alpha-reductase inhibitors, anticholinergic agents, and herbal therapies in the management of BPH. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. A cost-benefit analysis of produced water management opportunities in selected unconventional oil and gas plays

    NASA Astrophysics Data System (ADS)

    Marsters, P.; Macknick, J.; Bazilian, M.; Newmark, R. L.

    2013-12-01

    Unconventional oil and gas production in North America has grown enormously over the past decade. The combination of horizontal drilling and hydraulic fracturing has made production from shale and other unconventional resources economically attractive for oil and gas operators, but has also resulted in concerns over potential water use and pollution issues. Hydraulic fracturing operations must manage large volumes of water on both the front end as well as the back end of operations, as significant amounts of water are coproduced with hydrocarbons. This water--often called flowback or produced water--can contain chemicals from the hydraulic fracturing fluid, salts dissolved from the source rock, various minerals, volatile organic chemicals, and radioactive constituents, all of which pose potential management, safety, and public health issues. While the long-term effects of hydraulic fracturing on aquifers, drinking water supplies, and surface water resources are still being assessed, the immediate impacts of produced water on local infrastructure and water supplies are readily evident. Produced water management options are often limited to underground injection, disposal at centralized treatment facilities, or recycling for future hydraulic fracturing operations. The costs of treatment, transport, and recycling are heavily dependent on local regulations, existing infrastructure, and technologies utilized. Produced water treatment costs also change over time during energy production as the quality of the produced water often changes. To date there is no publicly available model that evaluates the cost tradeoffs associated with different produced water management techniques in different regions. This study addresses that gap by characterizing the volume, qualities, and temporal dynamics of produced water in several unconventional oil and gas plays; evaluating potential produced water management options, including reuse and recycling; and assessing how hydraulic fracturing and produced water issues relate to the larger water-energy nexus. Specifically, this study develops a play-specific model to compare the decision factors and costs involved in managing produced water. For example, when transport distances to a wastewater disposal site are far enough, options for recycling water become more favorable, depending on the characteristics of each play. This model can provide policymakers and other interested parties with cost estimates of different water management options, including a better understanding of the costs and opportunities associated with recycling produced water. This work provides a cross-play assessment of produced water management options and costs and could serve as the foundation for more detailed analyses of opportunities to minimize hydraulic fracturing's impacts on freshwater resources.

  2. Potential for reduced methane and carbon dioxide emissions from livestock and pasture management in the tropics

    PubMed Central

    Thornton, Philip K.; Herrero, Mario

    2010-01-01

    We estimate the potential reductions in methane and carbon dioxide emissions from several livestock and pasture management options in the mixed and rangeland-based production systems in the tropics. The impacts of adoption of improved pastures, intensifying ruminant diets, changes in land-use practices, and changing breeds of large ruminants on the production of methane and carbon dioxide are calculated for two levels of adoption: complete adoption, to estimate the upper limit to reductions in these greenhouse gases (GHGs), and optimistic but plausible adoption rates taken from the literature, where these exist. Results are expressed both in GHG per ton of livestock product and in Gt CO2-eq. We estimate that the maximum mitigation potential of these options in the land-based livestock systems in the tropics amounts to approximately 7% of the global agricultural mitigation potential to 2030. Using historical adoption rates from the literature, the plausible mitigation potential of these options could contribute approximately 4% of global agricultural GHG mitigation. This could be worth on the order of $1.3 billion per year at a price of $20 per t CO2-eq. The household-level and sociocultural impacts of some of these options warrant further study, however, because livestock have multiple roles in tropical systems that often go far beyond their productive utility. PMID:20823225

  3. 41 CFR 102-194.5 - What is the Standard and Optional Forms Management Program?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What is the Standard and Optional Forms Management Program? 102-194.5 Section 102-194.5 Public Contracts and Property Management... PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.5 What is the Standard and Optional...

  4. MENU OF NOX EMISSION CONTROL OPTIONS FOR COAL-FIRED ELECTRIC UTILITY BOILERS

    EPA Science Inventory

    The paper reviews NOx control options for coal-fired electric utility boilers. (NOTE: Acid Rain NOx regulations, the Ozone Transport Commission's NOx Budget Program, revision of the New Source Performance Standards (NSPS) for NOx emissions from utility sources, and Ozone Transpor...

  5. Cooperative drought adaptation: Integrating infrastructure development, conservation, and water transfers into adaptive policy pathways

    NASA Astrophysics Data System (ADS)

    Zeff, Harrison B.; Herman, Jonathan D.; Reed, Patrick M.; Characklis, Gregory W.

    2016-09-01

    A considerable fraction of urban water supply capacity serves primarily as a hedge against drought. Water utilities can reduce their dependence on firm capacity and forestall the development of new supplies using short-term drought management actions, such as conservation and transfers. Nevertheless, new supplies will often be needed, especially as demands rise due to population growth and economic development. Planning decisions regarding when and how to integrate new supply projects are fundamentally shaped by the way in which short-term adaptive drought management strategies are employed. To date, the challenges posed by long-term infrastructure sequencing and adaptive short-term drought management are treated independently, neglecting important feedbacks between planning and management actions. This work contributes a risk-based framework that uses continuously updating risk-of-failure (ROF) triggers to capture the feedbacks between short-term drought management actions (e.g., conservation and water transfers) and the selection and sequencing of a set of regional supply infrastructure options over the long term. Probabilistic regional water supply pathways are discovered for four water utilities in the "Research Triangle" region of North Carolina. Furthermore, this study distinguishes the status-quo planning path of independent action (encompassing utility-specific conservation and new supply infrastructure only) from two cooperative formulations: "weak" cooperation, which combines utility-specific conservation and infrastructure development with regional transfers, and "strong" cooperation, which also includes jointly developed regional infrastructure to support transfers. Results suggest that strong cooperation aids utilities in meeting their individual objectives at substantially lower costs and with less overall development. These benefits demonstrate how an adaptive, rule-based decision framework can coordinate integrated solutions that would not be identified using more traditional optimization methods.

  6. Selected Energy Management Options for Small Business and Local Government.

    ERIC Educational Resources Information Center

    Wert, Jonathan M.; Worthington, Barry K.

    This document is a checklist of 257 energy management options for small business and local government. The energy management options are categorized under: (1) Energy management strategies; (2) Buildings; (3) Lighting; (4) Water; (5) Waste operations; (6) Equipment; (7) Transportation; and (8) Food preparation. To select options for…

  7. Small-diameter utilization issues and opportunities

    Treesearch

    John Rusty Dramm

    1999-01-01

    This presentation provides a thought-provoking look at options for utilizing small- diameter wood to help reduce the widespread risk of catastrophic wildfire throughout the West while providing economic recovery of timber-depressed communities and sustaining viable forest products industry. Potentially viable utilization and marketing options are explored and current...

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

    Bird, Lori; Brown, Elizabeth

    In the early 1990s, only a handful of utilities offered their customers a choice of purchasing electricity generated from renewable energy sources. Today, more than 600 utilities—or about 20% of all utilities nationally—provide their customers a “green power” option. Because some utilities offer programs in conjunction with cooperative associations or other publicly owned power entities, the number of distinct programs totals more than 130. Through these programs, more than 50 million customers have the ability to purchase renewable energy to meet some portion or all of their electricity needs—or make contributions to support the development of renewable energy resources. Typically,more » customers pay a premium above standard electricity rates for this service. This report presents year-end 2005 data on utility green pricing programs, and examines trends in consumer response and program implementation over time. The data in this report, which were obtained via a questionnaire distributed to utility green pricing program managers, can be used by utilities to benchmark the success of their green power programs.« less

  9. A prospective study of maternal preference for indomethacin prophylaxis versus symptomatic treatment of a patent ductus arteriosus in preterm infants.

    PubMed

    AlFaleh, Khalid; Alluwaimi, Eman; AlOsaimi, Ahlam; Alrajebah, Sheikha; AlOtaibi, Bashayer; AlRasheed, Fatima; AlKharfi, Turki; Paes, Bosco

    2015-04-22

    The management of a patent ductus arteriosus in preterm infants continues to be debated among neonatologists due to the absence of concrete evidence that precisely weighs the long term outcomes of active, early intervention against a conservative approach. In the majority of institutions, parents are encouraged to play an active role in the complex, decision -making processes with regard to the care of their infants. The objective of this study is to elicit maternal preferences for indomethacin prophylaxis versus treatment of a patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants, utilizing a decision aid instrument (DAI). Healthy and high risk pregnant women at 23-28 weeks gestation, and mothers of admitted ELBW infants were enrolled. A computer based, validated DAI was utilized during interviews. The DAI first provides information about prematurity and concurrent morbidities with comprehensive facts of the pros and cons about prophylactic versus treatment options. It subsequently coaches participants how to select values and preferences based on their decisions. A 17-item questionnaire assessed and valued each short and long term morbidity of extreme prematurity and preferred choice for PDA management. Two hundred ninety nine subjects were enrolled; 75% were healthy women at 23-28 weeks gestation, 19% were high risk and 6% recently delivered an ELBW infant. Eighty-two percent preferred a prophylactic indomethacin strategy versus symptomatic treatment for the management of PDA. Across a spectrum of potential morbidities, the occurrence of severe intraventricular hemorrhage was viewed by mothers as the most un-wanted outcome irrespective of the two proposed options. In contrast to neonatal practitioners, mothers who used this particular DAI strongly endorsed prophylactic indomethacin versus a treatment intervention for the management of PDA in preterm infants.

  10. Naval Undersea Warfare Center Division Newport utilities metering, Phase 1

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

    Carroll, D.M.

    Pacific Northwest Laboratory developed this report for the US Navy`s Naval Undersea Warfare Center Division Newport, Rhode Island (NUWC). The purpose of the report was to review options for metering electricity and steam used in the NUWC compound, and to make recommendations to NUWC for implementation under a follow-on project. An additional NUWC concern is a proposed rate change by the servicing utility, Newport Electric, which would make a significant shift from consumption to demand billing, and what effect that rate change would have on the NUWC utility budget. Automated, remote reading meters are available which would allow NUWC tomore » monitor its actual utility consumption and demand for both the entire NUWC compound and by end-use in individual buildings. Technology is available to perform the meter reads and manipulate the data using a personal computer with minimal staff requirement. This is not meant to mislead the reader into assuming that there is no requirement for routine preventive maintenance. All equipment requires routine maintenance to maintain its accuracy. While PNL reviewed the data collected during the site visit, however, it became obvious that significant opportunities exist for reducing the utility costs other than accounting for actual consumption and demand. Unit costs for both steam and electricity are unnecessarily high, and options are presented in this report for reducing them. Additionally, NUWC has an opportunity to undertake a comprehensive energy resource management program to significantly reduce its energy demand, consumption, and costs.« less

  11. Naval Undersea Warfare Center Division Newport utilities metering, Phase 1

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

    Carroll, D.M.

    Pacific Northwest Laboratory developed this report for the US Navy's Naval Undersea Warfare Center Division Newport, Rhode Island (NUWC). The purpose of the report was to review options for metering electricity and steam used in the NUWC compound, and to make recommendations to NUWC for implementation under a follow-on project. An additional NUWC concern is a proposed rate change by the servicing utility, Newport Electric, which would make a significant shift from consumption to demand billing, and what effect that rate change would have on the NUWC utility budget. Automated, remote reading meters are available which would allow NUWC tomore » monitor its actual utility consumption and demand for both the entire NUWC compound and by end-use in individual buildings. Technology is available to perform the meter reads and manipulate the data using a personal computer with minimal staff requirement. This is not meant to mislead the reader into assuming that there is no requirement for routine preventive maintenance. All equipment requires routine maintenance to maintain its accuracy. While PNL reviewed the data collected during the site visit, however, it became obvious that significant opportunities exist for reducing the utility costs other than accounting for actual consumption and demand. Unit costs for both steam and electricity are unnecessarily high, and options are presented in this report for reducing them. Additionally, NUWC has an opportunity to undertake a comprehensive energy resource management program to significantly reduce its energy demand, consumption, and costs.« less

  12. Cost-utility evaluation of vortioxetine in patients with Major Depressive Disorder experiencing inadequate response to alternative antidepressants in the United Kingdom.

    PubMed

    Young, A H; Evitt, L; Brignone, M; Diamand, F; Atsou, K; Campbell, R; Cure, S; Danchenko, N

    2017-08-15

    Patients frequently require several lines of therapy for treatment of major depressive episodes. This economic analysis details the management of patients who responded inadequately due to lack of efficacy or intolerability to two previous antidepressants in the UK. The model included a decision tree and a Markov component. Health states considered in the decision tree were remission, response, no response, withdrawal due to adverse events, relapse, recovery, and recurrence. The time horizon was 24 months. Patients were on third-line treatment for up to a 3-month acute phase and a 6-month maintenance phase. As third-line efficacy data were not available, inputs were calculated by adjusting original second-line data to third-line based on proportionate reductions observed in STAR*D. Equivalent efficacy was assumed for all comparators. Healthcare resource use and utilities were based on UK estimates. Vortioxetine was a cost-effective treatment option at a threshold of £20,000/QALY vs. escitalopram, citalopram, sertraline, and was associated with more health benefits, less costs (was dominant) versus relevant third-line comparators venlafaxine and duloxetine. Agomelatine was found not to be a cost-effective option. The 22-month maintenance phase treatment scenario results were similar to the 6-month base case. Third-line efficacy data were not available. This highlights the need for studies in patients receiving third-line treatment. This model provides an overview for the management of patients receiving third-line treatment where limited evidence currently exists. Vortioxetine, with its novel mechanism of action, is expected to be a dominant treatment option versus relevant comparators in the UK. Copyright © 2017. Published by Elsevier B.V.

  13. 42 CFR 456.506 - Waiver options for Medicaid agency.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers... options for Medicaid agency. (a) The agency may apply for a waiver at any time it has the procedures...

  14. Surgical management of bilateral vocal fold paralysis: A cost-effectiveness comparison of two treatments.

    PubMed

    Naunheim, Matthew R; Song, Phillip C; Franco, Ramon A; Alkire, Blake C; Shrime, Mark G

    2017-03-01

    Endoscopic management of bilateral vocal fold paralysis (BVFP) includes cordotomy and arytenoidectomy, and has become a well-accepted alternative to tracheostomy. However, the costs and quality-of-life benefits of endoscopic management have not been examined with formal economic analysis. This study undertakes a cost-effectiveness analysis of tracheostomy versus endoscopic management of BVFP. Cost-effectiveness analysis. A literature review identified a range of costs and outcomes associated with surgical options for BVFP. Additional costs were derived from Medicare reimbursement data; all were adjusted to 2014 dollars. Cost-effectiveness analysis evaluated both therapeutic strategies in short-term and long-term scenarios. Probabilistic sensitivity analysis was used to assess confidence levels regarding the economic evaluation. The incremental cost effectiveness ratio for endoscopic management versus tracheostomy is $31,600.06 per quality-adjusted life year (QALY), indicating that endoscopic management is the cost-effective short-term strategy at a willingness-to-pay (WTP) threshold of $50,000/QALY. The probability that endoscopic management is more cost-effective than tracheostomy at this WTP is 65.1%. Threshold analysis demonstrated that the model is sensitive to both utilities and cost in the short-term scenario. When costs of long-term care are included, tracheostomy is dominated by endoscopic management, indicating the cost-effectiveness of endoscopic management at any WTP. Endoscopic management of BVFP appears to be more cost-effective than tracheostomy. Though endoscopic cordotomy and arytenoidectomy require expertise and specialized equipment, this model demonstrates utility gains and long-term cost advantages to an endoscopic strategy. These findings are limited by the relative paucity of robust utility data and emphasize the need for further economic analysis in otolaryngology. NA Laryngoscope, 127:691-697, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  15. A Distributed Dynamic Programming-Based Solution for Load Management in Smart Grids

    NASA Astrophysics Data System (ADS)

    Zhang, Wei; Xu, Yinliang; Li, Sisi; Zhou, MengChu; Liu, Wenxin; Xu, Ying

    2018-03-01

    Load management is being recognized as an important option for active user participation in the energy market. Traditional load management methods usually require a centralized powerful control center and a two-way communication network between the system operators and energy end-users. The increasing user participation in smart grids may limit their applications. In this paper, a distributed solution for load management in emerging smart grids is proposed. The load management problem is formulated as a constrained optimization problem aiming at maximizing the overall utility of users while meeting the requirement for load reduction requested by the system operator, and is solved by using a distributed dynamic programming algorithm. The algorithm is implemented via a distributed framework and thus can deliver a highly desired distributed solution. It avoids the required use of a centralized coordinator or control center, and can achieve satisfactory outcomes for load management. Simulation results with various test systems demonstrate its effectiveness.

  16. Temporomandibular disorders. Part 2: conservative management

    PubMed Central

    Shaffer, Stephen M; Brismée, Jean-Michel; Sizer, Phillip S; Courtney, Carol A

    2014-01-01

    Appropriate management of temporomandibular disorders (TMD) requires an understanding of the underlying dysfunction associated with the temporomandibular joint (TMJ) and surrounding structures. A comprehensive examination process, as described in part 1 of this series, can reveal underlying clinical findings that assist in the delivery of comprehensive physical therapy services for patients with TMD. Part 2 of this series focuses on management strategies for TMD. Physical therapy is the preferred conservative management approach for TMD. Physical therapists are professionally well-positioned to step into the void and provide clinical services for patients with TMD. Clinicians should utilize examination findings to design rehabilitation programs that focus on addressing patient-specific impairments. Potentially appropriate plan of care components include joint and soft tissue mobilization, trigger point dry needling, friction massage, therapeutic exercise, patient education, modalities, and outside referral. Management options should address both symptom reduction and oral function. Satisfactory results can often be achieved when management focuses on patient-specific clinical variables. PMID:24976744

  17. Power management and distribution considerations for a lunar base

    NASA Technical Reports Server (NTRS)

    Kenny, Barbara H.; Coleman, Anthony S.

    1991-01-01

    Design philosophies and technology needs for the power management and distribution (PMAD) portion of a lunar base power system are discussed. A process is described whereby mission planners may proceed from a knowledge of the PMAD functions and mission performance requirements to a definition of design options and technology needs. Current research efforts at the NASA LRC to meet the PMAD system needs for a Lunar base are described. Based on the requirements, the lunar base PMAD is seen as best being accomplished by a utility like system, although with some additional demands including autonomous operation and scheduling and accurate, predictive modeling during the design process.

  18. 76 FR 31998 - Cancellation of an Optional Form by the Office of Personnel Management

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-02

    ... OFFICE OF PERSONNEL MANAGEMENT Cancellation of an Optional Form by the Office of Personnel Management AGENCY: U.S. Office of Personnel Management. ACTION: Notice. SUMMARY: The U.S. Office of Personnel Management (OPM) is cancelling the Optional Application for Federal Employment. The information contained in...

  19. Precision diagnostics: moving towards protein biomarker signatures of clinical utility in cancer.

    PubMed

    Borrebaeck, Carl A K

    2017-03-01

    Interest in precision diagnostics has been fuelled by the concept that early detection of cancer would benefit patients; that is, if detected early, more tumours should be resectable and treatment more efficacious. Serum contains massive amounts of potentially diagnostic information, and affinity proteomics has risen as an accurate approach to decipher this, to generate actionable information that should result in more precise and evidence-based options to manage cancer. To achieve this, we need to move from single to multiplex biomarkers, a so-called signature, that can provide significantly increased diagnostic accuracy. This Opinion article focuses on the progress being made in identifying protein biomarker signatures of clinical utility, using blood-based proteomics.

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

    Bird, L.; Brown, E.

    In the early 1990s, only a handful of utilities offered their customers a choice of purchasing electricity generated from renewable energy sources. Today, nearly 600 utilities in regulated electricity markets--or almost 20% of all utilities nationally--provide their customers a "green power" option. Because some utilities offer programs in conjunction with cooperative associations or other publicly owned power entities, the number of distinct programs totals about 125. Through these programs, more than 40 million customers spanning 34 states have the ability to purchase renewable energy to meet some portion or all of their electricity needs--or make contributions to support the developmentmore » of renewable energy resources. Typically, customers pay a premium above standard electricity rates for this service. This report presents year-end 2004 data on utility green pricing programs, and examines trends in consumer response and program implementation over time. The data in this report, which were obtained via a questionnaire distributed to utility green pricing program managers, can be used by utilities as benchmarks by which to gauge the success of their green power programs.« less

  1. Handling the phosphorus paradox in agriculture and natural ecosystems: Scarcity, necessity, and burden of P.

    PubMed

    Leinweber, Peter; Bathmann, Ulrich; Buczko, Uwe; Douhaire, Caroline; Eichler-Löbermann, Bettina; Frossard, Emmanuel; Ekardt, Felix; Jarvie, Helen; Krämer, Inga; Kabbe, Christian; Lennartz, Bernd; Mellander, Per-Erik; Nausch, Günther; Ohtake, Hisao; Tränckner, Jens

    2018-01-01

    This special issue of Ambio compiles a series of contributions made at the 8th International Phosphorus Workshop (IPW8), held in September 2016 in Rostock, Germany. The introducing overview article summarizes major published scientific findings in the time period from IPW7 (2015) until recently, including presentations from IPW8. The P issue was subdivided into four themes along the logical sequence of P utilization in production, environmental, and societal systems: (1) Sufficiency and efficiency of P utilization, especially in animal husbandry and crop production; (2) P recycling: technologies and product applications; (3) P fluxes and cycling in the environment; and (4) P governance. The latter two themes had separate sessions for the first time in the International Phosphorus Workshops series; thus, this overview presents a scene-setting rather than an overview of the latest research for these themes. In summary, this paper details new findings in agricultural and environmental P research, which indicate reduced P inputs, improved management options, and provide translations into governance options for a more sustainable P use.

  2. A combined model to assess technical and economic consequences of changing conditions and management options for wastewater utilities.

    PubMed

    Giessler, Mathias; Tränckner, Jens

    2018-02-01

    The paper presents a simplified model that quantifies economic and technical consequences of changing conditions in wastewater systems on utility level. It has been developed based on data from stakeholders and ministries, collected by a survey that determined resulting effects and adapted measures. The model comprises all substantial cost relevant assets and activities of a typical German wastewater utility. It consists of three modules: i) Sewer for describing the state development of sewer systems, ii) WWTP for process parameter consideration of waste water treatment plants (WWTP) and iii) Cost Accounting for calculation of expenses in the cost categories and resulting charges. Validity and accuracy of this model was verified by using historical data from an exemplary wastewater utility. Calculated process as well as economic parameters shows a high accuracy compared to measured parameters and given expenses. Thus, the model is proposed to support strategic, process oriented decision making on utility level. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Prospect relativity: how choice options influence decision under risk.

    PubMed

    Stewart, Neil; Chater, Nick; Stott, Henry P; Reimers, Stian

    2003-03-01

    In many theories of decision under risk (e.g., expected utility theory, rank-dependent utility theory, and prospect theory), the utility of a prospect is independent of other options in the choice set. The experiments presented here show a large effect of the available options, suggesting instead that prospects are valued relative to one another. The judged certainty equivalent for a prospect is strongly influenced by the options available. Similarly, the selection of a preferred prospect is strongly influenced by the prospects available. Alternative theories of decision under risk (e.g., the stochastic difference model, multialternative decision field theory, and range frequency theory), where prospects are valued relative to one another, can provide an account of these context effects.

  4. Pediatric status epilepticus: improved management with new drug therapies?

    PubMed

    Verrotti, Alberto; Ambrosi, Michela; Pavone, Piero; Striano, Pasquale

    2017-06-01

    Status Epilepticus (SE) is the most common neurological emergency of childhood. It requires prompt administration of appropriately selected anti-seizure medications. Areas covered: Following a distinction between estabilished and emergent drugs, we present pharmacological treatment options and their clinical utility in children, with a short mention on alternatives to drug treatment. We also propose an algorithm for the management of pediatric SE. For this review a Pubmed, Medline and Embase search was performed. Expert opinion: In early SE in children, in the prehospital setting, rectal diazepam or buccal midazolam are efficacious drugs; whereas in the hospital setting, intravenous lorazepam or diazepam are indicated. As regard estabilished stage of SE, in addition to the 'classic' compounds, such as phenytoin and phenobarbital, other drugs such as valproic acid, levetiracetam and lacosamide have been demonstrated efficacious. Treatment recommendations of refractory SE depend on retrospective case series and uncontrolled studies. We reported experiences about the use of midazolam, propofol, ketamine and lidocaine. They could be a valid option, but further prospective studies are necessary. Over the last few decades, important advances in basic mechanisms underlying refractory SE have been achieved, but few data are available regarding management of these stages.

  5. 13 CFR 107.250 - Exclusion of stock options issued by Licensee from Management Expenses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Sbic § 107.250 Exclusion of stock options issued by Licensee from Management Expenses. Stock options... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Exclusion of stock options issued by Licensee from Management Expenses. 107.250 Section 107.250 Business Credit and Assistance SMALL...

  6. Risk-based decision-making framework for the selection of sediment dredging option.

    PubMed

    Manap, Norpadzlihatun; Voulvoulis, Nikolaos

    2014-10-15

    The aim of this study was to develop a risk-based decision-making framework for the selection of sediment dredging option. Descriptions using case studies of the newly integrated, holistic and staged framework were followed. The first stage utilized the historical dredging monitoring data and the contamination level in media data into Ecological Risk Assessment phases, which have been altered for benefits in cost, time and simplicity. How Multi-Criteria Decision Analysis (MCDA) can be used to analyze and prioritize dredging areas based on environmental, socio-economic and managerial criteria was described for the next stage. The results from MCDA will be integrated into Ecological Risk Assessment to characterize the degree of contamination in the prioritized areas. The last stage was later described using these findings and analyzed using MCDA, in order to identify the best sediment dredging option, accounting for the economic, environmental and technical aspects of dredging, which is beneficial for dredging and sediment management industries. Copyright © 2014 Elsevier B.V. All rights reserved.

  7. Velocity control as a tool for optimal plume containment in the Equus Beds aquifer, Kansas

    USGS Publications Warehouse

    Heidari, M.; Sadeghipour, J.; Drici, O.

    1987-01-01

    A ground-water-management model was developed to investigate the best management options for the containment of an oil-field-brine plume in the Equus Beds aquifer in south-central Kansas. The main purpose of the management model was to find the optimal locations and minimum rates of pumpage of a set of plume-interception wells, to successfully reverse the velocity vectors at observation wells located along the plume front, and also to satisfy freshwater demands from supply wells. The effects of the calculated minimum withdrawals from the interception wells on the migration of contaminants throughout the ground-water system were evaluated utilizing a solute-transport model. This latter analysis was carried out to ensure the containment of the plume. Whereas application of the management model to the study area achieves the management objectives, the implementation of the results is believed to be impractical and expensive.

  8. Navigating financial and supply reliability tradeoffs in regional drought management portfolios

    NASA Astrophysics Data System (ADS)

    Zeff, Harrison B.; Kasprzyk, Joseph R.; Herman, Jonathan D.; Reed, Patrick M.; Characklis, Gregory W.

    2014-06-01

    Rising development costs and growing concerns over environmental impacts have led many communities to explore more diversified water management strategies. These "portfolio"-style approaches integrate existing supply infrastructure with other options such as conservation measures or water transfers. Diversified water supply portfolios have been shown to reduce the capacity and costs required to meet demand, while also providing greater adaptability to changing hydrologic conditions. However, this additional flexibility can also cause unexpected reductions in revenue (from conservation) or increased costs (from transfers). The resulting financial instability can act as a substantial disincentive to utilities seeking to implement more innovative water management techniques. This study seeks to design portfolios that employ financial tools (e.g., contingency funds and index insurance) to reduce fluctuations in revenues and costs, allowing these strategies to achieve improved performance without sacrificing financial stability. This analysis is applied to the development of coordinated regional supply portfolios in the "Research Triangle" region of North Carolina, an area comprising four rapidly growing municipalities. The actions of each independent utility become interconnected when shared infrastructure is utilized to enable interutility transfers, requiring the evaluation of regional tradeoffs in up to five performance and financial objectives. Diversified strategies introduce significant tradeoffs between achieving reliability goals and introducing burdensome variability in annual revenues and/or costs. Financial mitigation tools can mitigate the impacts of this variability, allowing for an alternative suite of improved solutions. This analysis provides a general template for utilities seeking to navigate the tradeoffs associated with more flexible, portfolio-style management approaches.

  9. An Update on Analyzing Differences Between Public and Private Sector Information Resource Management: Strategic Information Challenges and Critical Technologies

    DTIC Science & Technology

    2004-06-01

    ecommerce architecture is the business—it is the company’s competitive advantage. (Morgan, 1998:40) Morgan goes on to illustrate this point by...396 JONES APPAREL GROUP INC 896 NATIONAL RURAL UTILITIES COOPERATIVE 397 COX COMMUNICATIONS INC 897 TRANS WORLD ENTERTAINMENT 398 MELLON FINANCIAL...It Can Work in the Public Sector,” MIS Quarterly, Dec:435-448, 1990. Morgan, T.P. “ Ecommerce Options,” Global Technology Business, Sept:40-42

  10. Material flow analysis for resource management towards resilient palm oil production

    NASA Astrophysics Data System (ADS)

    Kamahara, H.; Faisal, M.; Hasanudin, U.; Fujie, K.; Daimon, H.

    2018-03-01

    Biomass waste generated from palm oil mill can be considered not only as the feedstock of renewable energy but also as the nutrient-rich resources to produce organic fertilizer. This study explored the appropriate resource management towards resilient palm oil production by applying material flow analysis. This study was conducted based on two palm oil mills in Lampung, Indonesia. The results showed that the empty fruit bunch (EFB) has the largest potential in terms of amount and energy among the biomass waste. The results also showed that the palm oil mills themselves had already self-managed their energy consumption thatwas obtained from palm kernel shell and palm press fiber. Finally, this study recommended the several utilization options of EFB for improvement of soil sustainability to contribute towards resilient palm oil production.

  11. Transition management - An analysis of strategic considerations for effective implementation

    NASA Technical Reports Server (NTRS)

    Hunsucker, John L.; Loos, David

    1989-01-01

    Six managerial guidelines are identified for facilitating successful change in an organization. They are: (1) the need for a catalyst to initiate change; (2) the setting of organizational goals which take into account the impact of technical, political, and cultural factors; (3) requiring a transition team to guide the change; (4) a demonstration by top management of a commitment to the change as well as their acting as change agents; (5) the utilization of employee participation and good communication to help overcome employee resistance; and (6) the evaluation of the change program as important to the success of present and future change programs. A description of each guideline is presented, and its importance is examined. Available options are also presented for management to deal with each of the guidelines.

  12. Strategy for the Identification of an INL Comprehensive Utility Corridor

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

    John Reisenauer

    2011-05-01

    This report documents the strategy developed to identify a comprehensive utility corridor (CUC) on the Idaho National Laboratory (INL) Site. The strategy established the process for which the Campus Development Office will evaluate land management issues. It is a process that uses geographical information system geospatial technology to layer critical INL mission information in a way that thorough evaluations can be conducted and strategies developed. The objective of the CUC Project was to develop a process that could be implemented to identify potential utility corridor options for consideration. The process had to take into account all the missions occurring onmore » the INL and other land-related issues. The process for developing a CUC strategy consists of the following four basic elements using geographical information system capabilities: 1. Development of an INL base layer map; this base layer map geospatially references all stationary geographical features on INL and sitewide information. 2. Development of current and future mission land-use need maps; this involved working with each directorate to identify current mission land use needs and future land use needs that project 30 years into the future. 3. Development of restricted and potential constraint maps; this included geospatially mapping areas such as wells, contaminated areas, firing ranges, cultural areas, ecological areas, hunting areas, easement, and grazing areas. 4. Development of state highway and power line rights of way map; this included geospatially mapping rights-of-way along existing state highways and power lines running through the INL that support INL operations. It was determined after completing and evaluating the geospatial information that the area with the least impact to INL missions was around the perimeter of the INL Site. Option 1, in this document, identifies this perimeter; however, it does not mean the entire perimeter is viable. Many places along the perimeter corridor cannot be used or are not economically viable. Specific detailed studies will need to be conducted on a case-by-case basis to clearly identify which sections along the perimeter can and cannot be used. Option 2, in this document, identifies areas along existing highways that could be a viable option. However, discussions would have to take place with the State of Idaho to use their easement as part of the corridor and mission impact would need to be evaluated if a specific request was made to the Department of Energy, Idaho Operations Office. Option 3, in this document, is a combination of Options 1 and 2. This option provides the most flexibility to minimize impacts to INL missions. As with the other two options, discussions and agreements with the State of Idaho would be needed and any specific route would need to be thoroughly evaluated for impact, implementation, and operability beyond just a strategy.« less

  13. A multi-criteria decision analysis assessment of waste paper management options.

    PubMed

    Hanan, Deirdre; Burnley, Stephen; Cooke, David

    2013-03-01

    The use of Multi-criteria Decision Analysis (MCDA) was investigated in an exercise using a panel of local residents and stakeholders to assess the options for managing waste paper on the Isle of Wight. Seven recycling, recovery and disposal options were considered by the panel who evaluated each option against seven environmental, financial and social criteria. The panel preferred options where the waste was managed on the island with gasification and recycling achieving the highest scores. Exporting the waste to the English mainland for incineration or landfill proved to be the least preferred options. This research has demonstrated that MCDA is an effective way of involving community groups in waste management decision making. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Acquired hemophilia A: a review of recent data and new therapeutic options.

    PubMed

    Franchini, Massimo; Vaglio, Stefania; Marano, Giuseppe; Mengoli, Carlo; Gentili, Sara; Pupella, Simonetta; Liumbruno, Giancarlo Maria

    2017-10-01

    Acquired hemophilia A (AHA) is a rare, but potentially life-threatening, bleeding disorder caused by an autoantibody against factor VIII that interferes with its coagulant function. We performed a narrative review focusing on the diagnostic aspects of AHA and on the current treatment strategies with particular regard to new data and therapeutic developments. The management of this severe hemorrhagic disorder is based on the control of bleeding with the use of bypassing agents and on the utilization of a variety of immunosuppressant agents with the goal of eliminating the autoantibody permanently. The optimal management of AHA should be multidisciplinary and requires a close collaboration between physicians from various specialties.

  15. Peats from West Kalimantan Province, Indonesia: The Distribution, Formation, Disturbances, Utilization and Conservation

    NASA Astrophysics Data System (ADS)

    Anshari, G. Z.

    2011-12-01

    A major portion of tropical peats, approximately between 180,000 and 210,000 km2, occurs in Indonesia. Peat is a water body that preserves and stores enormous organic Carbon of dead biomass vegetation. In a natural state, peat helps to maintain Carbon balance, hydrological cycle, and supply of dissolved and particulate organic matters into adjacent waters. Peat disturbances drive the change from Carbon sink function into Carbon source. This paper aims to discuss variability of tropical peats and peat degradation in West Kalimantan Province. The discussions include extent and formation, biodiversity, Carbon and water storage, major properties, utilization, peat disturbances (i.e. logging, forest conversion, drainage affects, and recurrent peat fires), and peat conservation. Management options for reducing peat fires and developing sustainable peat utilization are also explored. Data were collected from both coastal and inland peats in West Kalimantan Province. This paper declares that degradation of tropical peats in Indonesia is strongly associated with anthropogenic fires, peat forest conversion, and logging. To reduce speeds of peat degradation, the current utilization of peats needs being more intensive than extensive, and preventing water table drop by managing excessive drainage that leads to substantial decline of moisture in the upper peat layer, which is subsequently dry and flammable.

  16. Endoscopic and non-endoscopic approaches for the management of radiation-induced rectal bleeding

    PubMed Central

    Weiner, Joseph Paul; Wong, Andrew Thomas; Schwartz, David; Martinez, Manuel; Aytaman, Ayse; Schreiber, David

    2016-01-01

    Pelvic radiation is a commonly utilized treatment for malignancy of the genitourinary and lower gastrointestinal tract. Radiation proctitis and the resultant clinical picture varies from asymptomatic to potentially life threatening. Similarly, treatment options also vary greatly, from medical therapy to surgical intervention. Commonly utilized medical therapy includes sucralfate enemas, antibiotics, 5-aminosalicylic acid derivatives, probiotics, antioxidants, short-chain fatty acids, formalin instillation and fractionated hyperbaric oxygen. More invasive treatments include endoscopic-based, focally ablative interventions such as dilation, heater and bipolar cautery, neodymium/yttrium aluminum garnet argon laser, radiofrequency ablation or argon plasma coagulation. Despite its relatively common frequency, there is a dearth of existing literature reporting head-to-head comparisons of the various treatment options via a randomized controlled approach. The purpose of our review was to present the reader a consolidation of the existing evidence-based literature with the goal of highlighting the comparative effectiveness and risks of the various treatment approaches. Finally, we outline a pragmatic approach to the treatment of radiation proctitis. In light of the lack of randomized data, our goal is to pursue as least invasive an approach as possible, with escalation of care tailored to the severity of the patient’s symptoms. For those cases that are clinically asymptomatic or only mildly symptomatic, observation or medical management can be considered. Once a patient fails such management or symptoms become more severe, invasive procedures such as endoscopically based focal ablation or surgical intervention can be considered. Although not all recommendations are supported by level I evidence, reported case series and single-institutional studies in the literature suggest that successful treatment with cessation of symptoms can be obtained in the majority of cases. PMID:27610010

  17. Designing flexible engineering systems utilizing embedded architecture options

    NASA Astrophysics Data System (ADS)

    Pierce, Jeff G.

    This dissertation develops and applies an integrated framework for embedding flexibility in an engineered system architecture. Systems are constantly faced with unpredictability in the operational environment, threats from competing systems, obsolescence of technology, and general uncertainty in future system demands. Current systems engineering and risk management practices have focused almost exclusively on mitigating or preventing the negative consequences of uncertainty. This research recognizes that high uncertainty also presents an opportunity to design systems that can flexibly respond to changing requirements and capture additional value throughout the design life. There does not exist however a formalized approach to designing appropriately flexible systems. This research develops a three stage integrated flexibility framework based on the concept of architecture options embedded in the system design. Stage One defines an eight step systems engineering process to identify candidate architecture options. This process encapsulates the operational uncertainty though scenario development, traces new functional requirements to the affected design variables, and clusters the variables most sensitive to change. The resulting clusters can generate insight into the most promising regions in the architecture to embed flexibility in the form of architecture options. Stage Two develops a quantitative option valuation technique, grounded in real options theory, which is able to value embedded architecture options that exhibit variable expiration behavior. Stage Three proposes a portfolio optimization algorithm, for both discrete and continuous options, to select the optimal subset of architecture options, subject to budget and risk constraints. Finally, the feasibility, extensibility and limitations of the framework are assessed by its application to a reconnaissance satellite system development problem. Detailed technical data, performance models, and cost estimates were compiled for the Tactical Imaging Constellation Architecture Study and leveraged to complete a realistic proof-of-concept.

  18. 10 CFR 490.307 - Option for Electric Utilities.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 3 2014-01-01 2014-01-01 false Option for Electric Utilities. 490.307 Section 490.307 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel... motor vehicles, the following percentages of new light duty motor vehicles acquired shall be alternative...

  19. 10 CFR 490.307 - Option for Electric Utilities.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 3 2012-01-01 2012-01-01 false Option for Electric Utilities. 490.307 Section 490.307 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION ALTERNATIVE FUEL TRANSPORTATION PROGRAM Alternative Fuel... motor vehicles, the following percentages of new light duty motor vehicles acquired shall be alternative...

  20. Application of desktop computers in nuclear engineering education

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

    Graves, H.W. Jr.

    1990-01-01

    Utilization of desktop computers in the academic environment is based on the same objectives as in the industrial environment - increased quality and efficiency. Desktop computers can be extremely useful teaching tools in two general areas: classroom demonstrations and homework assignments. Although differences in emphasis exist, tutorial programs share many characteristics with interactive software developed for the industrial environment. In the Reactor Design and Fuel Management course at the University of Maryland, several interactive tutorial programs provided by Energy analysis Software Service have been utilized. These programs have been designed to be sufficiently structured to permit an orderly, disciplined solutionmore » to the problem being solved, and yet be flexible enough to accommodate most problem solution options.« less

  1. 23 CFR 500.104 - State option.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false State option. 500.104 Section 500.104 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRANSPORTATION INFRASTRUCTURE MANAGEMENT MANAGEMENT AND MONITORING SYSTEMS Management Systems § 500.104 State option. Except as specified in § 500.105 (a...

  2. An empirical analysis of the corporate call decision

    NASA Astrophysics Data System (ADS)

    Carlson, Murray Dean

    1998-12-01

    In this thesis we provide insights into the behavior of financial managers of utility companies by studying their decisions to redeem callable preferred shares. In particular, we investigate whether or not an option pricing based model of the call decision, with managers who maximize shareholder value, does a better job of explaining callable preferred share prices and call decisions than do other models of the decision. In order to perform these tests, we extend an empirical technique introduced by Rust (1987) to include the use of information from preferred share prices in addition to the call decisions. The model we develop to value the option embedded in a callable preferred share differs from standard models in two ways. First, as suggested in Kraus (1983), we explicitly account for transaction costs associated with a redemption. Second, we account for state variables that are observed by the decision makers but not by the preferred shareholders. We interpret these unobservable state variables as the benefits and costs associated with a change in capital structure that can accompany a call decision. When we add this variable, our empirical model changes from one which predicts exactly when a share should be called to one which predicts the probability of a call as the function of the observable state. These two modifications of the standard model result in predictions of calls, and therefore of callable preferred share prices, that are consistent with several previously unexplained features of the data; we show that the predictive power of the model is improved in a statistical sense by adding these features to the model. The pricing and call probability functions from our model do a good job of describing call decisions and preferred share prices for several utilities. Using data from shares of the Pacific Gas and Electric Co. (PGE) we obtain reasonable estimates for the transaction costs associated with a call. Using a formal empirical test, we are able to conclude that the managers of the Pacific Gas and Electric Company clearly take into account the value of the option to delay the call when making their call decisions. Overall, the model seems to be robust to tests of its specification and does a better job of describing the data than do simpler models of the decision making process. Limitations in the data do not allow us to perform the same tests in a larger cross-section of utility companies. However, we are able to estimate transaction cost parameters for many firms and these do not seem to vary significantly from those of PGE. This evidence does not cause us to reject our hypothesis that managerial behavior is consistent with a model in which managers maximize shareholder value.

  3. Esthetic rehabilitation of complicated crown fractures utilizing rapid orthodontic extrusion and two different restoration modalities.

    PubMed

    Milardovic Ortolan, Sladana; Strujic, Mihovil; Aurer, Andrej; Viskic, Josko; Bergman, Lana; Mehulic, Ketij

    2012-01-01

    This case report describes the management of a crown-root fractured maxillary right central incisor and a crown fractured maxillary left central incisor using two different techniques. A complex procedure was designed to manage this case including orthodontic extrusion to move the fracture line above the alveolar bone and surgical recontouring of the altered gingival margin. Finally, the right incisor was restored prosthodontically. Prosthetic treatment was based on performing a post and core, and all-ceramic crown on the extruded tooth. The left, less-damaged incisor was restored directly using composite resin. The treatment resulted in good esthetics and secured periodontal health. This case report demonstrates that a multidisciplinary treatment approach is a reliable and predictable option to save a tooth. How to cite this article: Ortolan SM, Strujic M, Aurer A, Viskic J, Bergman L, Mehulic K. Esthetic Rehabilitation of Complicated Crown Fractures Utilizing Rapid Orthodontic Extrusion and Two Different Restoration Modalities. Int J Clin Pediatr Dent 2012;5(1):64-67.

  4. Clinical review: Ketones and brain injury

    PubMed Central

    2011-01-01

    Although much feared by clinicians, the ability to produce ketones has allowed humans to withstand prolonged periods of starvation. At such times, ketones can supply up to 50% of basal energy requirements. More interesting, however, is the fact that ketones can provide as much as 70% of the brain's energy needs, more efficiently than glucose. Studies suggest that during times of acute brain injury, cerebral uptake of ketones increases significantly. Researchers have thus attempted to attenuate the effects of cerebral injury by administering ketones exogenously. Hypertonic saline is commonly utilized for management of intracranial hypertension following cerebral injury. A solution containing both hypertonic saline and ketones may prove ideal for managing the dual problems of refractory intracranial hypertension and low cerebral energy levels. The purpose of the present review is to explore the physiology of ketone body utilization by the brain in health and in a variety of neurological conditions, and to discuss the potential for ketone supplementation as a therapeutic option in traumatic brain injury. PMID:21489321

  5. Management/Technical Interaction in Integrated Information System Development.

    ERIC Educational Resources Information Center

    Bagley, Clarence H.; Gardner, Don E.

    The integrated information system element of the management information system concept has practical applications for management in the areas of both information analysis and decision-model building. Four basic options for achieving integration in operational data systems are: a default option, the coordinated file option, the distributed…

  6. Short-term outcomes of excisional atherectomy in lower limb arterial disease.

    PubMed

    Werner-Gibbings, Keagan; Dubenec, Steven

    2017-06-01

    Endovascular interventions are increasingly utilized in managing occlusive peripheral vascular disease. Angioplasty and stenting remain the mainstay of endovascular management; however, newer treatment modalities such as excisional atherectomy provide the clinician with additional treatment options. While demonstrating promising results in available trials, a paucity of data exist regarding peripheral atherectomy. The purpose of this retrospective clinical study was to assess the efficacy and safety of excisional atherectomy with the TurboHawk atherectomy device (Covidien/ev3, Plymouth, MN, USA) in the treatment of lower limb peripheral vascular disease and to evaluate the learning curve involved in the institution of a new treatment modality. A retrospective analysis was performed on all patients undergoing atherectomy for symptomatic lower limb peripheral vascular disease by a single clinician between November 2011 and June 2013. Forty-seven vessels on 28 legs in 24 patients were treated during the period. Atherectomy was possible in 98% of cases. The 6- and 12-month primary patency was 72.6 and 58.9%, respectively. The primary-assisted patency was 93.2% at 6 months and 74.6% at 12 months. There were significantly greater patency rates in the TransAtlantic Inter-Society Consensus A + B lesions and a non-significant trend towards improved patency rates in claudicants versus critical limb ischaemia. There were four instances of embolization and four cases of dissection. Excisional atherectomy provides a further option for the minimally invasive management of peripheral vascular disease. It has similar patency rates to established endovascular therapies and should be considered among the treatment options in patients with favourable pathology. © 2014 Royal Australasian College of Surgeons.

  7. PRELIMINARY PERFORMANCE AND COST ESTIMATES OF MERCURY EMISSION CONTROL OPTIONS FOR ELECTRIC UTILITY BOILERS

    EPA Science Inventory


    The paper discusses preliminary performance and cost estimates of mercury emission control options for electric utility boilers. Under the Clean Air Act Amendments of 1990, EPA had to determine whether mercury emissions from coal-fired power plants should be regulated. To a...

  8. Multiple ecosystem services in a working landscape

    PubMed Central

    Eastburn, Danny J.; O’Geen, Anthony T.; Tate, Kenneth W.; Roche, Leslie M.

    2017-01-01

    Policy makers and practitioners are in need of useful tools and models for assessing ecosystem service outcomes and the potential risks and opportunities of ecosystem management options. We utilize a state-and-transition model framework integrating dynamic soil and vegetation properties to examine multiple ecosystem services—specifically agricultural production, biodiversity and habitat, and soil health—across human created vegetation states in a managed oak woodland landscape in a Mediterranean climate. We found clear tradeoffs and synergies in management outcomes. Grassland states maximized agricultural productivity at a loss of soil health, biodiversity, and other ecosystem services. Synergies existed among multiple ecosystem services in savanna and woodland states with significantly larger nutrient pools, more diversity and native plant richness, and less invasive species. This integrative approach can be adapted to a diversity of working landscapes to provide useful information for science-based ecosystem service valuations, conservation decision making, and management effectiveness assessments. PMID:28301475

  9. Advances in the management of venous thromboembolism.

    PubMed

    Schulman, Sam

    2012-09-01

    The past decade has witnessed important advances in the diagnosis and treatment of venous thromboembolism with excellent opportunities to apply evidence-based medicine for many of the steps in the management of the disease. This review discusses the clinical prediction rules that should be used to reduce utilization of imaging diagnosis for deep vein thrombosis or pulmonary embolism and the risk stratification for thrombolytic therapy or outpatient management of pulmonary embolism. The treatment options have increased and include low-molecular-weight heparin (LMWH), intravenous or subcutaneous unfractionated heparin - the latter either monitored or not monitored, fondaparinux and rivaroxaban for the initial phase. Thereafter, vitamin K antagonists (VKAs), LMWH, oral factor Xa or thrombin inhibitors are or will soon become available. The VKAs have been subjected to many randomised trial addressing the initiation, intensity, monitoring and self-management. Extended anticoagulation and the selection for that is finally reviewed. Copyright © 2012. Published by Elsevier Ltd.

  10. Multiple ecosystem services in a working landscape.

    PubMed

    Eastburn, Danny J; O'Geen, Anthony T; Tate, Kenneth W; Roche, Leslie M

    2017-01-01

    Policy makers and practitioners are in need of useful tools and models for assessing ecosystem service outcomes and the potential risks and opportunities of ecosystem management options. We utilize a state-and-transition model framework integrating dynamic soil and vegetation properties to examine multiple ecosystem services-specifically agricultural production, biodiversity and habitat, and soil health-across human created vegetation states in a managed oak woodland landscape in a Mediterranean climate. We found clear tradeoffs and synergies in management outcomes. Grassland states maximized agricultural productivity at a loss of soil health, biodiversity, and other ecosystem services. Synergies existed among multiple ecosystem services in savanna and woodland states with significantly larger nutrient pools, more diversity and native plant richness, and less invasive species. This integrative approach can be adapted to a diversity of working landscapes to provide useful information for science-based ecosystem service valuations, conservation decision making, and management effectiveness assessments.

  11. Historical perspective and contemporary management of acute coronary syndromes: from MONA to THROMBINS2.

    PubMed

    Kline, Kristopher P; Conti, C Richard; Winchester, David E

    2015-01-01

    Acute coronary syndrome (ACS) remains a major burden on morbidity and mortality in the United States. Medical professionals and students often use the mnemonic 'MONA' (morphine, oxygen, nitroglycerin and aspirin) to recall treatments for ACS; however, this list of therapies is outdated. We provide a historical perspective on 'MONA,' attempt to uncover its origin in the medical literature, and demonstrate the myriad changes that have occurred over the last 50 years of ACS management. We have developed a novel mnemonic, 'THROMBINS2' (thienopyridines, heparin/enoxaparin, renin-angiotensin system blockers, oxygen, morphine, beta blocker, intervention, nitroglycerin, statin/salicylate) to help bedside clinicians recall all the elements of contemporary ACS management. We demonstrate the mortality benefit for each component of contemporary ACS management, correlating the continued improvement with historical data on mortality after myocardial infarction. We encourage providers to utilize this mnemonic to explore options and guide treatments in ACS patients.

  12. Modelling marine protected areas: insights and hurdles

    PubMed Central

    Fulton, Elizabeth A.; Bax, Nicholas J.; Bustamante, Rodrigo H.; Dambacher, Jeffrey M.; Dichmont, Catherine; Dunstan, Piers K.; Hayes, Keith R.; Hobday, Alistair J.; Pitcher, Roland; Plagányi, Éva E.; Punt, André E.; Savina-Rolland, Marie; Smith, Anthony D. M.; Smith, David C.

    2015-01-01

    Models provide useful insights into conservation and resource management issues and solutions. Their use to date has highlighted conditions under which no-take marine protected areas (MPAs) may help us to achieve the goals of ecosystem-based management by reducing pressures, and where they might fail to achieve desired goals. For example, static reserve designs are unlikely to achieve desired objectives when applied to mobile species or when compromised by climate-related ecosystem restructuring and range shifts. Modelling tools allow planners to explore a range of options, such as basing MPAs on the presence of dynamic oceanic features, and to evaluate the potential future impacts of alternative interventions compared with ‘no-action’ counterfactuals, under a range of environmental and development scenarios. The modelling environment allows the analyst to test if indicators and management strategies are robust to uncertainties in how the ecosystem (and the broader human–ecosystem combination) operates, including the direct and indirect ecological effects of protection. Moreover, modelling results can be presented at multiple spatial and temporal scales, and relative to ecological, economic and social objectives. This helps to reveal potential ‘surprises', such as regime shifts, trophic cascades and bottlenecks in human responses. Using illustrative examples, this paper briefly covers the history of the use of simulation models for evaluating MPA options, and discusses their utility and limitations for informing protected area management in the marine realm. PMID:26460131

  13. Wastewater and sludge management and research in Oman: An overview.

    PubMed

    Jaffar Abdul Khaliq, Suaad; Ahmed, Mushtaque; Al-Wardy, Malik; Al-Busaidi, Ahmed; Choudri, B S

    2017-03-01

    It is well recognized that management of wastewater and sludge is a critical environmental issue in many countries. Wastewater treatment and sludge production take place under different technical, economic, and social contexts, thus requiring different approaches and involving different solutions. In most cases, a regular and environmentally safe wastewater treatment and associated sludge management requires the development of realistic and enforceable regulations, as well as treatment systems appropriate to local circumstances. The main objective of this paper is to provide useful information about the current wastewater and sludge treatment, management, regulations, and research in Oman. Based on the review and discussion, the wastewater treatment and sludge management in Oman has been evolving over the years. Further, the land application of sewage sludge should encourage revision of existing standards, regulations, and policies for the management and beneficial use of sewage sludge in Oman. Wastewater treatment and sludge management in Oman have been evolving over the years. Sludge utilization has been a challenge due to its association with human waste. Therefore, composting of sewage sludge is the best option in agriculture activities. Sludge and wastewater utilization can add up positively in the economic aspects of the country in terms of creating jobs and improving annual income rate. The number of research projects done on wastewater reuse and other ongoing ones related to the land application of sewage sludge should encourage revision of existing standards, regulations, and policies for the management and beneficial use of sewage sludge in Oman.

  14. Enhancing Response Rates in Physician Surveys: The Limited Utility of Electronic Options

    PubMed Central

    Nicholls, Keith; Chapman, Kathryn; Shaw, Thomas; Perkins, Allen; Sullivan, Margaret Murray; Crutchfield, Susan; Reed, Eddie

    2011-01-01

    Objective To evaluate the utility of offering physicians electronic options as alternatives to completing mail questionnaires. Data Source A survey of colorectal cancer screening practices of Alabama primary care physicians, conducted May–June 2010. Study Design In the follow-up to a mail questionnaire, physicians were offered options of completing surveys by telephone, fax, email, or online. Data Collection Method Detailed records were kept on the timing and mode of completion of surveys. Principal Findings Eighty-eight percent of surveys were returned by mail, 10 percent were returned by fax, and only 2 percent were completed online; none were completed by telephone or email. Conclusions Offering fax options increases response rates, but providing other electronic options does not. PMID:21492157

  15. 41 CFR 101-39.004 - Optional operations.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.0-General Provisions § 101-39.004 Optional operations. Nothing in this part shall preclude the establishment or operation of interagency fleet management systems by GSA or by... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Optional operations. 101...

  16. An index-based robust decision making framework for watershed management in a changing climate.

    PubMed

    Kim, Yeonjoo; Chung, Eun-Sung

    2014-03-01

    This study developed an index-based robust decision making framework for watershed management dealing with water quantity and quality issues in a changing climate. It consists of two parts of management alternative development and analysis. The first part for alternative development consists of six steps: 1) to understand the watershed components and process using HSPF model, 2) to identify the spatial vulnerability ranking using two indices: potential streamflow depletion (PSD) and potential water quality deterioration (PWQD), 3) to quantify the residents' preferences on water management demands and calculate the watershed evaluation index which is the weighted combinations of PSD and PWQD, 4) to set the quantitative targets for water quantity and quality, 5) to develop a list of feasible alternatives and 6) to eliminate the unacceptable alternatives. The second part for alternative analysis has three steps: 7) to analyze all selected alternatives with a hydrologic simulation model considering various climate change scenarios, 8) to quantify the alternative evaluation index including social and hydrologic criteria with utilizing multi-criteria decision analysis methods and 9) to prioritize all options based on a minimax regret strategy for robust decision. This framework considers the uncertainty inherent in climate models and climate change scenarios with utilizing the minimax regret strategy, a decision making strategy under deep uncertainty and thus this procedure derives the robust prioritization based on the multiple utilities of alternatives from various scenarios. In this study, the proposed procedure was applied to the Korean urban watershed, which has suffered from streamflow depletion and water quality deterioration. Our application shows that the framework provides a useful watershed management tool for incorporating quantitative and qualitative information into the evaluation of various policies with regard to water resource planning and management. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. Cost-Utility Analysis: Sartorius Flap versus Negative Pressure Therapy for Infected Vascular Groin Graft Managment.

    PubMed

    Chatterjee, Abhishek; Macarios, David; Griffin, Leah; Kosowski, Tomasz; Pyfer, Bryan J; Offodile, Anaeze C; Driscoll, Daniel; Maddali, Sirish; Attwood, John

    2015-11-01

    Sartorius flap coverage and adjunctive negative pressure wound therapy (NPWT) have been described in managing infected vascular groin grafts with varying cost and clinical success. We performed a cost-utility analysis comparing sartorius flap with NPWT in managing an infected vascular groin graft. A literature review compiling outcomes for sartorius flap and NPWT interventions was conducted from peer-reviewed journals in MEDLINE (PubMed) and EMBASE. Utility scores were derived from expert opinion and used to estimate quality-adjusted life years (QALYs). Medicare current procedure terminology and diagnosis-related groups codes were used to assess the costs for successful graft salvage with the associated complications. Incremental cost-effectiveness was assessed at $50,000/QALY, and both univariate and probabilistic sensitivity analyses were conducted to assess robustness of the conclusions. Thirty-two studies were used pooling 384 patients (234 sartorius flaps and 150 NPWT). NPWT had better clinical outcomes (86.7% success rate, 0.9% minor complication rate, and 13.3% major complication rate) than sartorius flap (81.6% success rate, 8.0% minor complication rate, and 18.4% major complication rate). NPWT was less costly ($12,366 versus $23,516) and slightly more effective (12.06 QALY versus 12.05 QALY) compared with sartorius flap. Sensitivity analyses confirmed the robustness of the base case findings; NPWT was either cost-effective at $50,000/QALY or dominated sartorius flap in 81.6% of all probabilistic sensitivity analyses. In our cost-utility analysis, use of adjunctive NPWT, along with debridement and antibiotic treatment, for managing infected vascular groin graft wounds was found to be a more cost-effective option when compared with sartorius flaps.

  18. Cost-Utility Analysis: Sartorius Flap versus Negative Pressure Therapy for Infected Vascular Groin Graft Managment

    PubMed Central

    Macarios, David; Griffin, Leah; Kosowski, Tomasz; Pyfer, Bryan J.; Offodile, Anaeze C.; Driscoll, Daniel; Maddali, Sirish; Attwood, John

    2015-01-01

    Background: Sartorius flap coverage and adjunctive negative pressure wound therapy (NPWT) have been described in managing infected vascular groin grafts with varying cost and clinical success. We performed a cost–utility analysis comparing sartorius flap with NPWT in managing an infected vascular groin graft. Methods: A literature review compiling outcomes for sartorius flap and NPWT interventions was conducted from peer-reviewed journals in MEDLINE (PubMed) and EMBASE. Utility scores were derived from expert opinion and used to estimate quality-adjusted life years (QALYs). Medicare current procedure terminology and diagnosis-related groups codes were used to assess the costs for successful graft salvage with the associated complications. Incremental cost-effectiveness was assessed at $50,000/QALY, and both univariate and probabilistic sensitivity analyses were conducted to assess robustness of the conclusions. Results: Thirty-two studies were used pooling 384 patients (234 sartorius flaps and 150 NPWT). NPWT had better clinical outcomes (86.7% success rate, 0.9% minor complication rate, and 13.3% major complication rate) than sartorius flap (81.6% success rate, 8.0% minor complication rate, and 18.4% major complication rate). NPWT was less costly ($12,366 versus $23,516) and slightly more effective (12.06 QALY versus 12.05 QALY) compared with sartorius flap. Sensitivity analyses confirmed the robustness of the base case findings; NPWT was either cost-effective at $50,000/QALY or dominated sartorius flap in 81.6% of all probabilistic sensitivity analyses. Conclusion: In our cost–utility analysis, use of adjunctive NPWT, along with debridement and antibiotic treatment, for managing infected vascular groin graft wounds was found to be a more cost-effective option when compared with sartorius flaps. PMID:26893991

  19. Scleral Lenses in the Management of Corneal Irregularity and Ocular Surface Disease.

    PubMed

    Shorter, Ellen; Harthan, Jennifer; Nau, Cherie B; Nau, Amy; Barr, Joseph T; Hodge, David O; Schornack, Muriel M

    2017-09-29

    To describe current practice patterns regarding the use of scleral lens therapy in the management of corneal irregularity and ocular surface disease among eye care providers who fit scleral lenses. The Scleral Lenses in Current Ophthalmic Practice: an Evaluation (SCOPE) study group conducted an electronic survey of eye care providers from January 15 to March 31, 2015. Respondents ranked management options for corneal irregularity in the order in which they would generally consider their use. Respondents also ranked options for the management of ocular surface disease in the order in which they would use each of the treatments. Results for each option were analyzed as percentage first-place ranking; percentage first-, second-, or third-place ranking; and mean rank score. Survey responses were obtained from 723 providers who had fit 5 or more scleral lenses. Of these respondents, 629 ranked options for management of corneal irregularity and 612 ranked options for management of ocular surface disease. Corneal rigid gas-permeable lenses were the first option for management of corneal irregularity for 44% of respondents, and scleral lenses were the first option for 34% of respondents. Lubricant drops were the first therapeutic recommendation for ocular surface disease for 84% of respondents, and scleral lenses were ranked first by 6% of respondents. Scleral lenses rank second only to corneal rigid gas-permeable lenses for management of corneal irregularity. Scleral lenses are generally considered after other medical intervention and before surgery for the management of ocular surface disease.

  20. Placing the power of real options analysis into the hands of natural resource managers - taking the next step.

    PubMed

    Nelson, Rohan; Howden, Mark; Hayman, Peter

    2013-07-30

    This paper explores heuristic methods with potential to place the analytical power of real options analysis into the hands of natural resource managers. The complexity of real options analysis has led to patchy or ephemeral adoption even by corporate managers familiar with the financial-market origins of valuation methods. Intuitively accessible methods for estimating the value of real options have begun to evolve, but their evaluation has mostly been limited to researcher-driven applications. In this paper we work closely with Bush Heritage Australia to evaluate the potential of real options analysis to support the intuitive judgement of conservation estate managers in covenanting land with uncertain future conservation value due to climate change. The results show that modified decision trees have potential to estimate the option value of covenanting individual properties while time and ongoing research resolves their future conservation value. Complementing this, Luehrman's option space has potential to assist managers with limited budgets to increase the portfolio value of multiple properties with different conservation attributes. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Roadmap for Testing and Validation of Electric Vehicle Communication Standards

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

    Pratt, Richard M.; Tuffner, Francis K.; Gowri, Krishnan

    Vehicle to grid communication standards are critical to the charge management and interoperability among plug-in electric vehicles (PEVs), charging stations and utility providers. The Society of Automobile Engineers (SAE), International Organization for Standardization (ISO), International Electrotechnical Commission (IEC) and the ZigBee Alliance are developing requirements for communication messages and protocols. While interoperability standards development has been in progress for more than two years, no definitive guidelines are available for the automobile manufacturers, charging station manufacturers or utility backhaul network systems. At present, there is a wide range of proprietary communication options developed and supported in the industry. Recent work bymore » the Electric Power Research Institute (EPRI), in collaboration with SAE and automobile manufacturers, has identified performance requirements and developed a test plan based on possible communication pathways using power line communication (PLC). Though the communication pathways and power line communication technology options are identified, much work needs to be done in developing application software and testing of communication modules before these can be deployed in production vehicles. This paper presents a roadmap and results from testing power line communication modules developed to meet the requirements of SAE J2847/1 standard.« less

  2. Embedded fiber-optic sensing for accurate internal monitoring of cell state in advanced battery management systems part 2: Internal cell signals and utility for state estimation

    NASA Astrophysics Data System (ADS)

    Ganguli, Anurag; Saha, Bhaskar; Raghavan, Ajay; Kiesel, Peter; Arakaki, Kyle; Schuh, Andreas; Schwartz, Julian; Hegyi, Alex; Sommer, Lars Wilko; Lochbaum, Alexander; Sahu, Saroj; Alamgir, Mohamed

    2017-02-01

    A key challenge hindering the mass adoption of Lithium-ion and other next-gen chemistries in advanced battery applications such as hybrid/electric vehicles (xEVs) has been management of their functional performance for more effective battery utilization and control over their life. Contemporary battery management systems (BMS) reliant on monitoring external parameters such as voltage and current to ensure safe battery operation with the required performance usually result in overdesign and inefficient use of capacity. More informative embedded sensors are desirable for internal cell state monitoring, which could provide accurate state-of-charge (SOC) and state-of-health (SOH) estimates and early failure indicators. Here we present a promising new embedded sensing option developed by our team for cell monitoring, fiber-optic (FO) sensors. High-performance large-format pouch cells with embedded FO sensors were fabricated. This second part of the paper focuses on the internal signals obtained from these FO sensors. The details of the method to isolate intercalation strain and temperature signals are discussed. Data collected under various xEV operational conditions are presented. An algorithm employing dynamic time warping and Kalman filtering was used to estimate state-of-charge with high accuracy from these internal FO signals. Their utility for high-accuracy, predictive state-of-health estimation is also explored.

  3. 41 CFR 101-39.4901 - Obtaining standard and optional forms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.49-Forms § 101-39.4901 Obtaining standard and optional... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Obtaining standard and optional forms. 101-39.4901 Section 101-39.4901 Public Contracts and Property Management Federal Property...

  4. Small modular reactor modeling using modelica for nuclear-renewable hybrid energy systems applications

    DOE PAGES

    Mikkelson, Daniel; Chang, Chih -Wei; Cetiner, Sacit M.; ...

    2015-10-01

    Here, the U.S. Department of Energy (DOE) supports research and development (R&D) that could lead to more efficient utilization of clean energy generation sources, including renewable and nuclear options, to meet grid demand and industrial thermal energy needs [1]. One hybridization approach being investigated by the DOE Offices of Nuclear Energy (NE) and the DOE Energy Efficiency and Renewable Energy (EERE) is tighter coupling of nuclear and renewable energy sources to better manage overall energy use for the combined electricity, industrial manufacturing, and transportation sectors.

  5. Percutaneous Mesocaval Shunt Creation in a Patient with Chronic Portal and Superior Mesenteric Vein Thrombosis

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

    Bercu, Zachary L., E-mail: zachary.bercu@mountsinai.org; Sheth, Sachin B., E-mail: sachinsheth@gmail.com; Noor, Amir, E-mail: amir.noor@gmail.com

    The creation of a transjugular intrahepatic portosystemic shunt (TIPS) is a critical procedure for the treatment of recurrent variceal bleeding and refractory ascites in the setting of portal hypertension. Chronic portal vein thrombosis remains a relative contraindication to conventional TIPS and options are limited in this scenario. Presented is a novel technique for management of refractory ascites in a patient with hepatitis C cirrhosis and chronic portal and superior mesenteric vein thrombosis secondary to schistosomiasis and lupus anticoagulant utilizing fluoroscopically guided percutaneous mesocaval shunt creation.

  6. Energy Systems Integration: NREL + HECO

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

    Hawaiian Electric Companies' (HECO) customers are among the nation's fastest-adopters of solar PV systems. For HECO, the increased daytime PV generation raises feeder voltage profiles. Emerging technologies such as advanced PV inverters, battery storage, electric vehicles, and controllable loads also have an impact on voltage profiles. From the utility's perspective, it is yet unclear how to effectively manage these customer-sited resources. NREL is helping HECO understand its options by validating several voltage regulation strategies, making specific use of advanced inverters with voltage support functions, and their integration with other controllable sources.

  7. Utilizing electromagnetic radiation for hair growth: a critical review of phototrichogenesis.

    PubMed

    Kalia, Sunil; Lui, Harvey

    2013-01-01

    Hair loss has a high prevalence in the general population and can have significant medical and psychological sequelae. Pattern hair loss and alopecia areata represent the major reasons patients present to dermatologists in relation to hair loss. Because conventional treatment options are generally incompletely effective, novel methods for hair grown induction are being developed. The role of using electromagnetic radiation, including low-level laser therapy for the management of hair loss through phototrichogenesis, is reviewed in this article. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  8. Treatment options for renal cell carcinoma in renal allografts: a case series from a single institution.

    PubMed

    Swords, Darden C; Al-Geizawi, Samer M; Farney, Alan C; Rogers, Jeffrey; Burkart, John M; Assimos, Dean G; Stratta, Robert J

    2013-01-01

    Renal cell carcinoma (RCC) is more common in renal transplant and dialysis patients than the general population. However, RCC in transplanted kidneys is rare, and treatment has previously consisted of nephrectomy with a return to dialysis. There has been recent interest in nephron-sparing procedures as a treatment option for RCC in allograft kidneys in an effort to retain allograft function. Four patients with RCC in allograft kidneys were treated with nephrectomy, partial nephrectomy, or radiofrequency ablation. All of the patients are without evidence of recurrence of RCC after treatment. We found nephron-sparing procedures to be reasonable initial options in managing incidental RCCs diagnosed in functioning allografts to maintain an improved quality of life and avoid immediate dialysis compared with radical nephrectomy of a functioning allograft. However, in non-functioning renal allografts, radical nephrectomy may allow for a higher chance of cure without the loss of transplant function. Consequently, radical nephrectomy should be utilized whenever the allograft is non-functioning and the patient's surgical risk is not prohibitive. © 2013 John Wiley & Sons A/S.

  9. Managing coal combustion residues in mines

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

    NONE

    2006-07-01

    Burning coal in electric utility plants produces, in addition to power, residues that contain constituents which may be harmful to the environment. The management of large volumes of coal combustion residues (CCRs) is a challenge for utilities, because they must either place the CCRs in landfills, surface impoundments, or mines, or find alternative uses for the material. This study focuses on the placement of CCRs in active and abandoned coal mines. The Committee on Mine Placement of Coal Combustion Wastes of the National Research Council believes that placement of CCRs in mines as part of the reclamation process may bemore » a viable option for the disposal of this material as long as the placement is properly planned and carried out in a manner that avoids significant adverse environmental and health impacts. This report discusses a variety of steps that are involved in planning and managing the use of CCRs as minefills, including an integrated process of CCR characterization and site characterization, management and engineering design of placement activities, and design and implementation of monitoring to reduce the risk of contamination moving from the mine site to the ambient environment. Enforceable federal standards are needed for the disposal of CCRs in minefills to ensure that states have adequate, explicit authority and that they implement minimum safeguards. 267 refs., 6 apps.« less

  10. Internet interventions to support lifestyle modification for diabetes management: a systematic review of the evidence.

    PubMed

    Cotter, Alexander P; Durant, Nefertiti; Agne, April A; Cherrington, Andrea L

    2014-01-01

    The Internet presents a widely accessible, 24-h means to promote chronic disease management. The objective of this review is to identify studies that used Internet based interventions to promote lifestyle modification among adults with type 2 diabetes. We searched PubMed using the terms: [internet, computer, phone, smartphone, mhealth, mobile health, web based, telehealth, social media, text messages] combined with [diabetes management and diabetes control] through January 2013. Studies were included if they described an Internet intervention, targeted adults with type 2 diabetes, focused on lifestyle modification, and included an evaluation component with behavioral outcomes. Of the 2803 papers identified, nine met inclusion criteria. Two studies demonstrated improvements in diet and/or physical activity and two studies demonstrated improvements in glycemic control comparing web-based intervention with control. Successful studies were theory-based, included interactive components with tracking and personalized feedback, and provided opportunities for peer support. Website utilization declined over time in all studies that reported on it. Few studies focused on high risk, underserved populations. Web-based strategies provide a viable option for facilitating diabetes self-management. Future research is needed on the use of web-based interventions in underserved communities and studies examining website utilization patterns and engagement over time. © 2014 Elsevier Inc. All rights reserved.

  11. Contemporary management of cancer of the oral cavity

    PubMed Central

    Genden, Eric M.; Silver, Carl E.; Takes, Robert P.; Suárez, Carlos; Owen, Randall P.; Haigentz, Missak; Stoeckli, Sandro J.; Shaha, Ashok R.; Rapidis, Alexander D.; Rodrigo, Juan Pablo; Rinaldo, Alessandra

    2010-01-01

    Oral cancer represents a common entity comprising a third of all head and neck malignant tumors. The options for curative treatment of oral cavity cancer have not changed significantly in the last three decades; however, the work up, the approach to surveillance, and the options for reconstruction have evolved significantly. Because of the profound functional and cosmetic importance of the oral cavity, management of oral cavity cancers requires a thorough understanding of disease progression, approaches to management and options for reconstruction. The purpose of this review is to discuss the most current management options for oral cavity cancers. PMID:20155361

  12. Q-BIC3 - A Québec-Bavarian international collaboration for adapting regional watershed management to climate change

    NASA Astrophysics Data System (ADS)

    Ludwig, Ralf

    2010-05-01

    Adapting to the impacts of climate change is certainly one of the major challenges in water resources management over the next decades. Adaptation to climate change risks is most crucial in this domain, since projected increase in mean air temperature in combination with an expected increase in the temporal variability of precipitation patterns will contribute to pressure on current water availability, allocation and management practices. The latter often involve the utilization of valuable infrastructure, such as dams, reservoirs and water intakes, for which adaptation options must by developed over long-term and often dynamic planning horizons. Research to establish novel methodologies for improved adaptation to climate change is thus very important and only beginning to emerge in regional watershed management. The presented project Q-BIC³, funded by the Bavarian Minstry for the Environment and the Québec Ministère du Développement économique, de l'Innovation et de l'Exportation, aims to develop and apply a newly designed spectrum of tools to support the improved assessment of adaptation options to climate change in regional watershed management. It addresses in particular selected study sites in Québec and Bavaria. The following key issues have been prioritized within Q-BIC³: i) The definition of potential adaptation options in the context of climate change for pre-targeted water management key issues using a subsequent and logical chain of modelling tools (climate, hydrological and water management modeling tools) ii) The definition of an approach that accounts for hydrological projection uncertainties in the search for potential adaptation options in the context of climate change iii) The investigation of the required complexity in hydrological models to estimate climate change impacts and to develop specific adaptation options for Québec and Bavaria watersheds. iv) The development and prototyping of a regionally transferable and modular modelling system for integrated watershed management under climate change conditions. The study sites under investigation, namely the Haut-Saint Francois and Gatineau watersheds in Québec and the Isar and Regnitz catchments in Bavaria, are under heavy anthropogenic use. Intense dam and reservoir operations and even water transfer systems are in place to satisfy multi-purpose demands on available water resources. These are imposing extreme modifications to the natural flow regimes. In the first phase of the project, climatic forcing, stemming from an ensemble of selected GCM and RCM runs, is applied to a variety of hydrological models with different complexity. The derived projections of future hydrological conditions serve to investigate, whether current operation rules and/or existing infrastructure needs to be adapted to a changing environment. First findings demonstrate the large uncertainties associated to the model chain outputs, but also indicate that related adaptation is indispensable to meet the challenges of the rapidly changing man-environment systems.

  13. Key Design Considerations When Calculating Cost Savings for Population Health Management Programs in an Observational Setting.

    PubMed

    Murphy, Shannon M E; Hough, Douglas E; Sylvia, Martha L; Dunbar, Linda J; Frick, Kevin D

    2018-02-08

    To illustrate the impact of key quasi-experimental design elements on cost savings measurement for population health management (PHM) programs. Population health management program records and Medicaid claims and enrollment data from December 2011 through March 2016. The study uses a difference-in-difference design to compare changes in cost and utilization outcomes between program participants and propensity score-matched nonparticipants. Comparisons of measured savings are made based on (1) stable versus dynamic population enrollment and (2) all eligible versus enrolled-only participant definitions. Options for the operationalization of time are also discussed. Individual-level Medicaid administrative and claims data and PHM program records are used to match study groups on baseline risk factors and assess changes in costs and utilization. Savings estimates are statistically similar but smaller in magnitude when eliminating variability based on duration of population enrollment and when evaluating program impact on the entire target population. Measurement in calendar time, when possible, simplifies interpretability. Program evaluation design elements, including population stability and participant definitions, can influence the estimated magnitude of program savings for the payer and should be considered carefully. Time specifications can also affect interpretability and usefulness. © Health Research and Educational Trust.

  14. Update on mandibular condylar fracture management.

    PubMed

    Weiss, Joshua P; Sawhney, Raja

    2016-08-01

    Fractures of the mandibular condyle have provided a lasting source of controversy in the field of facial trauma. Concerns regarding facial nerve injury as well as reasonable functional outcomes with closed management led to a reluctance to treat with an open operative intervention. This article reviews how incorporating new technologies and surgical methods have changed the treatment paradigm. Multiple large studies and meta-analyses continue to demonstrate superior outcomes for condylar fractures when managed surgically. Innovations, including endoscopic techniques, three-dimensional miniplates, and angled drills provide increased options in the treatment of condylar fractures. The literature on pediatric condylar fractures is limited and continues to favor a more conservative approach. There continues to be mounting evidence in radiographic, quality of life, and functional outcome studies to support open reduction with internal fixation for the treatment of condylar fractures in patients with malocclusion, significant displacement, or dislocation of the temporomandibular joint. The utilization of three-dimensional trapezoidal miniplates has shown improved outcomes and theoretically enhanced biomechanical properties when compared with traditional fixation with single or double miniplates. Endoscopic-assisted techniques can decrease surgical morbidity, but are technically challenging, require skilled assistants, and utilize specialized equipment.

  15. Insurer and employer views on pediatric obesity treatment: a qualitative study.

    PubMed

    Hampl, S E; Davis, A M; Sampilo, M L; Stephens, K L; Dean, K

    2013-04-01

    The effectiveness of group-based comprehensive, multidisciplinary (stage 3) pediatric weight management programs is backed by a growing body of literature, yet insurance coverage of these programs is scarce to nonexistent, limiting their reach and long-term survival. The objective of this study was to better understand the perspectives of insurers and large employers on the issue of group-based treatment coverage. The authors performed a qualitative study utilizing structured interviews with these stakeholders, following accepted techniques. Six major themes emerged: cost, program effectiveness, corporate social responsibility, secondary parental (employee) benefits, coverage options and new benefit determination. Future efforts to secure payment for group-based pediatric weight management programs should address these key themes. Copyright © 2012 The Obesity Society.

  16. Electromagnetic Navigational Bronchoscopy

    PubMed Central

    Port, Jeffrey; Harrison, Sebron

    2013-01-01

    Despite advances in technology and treatment options, lung cancer remains a deadly disease. National screening programs are being instituted in an attempt to discover lung cancer in high-risk individuals at an earlier stage. Such screening programs invariably discover small peripheral nodules that previously would not have been clinically apparent; the management of such lesions can be challenging. Current diagnostic options such as percutaneous biopsy are effective; however, they are hindered by their risk of morbidity such as pneumothorax. Electromagnetic bronchoscopy (ENB) is an emerging technology that allows the practitioner the ability to both sample and treat small peripheral pulmonary lesions. In experienced centers, ENB provides high rates of diagnostic yield for small lesions and a complication rate significantly lower than that of more conventional diagnostic modalities. Although there are current barriers to its widespread utilization (cost, specialized imaging, technical training), these obstacles will handled similarly to any other emerging technology and will likely not be long-term impediments to its use. PMID:24436528

  17. Indications and interventional options for non-resectable tracheal stenosis

    PubMed Central

    Bacon, Jenny Louise; Patterson, Caroline Marie

    2014-01-01

    Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable tracheal stenosis can be successfully managed by interventional bronchoscopy, with therapeutic options including airway dilatation, local tissue destruction and airway stenting. There are common aspects to the management of tracheal obstruction, tracheomalacia and tracheal fistulae. This paper reviews the pathogenesis, presentation, investigation and management of tracheal disease, with a focus on tracheal obstruction and the role of endotracheal intervention in management. PMID:24624290

  18. Development of a Medicare Beneficiary Comprehension Test: Assessing Medicare Part D Beneficiaries' Comprehension of Their Benefits

    PubMed Central

    Aruru, Meghana V.; Salmon, J. Warren

    2013-01-01

    Background Medicare Part D, the senior prescription drug benefit plan, was introduced through the Medicare Modernization Act of 2003. Medicare beneficiaries receive information about plan options through multiple sources, and it is often assumed by consumer health plans and healthcare providers that beneficiaries can understand and compare plan information. Medicare beneficiaries are older, may have cognitive problems, and may not have a true understanding of managed care. They are more likely than younger persons to have inadequate health literacy, thereby demonstrating significant gaps in knowledge and information about healthcare. Objective To develop a Medicare Beneficiary Comprehension Test (MBCT) to evaluate Medicare beneficiaries' understanding of Part D plan concepts, as presented in the 2008 Medicare & You handbook. Methods A 10-question MBCT was developed using a case-vignette approach that required beneficiaries to read portions of the Medicare & You handbook and answer Part D–related questions associated with healthcare decision-making. The test was divided into 2 sections: (I) insurance concepts and (II) utilization management/appeals and grievances to cover standard terminology, as well as newer utilization management and appeals and grievances procedures that are unique to Part D. The test was administered to 100 beneficiaries at 2 sites—a university geriatrics clinic and a private retirement facility. Beneficiaries were tested for cognition and health literacy before being administered the test. Results The mean score on the MBCT was 3.5 of a maximum of 5, with no statistical difference found between both sites. Ten faculty members and 4 graduate students assessed the content validity of the instrument using a 4-point Likert rating rubric. The construct validity of the instrument was assessed using a principal components analysis with varimax rotation. The principal components analysis yielded 4 factors that were labeled as “Plan D concepts,” “managed care/utilization management,” “cost-sharing,” and “plan comparisons.” The factor analysis indicated that the test is multidimensional and did measure the construct. Conclusions Medicare beneficiaries' understanding of Part D may play a key role in the management of their drug use and health and the associated outcomes. The MBCT and its pending revisions can be administered to beneficiaries with differing health outcomes. Medicare beneficiaries are often faced with several pieces of information involving a complex array of choices amidst bewildering plan options. It is crucial that beneficiaries and/or their family members involved in the decision-making process understand the plan benefits to truly make an informed decision. As the number of Medicare beneficiaries increases over the coming years with the baby boomers, it becomes even more imperative that the elderly have improved access to treatments that can achieve desirable outcomes. Measuring comprehension by Medicare beneficiaries may be an initial step toward understanding more complex issues, such as treatment adherence, decision-making, and, ultimately, trends in healthcare utilization and outcomes. PMID:24991375

  19. Applicability of risk-based management and the need for risk-based economic decision analysis at hazardous waste contaminated sites.

    PubMed

    Khadam, Ibrahim; Kaluarachchi, Jagath J

    2003-07-01

    Decision analysis in subsurface contamination management is generally carried out through a traditional engineering economic viewpoint. However, new advances in human health risk assessment, namely, the probabilistic risk assessment, and the growing awareness of the importance of soft data in the decision-making process, require decision analysis methodologies that are capable of accommodating non-technical and politically biased qualitative information. In this work, we discuss the major limitations of the currently practiced decision analysis framework, which evolves around the definition of risk and cost of risk, and its poor ability to communicate risk-related information. A demonstration using a numerical example was conducted to provide insight on these limitations of the current decision analysis framework. The results from this simple ground water contamination and remediation scenario were identical to those obtained from studies carried out on existing Superfund sites, which suggests serious flaws in the current risk management framework. In order to provide a perspective on how these limitations may be avoided in future formulation of the management framework, more matured and well-accepted approaches to decision analysis in dam safety and the utility industry, where public health and public investment are of great concern, are presented and their applicability in subsurface remediation management is discussed. Finally, in light of the success of the application of risk-based decision analysis in dam safety and the utility industry, potential options for decision analysis in subsurface contamination management are discussed.

  20. Economic analysis of emerald ash borer (Coleoptera: Buprestidae) management options.

    PubMed

    Vannatta, A R; Hauer, R H; Schuettpelz, N M

    2012-02-01

    Emerald ash borer, Agrilus planipennis (Fairmaire) (Coleoptera: Buprestidae), plays a significant role in the health and extent of management of native North American ash species in urban forests. An economic analysis of management options was performed to aid decision makers in preparing for likely future infestations. Separate ash tree population valuations were derived from the i-Tree Streets program and the Council of Tree and Landscape Appraisers (CTLA) methodology. A relative economic analysis was used to compare a control option (do-nothing approach, only removing ash trees as they die) to three distinct management options: 1) preemptive removal of all ash trees over a 5 yr period, 2) preemptive removal of all ash trees and replacement with comparable nonash trees, or 3) treating the entire population of ash trees with insecticides to minimize mortality. For each valuation and management option, an annual analysis was performed for both the remaining ash tree population and those lost to emerald ash borer. Retention of ash trees using insecticide treatments typically retained greater urban forest value, followed by doing nothing (control), which was better than preemptive removal and replacement. Preemptive removal without tree replacement, which was the least expensive management option, also provided the lowest net urban forest value over the 20-yr simulation. A "no emerald ash borer" scenario was modeled to further serve as a benchmark for each management option and provide a level of economic justification for regulatory programs aimed at slowing the movement of emerald ash borer.

  1. Exposure Assessment of Livestock Carcass Management ...

    EPA Pesticide Factsheets

    Report This report describes relative exposures and hazards for different livestock carcass management options in the event of a natural disaster. A quantitative exposure assessment by which livestock carcass management options are ranked relative to one another for a hypothetical site setting, a standardized set of environmental conditions (e.g., meteorology), and following a single set of assumptions about how the carcass management options are designed and implemented. These settings, conditions, and assumptions are not necessarily representative of site-specific carcass management efforts. Therefore, the exposure assessment should not be interpreted as estimating levels of chemical and microbial exposure that can be expected to result from the management options evaluated. The intent of the relative rankings is to support scientifically-based livestock carcass management decisions that consider potential hazards to human health, livestock, and the environment. This exposure assessment also provides information to support choices about mitigation measures to minimize or eliminate specific exposure pathways.

  2. 16 CFR 432.4 - Optional disclosures.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 1 2011-01-01 2011-01-01 false Optional disclosures. 432.4 Section 432.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES POWER OUTPUT CLAIMS FOR AMPLIFIERS UTILIZED IN HOME ENTERTAINMENT PRODUCTS § 432.4 Optional disclosures. Other operating characteristics and...

  3. 16 CFR 432.4 - Optional disclosures.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 1 2012-01-01 2012-01-01 false Optional disclosures. 432.4 Section 432.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES POWER OUTPUT CLAIMS FOR AMPLIFIERS UTILIZED IN HOME ENTERTAINMENT PRODUCTS § 432.4 Optional disclosures. Other operating characteristics and...

  4. 16 CFR 432.4 - Optional disclosures.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Optional disclosures. 432.4 Section 432.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES POWER OUTPUT CLAIMS FOR AMPLIFIERS UTILIZED IN HOME ENTERTAINMENT PRODUCTS § 432.4 Optional disclosures. Other operating characteristics and...

  5. 16 CFR 432.4 - Optional disclosures.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 1 2013-01-01 2013-01-01 false Optional disclosures. 432.4 Section 432.4 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES POWER OUTPUT CLAIMS FOR AMPLIFIERS UTILIZED IN HOME ENTERTAINMENT PRODUCTS § 432.4 Optional disclosures. Other operating characteristics and...

  6. 42 CFR 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

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

  7. 42 CFR 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

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

  8. PROFILE: Airfoil Geometry Manipulation and Display. User's Guide

    NASA Technical Reports Server (NTRS)

    Collins, Leslie; Saunders, David

    1997-01-01

    This report provides user information for program PROFILE, an aerodynamics design utility for plotting, tabulating, and manipulating airfoil profiles. A dozen main functions are available. The theory and implementation details for two of the more complex options are also presented. These are the REFINE option, for smoothing curvature in selected regions while retaining or seeking some specified thickness ratio, and the OPTIMIZE option, which seeks a specified curvature distribution. Use of programs QPLOT and BPLOT is also described, since all of the plots provided by PROFILE (airfoil coordinates, curvature distributions, pressure distributions)) are achieved via the general-purpose QPLOT utility. BPLOT illustrates (again, via QPLOT) the shape functions used by two of PROFILE's options. These three utilities should be distributed as one package. They were designed and implemented for the Applied Aerodynamics Branch at NASA Ames Research Center, Moffett Field, California. They are all written in FORTRAN 77 and run on DEC and SGI systems under OpenVMS and IRIX.

  9. A Framework for Understanding and Generating Integrated Solutions for Residential Peak Energy Demand

    PubMed Central

    Buys, Laurie; Vine, Desley; Ledwich, Gerard; Bell, John; Mengersen, Kerrie; Morris, Peter; Lewis, Jim

    2015-01-01

    Supplying peak energy demand in a cost effective, reliable manner is a critical focus for utilities internationally. Successfully addressing peak energy concerns requires understanding of all the factors that affect electricity demand especially at peak times. This paper is based on past attempts of proposing models designed to aid our understanding of the influences on residential peak energy demand in a systematic and comprehensive way. Our model has been developed through a group model building process as a systems framework of the problem situation to model the complexity within and between systems and indicate how changes in one element might flow on to others. It is comprised of themes (social, technical and change management options) networked together in a way that captures their influence and association with each other and also their influence, association and impact on appliance usage and residential peak energy demand. The real value of the model is in creating awareness, understanding and insight into the complexity of residential peak energy demand and in working with this complexity to identify and integrate the social, technical and change management option themes and their impact on appliance usage and residential energy demand at peak times. PMID:25807384

  10. A framework for understanding and generating integrated solutions for residential peak energy demand.

    PubMed

    Buys, Laurie; Vine, Desley; Ledwich, Gerard; Bell, John; Mengersen, Kerrie; Morris, Peter; Lewis, Jim

    2015-01-01

    Supplying peak energy demand in a cost effective, reliable manner is a critical focus for utilities internationally. Successfully addressing peak energy concerns requires understanding of all the factors that affect electricity demand especially at peak times. This paper is based on past attempts of proposing models designed to aid our understanding of the influences on residential peak energy demand in a systematic and comprehensive way. Our model has been developed through a group model building process as a systems framework of the problem situation to model the complexity within and between systems and indicate how changes in one element might flow on to others. It is comprised of themes (social, technical and change management options) networked together in a way that captures their influence and association with each other and also their influence, association and impact on appliance usage and residential peak energy demand. The real value of the model is in creating awareness, understanding and insight into the complexity of residential peak energy demand and in working with this complexity to identify and integrate the social, technical and change management option themes and their impact on appliance usage and residential energy demand at peak times.

  11. DEVELOPING AN INTEGRATED MANAGEMENT SYSTEM FOR URBAN AND ENERGY PLANNING TOWARDS A LOW-CARBON CITY

    NASA Astrophysics Data System (ADS)

    Maeda, Hideto; Nakakubo, Toyohiko; Tokai, Akihiro

    In this study, we developed an integrated management model that supports local government to make a promising energy saving measure on a block-scale combined with urban planning. We applied the model to Osaka city and estimated CO2 emissions from the residential and commercial buildings to 2050. The urban renewal cases selected in this study included advanced multipole accumulation case, normal multipole accumulation case, and actual trend continuation case. The energy saving options introduced in each case included all-electric HP system, micro grid system, and we also set the option where the greater CO2 reduction one is selected in each block. The results showed that CO2 emission in 2050 would be reduced by 54.8-57.6% relative to the actual condition by introducing the new energy system in all cases. In addition, the amount of CO2 reduction in actual trend continuation case was highest. The major factor was that the effect of CO2 emission reductions by installing the solar power generation panel was higher than the effect by utilizing heated water mutually on the high-density blocks in terms of total urban buildings' energy consumption.

  12. The management of an endodontically abscessed tooth: patient health state utility, decision-tree and economic analysis

    PubMed Central

    Balevi, Ben; Shepperd, Sasha

    2007-01-01

    Background A frequent encounter in clinical practice is the middle-aged adult patient complaining of a toothache caused by the spread of a carious infection into the tooth's endodontic complex. Decisions about the range of treatment options (conventional crown with a post and core technique (CC), a single tooth implant (STI), a conventional dental bridge (CDB), and a partial removable denture (RPD)) have to balance the prognosis, utility and cost. Little is know about the utility patients attach to the different treatment options for an endontically abscessed mandibular molar and maxillary incisor. We measured patients' dental-health-state utilities and ranking preferences of the treatment options for these dental problems. Methods Forty school teachers ranked their preferences for conventional crown with a post and core technique, a single tooth implant, a conventional dental bridge, and a partial removable denture using a standard gamble and willingness to pay. Data previously reported on treatment prognosis and direct "out-of-pocket" costs were used in a decision-tree and economic analysis Results The Standard Gamble utilities for the restoration of a mandibular 1st molar with either the conventional crown (CC), single-tooth-implant (STI), conventional dental bridge (CDB) or removable-partial-denture (RPD) were 74.47 [± 6.91], 78.60 [± 5.19], 76.22 [± 5.78], 64.80 [± 8.1] respectively (p < 0.05). Their respective Willingness-to-Pay ($CDN) were 1,782.05 [± 361.42], 1,871.79 [± 349.44], 1,605.13 [± 348.10], 1,351.28 [± 368.62] (p < 0.05). The standard gamble utilities for the restoration of a maxillary central incisor with a CC, STI, CDB and RPD were 88.50 [± 6.12], 90.68 [± 3.41], 89.78 [± 3.81] and 91.10 [± 3.57] respectively (p > 0.05). Their respective willingness-to-pay ($CDN) were: 1,782.05 [± 361.42], 1,871.79 [± 349.44], 1,605.13 [± 348.10] and 1,351.28 [± 368.62]. A statistical difference was found between the utility of treating a maxillary central incisor and mandibular 1st-molar (p < 0.05). The expected-utility-value for a 5-year prosthetic survival was highest for the CDB and the STI treatment of an abscessed mandibular molar (74.75 and 71.47 respectively) and maxillary incisor (86.24 and 84.91 respectively). This held up to a sensitivity analysis when the success of root canal therapy and the risk of damage to the adjacent tooth were varied. The RPD for both the molar and incisor was the favored treatment based on a cost-utility (3.85 and 2.74 CND$ per year of tooth saved respectively) and cost-benefit analysis (0.92 to 0.60 CND$ of cost per $ of benefit, respectively) for a prosthetic clinical survival of 5-years. Conclusion The position of the abscessed tooth and the amount of insurance coverage influences the utility and rank assigned by patients to the different treatment options. STI and CDB have optimal EUVs for a 5-year survival outcome, and RPD has significantly lower cost providing the better cost:benefit ratio. PMID:18053267

  13. Mind the Gap: Summary of Window Residential Retrofit Solutions

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

    Petersen, Joseph M.; Cort, Katherine A.; Widder, Sarah H.

    Improving the insulation, solar heat gain, and infiltration characteristics of windows in a home has the potential to significantly improve the overall thermal performance by reducing heat transfer through the window and also by decreasing infiltration of outdoor air into the home. As approximately 43% of existing homes still have single-pane clear windows (~50 million houses) and millions of other homes have only double-pane clear windows (Cort 2013), improving window performance also presents a significant opportunity for energy savings in the residential sector. Today, various energy-saving window retrofit opportunities are available to homeowners, ranging from window coverings and storm panelsmore » to highly-insulating triple-pane R-5 window replacements. Many of these technologies have been evaluated in the field, in the “Lab Homes” at Pacific Northwest National Laboratory, and through modeling to prove their cost-effectiveness and performance in different climate regions. Recently, the Pacific Northwest’s Regional Technical Forum approved a utility measure for low- emissivity storm windows based on such data. This action represents a watershed moment for increasing the variety and prevalence of fenestration options in utility programs, especially for the low-income demographic. This paper will review various window retrofit options, the most recent field test and modeling data regarding their performance and cost-effectiveness, and discuss future rating efforts. This information is useful for utilities and energy-efficiency program managers to help effectively implement incentive measures for these technologies.« less

  14. Implementing Google Apps for Education as Learning Management System in Math Education

    NASA Astrophysics Data System (ADS)

    Widodo, S.

    2017-09-01

    This study aims to find the effectiveness of math education using Google Apps for Education (GAFE) as learning management system to improve mathematical communication skill primary school preservice teacher. This research used quasi-experimental approach, utilizing the control group pre-test - post-test design of two group of primary school preservice teachers at UPI Kampus Purwakarta. The result of this study showed that mathematical communication skill of primary school preservice teacher in the experiment group is better than the control group. This is because the primary school preservice teacher in the experiment group used GAFE as a tool to communicate their idea. The students can communicate their idea because they have read the learning material on the learning management system using GAFE. All in all, it can be concluded that the communication tool is very important, beside the learning material, and also the options to choose the learning model to achieve the better result.

  15. Hypercortisolism in obesity-associated hypertension.

    PubMed

    Varughese, Amy G; Nimkevych, Oksana; Uwaifo, Gabriel I

    2014-07-01

    Obesity is prevalent worldwide and associated with co-morbidities that result in increased cardiovascular risk. Hypertension is the most prevalent obesity comorbidity associated with increased cardiovascular risk. Obesity hypertension is a distinct subtype of essential hypertension. While endogenous Cushing's syndrome is an uncommon cause of both obesity and hypertension, the recent recognition of other hypercortisolemic states has raised the profile of hypercortisolism as an important contributor in obesity hypertension. The high prevalence of exogenous, iatrogenic, pseudo, and subclinical Cushing's syndromes makes hypercortisolism an important diagnostic consideration in the evaluation and management of patients with obesity hypertension who are resistant to conventional management. Available data suggest that the renin-angiotensin-aldosterone system modulating antihypertensives have the best efficacy in hypercortisolism-mediated obesity hypertension. Strategies aimed at reducing cortisol production and action also have utility. This review provides a comprehensive overview of the epidemiology, etiopathogenesis and management options available for glucocorticoid-mediated obesity hypertension.

  16. Report on ISS Oxygen Production, Resupply, and Partial Pressure Management

    NASA Technical Reports Server (NTRS)

    Schaezler, Ryan; Ghariani, Ahmed; Leonard, Daniel; Lehman, Daniel

    2011-01-01

    The majority of oxygen used on International Space Station (ISS) is for metabolic support and denitrogenation procedures prior to Extra-Vehicular Activities. Oxygen is supplied by various visiting vehicles such as the Progress and Shuttle in addition to oxygen production capability on both the United States On-Orbit Segment (USOS) and Russian Segment (RS). To maintain a habitable atmosphere the oxygen partial pressure is controlled between upper and lower bounds. The full range of the allowable oxygen partial pressure along with the increased ISS cabin volume is utilized as a buffer allowing days to pass between oxygen production or direct addition of oxygen to the atmosphere from reserves. This paper summarizes amount of oxygen supplied and produced from all of the sources and describes past experience of managing oxygen partial pressure along with the range of management options available to the ISS.

  17. Study of Lyndon B. Johnson Space Center utility systems

    NASA Technical Reports Server (NTRS)

    Redding, T. E.; Huber, W. C.

    1977-01-01

    The results of an engineering study of potential energy saving utility system modifications for the NASA Lyndon B. Johnson Space Center are presented. The objective of the study was to define and analyze utility options that would provide facility energy savings in addition to the approximately 25 percent already achieved through an energy loads reduction program. A systems engineering approach was used to determine total system energy and cost savings resulting from each of the ten major options investigated. The results reported include detailed cost analyses and cost comparisons of various options. Cost are projected to the year 2000. Also included are a brief description of a mathematical model used for the analysis and the rationale used for a site survey to select buildings suitable for analysis.

  18. Modelling coastal processes and morphological changes of the UK east coast in support of coastal decision-making

    NASA Astrophysics Data System (ADS)

    Li, Xiaorong; Leonardi, Nicoletta; Brown, Jennifer; Plater, Andy

    2017-04-01

    The coastline of Eastern England is home to about one quarter of the UK's coastal habitats, including intertidal salt marshes, tidal flats and sand dunes. These geomorphic features are of great importance to the local wildlife, global biodiversity, marine environment and human society and economy. Due to sea-level rise and the occurrence of extreme weather conditions, the coastline of Eastern England is under high risk of erosion and recession, which could lead to tidal inundation of sites such as the RSPB Minsmere Reserve and power generation infrastructure at Sizewell. This research responds to the need for sustainable shoreline management plans of the UK east coast through sensitivity studies at the Dunwich-Sizewell area, Suffolk, UK. Particular interest is on the long-term morphodynamic response of the study area to possible environmental variations associated with global climate change. Key coastal processes, i.e. current, waves and sediment transport, and morphological evolution are studied using a process-based numerical model under the following scenarios: current mean sea level + calm wave conditions, current mean sea level + storms, sea level rise + calm wave conditions, and sea level rise + storms, all with a 'do nothing' management plan which allows the coastal environment to exist and respond dynamically. As a further aspect of this research, rules will be generalized for reduced-complexity, system-based modelling. Alternative management plans, including 'managed realignment' and 'advance the line', are also investigated in this research under the same environmental forcing scenarios, for the purposes of protection of infrastructure of national importance and conservation of wetland habitats. Both 'hard' and 'soft' engineering options, such as groynes and beach nourishment respectively, are considered. A more ecohydrological option which utilizes aquatic plant communities for wave energy dissipation and sediment trapping is also studied. The last option requires the numerical models to be modified based on understandings obtained through analysis of on-site observations and laboratory measurements.

  19. How Perceptions of Mental Illness Impact EAP Utilization.

    PubMed

    McRee, Jayme

    2017-01-01

    Studies of employee assistance program (EAP) clinical use across multiple industries and multiple EAP delivery models range from highs greater than 5% to lows of less than 1 %. Despite the range in utilization, the rates of employee behaviors that indicate a behavioral health issue are significantly higher, suggesting far too little use of EAPs overall. Studies of the costs to an employer for an employee with a mental health issue are as high as 37% lost annual productivity. EAPs have attempted to raise utilization through a variety of efforts, with mixed results. Most EAP utilization initiatives fail to address the impact of stigma, misunderstandings about mental illness and the reluctance of many employees to seek counseling as an option for better management of stress, work-life balance and overall mental wellness. For both employers and EAPs, addressing the impact of stigma and perceptions of mental illness is costly, requiring greater direct employee engagement and education. However, it is a more effective means of increasing EAP use than current practices and, ultimately, can result in significantly higher net gains in productivity while reducing employers' direct costs.

  20. 41 CFR 102-194.40 - For what Standard or Optional forms should an electronic version not be made available?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false For what Standard or... Contracts and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION ADMINISTRATIVE PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.40...

  1. Essential information: Uncertainty and optimal control of Ebola outbreaks

    USGS Publications Warehouse

    Li, Shou-Li; Bjornstad, Ottar; Ferrari, Matthew J.; Mummah, Riley; Runge, Michael C.; Fonnesbeck, Christopher J.; Tildesley, Michael J.; Probert, William J. M.; Shea, Katriona

    2017-01-01

    Early resolution of uncertainty during an epidemic outbreak can lead to rapid and efficient decision making, provided that the uncertainty affects prioritization of actions. The wide range in caseload projections for the 2014 Ebola outbreak caused great concern and debate about the utility of models. By coding and running 37 published Ebola models with five candidate interventions, we found that, despite this large variation in caseload projection, the ranking of management options was relatively consistent. Reducing funeral transmission and reducing community transmission were generally ranked as the two best options. Value of information (VoI) analyses show that caseloads could be reduced by 11% by resolving all model-specific uncertainties, with information about model structure accounting for 82% of this reduction and uncertainty about caseload only accounting for 12%. Our study shows that the uncertainty that is of most interest epidemiologically may not be the same as the uncertainty that is most relevant for management. If the goal is to improve management outcomes, then the focus of study should be to identify and resolve those uncertainties that most hinder the choice of an optimal intervention. Our study further shows that simplifying multiple alternative models into a smaller number of relevant groups (here, with shared structure) could streamline the decision-making process and may allow for a better integration of epidemiological modeling and decision making for policy.

  2. Essential information: Uncertainty and optimal control of Ebola outbreaks.

    PubMed

    Li, Shou-Li; Bjørnstad, Ottar N; Ferrari, Matthew J; Mummah, Riley; Runge, Michael C; Fonnesbeck, Christopher J; Tildesley, Michael J; Probert, William J M; Shea, Katriona

    2017-05-30

    Early resolution of uncertainty during an epidemic outbreak can lead to rapid and efficient decision making, provided that the uncertainty affects prioritization of actions. The wide range in caseload projections for the 2014 Ebola outbreak caused great concern and debate about the utility of models. By coding and running 37 published Ebola models with five candidate interventions, we found that, despite this large variation in caseload projection, the ranking of management options was relatively consistent. Reducing funeral transmission and reducing community transmission were generally ranked as the two best options. Value of information (VoI) analyses show that caseloads could be reduced by 11% by resolving all model-specific uncertainties, with information about model structure accounting for 82% of this reduction and uncertainty about caseload only accounting for 12%. Our study shows that the uncertainty that is of most interest epidemiologically may not be the same as the uncertainty that is most relevant for management. If the goal is to improve management outcomes, then the focus of study should be to identify and resolve those uncertainties that most hinder the choice of an optimal intervention. Our study further shows that simplifying multiple alternative models into a smaller number of relevant groups (here, with shared structure) could streamline the decision-making process and may allow for a better integration of epidemiological modeling and decision making for policy.

  3. Emergency medicine: an operations management view.

    PubMed

    Soremekun, Olan A; Terwiesch, Christian; Pines, Jesse M

    2011-12-01

    Operations management (OM) is the science of understanding and improving business processes. For the emergency department (ED), OM principles can be used to reduce and alleviate the effects of crowding. A fundamental principle of OM is the waiting time formula, which has clear implications in the ED given that waiting time is fundamental to patient-centered emergency care. The waiting time formula consists of the activity time (how long it takes to complete a process), the utilization rate (the proportion of time a particular resource such a staff is working), and two measures of variation: the variation in patient interarrival times and the variation in patient processing times. Understanding the waiting time formula is important because it presents the fundamental parameters that can be managed to reduce waiting times and length of stay. An additional useful OM principle that is applicable to the ED is the efficient frontier. The efficient frontier compares the performance of EDs with respect to two dimensions: responsiveness (i.e., 1/wait time) and utilization rates. Some EDs may be "on the frontier," maximizing their responsiveness at their given utilization rates. However, most EDs likely have opportunities to move toward the frontier. Increasing capacity is a movement along the frontier and to truly move toward the frontier (i.e., improving responsiveness at a fixed capacity), we articulate three possible options: eliminating waste, reducing variability, or increasing flexibility. When conceptualizing ED crowding interventions, these are the major strategies to consider. © 2011 by the Society for Academic Emergency Medicine.

  4. Perceptions about Iranian-Kurds' ethnic-inequality in health.

    PubMed

    Yari, Arezoo; Nedjat, Saharnaz; Asadi-Lari, Mohsen; Majdzadeh, Reza

    2017-09-12

    Evidence shows ethnic-inequality is a very effective variable in the Community and individual health associated outcomes. This study focused on gaining a deeper understanding of people's perception on inequality of health in Iranian-Kurds and its determinants. The study was conducted in the three cities of Marivan, Sanandaj (capital of Kurdistan province in Iran) and Tehran (capital of the country). The study was conducted through 34 in-depth interviews and ten focus group discussions with health services users, academic graduates and health delivery service personnel. Consensus on social, mental and physical health inequality did not exist within the study participants. However, there were concerns about differences in healthcare access and utilization. Several participants believed that access to health services and socio-cultural differences of Kurds affected the healthcare utilization. Since, people perceived ethnic-inequality in healthcare access and utilization, ethnicity must be considered as a mandatory stratifier in monitoring health status and a concern during planning health interventions. People's awareness, resources management and allocation are factors requiring more consideration when choosing policy options.

  5. 43 CFR 46.145 - Using adaptive management.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... implementation decisions. The NEPA analysis conducted in the context of an adaptive management approach should identify the range of management options that may be taken in response to the results of monitoring and should analyze the effects of such options. The environmental effects of any adaptive management strategy...

  6. 43 CFR 46.145 - Using adaptive management.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... implementation decisions. The NEPA analysis conducted in the context of an adaptive management approach should identify the range of management options that may be taken in response to the results of monitoring and should analyze the effects of such options. The environmental effects of any adaptive management strategy...

  7. Gold nanostructure materials in diabetes management

    NASA Astrophysics Data System (ADS)

    Si, Satyabrata; Pal, Arttatrana; Mohanta, Jagdeep; Sagar Satapathy, Smith

    2017-04-01

    Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia, and is now one of the most non-communicable diseases globally and can be lethal if not properly controlled. Prolonged exposure to chronic hyperglycemia, without proper management, can lead to various vascular complications and represents the main cause of morbidity and mortality in diabetes patients. Studies have indicated that major long-term complications of diabetes arise from persistent oxidative-nitrosative stress and dysregulation in multiple metabolic pathways. Presently, the main focus for diabetes management is to optimize the available techniques to ensure adequate blood sugar level, blood pressure and lipid profile, thereby minimizing the diabetes complications. In this regard, nanomedicine utilizing gold nanostructures has great potential and seems to be a promising option. The present review highlights the basic concepts and up-to-date literature survey of gold nanostructure materials in management of diabetes in several ways, which include sensing, imaging, drug delivery and therapy. The work can be of interest to various researchers working on basic and applied sciences including nanosciences.

  8. What Climate Information Do Water Managers Need to Make Robust, Long-Term Plans?

    NASA Astrophysics Data System (ADS)

    Duran, R.; Lempert, R.; Groves, D.

    2008-12-01

    What climate information do water managers need to respond to threat of climate change? Southern California's Inland Empire Utilities Agency (IEUA) completed a long-range water resource management plan in 2005 that addressed expected economic and population growth in their service region, but did not consider the potential impacts of climate change. Using a robust decision making (RDM) approach for policy under deep uncertainty, we recently worked with IEUA to conduct a climate-change vulnerability and response options analysis of the agency's long-range plans. This analysis suggests that IEUA is vulnerable to future climate change, but can significantly reduce this vulnerability by increasing their near-term conservation programs and careful monitoring and updating to adjust their plan in the years ahead. In addition to helping IEUA, this analysis provides important guidance on the types of climate and other information that can be most useful for water managers as they attempt to take robust, near-term actions to increaase their resilience to climate change.

  9. Geographic Information Systems for Assessing Existing and Potential Bio-energy Resources: Their Use in Determining Land Use and Management Options which Minimize Ecological and Landscape Impacts in Rural Areas

    NASA Technical Reports Server (NTRS)

    Jackman, A. E.; Fabos, J. G.; Carlozzi, C. C.

    1982-01-01

    A management construct is described which forms part of an overall landscape ecological planning model which has as a principal objective the extension of the traditional descriptive land use mapping capabilities of geographic information systems into land management realms. It is noted that geographic information systems appear to be moving to more comprehensive methods of data handling and storage, such as relational and hierarchical data management systems, and a clear need has simultaneously arisen therefore for planning assessment techniques and methodologies which can actually use such complex levels of data in a systematic, yet flexible and scenario dependent way. The descriptive of mapping method proposed broaches such issues and utilizes a current New England bioenergy scenario, stimulated by the use of hardwoods for household heating purposes established in the post oil crisis era and the increased awareness of the possible landscape and ecological ramifications of the continued increasing use of the resource.

  10. Blood Ketones: Measurement, Interpretation, Limitations, and Utility in the Management of Diabetic Ketoacidosis

    PubMed Central

    Dhatariya, Ketan

    2016-01-01

    Diabetic ketoacidosis (DKA) remains a common medical emergency. Over the last few years, new national guidelines have changed the focus in managing the condition from being glucose-centered to ketone-centered. With the advent of advancing technology and the increasing use of hand-held, point-of-care ketone meters, greater emphasis is placed on making treatment decisions based on these readings. Furthermore, recent warnings about euglycemic DKA occurring in people with diabetes using sodium-glucose co-transporter 2 (SGLT-2) inhibitors urge clinicians to inform their patients of this condition and possible testing options. This review describes the reasons for a change in treating DKA, and outlines the benefits and limitations of using ketone readings, in particular highlighting the difference between urine and capillary readings. PMID:28278308

  11. Characterization and constructive utilization of sludge produced in clari-flocculation unit of water treatment plant

    NASA Astrophysics Data System (ADS)

    Ahmad, Tarique; Ahmad, Kafeel; Alam, Mehtab

    2018-03-01

    All water treatment plants produce waste/residue amid the treatment of raw water. This study selectively investigates the clariflocculator sludge for its physicochemical characteristics and potential reuse options. Sieve analysis, XRF, SEM, XRD, FTIR, and TG-DTA instrumental techniques have been used to characterize the sludge sample. Results show that clariflocculator sludge contains about 78% fine sand having grain size range 150-75 μm. SiO2, Al2O3, Fe2O3 and CaO constitute the maximum percentage of chemical compounds present in the sludge and quartz is the main crystalline phase of the sludge. Recycling and reuse of this sludge, especially, as fine sand in preparing mortar, concrete mix and other civil engineering products would pave the way for constructive utilization with safe and sustainable sludge management strategies.

  12. Electric Vehicle Communication Standards Testing and Validation Phase I: SAE J2847/1

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

    Pratt, Richard M.; Tuffner, Francis K.; Gowri, Krishnan

    Executive Summary Vehicle to grid communication standards are critical to the charge management and interoperability among vehicles, charging stations and utility providers. Several standards initiatives by the Society of Automobile Engineers (SAE), International Standards Organization and International Electrotechnical Commission (ISO/IEC), and ZigBee / HomePlug Alliance are developing requirements for communication messages and protocols. While the standard development is in progress for more than two years, no definitive guidelines are available for the automobile manufacturers, charging station manufacturers and utility backhaul network systems. At present, there is a wide range of proprietary communication options developed and supported in the industry. Recentmore » work by the Electric Power Research Institute (EPRI) in collaboration with SAE and automobile manufacturers has identified performance requirements and test plan based on possible communication pathways using power line communication over the control pilot and mains. Though the communication pathways and power line communication technology options are identified, much work needs to be done in developing application software and testing of communication modules before these can be deployed in production vehicles. This report presents a test plan and results from initial testing of two power line communication modules developed to meet the requirements of SAE J2847/1 standard.« less

  13. Evaluating options for balancing the water-electricity nexus in California: Part 2--greenhouse gas and renewable energy utilization impacts.

    PubMed

    Tarroja, Brian; AghaKouchak, Amir; Sobhani, Reza; Feldman, David; Jiang, Sunny; Samuelsen, Scott

    2014-11-01

    A study was conducted to compare the technical potential and effectiveness of different water supply options for securing water availability in a large-scale, interconnected water supply system under historical and climate-change augmented inflow and demand conditions. Part 2 of the study focused on determining the greenhouse gas and renewable energy utilization impacts of different pathways to stabilize major surface reservoir levels. Using a detailed electric grid model and taking into account impacts on the operation of the water supply infrastructure, the greenhouse gas emissions and effect on overall grid renewable penetration level was calculated for each water supply option portfolio that successfully secured water availability from Part 1. The effects on the energy signature of water supply infrastructure were found to be just as important as that of the fundamental processes for each option. Under historical (baseline) conditions, many option portfolios were capable of securing surface reservoir levels with a net neutral or negative effect on emissions and a benefit for renewable energy utilization. Under climate change augmented conditions, however, careful selection of the water supply option portfolio was required to prevent imposing major emissions increases for the system. Overall, this analysis provided quantitative insight into the tradeoffs associated with choosing different pathways for securing California's water supply. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. What’s Needed from Climate Modeling to Advance Actionable Science for Water Utilities?

    NASA Astrophysics Data System (ADS)

    Barsugli, J. J.; Anderson, C. J.; Smith, J. B.; Vogel, J. M.

    2009-12-01

    “…perfect information on climate change is neither available today nor likely to be available in the future, but … over time, as the threats climate change poses to our systems grow more real, predicting those effects with greater certainty is non-discretionary. We’re not yet at a level at which climate change projections can drive climate change adaptation.” (Testimony of WUCA Staff Chair David Behar to the House Committee on Science and Technology, May 5, 2009) To respond to this challenge, the Water Utility Climate Alliance (WUCA) has sponsored a white paper titled “Options for Improving Climate Modeling to Assist Water Utility Planning for Climate Change. ” This report concerns how investments in the science of climate change, and in particular climate modeling and downscaling, can best be directed to help make climate projections more actionable. The meaning of “model improvement” can be very different depending on whether one is talking to a climate model developer or to a water manager trying to incorporate climate projections in to planning. We first surveyed the WUCA members on present and potential uses of climate model projections and on climate inputs to their various system models. Based on those surveys and on subsequent discussions, we identified four dimensions along which improvement in modeling would make the science more “actionable”: improved model agreement on change in key parameters; narrowing the range of model projections; providing projections at spatial and temporal scales that match water utilities system models; providing projections that water utility planning horizons. With these goals in mind we developed four options for improving global-scale climate modeling and three options for improving downscaling that will be discussed. However, there does not seem to be a single investment - the proverbial “magic bullet” -- which will substantially reduce the range of model projections at the scales at which utility planning is conducted. In the near term we feel strongly that water utilities and climate scientists should work together to leverage the upcoming Coupled Model Intercomparison Project, Phase 5 (CMIP5; a coordinated set climate model experiments that will be used to support the upcoming IPCC Fifth Assessment) to better benefit water utilities. In the longer term, even with model and downscaling improvements, it is very likely that substantial uncertainty about future climate change at the desired spatial and temporal scales will remain. Nonetheless, there is no doubt the climate is changing, and the challenge is to work with what we have, or what we can reasonably expect to have in the coming years to make the best decisions we can.

  15. 41 CFR 102-194.25 - What is an automated Standard or Optional format?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION ADMINISTRATIVE PROGRAMS 194-STANDARD AND OPTIONAL FORMS MANAGEMENT PROGRAM § 102-194.25 What is an automated Standard or... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What is an automated...

  16. Management of complications of Dupuytren contracture.

    PubMed

    Cheung, Kevin; Walley, Kempland C; Rozental, Tamara D

    2015-05-01

    This evidence-based article discusses the current management options of Dupuytren disease and strategies to avoid and manage any potential complications. Treatment options include fasciectomy, needle fasciotomy/aponeurotomy, and collagenase injection. Complications include digital nerve and artery injury, flexor tendon injury, skin fissures and wound healing complications, hematoma, infection, flare reaction/complex regional pain syndrome, and recurrence. Complication rates, prevention, and management differ with each treatment modality. A detailed understanding of each of these options allows hand surgeons to select the most appropriate treatment for each patient. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Utility of the AAOS Appropriate Use Criteria (AUC) for Pediatric Supracondylar Humerus Fractures in Clinical Practice.

    PubMed

    Ibrahim, Talal; Hegazy, Abdelsalam; Abulhail, Safa I S; Ghomrawi, Hassan M K

    2017-01-01

    The American Academy of Orthopaedic Surgeons (AAOS) recently developed an Appropriate Use Criteria (AUC) for pediatric supracondylar humerus fractures (PSHF). The AUC is intended to improve quality of care by informing surgeon decision making. The aim of our study was to cross-reference the management of operatively treated PSHF with the AAOS-published AUC. The AUC for PSHF include 220 patient scenarios, based on different combinations of 6 factors. For each patient scenario, 8 treatment options are evaluated as "appropriate," "maybe appropriate," and "rarely appropriate." We retrospectively reviewed the medical charts and radiographs of all operatively treated PSHF at our hospital from January 2013 to December 2014 and determined the appropriateness of the treatment. Over the study period, 94 children (mean age: 5.2 y; 51 male, 43 female) were admitted with PSHF and underwent a surgical procedure (type IIA: 7, type IIB: 14, type III: 70, flexion type: 3). Only 8 of the 220 scenarios were observed in our patient cohort. The most frequent scenario was represented by a type III fracture, palpable distal pulse, no nerve injury, closed soft-tissue envelope, no radius/ulna fracture, and typical swelling. Of the 94 fractures, the AUC was "appropriate" for 84 cases and "maybe appropriate" for 9 cases. There was only 1 case of "rarely appropriate" management. Closed reduction with lateral pinning and immobilization was the most prevalent treatment option (58.5%). The rate of appropriateness was not affected by the operating surgeon. However, the definition of a case as emergent had a significant impact on the rate of appropriateness. Application of the AUC to actual clinical data was relatively simple. The majority of operatively treated PSHF (89.4%) were managed appropriately. With the introduction of electronic medical charts, an AUC application becomes attractive and easy for orthopaedic surgeons to utilize in clinical practice. However, validity studies of the AUC in different clinical settings are still required. Level IV.

  18. Effect of allelopathic rice varieties combined with cultural management options on paddy field weeds.

    PubMed

    Kong, Chui-Hua; Hu, Fei; Wang, Peng; Wu, Jing-Lun

    2008-03-01

    A number of techniques, including cultural management, allelopathy and bioherbicide, have been considered as alternatives for synthetic herbicides, but successful weed control will require the careful integration of these multiple techniques. This study was conducted to assess the use of allelopathic rice varieties in combination with cultural management options on paddy weeds, in order to develop an allelopathy-based technique to reduce herbicide use in paddies. The weed-suppressive effects of the rice varieties tested varied highly with allelopathic trait, planting pattern and cultural management including planting density, flooding depth and duration and supply of nitrogen. Allelopathic rice varieties PI312777 and Huagan-1 demonstrated much stronger weed suppression than the non-allelopathic variety Huajianxian under the same planting pattern and cultural management. Their weed-suppressive effect was increased with cultural management options. In particular, if integrated cultural management options of allelopathic rice varieties included a low-dose (bensulfuron-methyl, 25 g AI ha(-1), a third of the recommended dose) herbicide application, the emergence and growth of most weeds found in paddy fields was completely controlled. No grain yield reduction for allelopathic varieties occurred under integrated cultural management options, whereas with the non-allelopathic variety a reduction of up to 45-60% was measurable even with the low-dose herbicide application. The allelopathic potential of rice varieties will likely have a great impact on paddy weed control if integrated with cultural management options and application of low doses of herbicides. Therefore, it is feasible to reduce herbicide input in paddies if allelopathic rice is grown under integrated cultural management practices. (c) 2008 Society of Chemical Industry.

  19. Managing Cancer Care: a psycho-educational intervention to improve knowledge of care options and breast cancer self-management.

    PubMed

    Schulman-Green, Dena; Jeon, Sangchoon

    2017-02-01

    We tested the feasibility and acceptability of a psycho-educational self-management intervention, Managing Cancer Care: A Personal Guide (MCC), to improve knowledge of care options (curative, palliative, and hospice care) among a range of breast cancer self-management skills. We conducted a one-group, pre-post-test study among women with non-metastatic breast cancer (n = 105). We gave participants the printed, self-guided, seven-module intervention following enrollment. At baseline and 2  months, we measured knowledge of care options, desired and actual role in self-management, medical communication skills, experience and management of transitions, anxiety, depression, uncertainty, and self-efficacy. We conducted interviews to obtain module ratings and qualitative data on strengths and limitations of MCC. Knowledge of care options (δ = 0.40 (1.11), p = 0.0005) and desired role in self-management (δ = -0.28 (1.08), p = 0.0177) significantly improved. Less skilled medical communicators significantly improved their communication (δ = 3.47, standard deviation = 6.58, p = 0.0449). Multivariate modeling showed that changes in our primary outcomes of medical communication and management of transitions seemed to drive positive changes in our secondary outcomes of anxiety, depression, uncertainty, and self-efficacy. Participants highly rated MCC and reported the importance of understanding care options despite non-metastatic disease. MCC is a feasible and acceptable means of improving knowledge of care options and other aspects of breast cancer self-management. The combination of modules offered in MCC appears to have beneficial interactive effects. We are currently testing MCC more rigorously in a randomized controlled trial to explore mediating and moderating relationships. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  20. MIUS community conceptual design study

    NASA Technical Reports Server (NTRS)

    Fulbright, B. E.

    1976-01-01

    The feasibility, practicality, and applicability of the modular integrated utility systems (MIUS) concept to a satellite new-community development with a population of approximately 100,000 were analyzed. Two MIUS design options, the 29-MIUS-unit (option 1) and the 8-MIUS-unit (option 2) facilities were considered. Each resulted in considerable resource savings when compared to a conventional utility system. Economic analyses indicated that the total cash outlay and operations and maintenance costs for these two options were considerably less than for a conventional system. Computer analyses performed in support of this study provided corroborative data for the study group. An environmental impact assessment was performed to determine whether the MIUS meets or will meet necessary environmental standards. The MIUS can provide improved efficiency in the conservation of natural resources while not adversely affecting the physical environment.

  1. Nuclear energy: Where do we go from here?

    NASA Astrophysics Data System (ADS)

    Muslim, Dato'Noramly, Dr

    2015-04-01

    As Malaysia progresses towards 2020, the depleting resource of oil and gas has forced a re-look at alternatives to replace fossil fuels as energy sources. Among the viable options is nuclear energy, enabling us to meet energy needs and sustain national development in the twenty-first century. Three essential steps Malaysia must take to introduce nuclear power into its energy mix are: energy planning, infrastructure development, and deployment. Malaysia has to face a series of challenges, including public acceptance, waste management, minimizing proliferation risk, and ensuring the security of nuclear plants and materials. Timely development of qualified and competent manpower is a key limiting factor in the development and transfer of nuclear technologies — and education and training take time, effort and money. There is a need for political will. Within the Asian region, China, Korea and Japan are in the forefront in utilizing nuclear power to meet electricity demands. Countries such as UAE, Bangladesh, Vietnam and Turkey are moving ahead with the nuclear option for electricity generation and they have begun planning and construction of nuclear power plants. Against this backdrop, what are Malaysia's moves? This paper discusses various options and challenges, obstacles and repercussions in meeting future energy demands.

  2. The Role of Proteomics in the Diagnosis and Treatment of Women's Cancers: Current Trends in Technology and Future Opportunities

    PubMed Central

    Breuer, Eun-Kyoung Yim; Murph, Mandi M.

    2011-01-01

    Technological and scientific innovations over the last decade have greatly contributed to improved diagnostics, predictive models, and prognosis among cancers affecting women. In fact, an explosion of information in these areas has almost assured future generations that outcomes in cancer will continue to improve. Herein we discuss the current status of breast, cervical, and ovarian cancers as it relates to screening, disease diagnosis, and treatment options. Among the differences in these cancers, it is striking that breast cancer has multiple predictive tests based upon tumor biomarkers and sophisticated, individualized options for prescription therapeutics while ovarian cancer lacks these tools. In addition, cervical cancer leads the way in innovative, cancer-preventative vaccines and multiple screening options to prevent disease progression. For each of these malignancies, emerging proteomic technologies based upon mass spectrometry, stable isotope labeling with amino acids, high-throughput ELISA, tissue or protein microarray techniques, and click chemistry in the pursuit of activity-based profiling can pioneer the next generation of discovery. We will discuss six of the latest techniques to understand proteomics in cancer and highlight research utilizing these techniques with the goal of improvement in the management of women's cancers. PMID:21886869

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

    Muslim, Dato’ Dr Noramly, E-mail: noramlymuslim@yahoo.com

    As Malaysia progresses towards 2020, the depleting resource of oil and gas has forced a re-look at alternatives to replace fossil fuels as energy sources. Among the viable options is nuclear energy, enabling us to meet energy needs and sustain national development in the twenty-first century. Three essential steps Malaysia must take to introduce nuclear power into its energy mix are: energy planning, infrastructure development, and deployment. Malaysia has to face a series of challenges, including public acceptance, waste management, minimizing proliferation risk, and ensuring the security of nuclear plants and materials. Timely development of qualified and competent manpower ismore » a key limiting factor in the development and transfer of nuclear technologies — and education and training take time, effort and money. There is a need for political will. Within the Asian region, China, Korea and Japan are in the forefront in utilizing nuclear power to meet electricity demands. Countries such as UAE, Bangladesh, Vietnam and Turkey are moving ahead with the nuclear option for electricity generation and they have begun planning and construction of nuclear power plants. Against this backdrop, what are Malaysia’s moves? This paper discusses various options and challenges, obstacles and repercussions in meeting future energy demands.« less

  4. Optimal planning for the sustainable utilization of municipal solid waste.

    PubMed

    Santibañez-Aguilar, José Ezequiel; Ponce-Ortega, José María; Betzabe González-Campos, J; Serna-González, Medardo; El-Halwagi, Mahmoud M

    2013-12-01

    The increasing generation of municipal solid waste (MSW) is a major problem particularly for large urban areas with insufficient landfill capacities and inefficient waste management systems. Several options associated to the supply chain for implementing a MSW management system are available, however to determine the optimal solution several technical, economic, environmental and social aspects must be considered. Therefore, this paper proposes a mathematical programming model for the optimal planning of the supply chain associated to the MSW management system to maximize the economic benefit while accounting for technical and environmental issues. The optimization model simultaneously selects the processing technologies and their location, the distribution of wastes from cities as well as the distribution of products to markets. The problem was formulated as a multi-objective mixed-integer linear programing problem to maximize the profit of the supply chain and the amount of recycled wastes, where the results are showed through Pareto curves that tradeoff economic and environmental aspects. The proposed approach is applied to a case study for the west-central part of Mexico to consider the integration of MSW from several cities to yield useful products. The results show that an integrated utilization of MSW can provide economic, environmental and social benefits. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. 77 FR 75243 - Self-Regulatory Organizations; Options Clearing Corporation; Order Approving Proposed Rule Change...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-19

    ... modeling and risk management procedures (``Risk Management Proposal'') \\9\\ is approved by the Commission.... The enhancements are part of OCC's ongoing efforts to test and improve its risk management operations... Index Options,\\12\\ and only subject to the filing and approval of the Risk Management Proposal, as...

  6. Pawnee Nation Energy Option Analyses

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

    Matlock, M.; Kersey, K.; Riding In, C.

    2009-07-31

    In 2003, the Pawnee Nation leadership identified the need for the tribe to comprehensively address its energy issues. During a strategic energy planning workshop a general framework was laid out and the Pawnee Nation Energy Task Force was created to work toward further development of the tribe’s energy vision. The overarching goals of the “first steps” project were to identify the most appropriate focus for its strategic energy initiatives going forward, and to provide information necessary to take the next steps in pursuit of the “best fit” energy options. Based on the request of Pawnee Nation’s Energy Task Force themore » research team, consisting Tribal personnel and Summit Blue Consulting, focused on a review of renewable energy resource development potential, funding sources and utility organizational along with energy savings options. Elements of the energy demand forecasting and characterization and demand side options review remained in the scope of work, but were only addressed at a high level. Description of Activities Performed Renewable Energy Resource Development Potential The research team reviewed existing data pertaining to the availability of biomass (focusing on woody biomass, agricultural biomass/bio-energy crops, and methane capture), solar, wind and hydropower resources on the Pawnee-owned lands. Using these data, combined with assumptions about costs and revenue streams, the research team performed preliminary feasibility assessments for each resource category. The research team also reviewed available funding resources and made recommendations to Pawnee Nation highlighting those resources with the greatest potential for financially-viable development, both in the near-term and over a longer time horizon. Energy Efficiency Options While this was not a major focus of the project, the research team highlighted common strategies for reducing energy use in buildings. The team also discussed the benefits of adopting a building energy code and introduced two model energy codes Pawnee Nation should consider for adoption. Summary of Current and Expected Future Electricity Usage The research team provided a summary overview of electricity usage patterns in current buildings and included discussion of known plans for new construction. Utility Options Review Pawnee Nation electric utility options were analyzed through a four-phase process, which included: 1) summarizing the relevant utility background information; 2) gathering relevant utility assessment data; 3) developing a set of realistic Pawnee electric utility service options, and 4) analyzing the various Pawnee electric utility service options for the Pawnee Energy Team’s consideration. III. Findings and Recommendations Due to a lack of financial incentives for renewable energy, particularly at the state level, combined mediocre renewable energy resources, renewable energy development opportunities are limited for Pawnee Nation. However, near-term potential exists for development of solar hot water at the gym, and an exterior wood-fired boiler system at the tribe’s main administrative building. Pawnee Nation should also explore options for developing LFGTE resources in collaboration with the City of Pawnee. Significant potential may also exist for development of bio-energy resources within the next decade. Pawnee Nation representatives should closely monitor market developments in the bio-energy industry, establish contacts with research institutions with which the tribe could potentially partner in grant-funded research initiatives. In addition, a substantial effort by the Kaw and Cherokee tribes is underway to pursue wind development at the Chilocco School Site in northern Oklahoma where Pawnee is a joint landowner. Pawnee Nation representatives should become actively involved in these development discussions and should explore the potential for joint investment in wind development at the Chilocco site.« less

  7. Compensation for Distributed Solar. A Survey of Options to Preserve Stakeholder Value

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

    Flores-Espino, Francisco

    2015-09-01

    Compensation mechanisms for electricity generation systems installed behind the meter are under scrutiny in several jurisdictions in the United States. Legislators in 29 states introduced bills to amend net metering provisions in 2014, and in 33 states in the 2015 legislative session as of August 20, 2015. Some utilities have also sought to increase the revenue they receive from net-metered customers through rate redesign. The circumstances that have triggered the recent push for change include a growing percentage of net-metered customers, potential effects of distributed generation on cost allocation, decreasing photovoltaic (PV) system costs, the challenges of integrating high levelsmore » of solar generation in the distribution network, and increasing pressure on utility business models. This report presents a survey of options to charge and compensate PV customers, as well as options that may preserve utility revenues in scenarios with increased DG. These options could be used as building blocks to create a distributed generation (DG) compensation policy that may preserve the value of the different stakeholders and balance their interests.« less

  8. The user experiences and clinical outcomes of an online personal health record to support self-management of bipolar disorder: A pretest-posttest pilot study.

    PubMed

    van den Heuvel, Silvio C G H; Meije, Daniëlle; Regeer, Eline J; Sinnema, Henny; Riemersma, Rixt F; Kupka, Ralph W

    2018-06-03

    Self-management comprises knowledge, behavior, activities and resources providing people with bipolar disorder (BD) control over fluctuating mood and activity-patterns. The 'Self-management and Dialogue in Bipolar Disorder' project entailed the tailoring of an online personal health record (PHR) originally designed for the chronically ill to monitor condition and share information with their clinician to people with BD (PHR-BD). The aim of this study was to evaluate the feasibility, utility and user-experiences of participants with BD, relatives, and healthcare professionals who worked with the PHR-BD. Post-test online closed- and open ended questionnaires were used to collect information on utility, and user-experiences with PHR-BD. A pre-posttest design to evaluate clinical effects on quality of life, empowerment, symptom reduction, changes in mood and activity, and illness burden and severity at baseline and at 12-months follow-up. Sixty-six participants with BD logged in at baseline. At study endpoint thirty-nine participants with BD, eleven professionals and one family caregiver filled out the evaluations. No significant differences in the clinical outcomes from baseline were found. Qualitative evaluations showed a frequent utility of the mood chart modules, improved communication between clinician and participant with BD and, increased insight in influencing factors of mood fluctuations. Small convenience sample, no controls. The option to alternate the interface from a prospective to a retrospective mood chart , and integration with the personal crisis plan was considered to be of added value in self-managing BD. The findings of this study will guide the future implementation of the PHR-BD. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. Health state utilities among contemporary prostate cancer patients on active surveillance.

    PubMed

    Loeb, Stacy; Curnyn, Caitlin; Walter, Dawn; Fagerlin, Angela; Siebert, Uwe; Mühlberger, Nick; Braithwaite, R Scott; Schwartz, Mark D; Lepor, Herbert; Sedlander, Erica

    2018-04-01

    Active surveillance (AS) is the most rapidly expanding management option for favorable-risk prostate cancer (PCa). Early studies suggested substantial decrements in utility (quality of life weights) from disease-related anxiety. Our objective was to determine utilities for contemporary AS patients using different instruments. We performed a systematic review of PubMed, PMC and OVID for utility measurements in modern AS patients. We then examined utilities among 37 men on AS participating in focus groups between 2015-2016 using the generic EurQol five dimensions questionnaire (EQ-5D-3L) and Patient Oriented Prostate Utility Scale (PORPUS), a PCa-specific instrument. The systematic review found previous studies with utilities for PCa treatment and historical watchful waiting populations, but none specifically in contemporary AS. In our AS population, the mean EQ-5D-3L score was 0.90±0.16 (median, 1.00; range, 0.21-1.00) and PORPUS was 0.98±0.03 (median, 0.99; range, 0.84-1.00). The Spearman correlation between the EQ-5D-3L and PORPUS was 0.87 (P<0.0001), and 38% of patients had a difference >0.1 between instruments. Most contemporary AS patients had high utility scores suggesting that they perceive themselves in good health without a major decrement in quality of life from the disease. However, some patients had substantial differences in utility measured with generic versus disease-specific instruments. Further study is warranted into the optimal instrument for utility assessment in contemporary AS patients.

  10. A feasibility study of municipal solid waste incineration fly ash utilisation in Estonia.

    PubMed

    Berber, Hakan; Frey, Ruedi; Voronova, Viktoria; Koroljova, Arina

    2017-09-01

    The purpose of this paper is to discuss the alternative environmental management options for the utilisation of municipal solid waste (MSW) incineration fly ash (FA), which is generated at Iru Power Plant where MSW is incinerated in Estonia. To determine sustainable and economically feasible environmental management options for MSW incineration FA in Estonia, CO 2 sequestration with a further carbonation process was examined. A partial Cost & Benefit Analysis has been conducted to compare the carbonation process to the current situation. Two carbonation options were developed. Option 1 is to use carbonated FA in any other processes based on the waste-to-product principle. Option 2 is to send carbonated FA to the non-hazardous landfill in Tallinn, Estonia. Important parameters, such as Net Present Value (NPV), Internal Rate of Return (IRR), Benefit-Cost Ratio (BCR) and Break Even Point (BEP), have been calculated for carbonation options and the current case. In addition, a sensitivity analysis has been conducted to examine its robustness. The results showed that the best option is carbonation Option 1 with NPV of 9,209,662 EUR, IRR of 43%, BCR of 2.63 and BEP between 2018 and 2019. Both Options 1 and 2 constitute more sustainable and environmentally friendly management options compared to the current situation. It can be concluded that this preliminary feasibility study showed that running a carbonation plant may be profitable and sustainable for Estonia. Currently, there is no treatment technology for MSW incineration FA in Estonia and FA is sent to a neighbouring country for further utilisation. This is the first study to demonstrate FA management options with economic and environmental benefits.

  11. When all seems lost: management of refractory constipation-Surgery, rectal irrigation, percutaneous endoscopic colostomy, and more.

    PubMed

    Wilkinson-Smith, V; Bharucha, A E; Emmanuel, A; Knowles, C; Yiannakou, Y; Corsetti, M

    2018-05-01

    While the pharmacological armamentarium for chronic constipation has expanded over the past few years, a substantial proportion of constipated patients do not respond to these medications. This review summarizes the pharmacological and behavioral options for managing constipation and details the management of refractory constipation. Refractory constipation is defined as an inadequate improvement in constipation symptoms evaluated with an objective scale despite adequate therapy (ie, pharmacological and/or behavioral) that is based on the underlying pathophysiology of constipation. Minimally invasive (ie, rectal irrigation and percutaneous endoscopic colostomy) and surgical therapies are used to manage refractory constipation. This review appraises these options, and in particular, percutaneous endoscopic colostomy, which as detailed by an article in this issue, is a less invasive option for managing refractory constipation than surgery. While these options benefit some patients, the evidence of the risk: benefit profile for these therapies is limited. © 2018 John Wiley & Sons Ltd.

  12. Cost-utility analysis of competing treatment strategies for drug-resistant epilepsy in children with Tuberous Sclerosis Complex.

    PubMed

    Fallah, Aria; Weil, Alexander G; Wang, Shelly; Lewis, Evan; Baca, Christine B; Mathern, Gary W

    2016-10-01

    The management of drug-resistant epilepsy in children with Tuberous Sclerosis Complex (TSC) is challenging because of the multitude of treatment options, wide range of associated costs, and uncertainty of seizure outcomes. The most cost-effective approach for children whose epilepsy has failed to improve with first-line medical therapy is uncertain. A review of MEDLINE from 1990 to 2015 was conducted. A cost-utility analysis, from a third-party payer perspective, was performed for children with drug-resistant epilepsy that had failed to improve with 2 antiseizure drugs (ASDs) and that was amenable to resective epilepsy surgery, across a time-horizon of 5years. Four strategies were included: (1) resective epilepsy surgery, (2) vagus nerve stimulator (VNS) implantation, (3) ketogenic diet, and (4) addition of a third ASD (specifically, carbamazepine). The incremental cost per quality-adjusted life year (QALY) gained was analyzed. Given a willingness-to-pay (WTP) of $100,000 per QALY, the addition of a third ASD ($6600 for a gain of 4.14 QALYs) was the most cost-effective treatment strategy. In a secondary analysis, if the child whose epilepsy had failed to improve with 3 ASDs, ketogenic diet, addition of a fourth ASD, and resective epilepsy surgery were incrementally cost-effective treatment strategies. Vagus nerve stimulator implantation was more expensive yet less effective than alternative strategies and should not be prioritized. The addition of a third ASD is a universally cost-effective treatment option in the management of children with drug-resistant epilepsy that has failed to improve with 2 ASDs. For children whose epilepsy has failed to improve with 3 ASDs, the most cost-effective treatment depends on the health-care resources available reflected by the WTP. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Preliminary Concept of Operations for the Spent Fuel Management System--WM2017

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

    Cumberland, Riley M; Adeniyi, Abiodun Idowu; Howard, Rob L

    The Nuclear Fuels Storage and Transportation Planning Project (NFST) within the U.S. Department of Energy s Office of Nuclear Energy is tasked with identifying, planning, and conducting activities to lay the groundwork for developing interim storage and transportation capabilities in support of an integrated waste management system. The system will provide interim storage for commercial spent nuclear fuel (SNF) from reactor sites and deliver it to a repository. The system will also include multiple subsystems, potentially including; one or more interim storage facilities (ISF); one or more repositories; facilities to package and/or repackage SNF; and transportation systems. The project teammore » is analyzing options for an integrated waste management system. To support analysis, the project team has developed a Concept of Operations document that describes both the potential integrated system and inter-dependencies between system components. The goal of this work is to aid systems analysts in the development of consistent models across the project, which involves multiple investigators. The Concept of Operations document will be updated periodically as new developments emerge. At a high level, SNF is expected to travel from reactors to a repository. SNF is first unloaded from reactors and placed in spent fuel pools for wet storage at utility sites. After the SNF has cooled enough to satisfy loading limits, it is placed in a container at reactor sites for storage and/or transportation. After transportation requirements are met, the SNF is transported to an ISF to store the SNF until a repository is developed or directly to a repository if available. While the high level operation of the system is straightforward, analysts must evaluate numerous alternative options. Alternative options include the number of ISFs (if any), ISF design, the stage at which SNF repackaging occurs (if any), repackaging technology, the types of containers used, repository design, component sizing, and timing of events. These alternative options arise due to technological, economic, or policy considerations. As new developments regularly emerge, the operational concepts will be periodically updated. This paper gives an overview of the different potential alternatives identified in the Concept of Operations document at a conceptual level.« less

  14. 41 CFR 101-39.004 - Optional operations.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.0-General Provisions § 101-39.004 Optional operations. Nothing in this part shall preclude the establishment or operation of interagency fleet management systems by GSA or by...

  15. 41 CFR 101-39.004 - Optional operations.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.0-General Provisions § 101-39.004 Optional operations. Nothing in this part shall preclude the establishment or operation of interagency fleet management systems by GSA or by...

  16. School Management Options for American Indians.

    ERIC Educational Resources Information Center

    Streiff, Paul R.

    In response to the Presidential/Secretarial Educational Objective of 1975 which called for a statement from American Indian communities relative to their educational management preferences, the Office of Indian Education Programs (OIEP) established a program for gathering and disseminating educational management options to Indian people. A seven…

  17. Acceptability and Feasibility of a Mobile Phone-Based Case Management Intervention to Retain Mothers and Infants from an Option B+ Program in Postpartum HIV Care.

    PubMed

    Schwartz, Sheree R; Clouse, Kate; Yende, Nompumelelo; Van Rie, Annelies; Bassett, Jean; Ratshefola, Mamothe; Pettifor, Audrey

    2015-09-01

    The objective of this study was to assess the acceptability and feasibility of a cell phone based case manager intervention targeting HIV-infected pregnant women on highly-active antiretroviral therapy (HAART). Pregnant women ≥36 weeks gestation attending antenatal care and receiving HAART through the Option B+ program at a primary care clinic in South Africa were enrolled into a prospective pilot intervention to receive text messages and telephone calls from a case manager through 6 weeks postpartum. Acceptability and feasibility of the intervention were assessed along with infant HIV testing rates and 10-week and 12-month postpartum maternal retention in care. Retention outcomes were compared to women of similar eligibility receiving care prior to the intervention. Fifty women were enrolled into the pilot from May to July 2013. Most (70%) were HAART-naive at time of conception and started HAART during antenatal care. During the intervention, the case manager sent 482 text messages and completed 202 telephone calls, for a median of 10 text messages and 4 calls/woman. Ninety-six percent completed the postpartum interview and 47/48 (98%) endorsed the utility of the intervention. Engagement in 10-week postpartum maternal HIV care was >90% in the pre-intervention (n = 50) and intervention (n = 50) periods; by 12-months retention fell to 72% and was the same across periods. More infants received HIV-testing by 10-weeks in the intervention period as compared to pre-intervention (90.0 vs. 63.3%, p < 0.01). Maternal support through a cell phone based case manager approach was highly acceptable among South African HIV infected women on HAART and feasible, warranting further assessment of effectiveness.

  18. Successful peripheral nerve field stimulation for thoracic radiculitis following Brown-Sequard syndrome.

    PubMed

    Desai, Mehul J; Desai, Mehul; Jacob, Lisa; Leiphart, James

    2011-01-01

      The objective of this study is to present a novel approach to the treatment of thoracic radiculitis following Brown-Sequard syndrome with peripheral nerve field stimulation (PNFS). Furthermore, we endeavor to discuss the role of PNFS in the management of refractory neuropathic pain conditions including post-traumatic and post-surgical neuropathy particularly with regards to the post-surgical spine.   Presented is a 57-year-old man with history of thoracic microdiscectomy resulting in Brown-Sequard syndrome presented with chronic post-operative thoracic radicular pain radiating to the abdomen, refractory to conservative management. The patient underwent three intercostal nerve blocks from T7 to T9 with transient symptomatic relief. The patient's options were limited to chemomodulation, neuromodulation, or selective intercostal nerve surgical neurectomy. He subsequently underwent a PNFS trial and reported >75% pain reduction. Permanent percutaneous PNFS electrodes were implanted subcutaneously over the right T7 and T9 intercostal nerves and replicated the trial results.   Neuromodulation produced pain relief with >90% improvement in pain compared with baseline both during the trial and following permanent implantation of the PNFS system.   Chronic radicular pain may be difficult to manage in the post-surgical patient and often requires the use of multiple therapeutic modalities. In this case, we successfully utilized PNFS as it demonstrated greater technical feasibility when compared with dorsal column stimulation and repeat surgery; therefore, it may be considered for the management of post-surgical neuropathy. Further controlled studies are needed to evaluate the efficacy of PNFS as a treatment option. © 2011 International Neuromodulation Society.

  19. The resurgence of selective contracting restrictions.

    PubMed

    Marsteller, J A; Bovbjerg, R R; Nichols, L M; Verrilli, D K

    1997-10-01

    As managed care has spread, so has legislation to force plans to contract with any willing provider (AWP) and give patients freedom of choice (FOC). Managed care organizations' selective networks and provider integration reduce patient access to providers, along with provider access to paying patients, so many providers have lobbied for AWP-FOC laws. In opposition are managed care organizations (MCOs), which want full freedom to contract selectively to control prices and utilization. This article comprehensively describes laws in all fifty-one jurisdictions, classifies their relative strength, and assesses the implications of the laws. Most are relatively weak forms and all are limited in application by ERISA and the federal HMO Act. The article also uses an associative multivariate analysis to relate the selective contracting environments to HMO penetration rates, rural population, physician density, and other variables. States with weak laws also have higher HMO penetration and higher physician density, but smaller rural populations. We conclude that the strongest laws overly restrict the management of care, to the likely detriment of cost control. But where market power is rapidly concentrating, not restricting selective contracting could diminish long-term competition and patient access to care. In the face of uncertainty about the impact of these laws, an intermediate approach may be better than all or nothing. States should consider mandating that plans offer point-of-service options, for a separate premium. This option expands patient choice of plans at the time of enrollment and of providers at the time of care, yet maintains plans' ability to control core providers.

  20. Wildlife habitats in managed rangelands—the Great Basin of southeastern Oregon: management practices and options.

    Treesearch

    Frederick C. Hall

    1985-01-01

    Management practices and options to provide habitat for wildlife in the Great Basin of southeastern Oregon deal with both vegetation treatment and protection, livestock management, maintenance or distribution of water developments, protection of wildlife areas through road closures or fencing, and direct manipulation of wildlife through hunting, trapping, or other...

  1. 5 CFR 870.705 - Amount and election of Option B and Option C.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Amount and election of Option B and Option C. 870.705 Section 870.705 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED... Compensationers § 870.705 Amount and election of Option B and Option C. (a) The number of multiples of Option B...

  2. Roadwaste : issues and options.

    DOT National Transportation Integrated Search

    1998-06-01

    The Oregon Department of Transportation (ODOT) is conducting a study to determine roadwaste management options. Phase 1 consisted of a thorough review of regulations and standards, roadwaste characterization, current management practices, and new tec...

  3. 41 CFR 101-26.302 - Standard and optional forms.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

  4. 41 CFR 101-26.302 - Standard and optional forms.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

  5. 41 CFR 101-26.302 - Standard and optional forms.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

  6. 41 CFR 101-26.302 - Standard and optional forms.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

  7. 41 CFR 101-26.302 - Standard and optional forms.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... forms. 101-26.302 Section 101-26.302 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.3-Procurement of GSA Stock Items § 101-26.302 Standard and optional forms. Agencies...

  8. 24 CFR 990.185 - Utilities expense level: Incentives for energy conservation/rate reduction.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) Utility benchmarking. HUD will pursue benchmarking utility consumption at the project level as part of the... convene a meeting with representation of appropriate stakeholders to review utility benchmarking options so that HUD may determine whether or how to implement utility benchmarking to be effective in FY 2011...

  9. 24 CFR 990.185 - Utilities expense level: Incentives for energy conservation/rate reduction.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...) Utility benchmarking. HUD will pursue benchmarking utility consumption at the project level as part of the... convene a meeting with representation of appropriate stakeholders to review utility benchmarking options so that HUD may determine whether or how to implement utility benchmarking to be effective in FY 2011...

  10. Development of a web-based application and multicountry analysis framework for assessing interdicted infections and cost-utility of screening donated blood for HIV, HCV and HBV.

    PubMed

    Custer, B; Janssen, M P; Hubben, G; Vermeulen, M; van Hulst, M

    2017-08-01

    Most countries test donations for HIV, HCV and HBV using serology with or without nucleic acid testing (NAT). Cost-utility analyses provide information on the relative value of different screening options. The aim of this project was to develop an open access risk assessment and cost-utility analysis web-tool for assessing HIV, HCV and HBV screening options (http://www.isbtweb.org/working-parties/transfusion-transmitted-infectious-diseases/). An analysis for six countries (Brazil, Ghana, the Netherlands, South Africa, Thailand and USA) was conducted. Four strategies; (1) antibody assays (Abs) for HIV and HCV + HBsAg, (2) antibody assays that include antigens for HIV and HCV (Combo) + HBsAg, (3) NAT in minipools of variable size (MP NAT) and (4) individual donation (ID) NAT can be evaluated using the tool. Country-specific data on donors, donation testing results, recipient outcomes and costs are entered using the online interface. Results obtained include the number infections interdicted using each screening options, and the (incremental and average) cost-utility of the options. In each of the six countries evaluated, the use of antibody assays is cost effective or even cost saving. NAT has varying cost-utility depending on the setting, and where adopted, the incremental cost-utility exceeds any previously defined or proposed threshold in each country. The web-tool allows an assessment of infectious units interdicted and value for money of different testing strategies. Regardless of gross national income (GNI) per capita, countries appear willing to dedicate healthcare resources to blood supply safety in excess of that for other sectors of health care. © 2017 International Society of Blood Transfusion.

  11. The Impact of 3-Option Responses to Multiple-Choice Questions on Guessing Strategies and Cut Score Determinations

    PubMed Central

    ROYAL, KENNETH D.; STOCKDALE, MYRAH R.

    2017-01-01

    Introduction: Research has asserted MCQ items using three response options (one correct answer with two distractors) is comparable to, and possibly preferable over, traditional MCQ item formats consisting of four response options (e.g., one correct answer with three distractors), or five response options (e.g., one correct answer with four distractors). Some medical educators have also adopted the practice of using 3-option responses on MCQ exams as a response to the difficulty experienced in generating additional plausible distractors. To date, however, little work has explored how 3-option responses might impact validity threats stemming from random guessing strategies, and what impact 3-option responses might have on cut-score determinations, particularly in the context of medical education classroom assessments. The purpose of this work is to further explore these critically important considerations that largely have gone ignored in the medical education literature to this point. Methods: A cumulative binomial distribution formula was used to calculate the probability that an examinee will answer at random a given number of items correctly on any exam (of any length). By way of a demonstration, a variety of scenarios were presented to illustrate how examination length and the number of response options impact examinees’ chances of passing a given examination, and how subsequent cut-score decisions may be impacted by these factors. Results: As a general rule, classroom assessments containing fewer items should utilize traditional 4-option or 5-option responses, whereas assessments of greater length are afforded greater flexibility in potentially utilizing 3-option responses. Conclusions: More research on items with 3-option responses is needed to better understand what value, if any, 3-option responses truly add to classroom assessments, and in what contexts potential benefits might be discernible. PMID:28367465

  12. The Impact of 3-Option Responses to Multiple-Choice Questions on Guessing Strategies and Cut Score Determinations.

    PubMed

    Royal, Kenneth D; Stockdale, Myrah R

    2017-04-01

    Research has asserted MCQ items using three response options (one correct answer with two distractors) is comparable to, and possibly preferable over, traditional MCQ item formats consisting of four response options (e.g., one correct answer with three distractors), or five response options (e.g., one correct answer with four distractors). Some medical educators have also adopted the practice of using 3-option responses on MCQ exams as a response to the difficulty experienced in generating additional plausible distractors. To date, however, little work has explored how 3-option responses might impact validity threats stemming from random guessing strategies, and what impact 3-option responses might have on cut-score determinations, particularly in the context of medical education classroom assessments. The purpose of this work is to further explore these critically important considerations that largely have gone ignored in the medical education literature to this point. A cumulative binomial distribution formula was used to calculate the probability that an examinee will answer at random a given number of items correctly on any exam (of any length). By way of a demonstration, a variety of scenarios were presented to illustrate how examination length and the number of response options impact examinees' chances of passing a given examination, and how subsequent cut-score decisions may be impacted by these factors. As a general rule, classroom assessments containing fewer items should utilize traditional 4-option or 5-option responses, whereas assessments of greater length are afforded greater flexibility in potentially utilizing 3-option responses. More research on items with 3-option responses is needed to better understand what value, if any, 3-option responses truly add to classroom assessments, and in what contexts potential benefits might be discernible.

  13. Autosomal dominant polycystic kidney disease and pain - a review of the disease from aetiology, evaluation, past surgical treatment options to current practice.

    PubMed

    Badani, K K; Hemal, A K; Menon, M

    2004-01-01

    Autosomal Dominant Polycystic Kidney Disease (ADPKD), often referred to as "adult" polycystic kidney disease, is one of the commonest hereditary disorders. It affects approximately 4 to 6 million individuals worldwide. The disease progresses to end-stage renal disease and it accounts for 10-15% of patients requiring dialysis in the United States. A comprehensive Medline search for aetiology, evaluation, screening, cellular biology, and treatment was utilized to locate, extract, and synthesize relevant data with respect to this topic. Special attention was focused on urologic literature and surgical textbooks regarding operative treatment of pain associated with ADPKD. Now, patients with ADPKD have more treatment options. More specifically, several therapeutic alternatives are now available for the management of pain in these patients. A recent review of literature supports the performance of open or laparoscopic cyst decortication procedures for control of pain and infection without the worry of causing further renal impairment in those with preserved renal function.

  14. Guide to purchasing electricity and gas

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

    Cunningham, P.R.; Burrell, D.

    1999-09-01

    An issue which now faces all energy users is understanding the specifics of the impact of the deregulation of the electric and natural gas industries. This book was written to help one understand the forces behind deregulation, and how one can use this knowledge now to negotiate lower utility rates, even if deregulation has not been fully implemented in one`s area. Readers will learn how coordinating new rate packages with the management of in-house loads can multiply savings. Essential ingredients to successful negotiation are clearly outlined, including assessing the alternatives for both load management and supply, understanding interruptible rate options,more » doing homework on ongoing deregulation activities, finding out who makes the decisions and working directly with them, and hands-on involvement in fine tuning the final contract. Case studies are also included.« less

  15. Cannabis: a controversial 21st-century drug of antiquity.

    PubMed

    Greydanus, D; Holt, M

    2014-05-01

    Cannabis consumption has been popular for thousands of years and its historical use is noted in many parts of the world including ancient China, India, the Middle East. It is currently the most popular illicit drug in the world, is being utilized as a medicinal plant, and many parts of the world are legalizing this drug. This discussion considers various aspects of cannabis use including its prevalence, history, co-morbid drug abuse, designer cannabinoids, psychiatric adverse effects, medical adverse effects, and management options. The youth of the world should be comprehensively taught that cannabis is neither a safe nor a benign drug. Prevention with comprehensive drug education is the best plan for our youth since management of a chronic or heavy cannabis consummer remains difficult and fraught with failure if cessation is the goal. Caveat emptor!

  16. Advances in the management of multiple sclerosis symptoms: pathophysiology and assessment of spasticity in multiple sclerosis.

    PubMed

    Tintoré, Mar

    2015-01-01

    Spasticity is a prevalent and troublesome symptom for people with multiple sclerosis (MS). Common instruments to measure MS spasticity include the clinician-rated (modified) Ashworth scale and the patient-rated 0-10 spasticity Numerical Rating Scale (NRS). Current opinion is that measurement of MS spasticity should incorporate the patient's perspective. Other instruments to assess spasticity-associated symptoms such as the Penn spasms frequency scale, sleep quality NRS and pain NRS can assist in tracking MS spasticity evolution and inform management choices. Worsening spasticity reduces patient autonomy, impacts negatively on quality of life and increases health resource utilization and costs. Despite the wide range of issues associated with MS spasticity, undertreatment is common and standard treatment options (physiotherapy and classical oral therapies) often fail to provide adequate symptomatic control.

  17. Current treatment for vitreous floaters.

    PubMed

    Sendrowski, David P; Bronstein, Mark A

    2010-03-01

    Vitreous floaters are a common complaint in the ophthalmic care setting. Patients seek explanation and advice regarding possible treatment options. Because the condition is considered benign, ophthalmic care practitioners have little to offer regarding treatment options. The majority of cases encountered are managed with patient education and reassurance. Although almost all patients accept the conservative management option, there is a small subset of patients who may desire a more aggressive treatment intervention for resolution of their visual symptoms. Information with regard to treatment options is readily available to patients through Internet searches and non-peer reviewed educational Web sites. The risks and benefits for these treatment options are not fully covered. Management of floaters should include education regarding "off-label" procedures as well as discussion about benefits and risks associated with such treatment options. It is vital that eye care practitioners advise and counsel patients with symptomatic floaters for optimum ocular health care. This article reviews the current conventional and "off-label" treatment options for symptomatic patients with vitreous floaters. Copyright (c) 2010 American Optometric Association. Published by Elsevier Inc. All rights reserved.

  18. Life cycle costing as a decision making tool for technology acquisition in radio-diagnosis

    PubMed Central

    Chakravarty, Abhijit; Debnath, Jyotindu

    2014-01-01

    Background Life cycle costing analysis is an emerging conceptual tool to validate capital investment in healthcare. Methods A preliminary study was done to analyze the long-term cost impact of acquiring a new 3 T MRI system when compared to technological upgradation of the existing 1.5 T MRI system with a view to evolve a decision matrix for correct investment planning and technology management. Operating costing method was utilized to estimate cost per unit MRI scan, costing inputs were considered for the existing 1.5 T and the proposed 3 T machine. Cost for each expected year in the life span of both 1.5 T and 3 T MRI scan options were then discounted to its Net Present Value. Net Present Value thus calculated for both the alternative options of 1.5 T and 3 T MRI machine was charted along with various intangible but critical Figures of Merit (FOM) to create a decision matrix for capital investment planning. Result Considering all fixed and variable costs contributing towards assumed operation, unit cost per MRI procedure was found to be Rs. 4244.58 for the 1.5 T upgrade and Rs. 6059.37 for the new 3 T MRI machine. Life Cycle Cost Analysis of the proposed 1.5 T upgrade and new 3 T machine showed a Net Present Value of Rs. 42,148,587.80 and Rs. 27,587,842.38 respectively. Conclusion The utility of life cycle costing as a strategic decision making tool towards evaluating alternative options for capital investment planning in health care environment is reiterated. PMID:25609862

  19. Personalized reminiscence therapy M-health application for patients living with dementia: Innovating using open source code repository.

    PubMed

    Zhang, Melvyn W B; Ho, Roger C M

    2017-01-01

    Dementia is known to be an illness which brings forth marked disability amongst the elderly individuals. At times, patients living with dementia do also experience non-cognitive symptoms, and these symptoms include that of hallucinations, delusional beliefs as well as emotional liability, sexualized behaviours and aggression. According to the National Institute of Clinical Excellence (NICE) guidelines, non-pharmacological techniques are typically the first-line option prior to the consideration of adjuvant pharmacological options. Reminiscence and music therapy are thus viable options. Lazar et al. [3] previously performed a systematic review with regards to the utilization of technology to delivery reminiscence based therapy to individuals who are living with dementia and has highlighted that technology does have benefits in the delivery of reminiscence therapy. However, to date, there has been a paucity of M-health innovations in this area. In addition, most of the current innovations are not personalized for each of the person living with Dementia. Prior research has highlighted the utility for open source repository in bioinformatics study. The authors hoped to explain how they managed to tap upon and make use of open source repository in the development of a personalized M-health reminiscence therapy innovation for patients living with dementia. The availability of open source code repository has changed the way healthcare professionals and developers develop smartphone applications today. Conventionally, a long iterative process is needed in the development of native application, mainly because of the need for native programming and coding, especially so if the application needs to have interactive features or features that could be personalized. Such repository enables the rapid and cost effective development of application. Moreover, developers are also able to further innovate, as less time is spend in the iterative process.

  20. Comparison of fermented animal feed and mushroom growth media as two value-added options for waste Cassava pulp management.

    PubMed

    Trakulvichean, Sivalee; Chaiprasert, Pawinee; Otmakhova, Julia; Songkasiri, Warinthorn

    2017-12-01

    Cassava is one of the main processed crops in Thailand, but this generates large amounts (7.3 million tons in 2015) of waste cassava pulp (WCP). The solid WCP is sold directly to farmers or pulp-drying companies at a low cost to reduce the burden of on-site waste storage. Using an integrated direct and environmental cost model, fermented animal feed and mushroom growth media were compared as added-value waste management alternatives for WCP to mitigate environmental problems. Primary and secondary data were collected from the literature, field data, and case studies. Data boundaries were restricted to a gate-to-gate scenario with a receiving capacity of 500 t WCP/d, and based on a new production unit being set up at the starch factory. The total production cost of each WCP utilization option was analyzed from the economic and environmental costs. Fermented animal feed was an economically attractive scenario, giving a higher net present value (NPV), lower investment cost and environmental impact, and a shorter payback period for the 10-year operational period. The selling price of mushrooms was the most sensitive parameter regarding the NPV, while the NPV for the price of fermented animal feed had the highest value in the best-case scenario.

  1. Clostridium difficile infection in the elderly: an update on management.

    PubMed

    Asempa, Tomefa E; Nicolau, David P

    2017-01-01

    The burden of Clostridium difficile infection (CDI) is profound and growing. CDI now represents a common cause of health care-associated diarrhea, and is associated with significant morbidity, mortality, and health care costs. CDI disproportionally affects the elderly, possibly explained by the following risk factors: age-related impairment of the immune system, increasing antibiotic utilization, and frequent health care exposure. In the USA, recent epidemiological studies estimate that two out of every three health care-associated CDIs occur in patients 65 years or older. Additionally, the elderly are at higher risk for recurrent CDI. Existing therapeutic options include metronidazole, oral vancomycin, and fidaxomicin. Choice of agent depends on disease severity, history of recurrence, and, increasingly, the drug cost. Bezlotoxumab, a recently approved monoclonal antibody targeting C. difficile toxin B, offers an exciting advancement into immunologic therapies. Similarly, fecal microbiota transplantation is gaining popularity as an effective option mainly for recurrent CDI. The challenge of decreasing CDI burden in the elderly involves adopting preventative strategies, optimizing initial treatment, and decreasing the risk of recurrence. Expanded strategies are certainly needed to improve outcomes in this high-risk population. This review considers available data from prospective and retrospective studies as well as case reports to illustrate the merits and gaps in care related to the management of CDI in the elderly.

  2. Clostridium difficile infection in the elderly: an update on management

    PubMed Central

    Asempa, Tomefa E; Nicolau, David P

    2017-01-01

    The burden of Clostridium difficile infection (CDI) is profound and growing. CDI now represents a common cause of health care–associated diarrhea, and is associated with significant morbidity, mortality, and health care costs. CDI disproportionally affects the elderly, possibly explained by the following risk factors: age-related impairment of the immune system, increasing antibiotic utilization, and frequent health care exposure. In the USA, recent epidemiological studies estimate that two out of every three health care–associated CDIs occur in patients 65 years or older. Additionally, the elderly are at higher risk for recurrent CDI. Existing therapeutic options include metronidazole, oral vancomycin, and fidaxomicin. Choice of agent depends on disease severity, history of recurrence, and, increasingly, the drug cost. Bezlotoxumab, a recently approved monoclonal antibody targeting C. difficile toxin B, offers an exciting advancement into immunologic therapies. Similarly, fecal microbiota transplantation is gaining popularity as an effective option mainly for recurrent CDI. The challenge of decreasing CDI burden in the elderly involves adopting preventative strategies, optimizing initial treatment, and decreasing the risk of recurrence. Expanded strategies are certainly needed to improve outcomes in this high-risk population. This review considers available data from prospective and retrospective studies as well as case reports to illustrate the merits and gaps in care related to the management of CDI in the elderly. PMID:29123385

  3. Risk-dependent reward value signal in human prefrontal cortex

    PubMed Central

    Tobler, Philippe N.; Christopoulos, George I.; O'Doherty, John P.; Dolan, Raymond J.; Schultz, Wolfram

    2009-01-01

    When making choices under uncertainty, people usually consider both the expected value and risk of each option, and choose the one with the higher utility. Expected value increases the expected utility of an option for all individuals. Risk increases the utility of an option for risk-seeking individuals, but decreases it for risk averse individuals. In 2 separate experiments, one involving imperative (no-choice), the other choice situations, we investigated how predicted risk and expected value aggregate into a common reward signal in the human brain. Blood oxygen level dependent responses in lateral regions of the prefrontal cortex increased monotonically with increasing reward value in the absence of risk in both experiments. Risk enhanced these responses in risk-seeking participants, but reduced them in risk-averse participants. The aggregate value and risk responses in lateral prefrontal cortex contrasted with pure value signals independent of risk in the striatum. These results demonstrate an aggregate risk and value signal in the prefrontal cortex that would be compatible with basic assumptions underlying the mean-variance approach to utility. PMID:19369207

  4. TECHNOLOGICAL OPTIONS FOR ACID RAIN CONTROL

    EPA Science Inventory

    Discussed are acid rain control options available to the electric utility industry. They include coal switching, flue gas desulfurization, and such emerging lower cost technologies as Limestone Injection Multistage Burners (LIMB) and Advanced Silicate (ADVACATE), both developed ...

  5. Management for adaptation

    Treesearch

    John Innes; Linda A. Joyce; Seppo Kellomaki; Bastiaan Louman; Aynslie Ogden; Ian Thompson; Matthew Ayres; Chin Ong; Heru Santoso; Brent Sohngen; Anita Wreford

    2009-01-01

    This chapter develops a framework to explore examples of adaptation options that could be used to ensure that the ecosystem services provided by forests are maintained under future climates. The services are divided into broad areas within which managers can identify specific management goals for individual forests or landscapes. Adaptation options exist for the major...

  6. 78 FR 17952 - Self-Regulatory Organizations; NASDAQ OMX BX, Inc.; Notice of Filing and Immediate Effectiveness...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... believes that, because SPX, SPXPM, and SPY options are ultimately derivative of the same benchmark--the S&P..., investors utilize SPX, SPXPM, and SPY options and their respective underlying instruments and futures to... Exchange proposes to eliminate position limits for options on the SPDR[supreg] S&P 500[supreg] exchange...

  7. 78 FR 17962 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-25

    ... believes that, because SPX, SPXPM, and SPY options are ultimately derivative of the same benchmark--the S&P..., investors utilize SPX, SPXPM, and SPY options and their respective underlying instruments and futures to... of the Proposed Rule Change NASDAQ proposes to eliminate position limits for options on the SPDR...

  8. Bt: One Option for Gypsy Moth Management

    Treesearch

    Deborah C. Mccullough; Leah S. Bauer

    2000-01-01

    Though the gypsy moth will never go away, you have a variety of options to help manage this pest during outbreaks. One option involves the use of Bt to protect tree foliage and reduce the annoyance caused by gypsy moth caterpillars during an outbreak. Bt or Btk refers to a microorganism called Bacillus Thuringeniesis var. kurstaki. Bt has been widely adopted for...

  9. Template for assessing climate change impacts and management options: TACCIMO user guide version 2.2

    Treesearch

    Emrys Treasure; Steven McNulty; Jennifer Moore Myers; Lisa Nicole Jennings

    2014-01-01

    The Template for Assessing Climate Change Impacts and Management Options (TACCIMO) is a Web-based tool developed by the Forest Service, U.S. Department of Agriculture to assist Federal, State, and private land managers and planners with evaluation of climate change science implications for sustainable natural resource management. TACCIMO is a dynamic information...

  10. A Review and Update of Treatment Options and Controversies in the Management of Hepatocellular Carcinoma.

    PubMed

    Dhir, Mashaal; Melin, Alyson A; Douaiher, Jeffrey; Lin, Chi; Zhen, Weining Ken; Hussain, Shahid M; Geschwind, Jean-Francois H; Doyle, Maria B Majella; Abou-Alfa, Ghassan K; Are, Chandrakanth

    2016-06-01

    To review the current management, outline recent advances and address controversies in the management of hepatocellular carcinoma (HCC). The treatment of HCC is multidisciplinary involving hepatologists, surgeons, medical oncologists, radiation oncologists, radiologists, interventional radiologists, and other disciplines. Each of these disciplines brings its unique perspective and differing opinions that add to controversies in the management of HCC. A focused literature review was performed to identify recent studies on the management of HCC and thereby summarize relevant information on the various therapeutic modalities and controversies involved in the treatment of HCC. The main treatment algorithms continue to rely on hepatic resection or transplantation with controversies involving patients harboring early stage disease and borderline hepatic function. The other treatment strategies include locoregional therapies, radiation, and systemic therapy used alone or in combination with other treatment modalities. Recent advances in locoregional therapies, radiation, and systemic therapies have provided better therapeutic options with curative intent potential for some locoregional therapies. Further refinements in combination therapies such as algorithms consisting of locoregional therapies and systemic or radiation therapies are likely to add additional options and improve survival. The management of HCC has witnessed significant strides with advances in existing options and introduction of several new treatment modalities of various combinations. Further refinements in these treatment options combined with enrollment in clinical trials are essential to improve the management and outcomes of patients with HCC.

  11. Commonwealth of the Northern Mariana Islands Energy Action Plan

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

    Conrad, M. D.; Ness, J. E.

    2013-07-01

    This document describes the three near-term energy strategies selected by the CNMI Energy Task Force during action planning workshops conducted in March 2013, and outlines the steps being taken to implement those strategies. The three energy strategies selected by the task force are (1) designing a demand-side management program focusing on utility, residential and commercial sectors, (2) developing an outreach and education plan focused on energy conservation in government agencies and businesses, including workplace rules, and (3) exploring waste-to-energy options. The task force also discussed several other medium- and long-term energy strategies that could be explored at a future date.

  12. Dioxin uptake by Indian plant species.

    PubMed

    Pandey, J S; Kumar, R; Wate, S R

    2008-08-01

    Dioxins like various gaseous pollutants and aerosols can be scavenged by appropriate vegetative greenbelts. Based on their stomatal properties and the models for contaminant uptake, uptake of dioxin (2,3,7,8-TCDD) by three important Indian plant species, viz. Eugenia jambolana (Jamun), Azadirachta indica (Neem) and Ficus religiosa (Peepal), has been estimated. 2,3,7,8-TCDD is a contaminant with severe harmful ecological ramifications. Computations show that Ficus religiosa has highest uptake capacity. The present exercise has its utility in designing appropriate green-belts for mitigating adverse environmental and human health impacts due to dioxins. This can be an effective management option for mitigating the damages caused by dioxins.

  13. Improving the Quality of Backup Process for Publishing Houses and Printing Houses

    NASA Astrophysics Data System (ADS)

    Proskuriakov, N. E.; Yakovlev, B. S.; Pries, V. V.

    2018-04-01

    The analysis of main types for data threats, used by print media, and their influence on the vitality and security of information is made. The influence of the programs settings for preparing archive files, the types of file managers on the backup process is analysed. We proposed a simple and economical version of the practical implementation of the backup process consisting of 4 components: the command line interpreter, the 7z archiver, the Robocopy utility, and network storage. We recommend that the best option would be to create backup copies, consisting of three local copies of data and two network copies.

  14. Integrated cost-effectiveness analysis of agri-environmental measures for water quality.

    PubMed

    Balana, Bedru B; Jackson-Blake, Leah; Martin-Ortega, Julia; Dunn, Sarah

    2015-09-15

    This paper presents an application of integrated methodological approach for identifying cost-effective combinations of agri-environmental measures to achieve water quality targets. The methodological approach involves linking hydro-chemical modelling with economic costs of mitigation measures. The utility of the approach was explored for the River Dee catchment in North East Scotland, examining the cost-effectiveness of mitigation measures for nitrogen (N) and phosphorus (P) pollutants. In-stream nitrate concentration was modelled using the STREAM-N and phosphorus using INCA-P model. Both models were first run for baseline conditions and then their effectiveness for changes in land management was simulated. Costs were based on farm income foregone, capital and operational expenditures. The costs and effects data were integrated using 'Risk Solver Platform' optimization in excel to produce the most cost-effective combination of measures by which target nutrient reductions could be attained at a minimum economic cost. The analysis identified different combination of measures as most cost-effective for the two pollutants. An important aspect of this paper is integration of model-based effectiveness estimates with economic cost of measures for cost-effectiveness analysis of land and water management options. The methodological approach developed is not limited to the two pollutants and the selected agri-environmental measures considered in the paper; the approach can be adapted to the cost-effectiveness analysis of any catchment-scale environmental management options. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Benchmarking of Decision-Support Tools Used for Tiered Sustainable Remediation Appraisal.

    PubMed

    Smith, Jonathan W N; Kerrison, Gavin

    2013-01-01

    Sustainable remediation comprises soil and groundwater risk-management actions that are selected, designed, and operated to maximize net environmental, social, and economic benefit (while assuring protection of human health and safety). This paper describes a benchmarking exercise to comparatively assess potential differences in environmental management decision making resulting from application of different sustainability appraisal tools ranging from simple (qualitative) to more quantitative (multi-criteria and fully monetized cost-benefit analysis), as outlined in the SuRF-UK framework. The appraisal tools were used to rank remedial options for risk management of a subsurface petroleum release that occurred at a petrol filling station in central England. The remediation options were benchmarked using a consistent set of soil and groundwater data for each tier of sustainability appraisal. The ranking of remedial options was very similar in all three tiers, and an environmental management decision to select the most sustainable options at tier 1 would have been the same decision at tiers 2 and 3. The exercise showed that, for relatively simple remediation projects, a simple sustainability appraisal led to the same remediation option selection as more complex appraisal, and can be used to reliably inform environmental management decisions on other relatively simple land contamination projects.

  16. Validation Test Report For The CRWMS Analysis and Logistics Visually Interactive Model Calvin Version 3.0, 10074-Vtr-3.0-00

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

    S. Gillespie

    2000-07-27

    This report describes the tests performed to validate the CRWMS ''Analysis and Logistics Visually Interactive'' Model (CALVIN) Version 3.0 (V3.0) computer code (STN: 10074-3.0-00). To validate the code, a series of test cases was developed in the CALVIN V3.0 Validation Test Plan (CRWMS M&O 1999a) that exercises the principal calculation models and options of CALVIN V3.0. Twenty-five test cases were developed: 18 logistics test cases and 7 cost test cases. These cases test the features of CALVIN in a sequential manner, so that the validation of each test case is used to demonstrate the accuracy of the input to subsequentmore » calculations. Where necessary, the test cases utilize reduced-size data tables to make the hand calculations used to verify the results more tractable, while still adequately testing the code's capabilities. Acceptance criteria, were established for the logistics and cost test cases in the Validation Test Plan (CRWMS M&O 1999a). The Logistics test cases were developed to test the following CALVIN calculation models: Spent nuclear fuel (SNF) and reactivity calculations; Options for altering reactor life; Adjustment of commercial SNF (CSNF) acceptance rates for fiscal year calculations and mid-year acceptance start; Fuel selection, transportation cask loading, and shipping to the Monitored Geologic Repository (MGR); Transportation cask shipping to and storage at an Interim Storage Facility (ISF); Reactor pool allocation options; and Disposal options at the MGR. Two types of cost test cases were developed: cases to validate the detailed transportation costs, and cases to validate the costs associated with the Civilian Radioactive Waste Management System (CRWMS) Management and Operating Contractor (M&O) and Regional Servicing Contractors (RSCs). For each test case, values calculated using Microsoft Excel 97 worksheets were compared to CALVIN V3.0 scenarios with the same input data and assumptions. All of the test case results compare with the CALVIN V3.0 results within the bounds of the acceptance criteria. Therefore, it is concluded that the CALVIN V3.0 calculation models and options tested in this report are validated.« less

  17. Emergy Analysis for the Sustainable Utilization of Biosolids ...

    EPA Pesticide Factsheets

    This contribution describes the application of an emergy-based methodology for comparing two management alternatives of biosolids produced in a wastewater treatment plant. The current management practice of using biosolids as soil fertilizers was evaluated and compared to another alternative, the recovery of energy from the biosolid gasification process. This emergy assessment and comparison approach identifies more sustainable processes which achieve economic and social benefits with a minimal environmental impact. In addition, emergy-based sustainability indicators and the GREENSCOPE methodology were used to compare the two biosolid management alternatives. According to the sustainability assessment results, the energy production from biosolid gasification is energetically profitable, economically viable, and environmentally suitable. Furthermore, it was found that the current use of biosolids as soil fertilizer does not generate any considerable environmental stress, has the potential to achieve more economic benefits, and a post-processing of biosolids prior to its use as soil fertilizer improves its sustainability performance. In conclusion, this emergy analysis provides a sustainability assessment of both alternatives of biosolid management and helps decision-makers to identify opportunities for improvement during the current process of biosolid management. This work aims to identify the best option for the use and management of biosolids generated in a wa

  18. Systematic Review of the Use of Phytochemicals for Management of Pain in Cancer Therapy.

    PubMed

    Harrison, Andrew M; Heritier, Fabrice; Childs, Bennett G; Bostwick, J Michael; Dziadzko, Mikhail A

    2015-01-01

    Pain in cancer therapy is a common condition and there is a need for new options in therapeutic management. While phytochemicals have been proposed as one pain management solution, knowledge of their utility is limited. The objective of this study was to perform a systematic review of the biomedical literature for the use of phytochemicals for management of cancer therapy pain in human subjects. Of an initial database search of 1,603 abstracts, 32 full-text articles were eligible for further assessment. Only 7 of these articles met all inclusion criteria for this systematic review. The average relative risk of phytochemical versus control was 1.03 [95% CI 0.59 to 2.06]. In other words (although not statistically significant), patients treated with phytochemicals were slightly more likely than patients treated with control to obtain successful management of pain in cancer therapy. We identified a lack of quality research literature on this subject and thus were unable to demonstrate a clear therapeutic benefit for either general or specific use of phytochemicals in the management of cancer pain. This lack of data is especially apparent for psychotropic phytochemicals, such as the Cannabis plant (marijuana). Additional implications of our findings are also explored.

  19. PROFILE user's guide

    NASA Technical Reports Server (NTRS)

    Collins, L.; Saunders, D.

    1986-01-01

    User information for program PROFILE, an aerodynamics design utility for refining, plotting, and tabulating airfoil profiles is provided. The theory and implementation details for two of the more complex options are also presented. These are the REFINE option, for smoothing curvature in selected regions while retaining or seeking some specified thickness ratio, and the OPTIMIZE option, which seeks a specified curvature distribution. REFINE uses linear techniques to manipulate ordinates via the central difference approximation to second derivatives, while OPTIMIZE works directly with curvature using nonlinear least squares techniques. Use of programs QPLOT and BPLOT is also described, since all of the plots provided by PROFILE (airfoil coordinates, curvature distributions) are achieved via the general purpose QPLOT utility. BPLOT illustrates (again, via QPLOT) the shape functions used by two of PROFILE's options. The programs were designed and implemented for the Applied Aerodynamics Branch at NASA Ames Research Center, Moffett Field, California, and written in FORTRAN and run on a VAX-11/780 under VMS.

  20. Learning from the implementation of residential optional time of use pricing in the United States electricity industry

    NASA Astrophysics Data System (ADS)

    Li, Xibao

    Residential time-of-use (TOU) rates have been in practice in the U.S. since the 1970s. However, for institutional, political, and regulatory reasons, only a very small proportion of residential customers are actually on these schedules. In this thesis, I explore why this is the case by empirically investigating two groups of questions: (1) On the "supply" side: Do utilities choose to offer TOU rates in residential sectors on their own initiative if state commissions do not order them to do so? Since utilities have other options, what is the relationship between the TOU rate and other alternatives? To answer these questions, I survey residential tariffs offered by more than 100 major investor-owned utilities, study the impact of various factors on utilities' rate-making behavior, and examine utility revealed preferences among four rate options: seasonal rates, inverted block rates, demand charges, and TOU rates. Estimated results suggest that the scale of residential sectors and the revenue contribution from residential sectors are the only two significant factors that influence utility decisions on offering TOU rates. Technical and economic considerations are not significant statistically. This implies that the little acceptance of TOU rates is partly attributed to utilities' inadequate attention to TOU rate design. (2) On the "demand" side: For utilities offering TOU tariffs, why do only a very small proportion of residential customers choose these tariffs? What factors influence customer choices? Unlike previous studies that used individual-level experimental data, this research employs actual aggregated information from 29 utilities offering optional TOU rates. By incorporating neo-classical demand analysis into an aggregated random coefficient logit model, I investigate the impact of both price and non-price tariff characteristics and non-tariff factors on customer choice behavior. The analysis indicates that customer pure tariff preference (which captures the effect of all unincluded factors) is a crucial obstacle to the public acceptance of TOU tariffs. Besides rate levels, non-price tariff characteristics and non-tariff factors are also important in influencing customer choice. It is observed that high income home owners have very different preferences than others.

  1. 17 CFR 210.12-12B - Open option contracts written.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Open option contracts written... § 210.12-12B Open option contracts written. [For management investment companies only] Col. A Col. B Col... Information as to put options shall be shown separately from information as to call options. 2 Options of an...

  2. Editorial Commentary: In a World of Endless Options, Is There a Single Solution? Management Options for Failed Anterior Instability Surgery in Athletes.

    PubMed

    Matzkin, Elizabeth

    2018-05-01

    There are many options to manage anterior instability of the shoulder. The management of athletes who have failed previous operative stabilization can make choosing a treatment solution difficult. A modified Latarjet without capsulolabral repair has been demonstrated to be a good choice when treating failed stabilization in a high-risk population with sufficient return to play and outcomes. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. The cost-effectiveness of sacral nerve stimulation (SNS) for the treatment of idiopathic medically refractory overactive bladder (wet) in the UK.

    PubMed

    Autiero, Silke Walleser; Hallas, Natalie; Betts, Christopher D; Ockrim, Jeremy L

    2015-12-01

    To estimate the long-term cost-effectiveness of specialised treatment options for medically refractory idiopathic overactive bladder (OAB) wet. The cost-effectiveness of competing treatment options for patients with medically refractory idiopathic OAB wet was estimated from the perspective of the National Health Service in the UK. We compared sacral nerve stimulation (SNS) with percutaneous nerve evaluation (PNE) or tined-lead evaluation (TLE) with optimal medical therapy (OMT), botulinum toxin type A (BoNT-A) injections, and percutaneous tibial nerve stimulation (PTNS). We used a Markov model with a 10-year time horizon for all treatment options with the exception of PTNS, which has a time horizon of 5 years. Costs and effects (measured as quality-adjusted life years) were calculated to derive incremental cost-effectiveness ratios (ICERs). Direct medical resources included are: device and drug acquisition costs, pre-procedure and procedure costs, and the cost of managing adverse events. Deterministic sensitivity analyses were performed to test robustness of results. At 5 years, SNS (PNE or TLE) was more effective and less costly than PTNS. Compared with OMT at 10 years, SNS (PNE or TLE) was more costly and more effective, and compared with BoNT-A, SNS PNE was less costly and more effective, and SNS TLE was more costly and more effective. Decreasing the BoNT-A dose from 150 to 100 IU marginally increased the 10 year ICERs for SNS TLE and PNE (SNS PNE was no longer dominant). However, both SNS options remained cost-effective. In the management of patients with idiopathic OAB wet, the results of this cost-utility analysis favours SNS (PNE or TLE) over PTNS or OMT, and the most efficient treatment strategy is SNS PNE over BoNT-A over a 10-year period. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

  4. In the aftermath of PURPA: The future of the biomass energy industry in Maine

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

    Adams, S.J.; Connors, J.F.

    During the 1980`s the biomass power industry in Maine grew to nearly 500 MW of installed capacity in 21 cogeneration and stand alone plants. By 1992 these plants consumed four million tons of woody fuels annually, while providing 25% of the states` electricity supply. Moreover, this new industry supported over 2500 jobs throughout rural Maine, generated substantial local property taxes and provided a critically need management option for forest management and mill waste disposal. All of this capacity was developed by non-utility generators as Qualifying Facilities (QF) under PURPA rules. Most power contracts were fixed price, must take agreements guidedmore » by avoided cost calculations that assumed high future costs for energy alternatives. Circumstances have changed. Historically low oil prices, economic recession, and rising electricity rates have made biomass fueled power plants some of the most expensive sources of electricity on the power grid. Utilities are responding to rising rates, to public and political pressure to control costs and lower rates by seeking to renegotiate or buy out power contracts and closing biomass plants. While there are strong demands to control electricity costs, there are equally strong concerns about losing the benefits that accrue from the use of indigenous renewable resources. This article evaluates the actions of Maine utilities, independent power producers, the Maine Public Utilities Commission, and the Main Legislature related to PURPA contracts and their likely effects on the future of the biomass power industry in Maine. In particular, we will describe Maine`s new Electric Rate Stabilization Program and subsequent efforts of the Executive Branch to mediate a compromise solution in one case of a utility buy out of a biomass power plant.« less

  5. Cognitive influences on risk-seeking by rhesus macaques

    PubMed Central

    Hayden, Benjamin Y.; Heilbronner, Sarah R.; Nair, Amrita C.; Platt, Michael L.

    2009-01-01

    Humans and other animals are idiosyncratically sensitive to risk, either preferring or avoiding options having the same value but differing in uncertainty. Many explanations for risk sensitivity rely on the non-linear shape of a hypothesized utility curve. Because such models do not place any importance on uncertainty per se, utility curve-based accounts predict indifference between risky and riskless options that offer the same distribution of rewards. Here we show that monkeys strongly prefer uncertain gambles to alternating rewards with the same payoffs, demonstrating that uncertainty itself contributes to the appeal of risky options. Based on prior observations, we hypothesized that the appeal of the risky option is enhanced by the salience of the potential jackpot. To test this, we subtly manipulated payoffs in a second gambling task. We found that monkeys are more sensitive to small changes in the size of the large reward than to equivalent changes in the size of the small reward, indicating that they attend preferentially to the jackpots. Together, these results challenge utility curve-based accounts of risk sensitivity, and suggest that psychological factors, such as outcome salience and uncertainty itself, contribute to risky decision-making. PMID:19844596

  6. 75 FR 20649 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Order Granting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-20

    ..., stock index futures contracts, options on futures, options on securities and indexes, equity caps... holding and/ or managing portfolios or baskets of securities, commodity futures contracts, options on commodity futures contracts, swaps, forward contracts and/or options on physical commodities and/or non-U.S...

  7. Sleep disorders and chronic craniofacial pain: Characteristics and management possibilities.

    PubMed

    Almoznino, Galit; Benoliel, Rafael; Sharav, Yair; Haviv, Yaron

    2017-06-01

    Chronic craniofacial pain involves the head, face and oral cavity and is associated with significant morbidity and high levels of health care utilization. A bidirectional relationship is suggested in the literature for poor sleep and pain, and craniofacial pain and sleep are reciprocally related. We review this relationship and discuss management options. Part I reviews the relationship between pain and sleep disorders in the context of four diagnostic categories of chronic craniofacial pain: 1) primary headaches: migraines, tension-type headache (TTH), trigeminal autonomic cephalalgias (TACs) and hypnic headache, 2) secondary headaches: sleep apnea headache, 3) temporomandibular joint disorders (TMD) and 4) painful cranial neuropathies: trigeminal neuralgia, post-herpetic trigeminal neuropathy, painful post-traumatic trigeminal neuropathy (PTTN) and burning mouth syndrome (BMS). Part II discusses the management of patients with chronic craniofacial pain and sleep disorders addressing the factors that modulate the pain experience as well as sleep disorders and including both non-pharmacological and pharmacological modalities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. When is irritable bowel syndrome not irritable bowel syndrome? Diagnosis and treatment of chronic functional abdominal pain.

    PubMed

    Grover, Madhusudan

    2012-08-01

    Functional abdominal pain syndrome (FAPS) is a distinct chronic gastrointestinal (GI) pain disorder characterized by the presence of constant or frequently recurring abdominal pain that is not associated with eating, change in bowel habits, or menstrual periods. The pain experience in FAPS is predominantly centrally driven as compared to other chronic painful GI conditions such as inflammatory bowel disease and chronic pancreatitis where peripherally acting factors play a major role in driving the pain. Psychosocial factors are often integrally associated with the disorder and can pose significant challenges to evaluation and treatment. Patients suffer from considerable loss of function, which can drive health care utilization. Treatment options are limited at best with most therapeutic regimens extrapolated from pain management of other functional GI disorders and chronic pain conditions. A comprehensive approach to management using a biopsychosocial construct and collaboration with pain specialists and psychiatry is most beneficial to the management of this disorder.

  9. Management Options for Control of a Stunt and Needle Nematode in Southern Forest Nurseries

    Treesearch

    Michelle M. Cram; Stephen W. Fraedrich

    2005-01-01

    Crop rotation and fallow are management options that can be used to control plant parasitic nematodes in forest tree nurseries. Before these options can be put into practice, it is important to determine the host range and survivability under fallow of the parasitic nematode to be controlled. The results of host range tests on a needle nematode (Longidorus...

  10. Current treatment options for the management of esophageal cancer

    PubMed Central

    Mawhinney, Mark R; Glasgow, Robert E

    2012-01-01

    In recent years, esophageal cancer characteristics and management options have evolved significantly. There has been a sharp increase in the frequency of esophageal adenocarcinoma and a decline in the frequency of squamous cell carcinoma. A more comprehensive understanding of prognostic factors influencing outcome has also been developed. This has led to more management options for esophageal cancer at all stages than ever before. A multidisciplinary, team approach to management in a high volume center is the preferred approach. Each patient should be individually assessed based on type of cancer, local or regional involvement, and his or her own functional status to determine an appropriate treatment regimen. This review will discuss management of esophageal cancer relative to disease progression and patient functional status. PMID:23152702

  11. RESTORATION PLUS: A COLLABORATIVE RESEARCH PROGRAM TO DEVELOP AND EVALUATE ECOSYSTEM RESTORATION AND MANAGEMENT OPTIONS TO ACHIEVE ECOLOGICALLY AND ECONOMICALLY SUSTAINABLE SOLUTIONS

    EPA Science Inventory

    EPA is evaluating ecosystem restoration and management techniques to ensure they create sustainable solutions for degraded watersheds. ORD NRMRL initiated the Restoration Plus (RePlus) program in 2002 to a) evaluate ecosystem restoration and management options, b) assess the non-...

  12. Options for change in the NHS consultant contract.

    PubMed

    Clarke, R W; Gray, C

    The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers.

  13. Options for change in the NHS consultant contract.

    PubMed Central

    Clarke, R. W.; Gray, C.

    1994-01-01

    The lead negotiators for the management and consultant sides in an NHS trust in northern England responded to debate in their trust about consultant contracts by offering to research the attitudes of their peers towards a variety of contract options. The options tested included the current contract; models already examined in the trust and elsewhere, such as time sensitive and mild performance related contracts; and some more radical and speculative possibilities, including consultants franchising their services to the trust. Beyond the predictable conclusion that consultants would prefer no change while managers desired it, a time sensitive contract emerged as having potential for successful negotiation. On the other hand, neither consultants nor managers favoured a strict performance related contract or a fee for service contract. There was a strong similarity of opinion between the two groups on the relative salary values of the options, though the consultants consistently priced these higher than the managers. PMID:8086915

  14. Deployable System for Crash-Load Attenuation

    NASA Technical Reports Server (NTRS)

    Kellas, Sotiris; Jackson, Karen E.

    2007-01-01

    An externally deployable honeycomb structure is investigated with respect to crash energy management for light aircraft. The new concept utilizes an expandable honeycomb-like structure to absorb impact energy by crushing. Distinguished by flexible hinges between cell wall junctions that enable effortless deployment, the new energy absorber offers most of the desirable features of an external airbag system without the limitations of poor shear stability, system complexity, and timing sensitivity. Like conventional honeycomb, once expanded, the energy absorber is transformed into a crush efficient and stable cellular structure. Other advantages, afforded by the flexible hinge feature, include a variety of deployment options such as linear, radial, and/or hybrid deployment methods. Radial deployment is utilized when omnidirectional cushioning is required. Linear deployment offers better efficiency, which is preferred when the impact orientation is known in advance. Several energy absorbers utilizing different deployment modes could also be combined to optimize overall performance and/or improve system reliability as outlined in the paper. Results from a series of component and full scale demonstration tests are presented as well as typical deployment techniques and mechanisms. LS-DYNA analytical simulations of selected tests are also presented.

  15. Design and analysis of advanced flight planning concepts

    NASA Technical Reports Server (NTRS)

    Sorensen, John A.

    1987-01-01

    The objectives of this continuing effort are to develop and evaluate new algorithms and advanced concepts for flight management and flight planning. This includes the minimization of fuel or direct operating costs, the integration of the airborne flight management and ground-based flight planning processes, and the enhancement of future traffic management systems design. Flight management (FMS) concepts are for on-board profile computation and steering of transport aircraft in the vertical plane between a city pair and along a given horizontal path. Flight planning (FPS) concepts are for the pre-flight ground based computation of the three-dimensional reference trajectory that connects the city pair and specifies the horizontal path, fuel load, and weather profiles for initializing the FMS. As part of these objectives, a new computer program called EFPLAN has been developed and utilized to study advanced flight planning concepts. EFPLAN represents an experimental version of an FPS. It has been developed to generate reference flight plans compatible as input to an FMS and to provide various options for flight planning research. This report describes EFPLAN and the associated research conducted in its development.

  16. Ligand binding assays in the 21st century laboratory: recommendations for characterization and supply of critical reagents.

    PubMed

    O'Hara, Denise M; Theobald, Valerie; Egan, Adrienne Clements; Usansky, Joel; Krishna, Murli; TerWee, Julie; Maia, Mauricio; Spriggs, Frank P; Kenney, John; Safavi, Afshin; Keefe, Jeannine

    2012-06-01

    Critical reagents are essential components of ligand binding assays (LBAs) and are utilized throughout the process of drug discovery, development, and post-marketing monitoring. Successful lifecycle management of LBA critical reagents minimizes assay performance problems caused by declining reagent activity and can mitigate the risk of delays during preclinical and clinical studies. Proactive reagent management assures adequate supply. It also assures that the quality of critical reagents is appropriate and consistent for the intended LBA use throughout all stages of the drug development process. This manuscript summarizes the key considerations for the generation, production, characterization, qualification, documentation, and management of critical reagents in LBAs, with recommendations for antibodies (monoclonal and polyclonal), engineered proteins, peptides, and their conjugates. Recommendations are given for each reagent type on basic and optional characterization profiles, expiration dates and storage temperatures, and investment in a knowledge database system. These recommendations represent a consensus among the authors and should be used to assist bioanalytical laboratories in the implementation of a best practices program for critical reagent life cycle management.

  17. 42 CFR 480.121 - Optional disclosure of nonconfidential information.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality... 42 Public Health 4 2013-10-01 2013-10-01 false Optional disclosure of nonconfidential information...

  18. 42 CFR 480.121 - Optional disclosure of nonconfidential information.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality... 42 Public Health 4 2012-10-01 2012-10-01 false Optional disclosure of nonconfidential information...

  19. 42 CFR 480.121 - Optional disclosure of nonconfidential information.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality... 42 Public Health 4 2011-10-01 2011-10-01 false Optional disclosure of nonconfidential information...

  20. 42 CFR 480.121 - Optional disclosure of nonconfidential information.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality... 42 Public Health 4 2010-10-01 2010-10-01 false Optional disclosure of nonconfidential information...

  1. 42 CFR 480.121 - Optional disclosure of nonconfidential information.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality... 42 Public Health 4 2014-10-01 2014-10-01 false Optional disclosure of nonconfidential information...

  2. Build Resilience at Your Utility

    EPA Pesticide Factsheets

    CREAT allows users to evaluate potential impacts of climate change on their utility and to evaluate adaptation options to address them using both traditional risk assessment and scenario-based decision making.

  3. Vessel co-option is common in human lung metastases and mediates resistance to anti-angiogenic therapy in preclinical lung metastasis models.

    PubMed

    Bridgeman, Victoria L; Vermeulen, Peter B; Foo, Shane; Bilecz, Agnes; Daley, Frances; Kostaras, Eleftherios; Nathan, Mark R; Wan, Elaine; Frentzas, Sophia; Schweiger, Thomas; Hegedus, Balazs; Hoetzenecker, Konrad; Renyi-Vamos, Ferenc; Kuczynski, Elizabeth A; Vasudev, Naveen S; Larkin, James; Gore, Martin; Dvorak, Harold F; Paku, Sandor; Kerbel, Robert S; Dome, Balazs; Reynolds, Andrew R

    2017-02-01

    Anti-angiogenic therapies have shown limited efficacy in the clinical management of metastatic disease, including lung metastases. Moreover, the mechanisms via which tumours resist anti-angiogenic therapies are poorly understood. Importantly, rather than utilizing angiogenesis, some metastases may instead incorporate pre-existing vessels from surrounding tissue (vessel co-option). As anti-angiogenic therapies were designed to target only new blood vessel growth, vessel co-option has been proposed as a mechanism that could drive resistance to anti-angiogenic therapy. However, vessel co-option has not been extensively studied in lung metastases, and its potential to mediate resistance to anti-angiogenic therapy in lung metastases is not established. Here, we examined the mechanism of tumour vascularization in 164 human lung metastasis specimens (composed of breast, colorectal and renal cancer lung metastasis cases). We identified four distinct histopathological growth patterns (HGPs) of lung metastasis (alveolar, interstitial, perivascular cuffing, and pushing), each of which vascularized via a different mechanism. In the alveolar HGP, cancer cells invaded the alveolar air spaces, facilitating the co-option of alveolar capillaries. In the interstitial HGP, cancer cells invaded the alveolar walls to co-opt alveolar capillaries. In the perivascular cuffing HGP, cancer cells grew by co-opting larger vessels of the lung. Only in the pushing HGP did the tumours vascularize by angiogenesis. Importantly, vessel co-option occurred with high frequency, being present in >80% of the cases examined. Moreover, we provide evidence that vessel co-option mediates resistance to the anti-angiogenic drug sunitinib in preclinical lung metastasis models. Assuming that our interpretation of the data is correct, we conclude that vessel co-option in lung metastases occurs through at least three distinct mechanisms, that vessel co-option occurs frequently in lung metastases, and that vessel co-option could mediate resistance to anti-angiogenic therapy in lung metastases. Novel therapies designed to target both angiogenesis and vessel co-option are therefore warranted. © 2016 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland. © 2016 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

  4. 18 CFR 35.26 - Recovery of stranded costs by public utilities and transmitting utilities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... the customer with the Commission. (A) Before marketing or brokering can begin, the utility and... associated energy the customer is entitled to schedule, and the duration of the customer's marketing or... section to exercise the marketing or brokering option. The customer must notify the utility in writing...

  5. Coalbed methane-produced water quality and its management options in Raniganj Basin, West Bengal, India

    NASA Astrophysics Data System (ADS)

    Mendhe, Vinod Atmaram; Mishra, Subhashree; Varma, Atul Kumar; Singh, Awanindra Pratap

    2017-06-01

    Coalbed methane (CBM) recovery is associated with production of large quantity of groundwater. The coal seams are depressurized by pumping of water for regular and consistent gas production. Usually, CBM operators need to pump >10 m3 of water per day from one well, which depends on the aquifer characteristics, drainage and recharge pattern. In India, 32 CBM blocks have been awarded for exploration and production, out of which six blocks are commercially producing methane gas at 0.5 million metric standard cubic feet per day. Large amount of water is being produced from CBM producing blocks, but no specific information or data are available for geochemical properties of CBM-produced water and its suitable disposal or utilization options for better management. CBM operators are in infancy and searching for the suitable solutions for optimal management of produced water. CBM- and mine-produced water needs to be handled considering its physical and geochemical assessment, because it may have environmental as well as long-term impact on aquifer. Investigations were carried out to evaluate geochemical and hydrogeological conditions of CBM blocks in Raniganj Basin. Totally, 15 water samples from CBM well head and nine water samples from mine disposal head were collected from Raniganj Basin. The chemical signature of produced water reveals high sodium and bicarbonate concentrations with low calcium and magnesium, and very low sulphate in CBM water. It is comprehend that CBM water is mainly of Na-HCO3 type and coal mine water is of Ca-Mg-SO4 and HCO3-Cl-SO4 type. The comparative studies are also carried out for CBM- and mine-produced water considering the geochemical properties, aquifer type, depth of occurrence and lithological formations. Suitable options like impounding, reverse osmosis, irrigation and industrial use after prerequisite treatments are suggested. However, use of this huge volume of CBM- and mine-produced water for irrigation or other beneficial purposes may require careful management based on water pH, EC, TDS, alkalinity, bicarbonate, sodium, fluoride, metals content and SAR values.

  6. MODELING CONCEPTS FOR BMP/LID SIMULATION

    EPA Science Inventory

    Enhancement of simulation options for stormwater best management practices (BMPs) and hydrologic source control is discussed in the context of the EPA Storm Water Management Model (SWMM). Options for improvement of various BMP representations are presented, with emphasis on inco...

  7. Embedded fiber-optic sensing for accurate internal monitoring of cell state in advanced battery management systems part 1: Cell embedding method and performance

    NASA Astrophysics Data System (ADS)

    Raghavan, Ajay; Kiesel, Peter; Sommer, Lars Wilko; Schwartz, Julian; Lochbaum, Alexander; Hegyi, Alex; Schuh, Andreas; Arakaki, Kyle; Saha, Bhaskar; Ganguli, Anurag; Kim, Kyung Ho; Kim, ChaeAh; Hah, Hoe Jin; Kim, SeokKoo; Hwang, Gyu-Ok; Chung, Geun-Chang; Choi, Bokkyu; Alamgir, Mohamed

    2017-02-01

    A key challenge hindering the mass adoption of Lithium-ion and other next-gen chemistries in advanced battery applications such as hybrid/electric vehicles (xEVs) has been management of their functional performance for more effective battery utilization and control over their life. Contemporary battery management systems (BMS) reliant on monitoring external parameters such as voltage and current to ensure safe battery operation with the required performance usually result in overdesign and inefficient use of capacity. More informative embedded sensors are desirable for internal cell state monitoring, which could provide accurate state-of-charge (SOC) and state-of-health (SOH) estimates and early failure indicators. Here we present a promising new embedded sensing option developed by our team for cell monitoring, fiber-optic sensors. High-performance large-format pouch cells with embedded fiber-optic sensors were fabricated. The first of this two-part paper focuses on the embedding method details and performance of these cells. The seal integrity, capacity retention, cycle life, compatibility with existing module designs, and mass-volume cost estimates indicate their suitability for xEV and other advanced battery applications. The second part of the paper focuses on the internal strain and temperature signals obtained from these sensors under various conditions and their utility for high-accuracy cell state estimation algorithms.

  8. 75 FR 40005 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Order Granting...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-13

    ... including, but not limited to, stock index futures contracts, options on futures, options on securities and... holding and/ or managing portfolios or baskets of securities, commodity futures contracts, options on commodity futures contracts, swaps, forward contracts and/or options on physical commodities and/or non-U.S...

  9. Chondrosarcoma third metacarpal: Diagnosis and management options.

    PubMed

    Sharma, Vipin; Verma, Lucky; Chander, Bal; Sharma, Seema

    2018-01-01

    Chondrosarcoma is a rare malignant tumor of cartilage commonly arising in the pelvis, proximal femur, and humerus, but quite uncommon in the small bones of the hand. Although limited surgical procedures such as curettage are mentioned as a management option in low-grade chondrosarcomas, they tend to have a high rate of recurrences. Hence, wide excision is recommended as a treatment option even in low-grade chondrosarcomas of the hand.

  10. Management Options for Reducing the Release of Antibiotics and Antibiotic Resistance Genes to the Environment

    PubMed Central

    Pruden, Amy; Amézquita, Alejandro; Collignon, Peter; Brandt, Kristian K.; Graham, David W.; Lazorchak, James M.; Suzuki, Satoru; Silley, Peter; Snape, Jason R.; Topp, Edward; Zhang, Tong; Zhu, Yong-Guan

    2013-01-01

    Background: There is growing concern worldwide about the role of polluted soil and water environments in the development and dissemination of antibiotic resistance. Objective: Our aim in this study was to identify management options for reducing the spread of antibiotics and antibiotic-resistance determinants via environmental pathways, with the ultimate goal of extending the useful life span of antibiotics. We also examined incentives and disincentives for action. Methods: We focused on management options with respect to limiting agricultural sources; treatment of domestic, hospital, and industrial wastewater; and aquaculture. Discussion: We identified several options, such as nutrient management, runoff control, and infrastructure upgrades. Where appropriate, a cross-section of examples from various regions of the world is provided. The importance of monitoring and validating effectiveness of management strategies is also highlighted. Finally, we describe a case study in Sweden that illustrates the critical role of communication to engage stakeholders and promote action. Conclusions: Environmental releases of antibiotics and antibiotic-resistant bacteria can in many cases be reduced at little or no cost. Some management options are synergistic with existing policies and goals. The anticipated benefit is an extended useful life span for current and future antibiotics. Although risk reductions are often difficult to quantify, the severity of accelerating worldwide morbidity and mortality rates associated with antibiotic resistance strongly indicate the need for action. PMID:23735422

  11. Climate change adaptation and mitigation options a guide for natural resource managers in southern forest ecosystems

    Treesearch

    James M. Vose; Kier D. Klepzig

    2014-01-01

    The rapid pace of climate change and its direct and indirect effects on forest ecosystems present a pressing need for better scientific understanding and the development of new science-management partnerships. Understanding the effects of stressors and disturbances (including climatic variability), and developing and testing science-based management options to deal...

  12. Information systems for material flow management in construction processes

    NASA Astrophysics Data System (ADS)

    Mesároš, P.; Mandičák, T.

    2015-01-01

    The article describes the options for the management of material flows in the construction process. Management and resource planning is one of the key factors influencing the effectiveness of construction project. It is very difficult to set these flows correctly. The current period offers several options and tools to do this. Information systems and their modules can be used just for the management of materials in the construction process.

  13. ARSENIC TREATMENT OPTIONS

    EPA Science Inventory

    The PPT presentation will provide information on the drinking water treatment options for small utilities to remove arsenic from ground water. The discussion will include information on the EPA BAT listed processes and on some of the newer technologies, such as the iron based ad...

  14. Effect of antecedent terrestrial land-use on C and N cycling in created wetlands

    NASA Astrophysics Data System (ADS)

    McCalley, C. K.; Al Graiti, T.; Williams, T.; Huang, S.; McGowan, M. B.; Eddingsaas, N. C.; Tyler, A. C.

    2017-12-01

    Land-use legacies and their interaction with both management actions and climate variability has a poorly characterized impact on the development of ecosystem functions and the trajectory of climate-carbon feedbacks. The complex structure-function relationships in wetlands foster delivery of valuable, climate sensitive, ecosystem services (carbon sequestration, nutrient removal, flood control, etc.) but also make them susceptible to colonization by invasive plants and lead to emission of key greenhouse gases. This project uses created wetland ecosystems as a model to understand how heterogeneity in antecedent conditions interacts with management options to create unique structure-function scenarios and a range of climate feedback outcomes. We utilized ongoing experiments in created wetlands that differ in antecedent conditions (crop agriculture, livestock grazing) and investigated how management options (invasive species removal, organic matter addition) interact with legacy impacts to promote key ecosystem functions, including greenhouse gas emissions, carbon sequestration, denitrification and plant biodiversity. The effects of antecedent land-use on soil chemistry, coupled with hydrologic patterns resulted in wetlands with divergent C and N dynamics despite their similar creation history. Additionally, the occurrence of extreme weather events (drought and excessive flooding) during the study period highlighted the overarching role that increased climate variability will play in determining key ecosystem processes in wetlands. Responses to management were linked to hydro-period: while organic matter addition successfully increased soil organic matter to more closely replicate natural systems at all sites, it had the largest impact on C and N cycling when soils were saturated. Overall, environmental conditions that promoted saturated soils, both those shaped by human activities or climate extremes, enhanced primary productivity, nutrient removal and greenhouse gas production as well as decreased soil respiration.

  15. Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss.

    PubMed

    Dalton, Vanessa K; Liang, Angela; Hutton, David W; Zochowski, Melissa K; Fendrick, A Mark

    2015-02-01

    The objective of this study was to estimate the economic consequences of expanding options for early pregnancy loss (EPL) treatment beyond expectant management and operating room surgical evacuation (usual care). We constructed a decision model using a hypothetical cohort of women undergoing EPL management within a 30 day horizon. Treatment options under the usual care arm include expectant management and surgical uterine evacuation in an operating room (OR). Treatment options under the expanded care arm included all evidence-based safe and effective treatment options for EPL: expectant management, misoprostol treatment, surgical uterine evacuation in an office setting, and surgical uterine evacuation in an OR. Probabilities of entering various treatment pathways were based on previously published observational studies. The cost per case was US $241.29 lower for women undergoing treatment in the expanded care model as compared with the usual care model (US $1033.29 per case vs US $1274.58 per case, expanded care and usual care, respectively). The model was the most sensitive to the failure rate of the expectant management arm, the cost of the OR surgical procedure, the proportion of women undergoing an OR surgical procedure under usual care, and the additional cost per patient associated with implementing and using the expanded care model. This study demonstrates that expanding women's treatment options for EPL beyond what is typically available can result in lower direct medical expenditures. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. A one-year economic evaluation of six alternative strategies in the management of uninvestigated upper gastrointestinal symptoms in Canadian primary care.

    PubMed

    Barkun, Alan N; Crott, Ralph; Fallone, Carlo A; Kennedy, Wendy A; Lachaine, Jean; Levinton, Carey; Armstrong, David; Chiba, Naoki; Thomson, Alan; Veldhuyzen van Zanten, Sander; Sinclair, Paul; Escobedo, Sergio; Chakraborty, Bijan; Smyth, Sandra; White, Robert; Kalra, Helen; Nevin, Krista

    2010-08-01

    The cost-effectiveness of initial strategies in managing Canadian patients with uninvestigated upper gastrointestinalsymptoms remains controversial. To assess the cost-effectiveness of six management approaches to uninvestigated upper gastrointestinal symptoms in the Canadian setting. The present study analyzed data from four randomized trials assessing homogeneous and complementary populations of Canadian patients with uninvestigated upper gastrointestinal symptoms with comparable outcomes. Symptom-free months, qualityadjusted life-years (QALYs) and direct costs in Canadian dollars of two management approaches based on the Canadian Dyspepsia Working Group (CanDys) Clinical Management Tool, and four additional strategies (two empirical antisecretory agents, and two prompt endoscopy) were examined and compared. Prevalence data, probabilities, utilities and costs were included in a Markov model, while sensitivity analysis used Monte Carlo simulations. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were determined. Empirical omeprazole cost $226 per QALY ($49 per symptom-free month) per patient. CanDys omeprazole and endoscopy approaches were more effective than empirical omeprazole, but more costly. Alternatives using H2-receptor antagonists were less effective than those using a proton pump inhibitor. No significant differences were found for most incremental cost-effectiveness ratios. As willingness to pay (WTP) thresholds rose from $226 to $24,000 per QALY, empirical antisecretory approaches were less likely to be the most costeffective choice, with CanDys omeprazole progressively becoming a more likely option. For WTP values ranging from $24,000 to $70,000 per QALY, the most clinically relevant range, CanDys omeprazole was the most cost-effective strategy (32% to 46% of the time), with prompt endoscopy-proton pump inhibitor favoured at higher WTP values. Although no strategy was the indisputable cost effective option, CanDys omeprazole may be the strategy of choiceover a clinically relevant range of WTP assumptions in the initial management of Canadian patients with uninvestigated dyspepsia.

  17. CREAT Risk Assessment Application for Water Utilities

    EPA Pesticide Factsheets

    CREAT allows users to evaluate potential impacts of climate change on their utility and to evaluate adaptation options to address them using both traditional risk assessment and scenario-based decision making.

  18. Management and marketing for the general practice dental office.

    PubMed

    Clarkson, Earl; Bhatia, Sanjeev

    2008-07-01

    This article reviews trends in the dental marketplace. Marketing is an essential element of dentistry. Communicating treatment options with patients is one aspect of marketing. Treatment planning helps patients understand the relationships between oral health, occlusion, temporomandibular joint function, and systemic health. Through marketing, dental practice owners inform patients of ever-changing treatment modalities. Understanding treatment options allows patients to make better, informed choices. More options leads to a higher level of care and more comprehensive dental treatment. Managing a practice requires tracking its financial health. Economic statistics measure the effect of management decisions that mark the direction of a dental practice.

  19. The effect of interest rate derivative transactions on debt savings for not-for-profit health systems.

    PubMed

    Venkataramani, Prakash; Johnson, Tricia; O'Neil, Patricia; Poindexter, Victoria; Rooney, Jeffrey

    2006-01-01

    The utilization of interest rate derivative instruments in US for-profit companies has grown exponentially since the early 1980s. International Swaps and Derivatives Association, Inc. (ISDA), reported that the amount of outstanding standard swaps grew by 25 percent during the first six months of 2003. The growth rate of all interest rate derivatives, which includes single-currency interest rate swaps, cross-currency interest rate swaps, and interest rate options, grew by 24 percent during the same period. The total outstanding amount of interest rate derivatives now totals $123.9 trillion compared to $99.9 trillion at the end of 2002 (Dodd, 2003). This explosion in usage is a testament to the efficacy and flexibility of the instruments and the increased appreciation by financial managers of the importance of financial risk management in a volatile interest rate environment.

  20. Mathematical Model and Artificial Intelligent Techniques Applied to a Milk Industry through DSM

    NASA Astrophysics Data System (ADS)

    Babu, P. Ravi; Divya, V. P. Sree

    2011-08-01

    The resources for electrical energy are depleting and hence the gap between the supply and the demand is continuously increasing. Under such circumstances, the option left is optimal utilization of available energy resources. The main objective of this chapter is to discuss about the Peak load management and overcome the problems associated with it in processing industries such as Milk industry with the help of DSM techniques. The chapter presents a generalized mathematical model for minimizing the total operating cost of the industry subject to the constraints. The work presented in this chapter also deals with the results of application of Neural Network, Fuzzy Logic and Demand Side Management (DSM) techniques applied to a medium scale milk industrial consumer in India to achieve the improvement in load factor, reduction in Maximum Demand (MD) and also the consumer gets saving in the energy bill.

  1. Recent advances in the molecular genetics of epilepsy.

    PubMed

    Hildebrand, Michael S; Dahl, Hans-Henrik M; Damiano, John Anthony; Smith, Richard J H; Scheffer, Ingrid E; Berkovic, Samuel F

    2013-05-01

    Recent advances in molecular genetics have translated into the increasing utilisation of genetic testing in the routine clinical practice of neurologists. There has been a steady, incremental increase in understanding the genetic variation associated with epilepsies. Genetic testing in the epilepsies is not yet widely practiced, but the advent of new screening technologies promises to exponentially expand both knowledge and clinical utility. To maximise the value of this new genetic insight we need to rapidly extrapolate genetic findings to inform patients of their diagnosis, prognosis, recurrence risk and the clinical management options available for their specific genetic condition. Comprehensive, highly specific and sensitive genetic test results improve the management of patients by neurologists and clinical geneticists. Here we discuss the latest developments in clinical genetic testing for epilepsy and describe new molecular genetics platforms that will transform both genetic screening and novel gene discovery.

  2. Advances in the Management of Gastric and Gastroesophageal Cancers.

    PubMed

    Kamran, Sophia C; Hong, Theodore S; Wo, Jennifer Y

    2016-02-01

    Management of gastric and gastroesophageal cancers is a complex, evolving paradigm. Involvement of multimodality specialties is the key. In gastric cancer, data are conflicting with regard to the specific roles of surgery, chemotherapy, and radiation, particularly between Asian and Western studies. However, current ongoing phase III trials will further elucidate the optimal treatment for this heterogeneous disease. For resectable gastroesophageal junction (GEJ) tumors, the publication of a landmark study in 2012 out of the Netherlands revealed a clear benefit in the utilization of trimodality therapy. This changed practice almost immediately around the world. In unresectable gastroesophageal disease, chemoradiation has been firmly established as a paradigm for treatment. The optimal chemotherapy regimen is still in flux. However, for both gastric and GEJ tumors, technological breakthroughs in genomics and pharmacologic targeting will soon provide physicians more options in the armamentarium to fight these diseases and, one day, individually personalize treatment.

  3. Informatics in Radiology (infoRAD): personal computer security: part 2. Software Configuration and file protection.

    PubMed

    Caruso, Ronald D

    2004-01-01

    Proper configuration of software security settings and proper file management are necessary and important elements of safe computer use. Unfortunately, the configuration of software security options is often not user friendly. Safe file management requires the use of several utilities, most of which are already installed on the computer or available as freeware. Among these file operations are setting passwords, defragmentation, deletion, wiping, removal of personal information, and encryption. For example, Digital Imaging and Communications in Medicine medical images need to be anonymized, or "scrubbed," to remove patient identifying information in the header section prior to their use in a public educational or research environment. The choices made with respect to computer security may affect the convenience of the computing process. Ultimately, the degree of inconvenience accepted will depend on the sensitivity of the files and communications to be protected and the tolerance of the user. Copyright RSNA, 2004

  4. Testing rank-dependent utility theory for health outcomes.

    PubMed

    Oliver, Adam

    2003-10-01

    Systematic violations of expected utility theory (EU) have been reported in the context of both money and health outcomes. Rank-dependent utility theory (RDU) is currently the most popular and influential alternative theory of choice under circumstances of risk. This paper reports a test of the descriptive performance of RDU compared to EU in the context of health. When one of the options is certain, violations of EU that can be explained by RDU are found. When both options are risky, no evidence that RDU is a descriptive improvement over EU is found, though this finding may be due to the low power of the tests. Copyright 2002 John Wiley & Sons, Ltd.

  5. Federal Employees Health Benefits Program: Enrollment Options Following the Termination of a Plan or Plan Option. Final rule.

    PubMed

    2015-10-28

    The U.S. Office of Personnel Management (OPM) is issuing a final rule to amend the Federal Employees Health Benefits (FEHB) Program regulations regarding enrollment options following the termination of a plan or plan option.

  6. Reading the Tea Leaves: How Utilities in the West Are Managing Carbon Regulatory Risk in their Resource Plans

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

    Barbose, Galen; Wiser, Ryan; Phadke, Amol

    2008-02-01

    The long economic lifetime and development lead-time of many electric infrastructure investments requires that utility resource planning consider potential costs and risks over a lengthy time horizon. One long-term -- and potentially far-reaching -- risk currently facing the electricity industry is the uncertain cost of future carbon dioxide (CO2) regulations. Recognizing the importance of this issue, many utilities (sometimes spurred by state regulatory requirements) are beginning to actively assess carbon regulatory risk within their resource planning processes, and to evaluate options for mitigating that risk. However, given the relatively recent emergence of this issue and the rapidly changing political landscape,more » methods and assumptions used to analyze carbon regulatory risk, and the impact of this analysis on the selection of a preferred resource portfolio, vary considerably across utilities. In this study, we examine the treatment of carbon regulatory risk in utility resource planning, through a comparison of the most-recent resource plans filed by fifteen investor-owned and publicly-owned utilities in the Western U.S. Together, these utilities account for approximately 60percent of retail electricity sales in the West, and cover nine of eleven Western states. This report has two related elements. First, we compare and assess utilities' approaches to addressing key analytical issues that arise when considering the risk of future carbon regulations. Second, we summarize the composition and carbon intensity of the preferred resource portfolios selected by these fifteen utilities and compare them to potential CO2 emission benchmark levels.« less

  7. Coordinating water conservation efforts through tradable credits: A proof of concept for drought response in the San Francisco Bay area

    NASA Astrophysics Data System (ADS)

    Gonzales, Patricia; Ajami, Newsha; Sun, Yujie

    2017-09-01

    Water utilities are increasingly relying on water efficiency and conservation to extend the availability of supplies. Despite spatial and institutional interdependency of many utilities, these demand-side management initiatives have traditionally been tackled by individual utilities operating in isolation. In this study, we introduce a policy framework for water conservation credits that enables collaboration at the regional scale. Under the proposed approach, utilities have the flexibility to invest in water conservation measures that are appropriate for their specific service area. When utilities have insufficient capacity for local cost-effective measures, they may opt to purchase credits, contributing to fund subsidies for utilities that do have that capacity and can provide the credits, while the region as a whole benefits from more reliable water supplies. This work aims to provide insights on the potential impacts of a water conservation credit policy framework when utilities are given the option to collaborate in their efforts. We model utility decisions as rational cost-minimizing actors subject to different decision-making dynamics and water demand scenarios, and demonstrate the institutional characteristics needed for the proposed policy to be effective. We apply this model to a counterfactual case study of water utility members of the Bay Area Water Supply and Conservation Agency in California during the drought period of June 2015 to May 2016. Our scenario analysis indicates that when the institutional structure and incentives are appropriately defined, water agencies can achieve economic benefits from collaborating in their conservation efforts, especially if they coordinate more closely in their decision-making.

  8. 2004 Methane and Nitrous Oxide Emissions from Manure Management in South Africa

    PubMed Central

    Moeletsi, Mokhele Edmond; Tongwane, Mphethe Isaac

    2015-01-01

    Simple Summary Livestock manure management is one of the main sources of greenhouse gas (GHG) emissions in South Africa producing mainly methane and nitrous oxide. The emissions from this sub-category are dependent on how manure is stored. Liquid-stored manure predominantly produces methane while dry-based manure enhances mainly production of nitrous oxide. Intergovernmental Panel on Climate Change (IPCC) guidelines were utilized at different tier levels in estimating GHG emissions from manure management. The results show that methane emissions are relatively higher than nitrous oxide emissions with 3104 Gg and 2272 Gg respectively in carbon dioxide global warming equivalent. Abstract Manure management in livestock makes a significant contribution towards greenhouse gas emissions in the Agriculture; Forestry and Other Land Use category in South Africa. Methane and nitrous oxide emissions are prevalent in contrasting manure management systems; promoting anaerobic and aerobic conditions respectively. In this paper; both Tier 1 and modified Tier 2 approaches of the IPCC guidelines are utilized to estimate the emissions from South African livestock manure management. Activity data (animal population, animal weights, manure management systems, etc.) were sourced from various resources for estimation of both emissions factors and emissions of methane and nitrous oxide. The results show relatively high methane emissions factors from manure management for mature female dairy cattle (40.98 kg/year/animal), sows (25.23 kg/year/animal) and boars (25.23 kg/year/animal). Hence, contributions for pig farming and dairy cattle are the highest at 54.50 Gg and 32.01 Gg respectively, with total emissions of 134.97 Gg (3104 Gg CO2 Equivalent). Total nitrous oxide emissions are estimated at 7.10 Gg (2272 Gg CO2 Equivalent) and the three main contributors are commercial beef cattle; poultry and small-scale beef farming at 1.80 Gg; 1.72 Gg and 1.69 Gg respectively. Mitigation options from manure management must be taken with care due to divergent conducive requirements of methane and nitrous oxide emissions requirements. PMID:26479229

  9. Parental Preference Assessment for Vesicoureteral Reflux Management in Children.

    PubMed

    Tran, Geraldine N; Bodapati, Anand V; Routh, Jonathan C; Saigal, Christopher S; Copp, Hillary L

    2017-03-01

    Parents of children with vesicoureteral reflux are presented with a variety of management options, which in many cases offer a similar risk-benefit ratio. To facilitate shared decision making, parental preferences regarding vesicoureteral reflux treatment options need to be acknowledged. We aimed to characterize the clinical experience of parents and elicit core themes affecting decision making in regard to managing vesicoureteral reflux in their child. A semistructured, qualitative interview script was developed and vetted by 25 pediatric urologists to discuss treatment options for vesicoureteral reflux. Additional patient interviews were conducted until new themes failed to arise. Content analysis was performed to extract all statements that described treatment options. Similar statements were combined until a final list of unique themes emerged. A total of 26 interviews were performed, yielding 689 statements about overall parent experiences with managing vesicoureteral reflux in the child and 450 statements (65%) pertaining to treatment options. Of the 13 themes that emerged, those most commonly considered were the prevention of future urinary tract infections by 85% of parents, the efficacy rate of treatment options by 85%, the burden of daily maintenance or compliance by 77%, antibiotic resistance by 69%, chronic kidney damage by 62% and invasiveness by 58%. Our study emphasizes that when choosing a treatment option for vesicoureteral reflux in their child, parent preferences regarding risks and benefits are variable. However, their chief concerns include whether a method decreases the risk of urinary tract infections, has an acceptable efficacy rate and aligns itself with the capabilities of the family. These themes help frame discussions between families and clinicians regarding vesicoureteral reflux management, and they can facilitate shared decision making. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  10. Methotrexate management for placenta accreta: a prospective study.

    PubMed

    Lin, Kaiqing; Qin, Jiale; Xu, Kaihong; Hu, Wen; Lin, Jun

    2015-06-01

    To observe efficacy following methotrexate (MTX) management in women with placenta accreta. Twenty-four stable patients with placenta accreta were treated with MTX. Beta-hCG values, vascular indices of the residual placenta, and other clinical characteristics were collected prospectively and were compared between the success and failure groups. After MTX management, the residual placentas were expulsed spontaneously in 33.3% of the patients. This was done through dilatation and curettage (D & C) in 45.8% of the patients. The residuals in the uterine wall were completely absorbed within 5.7 months. In the patients who were successfully treated with MTX, their beta-hCG values and vascular indices of the placentas decreased faster than those of failure patients (P < 0.05). Those (20.8%) failing MTX management and subsequent D & C showed that their vascular indices persisted high levels and some even experienced elevations despite significantly decreased hCG values. MTX management, when the beta-hCG value and vascular indices of placenta decreased significantly, is a conservative option for a stable patient with placenta accreta in China. 3D power Doppler ultrasound should be utilized for the follow-up of this condition.

  11. A holistic framework for design of cost-effective minimum water utilization network.

    PubMed

    Wan Alwi, S R; Manan, Z A; Samingin, M H; Misran, N

    2008-07-01

    Water pinch analysis (WPA) is a well-established tool for the design of a maximum water recovery (MWR) network. MWR, which is primarily concerned with water recovery and regeneration, only partly addresses water minimization problem. Strictly speaking, WPA can only lead to maximum water recovery targets as opposed to the minimum water targets as widely claimed by researchers over the years. The minimum water targets can be achieved when all water minimization options including elimination, reduction, reuse/recycling, outsourcing and regeneration have been holistically applied. Even though WPA has been well established for synthesis of MWR network, research towards holistic water minimization has lagged behind. This paper describes a new holistic framework for designing a cost-effective minimum water network (CEMWN) for industry and urban systems. The framework consists of five key steps, i.e. (1) Specify the limiting water data, (2) Determine MWR targets, (3) Screen process changes using water management hierarchy (WMH), (4) Apply Systematic Hierarchical Approach for Resilient Process Screening (SHARPS) strategy, and (5) Design water network. Three key contributions have emerged from this work. First is a hierarchical approach for systematic screening of process changes guided by the WMH. Second is a set of four new heuristics for implementing process changes that considers the interactions among process changes options as well as among equipment and the implications of applying each process change on utility targets. Third is the SHARPS cost-screening technique to customize process changes and ultimately generate a minimum water utilization network that is cost-effective and affordable. The CEMWN holistic framework has been successfully implemented on semiconductor and mosque case studies and yielded results within the designer payback period criterion.

  12. LETTER TO EDITOR REGARDING "ARSENIC CHALLENGES FOR WATER UTILITIES"

    EPA Science Inventory

    The two part series on "Arsenic Challenges for Water Utilities" have provided useful information for the many small water utilities faced with arsenic problems. Part II states that treatment options fall into six major categories and then proceeds to provide a short summary on e...

  13. 7 CFR 1781.14 - Planning, options, and appraisals.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 12 2011-01-01 2011-01-01 false Planning, options, and appraisals. 1781.14 Section 1781.14 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS...

  14. 7 CFR 1781.14 - Planning, options, and appraisals.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 12 2014-01-01 2013-01-01 true Planning, options, and appraisals. 1781.14 Section 1781.14 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS...

  15. 7 CFR 1781.14 - Planning, options, and appraisals.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 12 2012-01-01 2012-01-01 false Planning, options, and appraisals. 1781.14 Section 1781.14 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS...

  16. 7 CFR 1781.14 - Planning, options, and appraisals.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 12 2013-01-01 2013-01-01 false Planning, options, and appraisals. 1781.14 Section 1781.14 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) RESOURCE CONSERVATION AND DEVELOPMENT (RCD) LOANS AND WATERSHED (WS...

  17. A cost utility analysis of simeprevir used with peginterferon + ribavirin in the management of genotype 1 hepatitis C virus infection, from the perspective of the UK National Health Service.

    PubMed

    Westerhout, Kirsten; Treur, Maarten; Mehnert, Angelika; Pascoe, Katie; Ladha, Imran; Belsey, Jonathan

    2015-01-01

    Triple therapy using a protease inhibitor (PI) with peginterferon and ribavirin (PR) is increasingly used in patients with chronic hepatitis C virus (HCV) infection. The most recently introduced PI, simeprevir (SMV), offers high levels of viral eradication combined with a reduced overall duration of therapy. The objective of this study was to compare the cost-effectiveness of SMV + PR vs PR alone or in combination with telaprevir (TVR) or boceprevir (BOC) in patients infected with genotype 1 HCV Method: A cost-utility model was constructed, incorporating two phases, capturing the efficacy of therapy in an initial treatment phase, followed by a long-term post-treatment Markov phase, capturing lifetime outcomes according to whether a sustained viral response (SVR) had been achieved on treatment. Dosage regimens were based on the EMA approved label for each treatment. SVR estimates and adverse event rates were derived from a mixed treatment comparison. Baseline characteristics were drawn from an analysis of a UK HCV data-set and clinician opinion. Health state transition probabilities, utilities, and health state costs were drawn from previously published economic analyses. The model considered direct health costs only, and the perspective was that of the UK National Health Service. The model yielded an ICER for SMV + PR vs PR alone of £9725/QALY for treatment-naïve and £7819/QALY for treatment-experienced. Benefit was driven by increased likelihood of achieving SVR, with consequent long-term utility gains. SMV + PR dominated TVR + PR and BOC + PR in both patient groups. This principally reflected the QALY benefit of an increased likelihood of SVR with SMV, combined with lower overall drug costs, due to reduced mean treatment duration. Compared to other currently licensed treatment options, SMV + PR represents a cost effective treatment option for patients with chronic genotype 1 HCV infection.

  18. Positioning Model-Supported, Participatory, Water Management Decision Making under Uncertainty within the Western Philosphical Discourse on Knowledge and Governance

    NASA Astrophysics Data System (ADS)

    Purkey, D. R.; Escobar, M.; Mehta, V. K.; Forni, L.

    2016-12-01

    Two important trends currently shape the manner in which water resources planning and decision making occurs. The first relates to the increasing reliance on participatory stakeholder processes as a forum for evaluating water management options and selecting the appropriate course of action. The second relates to the growing recognition that earlier deterministic approaches to this evaluation of options may no longer be appropriate, nor required. The convergence of these two trends poses questions as to the proper role of data, information, analysis and expertise in the inherently social and political process of negotiating water resources management agreements and implementing water resources management interventions. The question of how to discover the best or optimal option in the face of deep uncertainty related to climate change, demography, economic development, and regulatory reform is compelling. More fundamentally the question of whether the "perfect" option even exits to be discovered is perhaps more critical. While this existential question may be new to the water resource management community, it is not new to western political theory. This paper explores early classical philosophical writing related to issues of knowledge and governance as captured in the work of Plato and Aristotle; and then attempts to place a new approach to analysis-supported, stakeholder-driven water resources planning and decision making within this philosophical discourse. Using examples from river systems in California and the Andes, where the theory of Robust Decision Making has been used as an organizing construct for stakeholder processes, it is argued that the expectation that analysis will lead to the discovery of the perfect option is not warranted when stakeholders are engaged in the process of discovering a consensus option. This argument will touch upon issue of the diversity of values, model uncertainty and creditability, and the visualization of model output required to explore the implications of various management options across a range of inherently unknowable future conditions.

  19. NOHIMS (Naval Occupational Health Information Management System) Users’ Guide: Introduction and OHS (Occupational Health System) Options.

    DTIC Science & Technology

    1984-06-26

    irred. 2’. 4’.. Nava Het esarch CenterU 0i P. 0. Bx 8512 San iego Caiforia 2138917 P. W. SUMMARY The Naval Occupational Health information Management System (WHIMS...Introduction and OHS Options I. INTRODUCTION TO THE NAVY OCCUPATIONAL HEALTH INFORMATION MANAGEMENT SYSTEM (NOHIMS) The objective of NOHIMS is to provide an

  20. Operational approaches to managing forests of the future in Mediterranean regions within a context of changing climates

    NASA Astrophysics Data System (ADS)

    Stephens, Scott L.; Millar, Constance I.; Collins, Brandon M.

    2010-04-01

    Many US forest managers have used historical ecology information to assist in the development of desired conditions. While there are many important lessons to learn from the past, we believe that we cannot rely on past forest conditions to provide us with blueprints for future management. To respond to this uncertainty, managers will be challenged to integrate adaptation strategies into plans in response to changing climates. Adaptive strategies include resistance options, resilience options, response options, and realignment options. Our objectives are to present ideas that could be useful in developing plans under changing climates that could be applicable to forests with Mediterranean climates. We believe that managing for species persistence at the broad ecoregion scale is the most appropriate goal when considering the effects of changing climates. Such a goal relaxes expectations that current species ranges will remain constant, or that population abundances, distribution, species compositions and dominances should remain stable. Allowing fundamental ecosystem processes to operate within forested landscapes will be critical. Management and political institutions will have to acknowledge and embrace uncertainty in the future since we are moving into a time period with few analogs and inevitably, there will be surprises.

  1. National Conference on Integrated Resource Planning: Proceedings

    NASA Astrophysics Data System (ADS)

    Until recently, state regulators have focused most of their attention on the development of least-cost or integrated resource planning (IRP) processes for electric utilities. A number of commissions are beginning to scrutinize the planning processes of local gas distribution companies (LDCs) because of the increased control that LDCs have over their purchased gas costs (as well as the associated risks) and because of questions surrounding the role and potential of gas end-use efficiency options. Traditionally, resource planning (LDCs) has concentrated on options for purchasing and storing gas. Integrated resource planning involves the creation of a process in which supply-side and demand-side options are integrated to create a resource mix that reliably satisfies customers' short-term and long-term energy service needs at the lowest cost. As applied to gas utilities, an integrated resource plan seeks to balance cost and reliability, and should not be interpreted simply as the search for lowest commodity costs. The National Association of Regulatory Utility Commissioners' (NARUC) Energy Conservation committee asked Lawrence Berkeley Laboratory (LBL) to survey state PUCs to determine the extent to which they have undertaken least cost planning for gas utilities. The survey included the following topics: status of state PUC least-cost planning regulations and practices for gas utilities; type and scope of natural gas DSM programs in effect, including fuel substitution; economic tests and analysis methods used to evaluate DSM programs; relationship between prudency reviews of gas utility purchasing practices and integrated resource planning; and key regulatory issues facing gas utilities during the next five years.

  2. Advising and Optimizing the Deployment of Sustainability-Oriented Technologies in the Integrated Electricity, Light-Duty Transportation, and Water Supply System

    NASA Astrophysics Data System (ADS)

    Tarroja, Brian

    The convergence of increasing populations, decreasing primary resource availability, and uncertain climates have drawn attention to the challenge of shifting the operations of key resource sectors towards a sustainable paradigm. This is prevalent in California, which has set sustainability-oriented policies such as the Renewable Portfolio Standards and Zero-Emission Vehicle mandates. To meet these goals, many options have been identified to potentially carry out these shifts. The electricity sector is focusing on accommodating renewable power generation, the transportation sector on alternative fuel drivetrains and infrastructure, and the water supply sector on conservation, reuse, and unconventional supplies. Historical performance evaluations of these options, however, have not adequately taken into account the impacts on and constraints of co-dependent infrastructures that must accommodate them and their interactions with other simultaneously deployed options. These aspects are critical for optimally choosing options to meet sustainability goals, since the combined system of all resource sectors must satisfy them. Certain operations should not be made sustainable at the expense of rendering others as unsustainable, and certain resource sectors should not meet their individual goals in a way that hinders the ability of the entire system to do so. Therefore, this work develops and utilizes an integrated platform of the electricity, transportation, and water supply sectors to characterize the performance of emerging technology and management options while taking into account their impacts on co-dependent infrastructures and identify synergistic or detrimental interactions between the deployment of different options. This is carried out by first evaluating the performance of each option in the context of individual resource sectors to determine infrastructure impacts, then again in the context of paired resource sectors (electricity-transportation, electricity-water), and finally in the context of the combined tri-sector system. This allows a more robust basis for composing preferred option portfolios to meet sustainability goals and gives a direction for coordinating the paradigm shifts of different resource sectors. Overall, it is determined that taking into account infrastructure constraints and potential operational interactions can significantly change the evaluation of the preferred role that different technologies should fulfill in contributing towards satisfying sustainability goals in the holistic context.

  3. Using info-Gap Decision Theory for Water Resources Planning Under Severe Uncertainty

    NASA Astrophysics Data System (ADS)

    Korteling, B.; Brazier, R.; Kapelan, Z.; Dessai, S.

    2012-12-01

    Water resource managers are required to develop comprehensive water resource plans based on severely uncertain information of the effects of climate change on local hydrology and future socio-economic changes on localised demand. In England and Wales, current water resource planning methodologies include a headroom estimation process that quantifies uncertainty based on only one point of an assumed range of deviations from the expected climate and projected demand 25 years into the future. There are many situations where there is not enough knowledge to be able to estimate a representative probability of occurrence, or to be confident that the tails of an assumed probability distribution will not exhibit unexpected skewness, or that the kurtosis of a distribution differs from the norm. These situations can be considered severely uncertain. Information-Gap decision theory offers a method to sample a wider range of uncertainty than with traditional methods, and as a result, compare the robustness of various water resource management options under conditions of severe uncertainty. A more robust management option is one that delivers the same level of performance as other options at higher levels of uncertainty. A case study is based on a Water Supply Area that encompasses the county of Cornwall in southwest England containing 17 reservoirs and 19 demand nodes. The performance success of management options are evaluated primarily by measures of water availability including a reservoir risk measure that tests the probability and magnitude that strategic reservoir storage levels fall below the drought management curve under adverse conditions and also a safety margin deficit that tests how quickly reservoir levels can return to optimum operating levels in favourable conditions. Multi-Criteria Decision Analysis (MCDA) is used to test the effectiveness of different management options with different weightings for metrics other than water availability including; capital and operating costs, costs to customers, carbon emissions, environmental impact and social acceptability. Findings show that beyond the uncertainty range explored with the traditional headroom method, preference reversals can occur, i.e. some management options that underperform at lower uncertainties, outperform at higher levels of uncertainty. This study also shows that when 50% or more of the population adopts demand side management, efficiency related measures and innovative options such as rainwater collection can perform equally well or better than some supply side options. The additional use of MCDA shifts the focus away from reservoir expansion options that perform best with respect to water availability, to combined strategies that include innovative demand side management actions of rainwater collection and greywater reuse as well as efficiency measures and additional regional transfers. This research illustrates how an Info-Gap based approach can offer a comprehensive picture of potential supply/demand futures and a rich variety of information to support adaptive management of water systems under severe uncertainty.

  4. A comparison of benefit and economic value between two sound therapy tinnitus management options.

    PubMed

    Newman, Craig W; Sandridge, Sharon A

    2012-02-01

    Sound therapy coupled with appropriate counseling has gained widespread acceptance in the audiological management of tinnitus. For many years, ear level sound generators (SGs) have been used to provide masking relief and to promote tinnitus habituation. More recently, an alternative treatment device was introduced, the Neuromonics Tinnitus Treatment (NTT), which employs spectrally-modified music in an acoustic desensitization approach in order to help patients overcome the disturbing consequences of tinnitus. It is unknown, however, if one treatment plan is more efficacious and cost-effective in comparison to the other. In today's economic climate, it has become critical that clinicians justify the value of tinnitus treatment devices in relation to observed benefit. To determine perceived benefit from, and economic value associated with, two forms of sound therapy, namely, SGs and NTT. Retrospective between-subject clinical study. A sample of convenience comprised of 56 patients drawn from the Tinnitus Management Clinic at the Cleveland Clinic participated. Twenty-three patients selected SGs, and 33 patients selected NTT as their preferred sound therapy treatment option. Sound therapy benefit was quantified using the Tinnitus Handicap Inventory (THI). The questionnaire was administered before and 6 mo after initiation of tinnitus treatment. Prior to device fitting, all patients participated in a 1.5 hr group education session about tinnitus and its management. Economic value comparisons between sound therapy options were made using a cost-effectiveness analysis (CEA) and cost-utility analysis (CUA). THI scores indicated a significant improvement (p < 0.001) in tinnitus reduction for both treatment types between a pre- and 6 mo postfitting interval, yet there were no differences (p > 0.05) between the treatment alternatives at baseline or 6 mo postfitting. The magnitude of improvement for both SGs and NTT was dependent on initial perceived tinnitus handicap. Based on the CEA and CUA economic analyses alone, it appears that the SGs may be the more cost-effective alternative; however, the magnitude of economic value is a function of preexisting perceived tinnitus activity limitation/participation restriction. Both SGs and NTT provide significant reduction in perceived tinnitus handicap, with benefit being more pronounced for those patients having greater tinnitus problems at the beginning of therapy. Although the economic models favored the SGs over the NTT, there are several other critical factors that clinicians must take into account when recommending a specific sound therapy option. These include initial tinnitus severity complaints and a number of patient preference variables such as sound preference, listening acceptability, and lifestyle. American Academy of Audiology.

  5. Roadwaste : Issues and Options : appendices.

    DOT National Transportation Integrated Search

    1998-06-01

    The appendices belong to "Roadwaste : Issues and Options". : The Oregon Department of Transportation (ODOT) is conducting a study to determine roadwaste management options. Phase 1 consisted of a thorough review of regulations and standards, roadwast...

  6. Changing climate, challenging choices: identifying and evaluating climate change adaptation options for protected areas management in Ontario, Canada.

    PubMed

    Lemieux, Christopher J; Scott, Daniel J

    2011-10-01

    Climate change will pose increasingly significant challenges to managers of parks and other forms of protected areas around the world. Over the past two decades, numerous scientific publications have identified potential adaptations, but their suitability from legal, policy, financial, internal capacity, and other management perspectives has not been evaluated for any protected area agency or organization. In this study, a panel of protected area experts applied a Policy Delphi methodology to identify and evaluate climate change adaptation options across the primary management areas of a protected area agency in Canada. The panel identified and evaluated one hundred and sixty five (165) adaptation options for their perceived desirability and feasibility. While the results revealed a high level of agreement with respect to the desirability of adaptation options and a moderate level of capacity pertaining to policy formulation and management direction, a perception of low capacity for implementation in most other program areas was identified. A separate panel of senior park agency decision-makers used a multiple criterion decision-facilitation matrix to further evaluate the institutional feasibility of the 56 most desirable adaptation options identified by the initial expert panel and to prioritize them for consideration in a climate change action plan. Critically, only two of the 56 adaptation options evaluated by senior decision-makers were deemed definitely implementable, due largely to fiscal and internal capacity limitations. These challenges are common to protected area agencies in developed countries and pervade those in developing countries, revealing that limited adaptive capacity represents a substantive barrier to biodiversity conservation and other protected area management objectives in an era of rapid climate change.

  7. Changing Climate, Challenging Choices: Identifying and Evaluating Climate Change Adaptation Options for Protected Areas Management in Ontario, Canada

    NASA Astrophysics Data System (ADS)

    Lemieux, Christopher J.; Scott, Daniel J.

    2011-10-01

    Climate change will pose increasingly significant challenges to managers of parks and other forms of protected areas around the world. Over the past two decades, numerous scientific publications have identified potential adaptations, but their suitability from legal, policy, financial, internal capacity, and other management perspectives has not been evaluated for any protected area agency or organization. In this study, a panel of protected area experts applied a Policy Delphi methodology to identify and evaluate climate change adaptation options across the primary management areas of a protected area agency in Canada. The panel identified and evaluated one hundred and sixty five (165) adaptation options for their perceived desirability and feasibility. While the results revealed a high level of agreement with respect to the desirability of adaptation options and a moderate level of capacity pertaining to policy formulation and management direction, a perception of low capacity for implementation in most other program areas was identified. A separate panel of senior park agency decision-makers used a multiple criterion decision-facilitation matrix to further evaluate the institutional feasibility of the 56 most desirable adaptation options identified by the initial expert panel and to prioritize them for consideration in a climate change action plan. Critically, only two of the 56 adaptation options evaluated by senior decision-makers were deemed definitely implementable, due largely to fiscal and internal capacity limitations. These challenges are common to protected area agencies in developed countries and pervade those in developing countries, revealing that limited adaptive capacity represents a substantive barrier to biodiversity conservation and other protected area management objectives in an era of rapid climate change.

  8. Options for Martian propellant production

    NASA Technical Reports Server (NTRS)

    Dowler, Warren; French, James; Ramohalli, Kumar

    1991-01-01

    A quantitative evaluation methodology for utilizing in-situ resources on Mars for the production of useful substances. The emphasis is on the chemical processes. Various options considering different feedstock (mostly, carbon dioxide, water, and iron oxides) are carefully examined for the product mix and the energy needs. Oxygen, carbon monoxide, alcohols, and other chemicals are the end products. The chemical processes involve electrolysis, methanation, and variations. It is shown that maximizing the product utility is more important than the production of oxygen, methane, or alcohols. An important factor is the storage of the chemicals produced. The product utility is dependent, to some extent, upon the mission. A combination of the stability, the enthalpy of formation, and the mass fraction of the products is seen to yield a fairly good quantitative feel for the overall utility and maximum mission impact.

  9. Implementation of power barrier option valuation

    NASA Astrophysics Data System (ADS)

    Cahyani, Agatha C. P.; Sumarti, Novriana

    2015-09-01

    Options are financial instruments that can be utilized to reduce risk in stock investment. Barrier options are one of the major types of options actively used in financial markets where its life period depends on the path of the underlying stock prices. The features of the barrier option can be used to modify other types of options. In this research, the barrier option will be implemented into power option, so it is called power barrier option. This option is an extension of the vanilla barrier options where the Call payoff being considered is defined as P C =max (STβ-Kβ,0 ) , and the Put payoff being considered is defined as P P =max (Kβ-STβ,0 ) . Here β > 0 and β ≠ 1, K is the strike price of the option, and ST is the price of the underlying stock at time maturity T. In this paper, we generate the prices of stock using binomial method which is adjusted to the power option. In the conclusion, the price of American power barrier option is more expensive than the price of European power barrier option.

  10. The promise of circulating tumor cells for precision cancer therapy.

    PubMed

    Hwang, William L; Hwang, Katie L; Miyamoto, David T

    2016-12-01

    The rapidly growing array of therapeutic options in cancer requires informative biomarkers to guide the rational selection and precision application of appropriate therapies. Circulating biomarkers such as circulating tumor cells have immense potential as noninvasive, serial 'liquid biopsies' that may be more representative of the complete spectrum of a patient's individual malignancy than spatially and temporally restricted tumor biopsies. In this review, we discuss the current state-of-the-art in the isolation and molecular characterization of circulating tumor cells as well as their utility in a wide range of clinical applications such as prognostics, treatment monitoring and identification of novel therapeutic targets and resistance mechanisms to enable real-time adjustments in the clinical management of cancer.

  11. Effective Utilization of Oral Hypoglycemic Agents to Achieve Individualized HbA1c Targets in Patients with Type 2 Diabetes Mellitus.

    PubMed

    Bannister, Margaret; Berlanga, Jenny

    2016-09-01

    Type 2 diabetes is a progressive condition that may require the combination of three oral treatments to achieve optimal glycemic management to prevent microvascular and macrovascular complications whilst minimizing the risk of acute complications and side effects or adverse reactions to treatments. With the widening availability of treatment options and increasing importance of individualized treatment pathways, including personalized HbA1c targets, this article will explore the mode of action of currently available oral treatments, factors to consider when individualizing HbA1c targets, the relevance of estimated glomerular filtration rate assessment, and the importance of reviewing the clinical impact of all treatment decisions.

  12. Greenhouse Gas and Ammonia Emissions from Different Stages of Liquid Manure Management Chains: Abatement Options and Emission Interactions.

    PubMed

    Mohankumar Sajeev, Erangu Purath; Winiwarter, Wilfried; Amon, Barbara

    2018-01-01

    Farm livestock manure is an important source of ammonia and greenhouse gases. Concerns over the environmental impact of emissions from manure management have resulted in research efforts focusing on emission abatement. However, questions regarding the successful abatement of manure-related emissions remain. This study uses a meta-analytical approach comprising 89 peer-reviewed studies to quantify emission reduction potentials of abatement options for liquid manure management chains from cattle and pigs. Analyses of emission reductions highlight the importance of accounting for interactions between emissions. Only three out of the eight abatement options considered (frequent removal of manure, anaerobic digesters, and manure acidification) reduced ammonia (3-60%), nitrous oxide (21-55%), and methane (29-74%) emissions simultaneously, whereas in all other cases, tradeoffs were identified. The results demonstrate that a shift from single-stage emission abatement options towards a whole-chain perspective is vital in reducing overall emissions along the manure management chain. The study also identifies some key elements like proper clustering, reporting of influencing factors, and explicitly describing assumptions associated with abatement options that can reduce variability in emission reduction estimates. Prioritization of abatement options according to their functioning can help to determine low-risk emission reduction options, specifically options that alter manure characteristics (e.g., reduced protein diets, anaerobic digestion, or slurry acidification). These insights supported by comprehensive emission measurement studies can help improve the effectiveness of emission abatement and harmonize strategies aimed at reducing air pollution and climate change simultaneously. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

  13. 77 FR 58983 - New England Fishery Management Council; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-25

    ...-0492. SUPPLEMENTARY INFORMATION: The Habitat Advisory Panel and Plan Development Team will review and further develop alternatives for Omnibus Essential Fish Habitat Amendment 2. Related to gear modification options for Habitat Management Areas, they will discuss ground cable modification options in general and...

  14. Future water supply management adaptation measures - case study of Ljubljana field aquifer

    NASA Astrophysics Data System (ADS)

    Čenčur Curk, B.; Zajc Benda, T.; Souvent, P.; Bračič Železnik, B.; Bogardi, I.

    2012-04-01

    The main drinking water supply problems are related to the significant change of groundwater quantity and quality observed in the last decades as an effect of land use practices and very likely also climate change. The latter may affect the ability of drinking water suppliers to provide enough water of sufficient quality to the consumers. These topics were studied in the frame of SEE project CC-WaterS (Climate Change and Impact on Water Supply) with the main goal to develop a water supply management system regarding optimisation of water extraction and land use restrictions under climate change scenarios for water suppliers, since existing management practices are mostly inadequate to reduce impacts of CC on water supply reliability. The main goal was a designation of appropriate measures and risk assessment to adapt water supply to changing climate and land use activities considering socio-economic aspects. This was accomplished by using 'Fuzzy Decimaker', which is a tool for selecting and ranking risk reduction measures or management actions for local waterworks or water authorities under the pressure of climate change. Firstly, management options were selected and ranked. For public water supply of Ljubljana, the capital of Slovenia, several management options were selected. For improvement of water supply and preservation of water resource quantities there is a need for engineering interventions, such as reducing water losses on pipelines. For improving drinking water safety and preserving water resource quality farmers are not allowed to use fertilisers in the first safeguarding zone and they get compensations for income reduction because of lower farming production. Compensations for farming restrictions in the second safeguarding zone were applied as additional management option. On the other hand, drinking water treatment is another management option to be considered. Trends in groundwater level are decreasing, above all recharge areas of waterworks; therefore there is a threat of reduction of water resource availability. For this following management options were proposed: artificial recharge with infiltration wells, setting up new and additional waterworks (one with river bank filtration, one with exploitation of local porous aquifer and one with deep groundwater exploitation from dolomite aquifer). Management actions can be evaluated according to several criteria, such as water supply risk reduction for the various users (drinking, agricultural, industrial and ecological), realization of the actions (cost, flexibility and leg time). Ranking criteria are characterized by different units (e.g. units of water supply (quantity) risk may involve number of unsupplied people, monetary terms, agricultural area or habitat loss). Decision making process is followed by defining relative weights, balancing factors and best and worst values for the indicators; calculating base risk and risk elements for each management option and sensitivity analysis. The result of this decision making process is evaluation of preferred management option(s) according to the ranking results.

  15. 48 CFR 47.305-11 - Options in shipment and delivery.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Options in shipment and... CONTRACT MANAGEMENT TRANSPORTATION Transportation in Supply Contracts 47.305-11 Options in shipment and... shipment and delivery, it may be desirable to provide specifically for certain options in the solicitation...

  16. Analysis of edible oil processing options for the BIO-Plex advanced life support system

    NASA Technical Reports Server (NTRS)

    Greenwalt, C. J.; Hunter, J.

    2000-01-01

    Edible oil is a critical component of the proposed plant-based Advanced Life Support (ALS) diet. Soybean, peanut, and single-cell oil are the oil source options to date. In terrestrial manufacture, oil is ordinarily extracted with hexane, an organic solvent. However, exposed solvents are not permitted in the spacecraft environment or in enclosed human tests by National Aeronautics and Space Administration due to their potential danger and handling difficulty. As a result, alternative oil-processing methods will need to be utilized. Preparation and recovery options include traditional dehulling, crushing, conditioning, and flaking, extrusion, pressing, water extraction, and supercritical extraction. These processing options were evaluated on criteria appropriate to the Advanced Life Support System and BIO-Plex application including: product quality, product stability, waste production, risk, energy needs, labor requirements, utilization of nonrenewable resources, usefulness of by-products, and versatility and mass of equipment to determine the most appropriate ALS edible oil-processing operation.

  17. Real options analysis for land use management: Methods, application, and implications for policy.

    PubMed

    Regan, Courtney M; Bryan, Brett A; Connor, Jeffery D; Meyer, Wayne S; Ostendorf, Bertram; Zhu, Zili; Bao, Chenming

    2015-09-15

    Discounted cash flow analysis, including net present value is an established way to value land use and management investments which accounts for the time-value of money. However, it provides a static view and assumes passive commitment to an investment strategy when real world land use and management investment decisions are characterised by uncertainty, irreversibility, change, and adaptation. Real options analysis has been proposed as a better valuation method under uncertainty and where the opportunity exists to delay investment decisions, pending more information. We briefly review the use of discounted cash flow methods in land use and management and discuss their benefits and limitations. We then provide an overview of real options analysis, describe the main analytical methods, and summarize its application to land use investment decisions. Real options analysis is largely underutilized in evaluating land use decisions, despite uncertainty in policy and economic drivers, the irreversibility and sunk costs involved. New simulation methods offer the potential for overcoming current technical challenges to implementation as demonstrated with a real options simulation model used to evaluate an agricultural land use decision in South Australia. We conclude that considering option values in future policy design will provide a more realistic assessment of landholder investment decision making and provide insights for improved policy performance. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Carbon footprint and energy use of food waste management options for fresh fruit and vegetables from supermarkets.

    PubMed

    Eriksson, Mattias; Spångberg, Johanna

    2017-02-01

    Food waste is a problem with economic, environmental and social implications, making it both important and complex. Previous studies have addressed food waste management options at the less prioritised end of the waste hierarchy, but information on more prioritised levels is also needed when selecting the best available waste management options. Investigating the global warming potential and primary energy use of different waste management options offers a limited perspective, but is still important for validating impacts from the waste hierarchy in a local context. This study compared the effect on greenhouse gas emissions and primary energy use of different food waste management scenarios in the city of Växjö, Sweden. A life cycle assessment was performed for four waste management scenarios (incineration, anaerobic digestion, conversion and donation), using five food products (bananas, tomatoes, apples, oranges and sweet peppers) from the fresh fruit and vegetables department in two supermarkets as examples when treated as individual waste streams. For all five waste streams, the established waste hierarchy was a useful tool for prioritising the various options, since the re-use options (conversion and donation) reduced the greenhouse gas emissions and the primary energy use to a significantly higher degree than the energy recovery options (incineration and anaerobic digestion). The substitution of other products and services had a major impact on the results in all scenarios. Re-use scenarios where food was replaced therefore had much higher potential to reduce environmental impact than the energy recovery scenarios where fossil fuel was replaced. This is due to the high level of resources needed to produce food compared with production of fossil fuels, but also to fresh fruit and vegetables having a high water content, making them inefficient as energy carriers. Waste valorisation measures should therefore focus on directing each type of food to the waste management system that can substitute the most resource-demanding products or services, even when the whole waste flow cannot be treated with the same method. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Greenhouse gas balances in low-productive drained boreal peatlands - is climate-friendly management possible?

    NASA Astrophysics Data System (ADS)

    Ojanen, Paavo; Minkkinen, Kari; Heikkinen, Tiina; Penttilä, Timo

    2016-04-01

    Five million hectares of peatland has been drained for forestry in Finland. About 20% of that, i.e. one million hectares, has been estimated to be so low-productive that the profitability of keeping them in forestry is questionable. At the same time, drainage has introduced changes in the ecosystem functions of these peatlands, including fluxes of greenhouse gases. Options to manage such peatlands include for example 1) no measures, i.e. leaving the drained peatlands as they are 2) increasing intensity by e.g. repetitive fertilisations and 3) restoration back to functional peatlands. Here we estimate the greenhouse gas impacts of these three management options. We collected GHG and organic carbon flux data from 50 low-productive peatlands under these management options over two years 2014-2015. Gas fluxes (CO2, CH4, N2O) were measured with closed chambers. Litter production rates of different plants above and below ground were estimated using litter traps (trees), biomass sampling (roots), through-grow nets (mosses), allometric biomass models (other vasculars) and published turnover rates (roots, other vasculars). Characteristics for estimating tree stand biomass increment were measured at each site from circular sample plots. In this presentation we will estimate the GHG impacts for the different management options, and aim to find the most climate-friendly options for the management of low-productive peatlands in the short and long term. This work was funded by Life+ LIFE12/ENV/FI/150.

  20. Management of the Jehovah’s Witness in Obstetrics and Gynecology: A Comprehensive Medical, Ethical and Legal Approach

    PubMed Central

    Zeybek, Burak; Childress, Andrew; Kilic, Gokhan S.; Phelps, John; Pacheco, Luis; Carter, Michele; Borahay, Mostafa A.

    2016-01-01

    Importance Obstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patients who refuse blood transfusion. Although there are some reports in the literature about management of Jehovah’s Witness patients in obstetrics and gynecology, most of them are case reports and a comprehensive review about these patients including ethico-legal perspective is lacking. Objective This review outlines the medical, ethical and legal implications of management of Jehovah’s Witness patients in obstetrical and gynecological settings. Evidence Acquisition A search of published literature using Pubmed, Ovid Medline, EMBASE and Cochrane databases was conducted about physiology of oxygen delivery and response to tissue hypoxia, mortality rates at certain hemoglobin levels, medical management options for anemic patients who refuse blood transfusion and ethical/legal considerations in Jehovah’s Witness patients. Results Early diagnosis of anemia and immediate initiation of therapy is essential in patients who refuse blood transfusion. Medical management options include iron supplementation and erythropoietin. There are also some promising therapies that are in development such as anti-hepcidin antibodies and hemoglobin based oxygen carriers. Options to decrease blood loss include anti-fibrinolytics, desmopressin, recombinant Factor VII and factor concentrates. When surgery is the only option, every effort should be made to pursue minimally invasive approaches. Conclusion and Relevance All obstetricians and gynecologists should be familiar with alternatives and ‘less invasive’ options for patients who refuse blood transfusions. Target Audience Obstetricians and gynecologists, family physicians PMID:27526872

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

    Lewis, M.S.

    The Barnwell Waste Management Facility (BWMF) is scheduled to restrict access to waste generators outside of the Atlantic Compact (SC, CT, NJ) on July 1, 2008. South Carolina, authorized under the Low-Level Waste Policy Act of 1980 and Amendments Act of 1985, and in agreement with the other Atlantic Compact states, will only accept Class A, B, and C low-level radioactive waste (LLRW) generated within compact. For many years, the BWMF has been the only LLRW disposal facility to accept Class B and C waste from LLRW generators throughout the country, except those that have access to the Northwest Compactmore » Site. Many Class B/C waste generators consider this to be a national crisis situation requiring interim or possible permanent storage, changes in operation, significant cost impacts, and/or elimination of services, especially in the health care and non-power generation industries. With proper in-house waste management practices and utilization of commercial processor services, a national crisis can be avoided, although some generators with specific waste forms or radionuclides will remain without options. In summary: It is unknown what the future will bring for commercial LLRW disposal. Could the anticipated post Barnwell Class B/C crisis be avoided by any of the following? - Barnwell Site remains open for the nation's commercial Class B/C waste; - Richland Site opens back up to the nation for commercial Class B/C waste; - Texas Site opens up to the nation for commercial Class B/C waste; - Federal Government intervenes by keeping a commercial Class B/C site open for the nation's commercial Class B/C waste; - Federal Government makes a DOE site available for commercial Class B/C waste; - Federal Government revisits the LLRW Policy Act of 1980 and Amendments Act of 1985. Without a future LLRW site capable of accepting Class B/C currently on the horizon, commercial LLRW generators are faced with waste volume elimination, reduction, or storage. With proper in-house waste management practices, utilization of commercial processor services and regulatory relief, a national crisis can be avoided. Waste volumes for storage can be reduced to as little as 10% of the current Class B/C volume. Although a national LLRW crisis can be avoided, some generators with specific waste forms or radionuclides will have a significant financial and/or operational impact due to a lack of commercial LLRW management options. (authors)« less

  2. 30 CFR 204.203 - What is the other relief option?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... MANAGEMENT ALTERNATIVES FOR MARGINAL PROPERTIES Accounting and Auditing Relief § 204.203 What is the other relief option? (a) Under this relief option, you may request any type of accounting and auditing relief...

  3. Management Options and Outcomes for Neonatal Hypoplastic Left Heart Syndrome in the Early Twenty-First Century.

    PubMed

    Kane, Jason M; Canar, Jeff; Kalinowski, Valerie; Johnson, Tricia J; Hoehn, K Sarah

    2016-02-01

    Without surgical treatment, neonatal hypoplastic left heart syndrome (HLHS) mortality in the first year of life exceeds 90 % and, in spite of improved surgical outcomes, many families still opt for non-surgical management. The purpose of this study was to investigate trends in neonatal HLHS management and to identify characteristics of patients who did not undergo surgical palliation. Neonates with HLHS were identified from a serial cross-sectional analysis using the Healthcare Cost and Utilization Project's Kids' Inpatient Database from 2000 to 2012. The primary analysis compared children undergoing surgical palliation to those discharged alive without surgery using a binary logistic regression model. Multivariate logistic regression was conducted to determine factors associated with treatment choice. A total of 1750 patients underwent analysis. Overall hospital mortality decreased from 35.3 % in 2000 to 22.9 % in 2012. The percentage of patients undergoing comfort care discharge without surgery also decreased from 21.2 to 14.8 %. After controlling for demographics and comorbidities, older patients at presentation were less likely to undergo surgery (OR 0.93, 0.91-0.96), and patients in 2012 were more likely to undergo surgery compared to those in prior years (OR 1.5, 1.1-2.1). Discharge without surgical intervention is decreasing with a 30 % reduction between 2000 and 2012. Given the improvement in surgical outcomes, further dialogue about ethical justification of non-operative comfort or palliative care is warranted. In the meantime, clinicians should present families with surgical outcome data and recommend intervention, while supporting their option to refuse.

  4. The ultimate disposition of depleted uranium

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

    Not Available

    1990-12-01

    Significant amounts of the depleted uranium (DU) created by past uranium enrichment activities have been sold, disposed of commercially, or utilized by defense programs. In recent years, however, the demand for DU has become quite small compared to quantities available, and within the US Department of Energy (DOE) there is concern for any risks and/or cost liabilities that might be associated with the ever-growing inventory of this material. As a result, Martin Marietta Energy Systems, Inc. (Energy Systems), was asked to review options and to develop a comprehensive plan for inventory management and the ultimate disposition of DU accumulated atmore » the gaseous diffusion plants (GDPs). An Energy Systems task team, under the chairmanship of T. R. Lemons, was formed in late 1989 to provide advice and guidance for this task. This report reviews options and recommends actions and objectives in the management of working inventories of partially depleted feed (PDF) materials and for the ultimate disposition of fully depleted uranium (FDU). Actions that should be considered are as follows. (1) Inspect UF{sub 6} cylinders on a semiannual basis. (2) Upgrade cylinder maintenance and storage yards. (3) Convert FDU to U{sub 3}O{sub 8} for long-term storage or disposal. This will include provisions for partial recovery of costs to offset those associated with DU inventory management and the ultimate disposal of FDU. Another recommendation is to drop the term tails'' in favor of depleted uranium'' or DU'' because the tails'' label implies that it is waste.'' 13 refs.« less

  5. Options to improve energy efficiency for educational building

    NASA Astrophysics Data System (ADS)

    Jahan, Mafruha

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

  6. The medical management of abnormal uterine bleeding in reproductive-aged women.

    PubMed

    Bradley, Linda D; Gueye, Ndeye-Aicha

    2016-01-01

    In the treatment of women with abnormal uterine bleeding, once a thorough history, physical examination, and indicated imaging studies are performed and all significant structural causes are excluded, medical management is the first-line approach. Determining the acuity of the bleeding, the patient's medical history, assessing risk factors, and establishing a diagnosis will individualize their medical regimen. In acute abnormal uterine bleeding with a normal uterus, parenteral estrogen, a multidose combined oral contraceptive regimen, a multidose progestin-only regimen, and tranexamic acid are all viable options, given the appropriate clinical scenario. Heavy menstrual bleeding can be treated with a levonorgestrel-releasing intrauterine system, combined oral contraceptives, continuous oral progestins, and tranexamic acid with high efficacy. Nonsteroidal antiinflammatory drugs may be utilized with hormonal methods and tranexamic acid to decrease menstrual bleeding. Gonadotropin-releasing hormone agonists are indicated in patients with leiomyoma and abnormal uterine bleeding in preparation for surgical interventions. In women with inherited bleeding disorders all hormonal methods as well as tranexamic acid can be used to treat abnormal uterine bleeding. Women on anticoagulation therapy should consider using progestin-only methods as well as a gonadotropin-releasing hormone agonist to treat their heavy menstrual bleeding. Given these myriad options for medical treatment of abnormal uterine bleeding, many patients may avoid surgical intervention. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Family Communication, Risk Perception and Cancer Knowledge of Young Adults from BRCA1/2 Families: a Systematic Review.

    PubMed

    Young, Alison L; Butow, Phyllis N; Vetsch, Janine; Quinn, Veronica F; Patenaude, Andrea F; Tucker, Katherine M; Wakefield, Claire E

    2017-12-01

    Understanding challenges in familial communication of cancer risk has informed genetic service delivery. Parent-child interactions have received considerable attention, but few studies focus on young adulthood experiences within BRCA1/2 families. Young adults are approaching, or at a life stage where awareness of hereditary cancer risk is vital for informed choice of risk management options. This review assesses family communication, risk perception and cancer knowledge held by 18-40 year old individuals who have a parent with a BRCA1/2 gene mutation or carry the gene mutation themselves. Thirteen papers met the inclusion criteria. One utilized a 'mixed methods' methodology and the remaining used a qualitative approach. Findings were synthesized into themes and reported narratively. In general, parents are communicating openly about genetic risk with young adult offspring, but there is evidence that some young adults are withholding information from their parents about their own test results. Risk perception is influenced by a family history of cancer, childbearing plans and health providers' advice. Misconceptions about genetic risk appear to be common and gaps in hereditary cancer knowledge are evident. It is unclear whether incorrect knowledge was passed from parents to offspring. Health providers need to provide developmentally appropriate services for emerging adults (18-25 years old), with particular support in navigating through risk management options.

  8. Development and refinement of the WAItE: a new obesity-specific quality of life measure for adolescents.

    PubMed

    Oluboyede, Yemi; Hulme, Claire; Hill, Andrew

    2017-08-01

    Few weight-specific outcome measures, developed specifically for obese and overweight adolescents, exist and none are suitable for the elicitation of utility values used in the assessment of cost effectiveness. The development of a descriptive system for a new weight-specific measure. Qualitative interviews were conducted with 31 treatment-seeking (above normal weight status) and non-treatment-seeking (school sample) adolescents aged 11-18 years, to identify a draft item pool and associated response options. 315 eligible consenting adolescents, aged 11-18 years, enrolled in weight management services and recruited via an online panel, completed two version of a long-list 29-item descriptive system (consisting of frequency and severity response scales). Psychometric assessments and Rasch analysis were applied to the draft 29-item instrument to identify a brief tool containing the best performing items and associated response options. Seven items were selected, for the final item set; all displayed internal consistency, moderate floor effects and the ability to discriminate between weight categories. The assessment of unidimensionality was supported (t test statistic of 0.024, less than the 0.05 threshold value). The Weight-specific Adolescent Instrument for Economic-evaluation focuses on aspects of life affected by weight that are important to adolescents. It has the potential for adding key information to the assessment of weight management interventions aimed at the younger population.

  9. Photovoltaic technology for sustainability: An investigation of the distributed utility concept as a policy framework

    NASA Astrophysics Data System (ADS)

    Letendre, Steven Emery

    The U.S. electric utility sector in its current configuration is unsustainable. The majority of electricity in the United States is produced using finite fossil fuels. In addition, significant potential exists to improve the nation's efficient use of energy. A sustainable electric utility sector will be characterized by increased use of renewable energy sources and high levels of end-use efficiency. This dissertation analyzes two alternative policy approaches designed to move the U.S. electric utility sector toward sustainability. One approach is labeled incremental which involves maintaining the centralized structure of the electric utility sector but facilitating the introduction of renewable energy and efficiency into the electrical system through the pricing mechanism. A second policy approach was described in which structural changes are encouraged based on the emerging distributed utility (DU) concept. A structural policy orientation attempts to capture the unique localized benefits that distributed renewable resources and energy efficiency offer to electric utility companies and their customers. A market penetration analysis of PV in centralized energy supply and distributed peak-shaving applications is conducted for a case-study electric utility company. Sensitivity analysis was performed based on incremental and structural policy orientations. The analysis provides compelling evidence which suggests that policies designed to bring about structural change in the electric utility sector are needed to move the industry toward sustainability. Specifically, the analysis demonstrates that PV technology, a key renewable energy option likely to play an important role in a renewable energy future, will begin to penetrate the electrical system in distributed peak-shaving applications long before the technology is introduced as a centralized energy supply option. Most policies to date, which I term incremental, attempt to encourage energy efficiency and renewables through the pricing system. Based on past policy experience, it is unlikely that such an approach would allow PV to compete in Delaware as an energy supply option in the next ten to twenty years. Alternatively, a market-based, or green pricing, approach will not create significant market opportunities for PV as a centralized energy supply option. However, structural policies designed to encourage the explicit recognition of the localized benefits of distributed resources could result in PV being introduced into the electrical system early in the next century.

  10. Dialysis-associated steal syndrome (DASS).

    PubMed

    Mohamed, Ahmed S; Peden, Eric K

    2017-03-06

    In this article, we will review the clinical symptoms of dialysis access steal syndrome (DASS), evaluation, treatment options, and our approach and treatment algorithm. We reviewed the literature discussing different aspects of DASS including its epidemiology, pathogenesis, clinical presentation, evaluation and management options. DASS is the most dreaded complication of access surgery. Although the incidence is low, all providers caring for dialysis patients should be aware of this problem. Symptoms can range from mild to limb threatening. Although various tests are available, the diagnosis of DASS remains a clinical one and requires thoughtful management to have the best outcomes. Multiple treatment options exist for steal. We present diagnostic evaluation and management algorithm.

  11. Understanding Consistency Maintenance in Service Discovery Architectures during Communication Failure

    DTIC Science & Technology

    2002-07-01

    our general model include: (1) service user (SU), (2) service manager (SM), and (3) service cache manager ( SCM ), where the SCM is an optional...maintained by SMs that satisfy specific requirements. Where employed, the SCM operates as an intermediary, matching advertised SDs of SMs to...Directory Service Agent (optional) not applicableLookup ServiceService Cache Manager ( SCM ) Service URL Service Type Service Attributes Template URL

  12. Complications of transplantation. Part 1: renal transplants.

    PubMed

    Khaja, Minhaj S; Matsumoto, Alan H; Saad, Wael E

    2014-10-01

    Vascular complications after solid-organ transplantation are not uncommon and may lead to graft dysfunction and ultimately graft loss. A thorough understanding of the surgical anatomy, etiologies, and types of vascular complications, their presentation, and the options for management are important for managing these complex patients. This article reviews the basic surgical anatomy, vascular complications, and endovascular management options of vascular complications in patients with renal transplants.

  13. Public Response to Wildfire: Is the Australian "Stay and Defend or Leave Early" Approach an Option for Wildfire Management in the United States?

    Treesearch

    Sarah M. McCaffrey; Alan Rhodes

    2009-01-01

    In the United States, the increasing costs and negative impacts of wildfires are causing fire managers and policymakers to reexamine traditional approaches to fire management including whether mass evacuation of populations threatened by wildfire is always the most appropriate option. This article examines the Australian "stay and defend or leave early" (SDLE...

  14. Management Options For Reducing The Release Of Antibiotics And Antibiotic Resistance Genes To The Environment

    EPA Science Inventory

    Background: There is growing concern worldwide about the role of polluted soil and water - 77 environments in the development and dissemination of antibiotic resistance. 78 Objective: To identify management options for reducing the spread of antibiotics and 79 antibiotic resist...

  15. 75 FR 14427 - Gulf of Mexico Fishery Management Council (Council); Public Meetings

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-25

    .... Stephen Bortone, Executive Director, Gulf of Mexico Fishery Management Council; telephone: 813- 348-1630... Reef Fish Scientific and Statistical Committee; discuss Options Paper for Amendment 32 Gag/Red Grouper... Statistical Committee Acceptable Biological Catch Control Rule Report; discuss the Options Paper for the...

  16. Consider Creating a Channel Management Strategy with Both Colleagues and Patients

    PubMed Central

    Felkey, Bill G.; Fox, Brent I.

    2013-01-01

    Patient engagement is poised to provide considerable opportunities for reaching patients. The range of connectivity options should be considered to include the best option for each specific patient. In this article, we address this area of growing importance, telecommunication channel management. PMID:24421455

  17. Grazing management options in meeting objectives of grazing experiments

    USDA-ARS?s Scientific Manuscript database

    Decisions on which grazing management option to use in grazing experiments can be critical in meeting research objectives and generating information for the scientific community or technologies that meets the needs of forage-based enterprises. It is necessary to have an understanding of animal per...

  18. Life Cycle Assessment of landfill biogas management: sensitivity to diffuse and combustion air emissions.

    PubMed

    Beylot, Antoine; Villeneuve, Jacques; Bellenfant, Gaël

    2013-02-01

    GOAL AND SCOPE: The life cycle inventory of landfill emissions is a key point in Life Cycle Assessment (LCA) of waste management options and is highly subject to discussion. Result sensitivity to data inventory is accounted for through the implementation of scenarios that help examine how waste landfilling should be modeled in LCA. Four landfill biogas management options are environmentally evaluated in a Life Cycle Assessment perspective: (1) no biogas management (open dump), conventional landfill with (2) flaring, (3) combined heat and power (CHP) production in an internal combustion engine and (4) biogas upgrading for use as a fuel in buses. Average, maximum and minimum literature values are considered both for combustion emission factors in flares and engines and for trace pollutant concentrations in biogas. Biogas upgrading for use as a fuel in buses appears as the most relevant option with respect to most non-toxic impact categories and ecotoxicity, when considering average values for trace gas concentrations and combustion emission factors. Biogas combustion in an engine for CHP production shows the best performances in terms of climate change, but generates significantly higher photochemical oxidant formation and marine eutrophication impact potentials than flaring or biogas upgrading for use as a fuel in buses. However the calculated environmental impact potentials of landfill biogas management options depend largely on the trace gas concentrations implemented in the model. The use of average or extreme values reported in the literature significantly modifies the impact potential of a given scenario (up to two orders of magnitude for open dumps with respect to human toxicity). This should be taken into account when comparing landfilling with other waste management options. Also, the actual performances of a landfill top cover (in terms of oxidation rates) and combustion technology (in terms of emission factors) appear as key parameters affecting the ranking of biogas management options. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Space station data system analysis/architecture study. Task 2: Options development, DR-5. Volume 3: Programmatic options

    NASA Technical Reports Server (NTRS)

    1985-01-01

    Task 2 in the Space Station Data System (SSDS) Analysis/Architecture Study is the development of an information base that will support the conduct of trade studies and provide sufficient data to make design/programmatic decisions. This volume identifies the preferred options in the programmatic category and characterizes these options with respect to performance attributes, constraints, costs, and risks. The programmatic category includes methods used to administrate/manage the development, operation and maintenance of the SSDS. The specific areas discussed include standardization/commonality; systems management; and systems development, including hardware procurement, software development and system integration, test and verification.

  20. Assessing the integrated pest management practices of southeastern US ornamental nursery operations.

    PubMed

    LeBude, Anthony V; White, Sarah A; Fulcher, Amy F; Frank, Steve; Klingeman Iii, William E; Chong, Juang-Horng; Chappell, Matthew R; Windham, Alan; Braman, Kris; Hale, Frank; Dunwell, Winston; Williams-Woodward, Jean; Ivors, Kelly; Adkins, Craig; Neal, Joe

    2012-09-01

    The Southern Nursery Integrated Pest Management (SNIPM) working group surveyed ornamental nursery crop growers in the southeastern United States to determine their pest management practices. Respondents answered questions about monitoring practices for insects, diseases and weeds, prevention techniques, intervention decisions, concerns about IPM and educational opportunities. Survey respondents were categorized into three groups based on IPM knowledge and pest management practices adopted. The three groups differed in the use of standardized sampling plans for scouting pests, in monitoring techniques, e.g. sticky cards, phenology and growing degree days, in record-keeping, in the use of spot-spraying and in the number of samples sent to a diagnostic clinic for identification and management recommendation. Stronger emphasis is needed on deliberate scouting techniques and tools to monitor pest populations to provide earlier pest detection and greater flexibility of management options. Most respondents thought that IPM was effective and beneficial for both the environment and employees, but had concerns about the ability of natural enemies to control insect pests, and about the availability and effectiveness of alternatives to chemical controls. Research and field demonstration is needed for selecting appropriate natural enemies for augmentative biological control. Two groups utilized cooperative extension almost exclusively, which would be an avenue for educating those respondents. Copyright © 2012 Society of Chemical Industry.

  1. Systematic Review of the Use of Phytochemicals for Management of Pain in Cancer Therapy

    PubMed Central

    Harrison, Andrew M.; Heritier, Fabrice; Childs, Bennett G.; Bostwick, J. Michael; Dziadzko, Mikhail A.

    2015-01-01

    Pain in cancer therapy is a common condition and there is a need for new options in therapeutic management. While phytochemicals have been proposed as one pain management solution, knowledge of their utility is limited. The objective of this study was to perform a systematic review of the biomedical literature for the use of phytochemicals for management of cancer therapy pain in human subjects. Of an initial database search of 1,603 abstracts, 32 full-text articles were eligible for further assessment. Only 7 of these articles met all inclusion criteria for this systematic review. The average relative risk of phytochemical versus control was 1.03 [95% CI 0.59 to 2.06]. In other words (although not statistically significant), patients treated with phytochemicals were slightly more likely than patients treated with control to obtain successful management of pain in cancer therapy. We identified a lack of quality research literature on this subject and thus were unable to demonstrate a clear therapeutic benefit for either general or specific use of phytochemicals in the management of cancer pain. This lack of data is especially apparent for psychotropic phytochemicals, such as the Cannabis plant (marijuana). Additional implications of our findings are also explored. PMID:26576425

  2. 24 CFR 965.505 - Standards for allowances for utilities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... PHA installs air conditioning, it shall provide, to the maximum extent economically feasible, systems... systems that offer each resident the option to choose air conditioning shall include retail meters or... allowances. For systems that offer residents the option to choose air conditioning but cannot be checkmetered...

  3. Space station data system analysis/architecture study. Task 2: Options development, DR-5. Volume 2: Design options

    NASA Technical Reports Server (NTRS)

    1985-01-01

    The primary objective of Task 2 is the development of an information base that will support the conduct of trade studies and provide sufficient data to make key design/programmatic decisions. This includes: (1) the establishment of option categories that are most likely to influence Space Station Data System (SSDS) definition; (2) the identification of preferred options in each category; and (3) the characterization of these options with respect to performance attributes, constraints, cost and risk. This volume contains the options development for the design category. This category comprises alternative structures, configurations and techniques that can be used to develop designs that are responsive to the SSDS requirements. The specific areas discussed are software, including data base management and distributed operating systems; system architecture, including fault tolerance and system growth/automation/autonomy and system interfaces; time management; and system security/privacy. Also discussed are space communications and local area networking.

  4. Analysis of Factors for Incorporating User Preferences in Air Traffic Management: A system Perspective

    NASA Technical Reports Server (NTRS)

    Sheth, Kapil S.; Gutierrez-Nolasco, Sebastian

    2010-01-01

    This paper presents an analysis of factors that impact user flight schedules during air traffic congestion. In pre-departure flight planning, users file one route per flight, which often leads to increased delays, inefficient airspace utilization, and exclusion of user flight preferences. In this paper, first the idea of filing alternate routes and providing priorities on each of those routes is introduced. Then, the impact of varying planning interval and system imposed departure delay increment is discussed. The metrics of total delay and equity are used for analyzing the impact of these factors on increased traffic and on different users. The results are shown for four cases, with and without the optional routes and priority assignments. Results demonstrate that adding priorities to optional routes further improves system performance compared to filing one route per flight and using first-come first-served scheme. It was also observed that a two-hour planning interval with a five-minute system imposed departure delay increment results in highest delay reduction. The trend holds for a scenario with increased traffic.

  5. A Review of Methamphetamine Dependence and Withdrawal Treatment: A Focus on Anxiety Outcomes.

    PubMed

    Hellem, Tracy L

    2016-12-01

    Rates of anxiety disorders among individuals who use methamphetamine are estimated to be as high as 30.2%. The presence of an anxiety disorder in methamphetamine users is associated with higher rates of relapse, non-adherence to treatment and poorer outcomes relative to methamphetamine users without an anxiety disorder. A review investigating current treatment options for methamphetamine dependence or withdrawal from methamphetamine was conducted using PubMed, CINAHL and PsycINFO. The focus of the review was trials that utilized an intervention and collected anxiety as an outcome measure. Seven studies were included in the review, and five of these studies examined a pharmacotherapy option, one studied a psychosocial intervention and one study investigated exercise as an intervention. Some of the pharmacotherapy studies and the study of exercise were associated with improvements in mood and/or a reduction in methamphetamine use. Concerns of sample size and measurement of anxiety were raised. Future well-designed research with large sample sizes is warranted to examine how to manage anxiety among methamphetamine users. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. [Dysphagia management of acute and long-term critically ill intensive care patients].

    PubMed

    Zielske, J; Bohne, S; Axer, H; Brunkhorst, F M; Guntinas-Lichius, O

    2014-10-01

    Dysphagia is a severe complication in critically ill patients and affects more than half the patients in an intensive care unit. Dysphagia also has a strong impact on morbidity and mortality. Risk factors for the development of dysphagia are neurological diseases, age >55-70 years, intubation >7 days and sepsis. With increasing numbers of long-term survivors chronic dysphagia is becoming an increasing problem. There is not much knowledge on the influence of specific diseases, including the direct impact of sepsis on the development of dysphagia. Fiberoptic evaluation of swallowing is a standardized tool for bedside evaluation, helping to plan swallowing training during the acute phase and to decrease the rate of chronic dysphagia. For evaluation of chronic dysphagia even more extensive diagnostic tools as well as several options of stepwise rehabilitation using restitution, compensation and adaption strategies for swallowing exist. Currently it seems that these options are not being sufficiently utilized. In general, there is a need for controlled clinical trials analyzing specific swallowing rehabilitation concepts for former critically ill patients and long-term survivors.

  7. Early ART initiation among HIV-positive pregnant women in central Mozambique: a stepped wedge randomized controlled trial of an optimized Option B+ approach.

    PubMed

    Cowan, James F; Micek, Mark; Cowan, Jessica F Greenberg; Napúa, Manuel; Hoek, Roxanne; Gimbel, Sarah; Gloyd, Stephen; Sherr, Kenneth; Pfeiffer, James T; Chapman, Rachel R

    2015-04-30

    Despite effective prevention strategies and increasing investments in global health, maternal to child transmission (MTCT) of HIV remains a significant problem globally, especially in sub-Saharan Africa. In 2012, there were 94,000 HIV-positive pregnant women in Mozambique. Approximately 15% of these women transmitted HIV to their newborn infants, resulting in nearly 14,000 new pediatric HIV infections that year. To address this issue, in 2013, the Mozambican Ministry of Health implemented the World Health Organization-recommended "Option B+" strategy in which all newly diagnosed HIV-positive pregnant women are counseled to initiate combination anti-retroviral therapy (ART) immediately upon diagnosis regardless of CD4 count and to continue treatment for life. Given the limited experience with Option B+ in sub-Saharan Africa, few rigorous pragmatic trials have studied this new treatment strategy. This study utilizes an initial formative research process involving patient and health care provider interviews and focus groups, workforce assessments, value stream mapping, and commodity utilization assessments to understand the strengths and weaknesses in the current Option B+ care cascade. The formative research is intended to guide identification and prioritization of key workflow modifications and the development of an enhanced adherence and retention package. These two components are bundled into a defined intervention implemented and evaluated across six health facilities utilizing a stepped wedge randomized controlled trial study design. The overall objective of this trial is to develop and test a pilot intervention in central Mozambique to implement the new Option B+ guidelines with high fidelity and increase the proportion of HIV-positive pregnant women in target antenatal clinics (ANC) who start ART prior to delivery and are retained in care. This pragmatic study utilizes research strategies that have the potential to meaningfully improve the Option B+ care cascade in central Mozambique and to decrease the MTCT of HIV. This trial is designed to identify critical low-cost improvement strategies that can be bundled into a defined intervention. If this intervention has a measurable impact, it can be rapidly scaled up to other ANC in Mozambique and sub-Saharan Africa. ClinicalTrials.gov: NCT02371265.

  8. Distributed Energy Implementation Options

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

    Shah, Chandralata N

    2017-09-13

    This presentation covers the options for implementing distributed energy projects. It distinguishes between options available for distributed energy that is government owned versus privately owned, with a focus on the privately owned options including Energy Savings Performance Contract Energy Sales Agreements (ESPC ESAs). The presentation covers the new ESPC ESA Toolkit and other Federal Energy Management Program resources.

  9. Scope Complexity Options Risks Excursions (SCORE) Version 3.0 Mathematical Description.

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

    Gearhart, Jared Lee; Samberson, Jonell Nicole; Shettigar, Subhasini

    The purpose of the Scope, Complexity, Options, Risks, Excursions (SCORE) model is to estimate the relative complexity of design variants of future warhead options. The results of this model allow those considering these options to understand the complexity tradeoffs between proposed warhead options. The core idea of SCORE is to divide a warhead option into a well- defined set of scope elements and then estimate the complexity of each scope element against a well understood reference system. The uncertainty associated with estimates can also be captured. A weighted summation of the relative complexity of each scope element is used tomore » determine the total complexity of the proposed warhead option or portions of the warhead option (i.e., a National Work Breakdown Structure code). The SCORE analysis process is a growing multi-organizational Nuclear Security Enterprise (NSE) effort, under the management of the NA- 12 led Enterprise Modeling and Analysis Consortium (EMAC), that has provided the data elicitation, integration and computation needed to support the out-year Life Extension Program (LEP) cost estimates included in the Stockpile Stewardship Management Plan (SSMP).« less

  10. Sound therapy for tinnitus management: practicable options.

    PubMed

    Hoare, Derek J; Searchfield, Grant D; El Refaie, Amr; Henry, James A

    2014-01-01

    The authors reviewed practicable options of sound therapy for tinnitus, the evidence base for each option, and the implications of each option for the patient and for clinical practice. To provide a general guide to selecting sound therapy options in clinical practice. Practicable sound therapy options. Where available, peer-reviewed empirical studies, conference proceedings, and review studies were examined. Material relevant to the purpose was summarized in a narrative. The number of peer-reviewed publications pertaining to each sound therapy option reviewed varied significantly (from none to over 10). Overall there is currently insufficient evidence to support or refute the routine use of individual sound therapy options. It is likely, however, that sound therapy combined with education and counseling is generally helpful to patients. Clinicians need to be guided by the patient's point of care, patient motivation and expectations of sound therapy, and the acceptability of the intervention both in terms of the sound stimuli they are to use and whether they are willing to use sound extensively or intermittently. Clinicians should also clarify to patients the role sound therapy is expected to play in the management plan. American Academy of Audiology.

  11. Analysis of returns above variable costs for management of Verticillium wilt in cotton

    USDA-ARS?s Scientific Manuscript database

    A large plot study located in Halfway, TX, was conducted from 2007 to 2013 in an irrigated field infested with Verticillium wilt. Management options (crop rotation, irrigation amount, variety election) and combinations of options that can reduce this disease were compared using returns above variabl...

  12. Lethal trap trees: a potential option for emerald ash borer (Agrilus planipennis Fairmaire) management

    Treesearch

    Deborah G McCullough; Therese M. Poland; Phillip A. Lewis

    2015-01-01

    BACKGROUND: Economic and ecological impacts of ash (Fraxinus spp.) mortality resulting from emerald ash borer (EAB) (Agrilus planipennis Fairmaire) invasion are severe in forested, residential and urban areas. Management options include girdling ash trees to attract ovipositing adult beetles and then destroying infested trees...

  13. Longleaf Pine: Natural Regeneration and Management

    Treesearch

    William D. Boyer

    1999-01-01

    Longleaf pine has long been recognized as a high-quality timber tree providing a number of valuable products. It is a versatile species with characteristics allowing the use of several silvicultural options. Both natural and artificial regeneration of longleaf pine are now practical management options. Natural regeneration is a lowcost alternative whenever sufficient...

  14. 76 FR 72488 - Self-Regulatory Organizations; Chicago Board Options Exchange, Incorporated; Notice of Filing and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-23

    ... investment and risk management strategies and decisions. The Exchange further believes this proposed rule change will provide investors with additional Weekly option classes for investment, trading and risk management purposes. Therefore, the Exchange requests a modest expansion of the current Weeklys Program. The...

  15. 78 FR 27367 - New England Fishery Management Council; Public Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-10

    ... Development Team (PDT) meeting; (4) provide a presentation outlining DAS/trip limit options developed by the... (ACT--applying management uncertainty to ACL), the range of DAS/trip limit alternatives (specifications), changes to the permit category H fishery boundary and any other options for DAS changes; (6) discuss...

  16. 12 CFR 350.4 - Contents of annual disclosure statement.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... for each such year. The annual disclosure statement may, at the option of bank management, consist of... Reserve System: (i) Schedule RC (Balance Sheet); (ii) Schedule RC-N (Past Due and Nonaccrual, Loans... option, provide additional information that bank management considers important to an evaluation of the...

  17. 12 CFR 18.4 - Contents of annual disclosure statement.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... the preceding year. The annual disclosure statement may, at the option of bank management, consist of... schedules. (1) For national banks: (i) Schedule RC (Balance Sheet); (ii) Schedule RC-N (Past Due and... narrative. Bank management may, at its option, provide a narrative discussion to supplement the annual...

  18. Centralized vs decentralized lunar power system study

    NASA Astrophysics Data System (ADS)

    Metcalf, Kenneth; Harty, Richard B.; Perronne, Gerald E.

    1991-09-01

    Three power-system options are considered with respect to utilization on a lunar base: the fully centralized option, the fully decentralized option, and a hybrid comprising features of the first two options. Power source, power conditioning, and power transmission are considered separately, and each architecture option is examined with ac and dc distribution, high and low voltage transmission, and buried and suspended cables. Assessments are made on the basis of mass, technological complexity, cost, reliability, and installation complexity, however, a preferred power-system architecture is not proposed. Preferred options include transmission based on ac, transmission voltages of 2000-7000 V with buried high-voltage lines and suspended low-voltage lines. Assessments of the total cost associated with the installations are required to determine the most suitable power system.

  19. Management of solid waste

    NASA Astrophysics Data System (ADS)

    Thompson, W. T.; Stinton, L. H.

    1980-04-01

    Compliance with the latest regulatory requirements addressing disposal of radioactive, hazardous, and sanitary solid waste criteria in the selection, design, and operation of solid waste management facilities. Due to the state of flux of these regulatory requirements from EPA and NRC, several waste management options were of solid waste. The current regulatory constraints and the design and operational requirements for construction of both storage and disposal facilities for use in management of DOE-ORO solid waste are highlighted. Capital operational costs are included for both disposal and storage options.

  20. The Caspian Sea Negotiation Support System 2.0

    NASA Astrophysics Data System (ADS)

    Rouhani, O. M.; Madani, K.

    2012-12-01

    The Caspian Sea is one of the most resourceful (both in energy and biological resources) areas of the world. The share allocation of Caspian Sea has been the subject of many disputes. Up to now, the negotiations to reach an agreement regarding the ownership status of the sea have not been completely successful. To facilitate reaching an agreement among littoral countries, research studies can provide valuable information. Researchers should examine different options for dividing the sea closely and determine the benefits of each of the options for the parties involved. Following an earlier effort, Caspian Sea Negotiation Support System is further developed in this regard. The model estimates countries' areal and utility shares under different legal methods/scenarios, attempting to minimize transportation costs of exploiting the resource. The applied model is more efficient than the earlier model and the used data includes more variables/attributes such as depth, the differentiation between gas and oil, and various fish resources than the previously employed data. Consequently, the estimates are calculated in more details than are calculated in the earlier study. The results still show a high sensitivity of outputs to the proposed division rules, suggesting a need to clarify the countries' utility and areal shares under any suggested legal regime. Compared to the previous results, the new results confirm the significant effect of the addition of the more variables/attributes to the analysis, in terms of the areal shares and allocations, valuation of resources, and asset management.

  1. Utilization of urban sewage sludge: Chinese perspectives.

    PubMed

    Chen, H; Yan, S-H; Ye, Z-L; Meng, H-J; Zhu, Y-G

    2012-06-01

    Urbanization and industrialization in China has resulted in a dramatic increase in the volume of wastewater and sewage sludge produced from wastewater treatment plants. Problems associated with sewage sludge have attracted increasing attention from the public and urban planners. How to manage sludge in an economically and environmentally acceptable manner is one of the critical issues that modern societies are facing. Sludge treatment systems consist of thickening, dewatering, and several different alternative main treatments (anaerobic digestion, aerobic digestion, drying, composting, and incineration). Agricultural application, landfill, and incineration are the principal disposal methods for sewage sludge in China. However, sewage sludge disposal in the future should focus on resource recovery, reducing environmental impacts and saving economic costs. The reuse of biosolids in all scenarios can be environmentally beneficial and cost-effective. Anaerobic digestion followed by land application is the preferable options due to low economic and energy costs and material reuse. It is necessary to formulate a standard suitable for the utilization of sewage sludge in China.

  2. Hospital reimbursement incentives: is there a more effective option?--Part II.

    PubMed

    Weil, Thomas P

    2013-01-01

    As discussed in Part I of this article, hospital executives in Canada, Germany, and the United States manage their facilities' resources to maximize the incentives inherent in their respective reimbursement system and thereby increase their bottom line. It was also discussed that an additional supply of available hospitals, physicians, and other services will generate increased utilization. Part II discusses how the Patient Protection and Affordable Care Act of 2010 will eventually fail since it neither controls prices nor utilization (e.g., imaging, procedures, ambulatory surgery, discretionary spending). This article concludes with the discussion of the German multipayer approach with universal access and global budgets that might well be a model for U.S. healthcare in the future. Although the German healthcare system has a number of shortfalls, its paradigm could offer the most appropriate compromise when selecting the economic incentives to reduce the percentage of the U.S. gross domestic product expenditure for healthcare from 17.4% to roughly 12.0%.

  3. Silage effluent management: a review.

    PubMed

    Gebrehanna, M M; Gordon, R J; Madani, A; VanderZaag, A C; Wood, J D

    2014-10-01

    Silage effluent is a potent wastewater that can be produced when ensiling crops that have a high moisture content (MC). Silage effluent can cause fish-kills and eutrophication due to its high biochemical oxygen demand (BOD) and nutrient content, respectively. It has a high acidity (pH ≈ 3.5-5) making it corrosive to steel and damaging to concrete, which makes handling, storage and disposal a challenge. Although being recognized as a concentrated wastewater, most research has focused on preventing its production. Despite noted imprecision in effluent production models-and therefore limited ability to predict when effluent will flow-there has been little research aimed at identifying effective reactive management options, such as containment and natural treatment systems. Increasing climate variability and intensifying livestock agriculture are issues that will place a greater importance on developing comprehensive, multi-layered management strategies that include both preventative and reactive measures. This paper reviews important factors governing the production of effluent, approaches to minimize effluent flows as well as treatment and disposal options. The challenges of managing silage effluent are reviewed in the context of its chemical constituents. A multi-faceted approach should be utilized to minimize environmental risks associated with silage effluent. This includes: (i) managing crop moisture content prior to ensiling to reduce effluent production, (ii) ensuring the integrity of silos and effluent storages, and (iii) establishing infrastructure for effluent treatment and disposal. A more thorough investigation of constructed wetlands and vegetated infiltration areas for treating dilute silage effluent is needed. In particular, there should be efforts to improve natural treatment system design criteria by identifying pre-treatment processes and appropriate effluent loading rates. There is also a need for research aimed at understanding the effects of repeated land application of effluent on soil quality and crop yields, as spreading is a common disposal practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. Green Power Marketing in the United States: A Status Report (Ninth Edition)

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

    Bird, L.; Swezey, B.

    Voluntary consumer decisions to purchase electricity supplied by renewable energy sources represent a powerful market support mechanism for renewable energy development. Beginning in the early 1990s, a small number of U.S. utilities began offering ''green power'' options to their customers. Since then, these products have become more prevalent, both from traditional utilities and from marketers operating in states that have introduced competition into their retail electricity markets. Today, more than half of all U.S. consumers have an option to purchase some type of green power product from a retail electricity provider. Currently, more than 600 utilities, or about 20% ofmore » utilities nationally, offer green power programs to customers. These programs allow customers to purchase some portion of their power supply as renewable energy--almost always at a higher price--or to contribute funds for the utility to invest in renewable energy development. The term ''green pricing'' is typically used to refer to these utility programs offered in regulated or noncompetitive electricity markets. This report documents green power marketing activities and trends in the United States.« less

  5. Solar System Exploration Augmented by In-Situ Resource Utilization: Human Planetary Base Issues for Mercury and Saturn

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan A.

    2017-01-01

    Human and robotic missions to Mercury and Saturn are presented and analyzed with a range of propulsion options. Historical studies of space exploration, planetary spacecraft, and astronomy, in-situ resource utilization (ISRU), and industrialization all point to the vastness of natural resources in the solar system. Advanced propulsion benefitted from these resources in many ways. While advanced propulsion systems were proposed in these historical studies, further investigation of nuclear options using high power nuclear thermal and nuclear pulse propulsion as well as advanced chemical propulsion can significantly enhance these scenarios. Updated analyses based on these historical visions are presented. Nuclear thermal propulsion and ISRU enhanced chemical propulsion landers are assessed for Mercury missions. At Saturn, nuclear pulse propulsion with alternate propellant feed systems and Saturn moon exploration with chemical propulsion and nuclear electric propulsion options are discussed. Issues with using in-situ resource utilization on Mercury missions are discussed. At Saturn, the best locations for exploration and the use of the moons Titan and Enceladus as central locations for Saturn moon exploration is assessed.

  6. Solar System Exploration Augmented by In-Situ Resource Utilization: Mercury and Saturn Propulsion Investigations

    NASA Technical Reports Server (NTRS)

    Palaszewski, Bryan

    2016-01-01

    Human and robotic missions to Mercury and Saturn are presented and analyzed with a range of propulsion options. Historical studies of space exploration, in-situ resource utilization (ISRU), and industrialization all point to the vastness of natural resources in the solar system. Advanced propulsion benefitted from these resources in many ways. While advanced propulsion systems were proposed in these historical studies, further investigation of nuclear options using high power nuclear thermal and nuclear pulse propulsion as well as advanced chemical propulsion can significantly enhance these scenarios. Updated analyses based on these historical visions will be presented. Nuclear thermal propulsion and ISRU enhanced chemical propulsion landers are assessed for Mercury missions. At Saturn, nuclear pulse propulsion with alternate propellant feed systems and Titan exploration with chemical propulsion options are discussed. In-situ resource utilization was found to be critical in making Mercury missions more amenable for human visits. At Saturn, refueling using local atmospheric mining was found to be difficult to impractical, while refueling the Saturn missions from Uranus was more practical and less complex.

  7. Understanding Consistency Maintenance in Service Discovery Architectures in Response to Message Loss

    DTIC Science & Technology

    2002-07-01

    manager (SM), and (3) service cache manager ( SCM ). The SCM is an optional element not supported by all discovery protocols. These components participate...the SCM operates as an intermediary, matching advertised SDs of SMs to requirements provided by SUs. Table 1 shows how these general concepts map...Service DescriptionService ItemService Description (SD) Directory Service Agent (optional) not applicableLookup ServiceService Cache Manager ( SCM

  8. 25 CFR 1200.5 - What are the advantages and disadvantages of managing trust funds under the options in § 1200.4?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false What are the advantages and disadvantages of managing trust funds under the options in § 1200.4? 1200.5 Section 1200.5 Indians OFFICE OF THE SPECIAL TRUSTEE... General Provisions § 1200.5 What are the advantages and disadvantages of managing trust funds under the...

  9. High-dose interleukin-2 (IL-2) for the treatment of melanoma: safety considerations and future directions.

    PubMed

    Marabondo, Stephen; Kaufman, Howard L

    2017-12-01

    In 1998, high-dose interleukin-2 (IL-2) was the first immunotherapy approved for the treatment of metastatic melanoma based on durable objective responses documented in a subset of patients but widespread utilization was limited by significant toxicity. Advances in targeted therapy and the emergence of T cell checkpoint inhibitors, which can generally be given in the ambulatory setting, have further limited consideration of IL-2 for melanoma patients and the role of IL-2 in the current landscape of melanoma treatment is uncertain. Areas covered: In this review, we will describe advances in clinical diagnostic and management strategies that have improved the therapeutic window for IL-2 therapy in patients with melanoma. Further, we will describe the potential for using IL-2 in patients whose disease has progressed after other interventions or as part of combination immunotherapy approaches that are now in clinical development. We will also review the common toxicities of IL-2 therapy and their current management will be discussed. Expert opinion: High-dose IL-2 remains an important option for patients with melanoma and has an improved therapeutic window in the contemporary era. The reasons why IL-2 is not utilized more frequently and measures for enhancing its use will be detailed.

  10. Calcific tendinitis of the rotator cuff: management options.

    PubMed

    Suzuki, Kentaro; Potts, Aaron; Anakwenze, Oke; Singh, Anshu

    2014-11-01

    Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical débridement. These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

  11. Community Pharmacists' Preferences for Continuing Education Delivery in Australia

    ERIC Educational Resources Information Center

    Mc Namara, Kevin P.; Duncan, Gregory J.; McDowell, Jenny; Marriott, Jennifer L.

    2009-01-01

    Introduction: New technologies such as the Internet offer an increasing number of options for the delivery of continuing education (CE) to community pharmacists. Many of these options are being utilized to overcome access- and cost-related problems. This paper identifies learning preferences of Australian community pharmacists for CE and…

  12. A Dynamic, Stochastic, Computational Model of Preference Reversal Phenomena

    ERIC Educational Resources Information Center

    Johnson, Joseph G.; Busemeyer, Jerome R.

    2005-01-01

    Preference orderings among a set of options may depend on the elicitation method (e.g., choice or pricing); these preference reversals challenge traditional decision theories. Previous attempts to explain these reversals have relied on allowing utility of the options to change across elicitation methods by changing the decision weights, the…

  13. Central Computational Facility CCF communications subsystem options

    NASA Technical Reports Server (NTRS)

    Hennigan, K. B.

    1979-01-01

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

  14. Water Management Planning: A Case Study at Blue Grass Army Depot

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

    Solana, Amy E.; Mcmordie, Katherine

    2006-04-03

    Executive Order 13123, Greening the Government Through Efficient Energy Management, mandates an aggressive policy for reducing potable water consumption at federal facilities. Implementation guid¬ance from the U.S. Department of Energy (DOE) set a requirement for each federal agency to “reduce potable water usage by implementing life cycle, cost-effective water efficiency programs that include a water management plan, and not less than four Federal Energy Management Program (FEMP) Best Manage¬ment Practices (BMPs).” The objective of this plan is to gain full compliance with Executive Order 13123 and associated DOE implementation guidance on behalf of Blue Grass Army Depot (BGAD), Richmond, Kentucky.more » In accordance with this plan, BGAD must: • Incorporate the plan as a component of the Installation energy conservation plan • Investigate the water savings potential and life-cycle cost effectiveness of the Operations and Maintenance (O&M) and retrofit/replacement options associated with the ten FEMP BMPs • Put into practice all applicable O&M options • Identify retrofit/replacement options appropriate for implementation (based upon calculation of the simple payback periods) • Establish a schedule for implementation of applicable and cost-effective retrofit/replacement options.« less

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

    Siddiqui, Afzal; Marnay, Chris

    This paper examines a California-based microgrid s decision to invest in a distributed generation (DG) unit that operates on natural gas. While the long-term natural gas generation cost is stochastic, we initially assume that the microgrid may purchase electricity at a fixed retail rate from its utility. Using the real options approach, we find natural gas generating cost thresholds that trigger DG investment. Furthermore, the consideration of operational flexibility by the microgrid accelerates DG investment, while the option to disconnect entirely from the utility is not attractive. By allowing the electricity price to be stochastic, we next determine an investmentmore » threshold boundary and find that high electricity price volatility relative to that of natural gas generating cost delays investment while simultaneously increasing the value of the investment. We conclude by using this result to find the implicit option value of the DG unit.« less

  16. Optimal behaviour can violate the principle of regularity.

    PubMed

    Trimmer, Pete C

    2013-07-22

    Understanding decisions is a fundamental aim of behavioural ecology, psychology and economics. The regularity axiom of utility theory holds that a preference between options should be maintained when other options are made available. Empirical studies have shown that animals violate regularity but this has not been understood from a theoretical perspective, such decisions have therefore been labelled as irrational. Here, I use models of state-dependent behaviour to demonstrate that choices can violate regularity even when behavioural strategies are optimal. I also show that the range of conditions over which regularity should be violated can be larger when options do not always persist into the future. Consequently, utility theory--based on axioms, including transitivity, regularity and the independence of irrelevant alternatives--is undermined, because even alternatives that are never chosen by an animal (in its current state) can be relevant to a decision.

  17. Economics of Utility Scale Photovoltaics at Purdue University

    NASA Astrophysics Data System (ADS)

    Arnett, William

    The research for this case study shows that utility scale solar photovoltaics has become a competitive energy investment option, even when a campus operates a power plant at low electricity rates. To evaluate this an economic model called SEEMS (Solar Economic Evaluation Modelling Spreadsheets) was developed to evaluate a number of financial scenarios in Real Time Pricing for universities. The three main financing structures considered are 1) land leasing, 2) university direct purchase, and 3) third party purchase. Unlike other commercially available models SEEMS specifically accounts for real time pricing, where the local utility provides electricity at an hourly rate that changes with the expected demand. In addition, SEEMS also includes a random simulation that allows the model to predict the likelihood of success for a given solar installation strategy. The research showed that there are several options for utility scale solar that are financially attractive. The most practical financing structure is with a third party partnership because of the opportunity to take advantage of tax incentives. Other options could become more attractive if non-financial benefits are considered. The case study for this research, Purdue University, has a unique opportunity to integrate utility-scale solar electricity into its strategic planning. Currently Purdue is updating its master plan which will define how land is developed. Purdue is also developing a sustainability plan that will define long term environmental goals. In addition, the university is developing over 500 acres of land west of campus as part of its Aerospace Innovation District. This research helps make the case for including utility-scale solar electricity as part of the university's strategic planning.

  18. Screening regional management options for their impact on climate resilience: an approach and case study in the Venen-Vechtstreek wetlands in the Netherlands.

    PubMed

    Wardekker, J A; Wildschut, D; Stemberger, S; van der Sluijs, J P

    2016-01-01

    Freshwater systems provide various resources and services. These are often vulnerable to climate change and other pressures. Therefore, enhancing resilience to climate change is important for their long term viability. This paper explores how management options can be evaluated on their resilience implications. The approach included five steps: (1) characterizing the system, (2) characterizing the impacts of climate change and other disturbances, (3) inventorying management options, (4) assessing the impacts of these on climate resilience, and (5) follow-up analysis. For the resilience assessment, we used a set of 'resilience principles': homeostasis, omnivory, high flux, flatness, buffering, and redundancy. We applied the approach in a case study in a Dutch wetlands region. Many options in the region's management plan contribute to resilience, however, the plan underutilised several principles, particularly flatness, but also redundancy and omnivory for agriculture, and high flux for nature. Co-benefits was identified as an important additional criterion to obtain support for adaptation from local stakeholders, such as farmers. The approach provided a relatively quick and participatory way to screen options. It allowed us to consider multiple impacts and sectors, multiple dimensions of resilience, and stakeholder perspectives. The results can be used to identify gaps or pitfalls, and set priorities for follow-up analyses.

  19. Using real options analysis to support strategic management decisions

    NASA Astrophysics Data System (ADS)

    Kabaivanov, Stanimir; Markovska, Veneta; Milev, Mariyan

    2013-12-01

    Decision making is a complex process that requires taking into consideration multiple heterogeneous sources of uncertainty. Standard valuation and financial analysis techniques often fail to properly account for all these sources of risk as well as for all sources of additional flexibility. In this paper we explore applications of a modified binomial tree method for real options analysis (ROA) in an effort to improve decision making process. Usual cases of use of real options are analyzed with elaborate study on the applications and advantages that company management can derive from their application. A numeric results based on extending simple binomial tree approach for multiple sources of uncertainty are provided to demonstrate the improvement effects on management decisions.

  20. Surgical management of chronic pancreatitis: current utilization in the United States.

    PubMed

    Bliss, Lindsay A; Yang, Catherine J; Eskander, Mariam F; de Geus, Susanna W L; Callery, Mark P; Kent, Tara S; Moser, A James; Freedman, Steven D; Tseng, Jennifer F

    2015-09-01

    Surgical intervention is uncommon in chronic pancreatitis. Literature largely describes single institution or international experiences. This study describes US-based chronic pancreatitis surgical management. Retrospective analysis of chronic pancreatitis patients in the Healthcare Cost and Utilization Project Florida State Inpatient Database 2007-2011. Patients with malignancy or congenital abnormalities were excluded. Univariate analysis using the chi-square test. The number of readmissions, inpatient length of stay and cost using Wilcoxon's signed-rank test. Multivariate analysis of surgery by logistic regression. Twenty-one thousand four hundred and forty-five patients with chronic pancreatitis. 10.8% (2 307) underwent surgery including 1652 cholecystectomies, 564 drainage procedures and 498 pancreatectomies. Procedures decreased from 12.1% to 8.3% over time (P < 0.001), but intervention within 3 months increased (7.2% to 8.4%; P = 0.017). 15.3% (3 278) had pancreatic cysts/pseudocysts and 43.4% (9 312) had diabetes. The median numbers of admissions were 2 [interquartile range (IQR) 1,5] and 3 (IQR 2,7) among non-surgical and surgical patients, respectively (P < 0.001). Predictors of surgery were fewer co-morbidities, private insurance, and either diabetes mellitus or pancreatic cyst/pseudocyst. Chronic pancreatitis leads to numerous inpatient readmissions, but surgical intervention only occurs in a minority of cases. Complicated patients are more likely to undergo surgery. The complexities of chronic pancreatitis management warrant early multidisciplinary evaluation and ongoing consideration of surgical and non-surgical options. © 2015 International Hepato-Pancreato-Biliary Association.

  1. Fidaxomicin in Clostridium difficile infection: latest evidence and clinical guidance

    PubMed Central

    2014-01-01

    The incidence of Clostridium difficile infection (CDI) has risen 400% in the last decade. It currently ranks as the third most common nosocomial infection. CDI has now crossed over as a community-acquired infection. The major failing of current therapeutic options for the management of CDI is recurrence of disease after the completion of treatment. Fidaxomicin has been proven to be superior to vancomycin in successful sustained clinical response to therapy. Improved outcomes may be due to reduced collateral damage to the gut microflora by fidaxomicin, bactericidal activity, inhibition of Clostridial toxin formation and inhibition of new sporulation. This superiority is maintained in groups previously reported as being at high risk for CDI recurrence including those: with relapsed infection after a single treatment course; on concomitant antibiotic therapy; aged >65 years; with cancer; and with chronic renal insufficiency. Because the acquisition cost of fidaxomicin far exceeds that of metronidazole or vancomycin, in order to rationally utilize this agent, it should be targeted to those populations who are at high risk for relapse and in whom the drug has demonstrated superiority. In this manuscript is reviewed the changing epidemiology of CDI, current treatment options for this infection, proposed benefits of fidaxomicin over currently available antimicrobial options, available analysis of cost effectiveness of the drug, and is given recommendations for judicious use of the drug based upon the available published literature. PMID:24587892

  2. Implied preference for seismic design level and earthquake insurance.

    PubMed

    Goda, K; Hong, H P

    2008-04-01

    Seismic risk can be reduced by implementing newly developed seismic provisions in design codes. Furthermore, financial protection or enhanced utility and happiness for stakeholders could be gained through the purchase of earthquake insurance. If this is not so, there would be no market for such insurance. However, perceived benefit associated with insurance is not universally shared by stakeholders partly due to their diverse risk attitudes. This study investigates the implied seismic design preference with insurance options for decisionmakers of bounded rationality whose preferences could be adequately represented by the cumulative prospect theory (CPT). The investigation is focused on assessing the sensitivity of the implied seismic design preference with insurance options to model parameters of the CPT and to fair and unfair insurance arrangements. Numerical results suggest that human cognitive limitation and risk perception can affect the implied seismic design preference by the CPT significantly. The mandatory purchase of fair insurance will lead the implied seismic design preference to the optimum design level that is dictated by the minimum expected lifecycle cost rule. Unfair insurance decreases the expected gain as well as its associated variability, which is preferred by risk-averse decisionmakers. The obtained results of the implied preference for the combination of the seismic design level and insurance option suggest that property owners, financial institutions, and municipalities can take advantage of affordable insurance to establish successful seismic risk management strategies.

  3. Fidaxomicin in Clostridium difficile infection: latest evidence and clinical guidance.

    PubMed

    Mullane, Kathleen

    2014-03-01

    The incidence of Clostridium difficile infection (CDI) has risen 400% in the last decade. It currently ranks as the third most common nosocomial infection. CDI has now crossed over as a community-acquired infection. The major failing of current therapeutic options for the management of CDI is recurrence of disease after the completion of treatment. Fidaxomicin has been proven to be superior to vancomycin in successful sustained clinical response to therapy. Improved outcomes may be due to reduced collateral damage to the gut microflora by fidaxomicin, bactericidal activity, inhibition of Clostridial toxin formation and inhibition of new sporulation. This superiority is maintained in groups previously reported as being at high risk for CDI recurrence including those: with relapsed infection after a single treatment course; on concomitant antibiotic therapy; aged >65 years; with cancer; and with chronic renal insufficiency. Because the acquisition cost of fidaxomicin far exceeds that of metronidazole or vancomycin, in order to rationally utilize this agent, it should be targeted to those populations who are at high risk for relapse and in whom the drug has demonstrated superiority. In this manuscript is reviewed the changing epidemiology of CDI, current treatment options for this infection, proposed benefits of fidaxomicin over currently available antimicrobial options, available analysis of cost effectiveness of the drug, and is given recommendations for judicious use of the drug based upon the available published literature.

  4. The management of arsenic wastes: problems and prospects.

    PubMed

    Leist, M; Casey, R J; Caridi, D

    2000-08-28

    Arsenic has found widespread use in agriculture and industry to control a variety of insect and fungicidal pests. Most of these uses have been discontinued, but residues from such activities, together with the ongoing generation of arsenic wastes from the smelting of various ores, have left a legacy of a large number of arsenic-contaminated sites. The treatment and/or removal of arsenic is hindered by the fact that arsenic has a variety of valence states. Arsenic is most effectively removed or stabilized when it is present in the pentavalent arsenate form. For the removal of arsenic from wastewater, coagulation, normally using iron, is the preferred option. The solidification/stabilization of arsenic is not such a clear-cut process. Factors such as the waste's interaction with the additives (e.g. iron or lime), as well as any effect on the cement matrix, all impact on the efficacy of the fixation. Currently, differentiation between available solidification/stabilization processes is speculative, partly due to the large number of differing leaching tests that have been utilized. Differences in the leaching fluid, liquid-to-solid ratio, and agitation time and method all impact significantly on the arsenic leachate concentrations. This paper reviews options available for dealing with arsenic wastes, both solid and aqueous through an investigation of the methods available for the removal of arsenic from wastewater as well as possible solidification/stabilization options for a variety of waste streams.

  5. LWR First Recycle of TRU with Thorium Oxide for Transmutation and Cross Sections

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

    Andrea Alfonsi; Gilles Youinou; Sonat Sen

    2013-02-01

    Thorium has been considered as an option to uranium-based fuel, based on considerations of resource utilization (thorium is approximately three times more plentiful than uranium) and as a result of concerns about proliferation and waste management (e.g. reduced production of plutonium, etc.). Since the average composition of natural Thorium is dominated (100%) by the fertile isotope Th-232, Thorium is only useful as a resource for breeding new fissile materials, in this case U-233. Consequently a certain amount of fissile material must be present at the start-up of the reactor in order to guarantee its operation. The thorium fuel can bemore » used in both once-through and recycle options, and in both fast and thermal spectrum systems. The present study has been aimed by the necessity of investigating the option of using reprocessed plutonium/TRU, from a once-through reference LEU scenario (50 GWd/ tIHM), mixed with natural thorium and the need of collect data (mass fractions, cross-sections etc.) for this particular fuel cycle scenario. As previously pointed out, the fissile plutonium is needed to guarantee the operation of the reactor. Four different scenarios have been considered: • Thorium – recycled Plutonium; • Thorium – recycled Plutonium/Neptunium; • Thorium – recycled Plutonium/Neptunium/Americium; • Thorium – recycled Transuranic. The calculations have been performed with SCALE6.1-TRITON.« less

  6. LWR First Recycle of TRU with Thorium Oxide for Transmutation and Cross Sections

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

    Andrea Alfonsi; Gilles Youinou

    2012-07-01

    Thorium has been considered as an option to uranium-based fuel, based on considerations of resource utilization (thorium is approximately three times more plentiful than uranium) and as a result of concerns about proliferation and waste management (e.g. reduced production of plutonium, etc.). Since the average composition of natural Thorium is dominated (100%) by the fertile isotope Th-232, Thorium is only useful as a resource for breeding new fissile materials, in this case U-233. Consequently a certain amount of fissile material must be present at the start-up of the reactor in order to guarantee its operation. The thorium fuel can bemore » used in both once-through and recycle options, and in both fast and thermal spectrum systems. The present study has been aimed by the necessity of investigating the option of using reprocessed plutonium/TRU, from a once-through reference LEU scenario (50 GWd/ tIHM), mixed with natural thorium and the need of collect data (mass fractions, cross-sections etc.) for this particular fuel cycle scenario. As previously pointed out, the fissile plutonium is needed to guarantee the operation of the reactor. Four different scenarios have been considered: • Thorium – recycled Plutonium; • Thorium – recycled Plutonium/Neptunium; • Thorium – recycled Plutonium/Neptunium/Americium; • Thorium – recycled Transuranic. The calculations have been performed with SCALE6.1-TRITON.« less

  7. Report on ISS O2 Production, Gas Supply and Partial Pressure Management

    NASA Technical Reports Server (NTRS)

    Schaezler, Ryan N.; Cook, Anthony J.

    2015-01-01

    Oxygen is used on International Space Station (ISS) for metabolic support and denitrogenation procedures prior to Extra-Vehicular Activities. Nitrogen is used to maintain total pressure and account for losses associated with leakage and operational losses. Oxygen and nitrogen have been supplied by various visiting vehicles such as the Progress and Shuttle in addition to the on-orbit oxygen production capability. Starting in 2014, new high pressure oxygen/nitrogen tanks are available to launch on commercial cargo vehicles and will replace the high pressure gas source that Shuttle used to provide. To maintain a habitable atmosphere the oxygen and nitrogen partial pressures are controlled between upper and lower bounds. The full range of the allowable partial pressures along with the increased ISS cabin volume are utilized as a buffer allowing days to pass between oxygen production or direct addition of oxygen and nitrogen to the atmosphere from reserves. This paper summarizes the amount of gas supplied and produced from all of the sources and describes past experience of managing partial pressures along with the range of management options available to the ISS.

  8. Wildlife population management: are contraceptive vaccines a feasible proposition?

    PubMed

    Gupta, Satish Kumar; Minhas, Vidisha

    2017-06-01

    To minimize human-animal conflicts for habitation and burden of zoonotic diseases, it is imperative to develop new strategies for wildlife population management. In this direction, contraceptive vaccines eliciting immune response against hormones/proteins critical for reproduction have emerged as one of the promising options. Contraceptive vaccines based on neutralization of gonadotropin releasing hormone (GnRH) have been used for inhibition of fertility in various species such as wild horses, white-tailed deer, pigs, cats, dogs etc. It has been used for immunocastration of male pigs to improve meat quality. However, additional safety studies of GnRH vaccine will be needed in light of presence of its receptor at extra-pituitary sites. Native porcine zona pellucida (PZP)-based contraceptive vaccines have shown their utility in the management of the population of both captive and free-ranging wild horses and white-tailed deer. Long-term use of the PZP-based contraceptive vaccines has also demonstrated their safety. Ideally single injection of the contraceptive vaccine should elicit long lasting immune response and desired contraceptive efficacy, which will require development of novel vaccine delivery platforms and more potent adjuvants.

  9. Manuka Honey: A Case Study of Severe Atopic Eczematous Dermatitis Reaction to Henna Tattoo.

    PubMed

    Harrison, Jeanine

    Many mainstream medications were derived from plants and originally utilized in patient management well prior to the extensive research and testing processes of current pharmaceutical standards. The evolution of therapeutic management within the pharmaceutical and skin care industry often uses synthetic processing of products with less of a focus on the natural ingredients from which they were originally derived. However, more recently there has been a shift in pharmacological management to include the therapeutic use of more holistic medicines and practices and thus a broadening of the uses of nontraditional medical treatment options. This has been seen in the use of treatments, such as Manuka honey, for skin conditions and dermal injuries. It is often with off-label uses, or conditions resistant to other treatments, that then prompt the use of holistic products and the true value of the product is validated. As with the following case study, the example of the use of Manuka honey on a severe atopic contact dermatitis eczematous reaction provides further documentation and supportive evidence of the potential efficacy of the properties of this particular natural product.

  10. New latent heat storage system with nanoparticles for thermal management of electric vehicles

    NASA Astrophysics Data System (ADS)

    Javani, N.; Dincer, I.; Naterer, G. F.

    2014-12-01

    In this paper, a new passive thermal management system for electric vehicles is developed. A latent heat thermal energy storage with nanoparticles is designed and optimized. A genetic algorithm method is employed to minimize the length of the heat exchanger tubes. The results show that even the optimum length of a shell and tube heat exchanger becomes too large to be employed in a vehicle. This is mainly due to the very low thermal conductivity of phase change material (PCM) which fills the shell side of the heat exchanger. A carbon nanotube (CNT) and PCM mixture is then studied where the probability of nanotubes in a series configuration is defined as a deterministic design parameter. Various heat transfer rates, ranging from 300 W to 600 W, are utilized to optimize battery cooling options in the heat exchanger. The optimization results show that smaller tube diameters minimize the heat exchanger length. Furthermore, finned tubes lead to a higher heat exchanger length due to more heat transfer resistance. By increasing the CNT concentration, the optimum length of the heat exchanger decreases and makes the improved thermal management system a more efficient and competitive with air and liquid thermal management systems.

  11. The application of virtual reality systems as a support of digital manufacturing and logistics

    NASA Astrophysics Data System (ADS)

    Golda, G.; Kampa, A.; Paprocka, I.

    2016-08-01

    Modern trends in development of computer aided techniques are heading toward the integration of design competitive products and so-called "digital manufacturing and logistics", supported by computer simulation software. All phases of product lifecycle: starting from design of a new product, through planning and control of manufacturing, assembly, internal logistics and repairs, quality control, distribution to customers and after-sale service, up to its recycling or utilization should be aided and managed by advanced packages of product lifecycle management software. Important problems for providing the efficient flow of materials in supply chain management of whole product lifecycle, using computer simulation will be described on that paper. Authors will pay attention to the processes of acquiring relevant information and correct data, necessary for virtual modeling and computer simulation of integrated manufacturing and logistics systems. The article describes possibilities of use an applications of virtual reality software for modeling and simulation the production and logistics processes in enterprise in different aspects of product lifecycle management. The authors demonstrate effective method of creating computer simulations for digital manufacturing and logistics and show modeled and programmed examples and solutions. They pay attention to development trends and show options of the applications that go beyond enterprise.

  12. 78 FR 49565 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Notice of Filing and Immediate Effectiveness...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-14

    ... new Options Floor Broker Management System. II. Self-Regulatory Organization's Statement of the... SECURITIES AND EXCHANGE COMMISSION [Release No. 34-70141; File No. SR-Phlx-2013-83] Self... Change To Delay the Implementation of the Options Floor Broker Management System Until the End of...

  13. 76 FR 40969 - Self-Regulatory Organizations; Notice of Filing and Immediate Effectiveness of a Proposed Rule...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-12

    ... risk management strategies and decisions. Furthermore, the Exchange has had to eliminate option classes... additional short term option classes for investment, trading, and risk management purposes. Finally, the... that various strategies that the investor put into play were disrupted and eliminated when the class...

  14. 75 FR 41790 - Address Management Services-Elimination of the Manual Card Option for Address Sequencing Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-19

    ... Electronic Address Sequencing (EAS) service processes a customer's addresses file for walk sequence and/or... POSTAL SERVICE 39 CFR Part 111 Address Management Services--Elimination of the Manual Card Option for Address Sequencing Services AGENCY: Postal Service TM . ACTION: Proposed rule. SUMMARY: The Postal...

  15. Acquiring Enterprise Systems as a Portfolio of Real Options

    DTIC Science & Technology

    2012-04-30

    expanded beyond valuing individual projects by the real options method to the valuation of a portfolio of options. Bardhan , Bagchi, and Soustad (2004... Bardhan , I., Bagchi, S., & Soustad, R. (2004). Prioritizing a portfolio of information technology investment projects. Journal of Management

  16. A Qualitative Assessment of the Evidence Utilization for Health Policy-Making on the Basis of SUPPORT Tools in a Developing Country

    PubMed Central

    Hasan Imani-Nasab, Mohammad; Seyedin, Hesam; Yazdizadeh, Bahareh; Majdzadeh, Reza

    2017-01-01

    Background: SUPPORT tools consist of 18 articles addressing the health policy-makers so that they can learn how to make evidence-informed health policies. These tools have been particularly recommended for developing countries. The present study tries to explain the process of evidence utilization for developing policy documents in the Iranian Ministry of Health and Medical Education (MoHME) and to compare the findings with those of SUPPORT tools. Methods: A qualitative research was conducted, using the framework analysis approach. Participants consisted of senior managers and technicians in MoHME. Purposeful sampling was done, with a maximum variety, for the selection of research participants: individuals having at least 5 years of experience in preparing evidence-based policy documents. Face-to-face interviews were conducted for data collection. As a guideline for the interviews, ‘the Utilization of Evidence in Policy-Making Organizations’ procedure was used. The data were analyzed through the analysis of the framework method using MAXQDA 10 software. Results: The participants acquired the research evidence in a topic-based form, and they were less likely to search on the basis of the evidence pyramid. To assess the quality of evidence, they did not use standard critical tools; to adapt the evidence and interventions with the local setting, they did not use the ideas and experiences of all stakeholders, and in preparing the evidence-based policy documents, they did not take into consideration the window of opportunity, did not refrain from using highly technical terms, did not write user-friendly summaries, and did not present alternative policy options. In order to develop health policies, however, they used the following innovations: attention to the financial burden of policy issues on the agenda, sensitivity analysis of the preferred policy option on the basis of technical, sociopolitical, and economic feasibility, advocacy from other scholars, using the multi-criteria decision-making models for the prioritization of policy options, implementation of policy based on the degree of readiness of policy-implementing units, and the classification of policy documents on the basis of different conditions of policy-making (urgent, short-term, and long-term). Conclusion: Findings showed that the process of evidence utilization in IR-MoH enjoys some innovations for the support of health policy development. The present study provides IR-MoH with considerable opportunities for the improvement of evidence-informed health policy-making. Moreover, the SUPPORT process and tools are recommended to be used in developing countries. PMID:28812845

  17. Extraction and utilization of saltcedar and Russian olive biomass

    Treesearch

    Dennis P. Dykstra

    2010-01-01

    This chapter assesses technologies that might be useful for utilization of saltcedar and Russian olive trees as biomass. These are invasive species that are being targeted for eradication by the Bureau of Reclamation under federal legislation passed in 2007. One option is to utilize the biomass from stems and branches, and possibly even from roots and foliage,...

  18. The benefits of herbicide-resistant crops.

    PubMed

    Green, Jerry M

    2012-10-01

    Since 1996, genetically modified herbicide-resistant crops, primarily glyphosate-resistant soybean, corn, cotton and canola, have helped to revolutionize weed management and have become an important tool in crop production practices. Glyphosate-resistant crops have enabled the implementation of weed management practices that have improved yield and profitability while better protecting the environment. Growers have recognized their benefits and have made glyphosate-resistant crops the most rapidly adopted technology in the history of agriculture. Weed management systems with glyphosate-resistant crops have often relied on glyphosate alone, have been easy to use and have been effective, economical and more environmentally friendly than the systems they have replaced. Glyphosate has worked extremely well in controlling weeds in glyphosate-resistant crops for more than a decade, but some key weeds have evolved resistance, and using glyphosate alone has proved unsustainable. Now, growers need to renew their weed management practices and use glyphosate with other cultural, mechanical and herbicide options in integrated systems. New multiple-herbicide-resistant crops with resistance to glyphosate and other herbicides will expand the utility of existing herbicide technologies and will be an important component of future weed management systems that help to sustain the current benefits of high-efficiency and high-production agriculture. Copyright © 2012 Society of Chemical Industry.

  19. A decision analysis approach to climate adaptation: comparing multiple pathways for multi-decadal decision making

    NASA Astrophysics Data System (ADS)

    Lin, B. B.; Little, L.

    2013-12-01

    Policy planners around the world are required to consider the implications of adapting to climatic change across spatial contexts and decadal timeframes. However, local level information for planning is often poorly defined, even though climate adaptation decision-making is made at this scale. This is especially true when considering sea level rise and coastal impacts of climate change. We present a simple approach using sea level rise simulations paired with adaptation scenarios to assess a range of adaptation options available to local councils dealing with issues of beach recession under present and future sea level rise and storm surge. Erosion and beach recession pose a large socioeconomic risk to coastal communities because of the loss of key coastal infrastructure. We examine the well-known adaptation technique of beach nourishment and assess various timings and amounts of beach nourishment at decadal time spans in relation to beach recession impacts. The objective was to identify an adaptation strategy that would allow for a low frequency of management interventions, the maintenance of beach width, and the ability to minimize variation in beach width over the 2010 to 2100 simulation period. 1000 replications of each adaptation option were produced against the 90 year simulation in order to model the ability each adaptation option to achieve the three key objectives. Three sets of adaptation scenarios were identified. Within each scenario, a number of adaptation options were tested. The three scenarios were: 1) Fixed periodic beach replenishment of specific amounts at 20 and 50 year intervals, 2) Beach replenishment to the initial beach width based on trigger levels of recession (5m, 10m, 20m), and 3) Fixed period beach replenishment of a variable amount at decadal intervals (every 10, 20, 30, 40, 50 years). For each adaptation option, we show the effectiveness of each beach replenishment scenario to maintain beach width and consider the implications of more frequent replenishment with that of implementation cost. We determine that a business as usual scenario, where no adaptation is implemented, would lead to an average beach recession of 12.02 meters and a maximum beach recession of 33.23 meters during the period of 2010-2100. The best adaptation option modeled was a fixed replenishment of 5 meters every 20 years leading to 4 replenishment events with an average beach recession of 2.99 meters and a maximum beach recession of 15.02 meters during the period of 2010-2100. The presented simulations explicitly address the uncertainty of future impacts due to sea level rise and storm surge and show a range of options that could be considered by a local council to meet their policy objectives. The simulation runs provide managers the ability to consider the utility of various adaptation options and the timing and costs of implementation. Such information provides an evidence-based practice to decision-making and allows policy makers to transparently make decisions based on best estimates of modeled climate change.

  20. The promise of circulating tumor cells for precision cancer therapy

    PubMed Central

    Hwang, William L; Hwang, Katie L; Miyamoto, David T

    2016-01-01

    The rapidly growing array of therapeutic options in cancer requires informative biomarkers to guide the rational selection and precision application of appropriate therapies. Circulating biomarkers such as circulating tumor cells have immense potential as noninvasive, serial ‘liquid biopsies’ that may be more representative of the complete spectrum of a patient’s individual malignancy than spatially and temporally restricted tumor biopsies. In this review, we discuss the current state-of-the-art in the isolation and molecular characterization of circulating tumor cells as well as their utility in a wide range of clinical applications such as prognostics, treatment monitoring and identification of novel therapeutic targets and resistance mechanisms to enable real-time adjustments in the clinical management of cancer. PMID:27924634

  1. A review on organic waste to energy systems in India.

    PubMed

    Dhar, Hiya; Kumar, Sunil; Kumar, Rakesh

    2017-12-01

    Waste generation is increasing day-by-day with the growth of population which directly affects the environment and economy. Organic municipal solid waste (MSW) and agriculture sectors contribute towards maximum waste generation in India. Thus, management of organic waste is very much essential with the increasing demand for energy. The present paper mainly focusses on reviewing waste to energy (WtE) potentials, its technologies, and the associated challenges. Different substrates are utilized through various technological options in India. Organic waste has good potential to attain sustainable energy yields with and without affecting the environment. A realistic scenario of WtE technologies and their challenges in line with the existing Indian condition is presented in this paper. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Analysis of power sector efficiency improvements for an integrated utility planning process in Costa Rica

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

    Waddle, D.B.; MacDonald, J.M.

    1990-01-01

    In an effort to analyze and document the potential for power sector efficiency improvements from generation to end-use, the Agency for International Development and the Government of Costa Rica are jointly conducting an integrated power sector efficiency analysis. Potential for energy and cost savings in power plants, transmission and distribution, and demand-side management programs are being evaluated. The product of this study will be an integrated investment plan for the Instituto Costarricense de Electricidad, incorporating both supply and demand side investment options. This paper presents the methodology employed in the study, as well as preliminary estimates of the results ofmore » the study. 14 refs., 4 figs., 5 tabs.« less

  3. Cutting power costs starts with basic analyses

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

    Paik, M.

    1996-10-07

    Oil and gas production departments should already be reducing their power costs. Regardless of how US deregulation of electricity finally shakes out, power costs are a large portion of total operating expense. Much has been written in recent months about the rosy days, ahead, when electric utilities will be fully deregulated. But this will only be an extension of the opportunities available today; although, after deregulation, many new options will add both opportunities along with complexities. There is no magic to reducing power costs. It is simply a matter of working at it. Recommended steps for lowering power costs ismore » shown. The paper discusses electricity basics, power bills, managing power cost, field equipment changes, electrical equipment changes and deregulation.« less

  4. Evaluating holistic environmental consequences of brownfield management options using consequential life cycle assessment for different perspectives.

    PubMed

    Lesage, Pascal; Deschênes, Louise; Samson, Réjean

    2007-08-01

    Brownfields are abandoned, idled, or underused sites whose reuse necessitates some sort of intervention. These sites are largely urban and are frequently contaminated. Brownfield management options can be associated with three types of environmental consequences: those resulting from changes in the site's environmental quality (primary impacts); those resulting from the actual intervention stage (secondary impacts); and, if the vocation of the site changes, those resulting from effects on regional land use (tertiary impacts). Different stakeholders and decision-making contexts will place a different importance on each of these types of impacts. This article proposes a framework for comparing brownfield management options in regard to these three types of environmental impacts and for interpreting these results from different perspectives. The assessment framework is based on consequential life cycle assessment (LCA), which is shown to provide environmental information on the three types of impacts. The results for a case study are presented, where a "rehabilitation" option allowing residential redevelopment is compared to an "exposure minimization" option not resulting in the site being reused. Calculated primary and tertiary impacts are favorable to the rehabilitation option, whereas secondary impacts are favorable to the exposure minimization option. A ternary diagram presents the favorable option for different stereotypical perspectives. Tertiary impacts are much greater than secondary impacts, and consequently all perspectives that consider tertiary impacts favor rehabilitation. The perspective that considers primary and secondary impacts receives conflicting information. The ternary diagram, showing results for all perspectives, could possibly be useful for consensus-building among stakeholders.

  5. Evaluating Holistic Environmental Consequences of Brownfield Management Options Using Consequential Life Cycle Assessment for Different Perspectives

    NASA Astrophysics Data System (ADS)

    Lesage, Pascal; Deschênes, Louise; Samson, Réjean

    2007-08-01

    Brownfields are abandoned, idled, or underused sites whose reuse necessitates some sort of intervention. These sites are largely urban and are frequently contaminated. Brownfield management options can be associated with three types of environmental consequences: those resulting from changes in the site’s environmental quality (primary impacts); those resulting from the actual intervention stage (secondary impacts); and, if the vocation of the site changes, those resulting from effects on regional land use (tertiary impacts). Different stakeholders and decision-making contexts will place a different importance on each of these types of impacts. This article proposes a framework for comparing brownfield management options in regard to these three types of environmental impacts and for interpreting these results from different perspectives. The assessment framework is based on consequential life cycle assessment (LCA), which is shown to provide environmental information on the three types of impacts. The results for a case study are presented, where a “rehabilitation” option allowing residential redevelopment is compared to an “exposure minimization” option not resulting in the site being reused. Calculated primary and tertiary impacts are favorable to the rehabilitation option, whereas secondary impacts are favorable to the exposure minimization option. A ternary diagram presents the favorable option for different stereotypical perspectives. Tertiary impacts are much greater than secondary impacts, and consequently all perspectives that consider tertiary impacts favor rehabilitation. The perspective that considers primary and secondary impacts receives conflicting information. The ternary diagram, showing results for all perspectives, could possibly be useful for consensus-building among stakeholders.

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

    Marnay, Chris; Siddiqui, Afzal; Marnay, Chris

    This paper examines a California-based microgrid?s decision to invest in a distributed generation (DG) unit fuelled by natural gas. While the long-term natural gas generation cost is stochastic, we initially assume that the microgrid may purchase electricity at a fixed retail rate from its utility. Using the real options approach, we find a natural gas generation cost threshold that triggers DG investment. Furthermore, the consideration of operational flexibility by the microgrid increases DG investment, while the option to disconnect from the utility is not attractive. By allowing the electricity price to be stochastic, we next determine an investment threshold boundarymore » and find that high electricity price volatility relative to that of natural gas generation cost delays investment while simultaneously increasing the value of the investment. We conclude by using this result to find the implicit option value of the DG unit when two sources of uncertainty exist.« less

  7. Optimal behaviour can violate the principle of regularity

    PubMed Central

    Trimmer, Pete C.

    2013-01-01

    Understanding decisions is a fundamental aim of behavioural ecology, psychology and economics. The regularity axiom of utility theory holds that a preference between options should be maintained when other options are made available. Empirical studies have shown that animals violate regularity but this has not been understood from a theoretical perspective, such decisions have therefore been labelled as irrational. Here, I use models of state-dependent behaviour to demonstrate that choices can violate regularity even when behavioural strategies are optimal. I also show that the range of conditions over which regularity should be violated can be larger when options do not always persist into the future. Consequently, utility theory—based on axioms, including transitivity, regularity and the independence of irrelevant alternatives—is undermined, because even alternatives that are never chosen by an animal (in its current state) can be relevant to a decision. PMID:23740781

  8. Use of large-scale silvicultural studies to evaluate management options in Pacific Northwest forests of the United States.

    Treesearch

    Stephen E. Reutebuch; Constance A. Harrington; David D. Marshall; Leslie C. Brodie

    2004-01-01

    A suite of large-scale silvicultural experiments has been established to develop and assess operational silviculture options for the Pacific Northwest Douglas-fir (Pseudotsuga menziesii [Mirb.] Franco vat. menziesii) forests. This paper summarizes three such studies that focus on three major stages in the life of managed stands...

  9. National Forest management options in response to climate change

    Treesearch

    Forest Service U.S. Department of Agriculture

    2009-01-01

    The effect of climate change on ecosystem structure, function, and services will depend on the ecosystem's degree of sensitivity to climate change, the natural ability of plants and animals to adapt, and the availability of effective management options. Sensitivity to climate change is a function of ecosystem health and environmental stresses such as air pollution...

  10. Developing management options for longleaf communities of the gulf coastal plain

    Treesearch

    Kenneth W. Outcalt

    2003-01-01

    Choosing treatments to reduce fuel loads and readjust structure and composition in longleaf communities of the Gulf Coastal Plains region is difficult because benefits and costs of possible treatment combinations are not fully known. The objective of this research project is to develop management options to reduce fuels and restore the ecosystem that are economically...

  11. Developing fire management mixes for fire program planning

    Treesearch

    Armando González-Cabán; Patricia B. Shinkle; Thomas J. Mills

    1986-01-01

    Evaluating economic efficiency of fire management program options requires information on the firefighting inputs, such as vehicles and crews, that would be needed to execute the program option selected. An algorithm was developed to translate automatically dollars allocated to type of firefighting inputs to numbers of units, using a set of weights for a specific fire...

  12. Evaluating ecosystem-based management options: Effects of trawling in Torres Strait, Australia

    NASA Astrophysics Data System (ADS)

    Ellis, Nick; Pantus, Francis; Welna, Andrzej; Butler, Alan

    2008-09-01

    A suite of management options for a prawn trawl fishery in Torres Strait, Australia was assessed for impacts on the benthic fauna using a dynamic management strategy evaluation approach. The specification of the management options was gained through consultation with stakeholders. Data for the model was drawn from several sources: the fleet data from fishery logbooks and satellite vessel monitoring systems, benthic depletion rates from trawl-down experiments, benthic recovery rates from post-experiment recovery monitoring studies, and benthic distribution from large-scale benthic surveys. Although there were large uncertainties in the resulting indicators, robust measures relevant to management were obtained by taking ratios relative to the status quo. The management control with the biggest effect was total effort; reducing trawl effort always led to increases in benthic faunal density of up to 10%. Spatial closures had a smaller benefit of up to 2%. The effect of closing a set of buffer zones around reefs to trawling was indistinguishable from the status quo option. Closing a larger area, however, was largely beneficial especially for sea cucumbers. When the spatial distributions of fauna prior to fishing were accounted for, fauna with distributions positively correlated with effort improved relative to those negatively correlated. The reduction in prawn catch under effort reduction scenarios could be ameliorated by introducing temporal closures over the full-moon period.

  13. Anticipative management for coral reef ecosystem services in the 21st century.

    PubMed

    Rogers, Alice; Harborne, Alastair R; Brown, Christopher J; Bozec, Yves-Marie; Castro, Carolina; Chollett, Iliana; Hock, Karlo; Knowland, Cheryl A; Marshell, Alyssa; Ortiz, Juan C; Razak, Tries; Roff, George; Samper-Villarreal, Jimena; Saunders, Megan I; Wolff, Nicholas H; Mumby, Peter J

    2015-02-01

    Under projections of global climate change and other stressors, significant changes in the ecology, structure and function of coral reefs are predicted. Current management strategies tend to look to the past to set goals, focusing on halting declines and restoring baseline conditions. Here, we explore a complementary approach to decision making that is based on the anticipation of future changes in ecosystem state, function and services. Reviewing the existing literature and utilizing a scenario planning approach, we explore how the structure of coral reef communities might change in the future in response to global climate change and overfishing. We incorporate uncertainties in our predictions by considering heterogeneity in reef types in relation to structural complexity and primary productivity. We examine 14 ecosystem services provided by reefs, and rate their sensitivity to a range of future scenarios and management options. Our predictions suggest that the efficacy of management is highly dependent on biophysical characteristics and reef state. Reserves are currently widely used and are predicted to remain effective for reefs with high structural complexity. However, when complexity is lost, maximizing service provision requires a broader portfolio of management approaches, including the provision of artificial complexity, coral restoration, fish aggregation devices and herbivore management. Increased use of such management tools will require capacity building and technique refinement and we therefore conclude that diversification of our management toolbox should be considered urgently to prepare for the challenges of managing reefs into the 21st century. © 2014 John Wiley & Sons Ltd.

  14. Fundamentals in the management of multiple myeloma.

    PubMed

    Fadilah, S A W

    2010-09-01

    Progress in our understanding of multiple myeloma and its treatment has resulted in a more tailored approach to patient management, with different therapeutics regimens for different patient populations. The decision to initiate therapy depends primarily on the presence of symptoms which has to balance the chance of tumor clearance and against the risks of treatment related mortality. Selection of appropriate initial treatment should be based primarily on patient's characteristics (biologic age, co-morbidities), the disease characteristics (tumor burden and genetic risk profile) and the expected toxicity profile of the different regimens. When treatment begins, in younger transplant eligible patients the goal is to achieve high quality responses with intensive therapies as the quality of response appears to be important surrogates for long-term outcome. In the majority of myeloma patients in whom intensive treatment is not an option due to advanced age and co-morbidities, treatment should emphasize on optimal disease control to obtain symptomatic relief and to maintain a satisfactory quality of life. The introduction of novel agents has substantially changed the treatment paradigm of this otherwise incurable disease. The utilization of these drugs has moved from relapse setting to the front line setting and has benefited all patient groups. Because of these rapid developments and many treatment options we need good quality clinical studies to guide clinical practice in the management of patients with multiple myeloma. This review presents an update on current concepts of diagnosis and treatment of patients with multiple myeloma and provides recommendations on tailored therapies with particular reference to the local practice. The information presented herein may be used by the health care providers caring for myeloma patients as a guideline to counsel patients to understand their disease and the treatment better.

  15. Advanced Health Management System for the Space Shuttle Main Engine

    NASA Technical Reports Server (NTRS)

    Davidson, Matt; Stephens, John

    2004-01-01

    Boeing-Canoga Park (BCP) and NASA-Marshall Space Flight Center (NASA-MSFC) are developing an Advanced Health Management System (AHMS) for use on the Space Shuttle Main Engine (SSME) that will improve Shuttle safety by reducing the probability of catastrophic engine failures during the powered ascent phase of a Shuttle mission. This is a phased approach that consists of an upgrade to the current Space Shuttle Main Engine Controller (SSMEC) to add turbomachinery synchronous vibration protection and addition of a separate Health Management Computer (HMC) that will utilize advanced algorithms to detect and mitigate predefined engine anomalies. The purpose of the Shuttle AHMS is twofold; one is to increase the probability of successfully placing the Orbiter into the intended orbit, and the other is to increase the probability of being able to safely execute an abort of a Space Transportation System (STS) launch. Both objectives are achieved by increasing the useful work envelope of a Space Shuttle Main Engine after it has developed anomalous performance during launch and the ascent phase of the mission. This increase in work envelope will be the result of two new anomaly mitigation options, in addition to existing engine shutdown, that were previously unavailable. The added anomaly mitigation options include engine throttle-down and performance correction (adjustment of engine oxidizer to fuel ratio), as well as enhanced sensor disqualification capability. The HMC is intended to provide the computing power necessary to diagnose selected anomalous engine behaviors and for making recommendations to the engine controller for anomaly mitigation. Independent auditors have assessed the reduction in Shuttle ascent risk to be on the order of 40% with the combined system and a three times improvement in mission success.

  16. Production and feeding strategies for phosphorus management on dairy farms.

    PubMed

    Rotz, C A; Sharpley, A N; Satter, L D; Gburek, W J; Sanderson, M A

    2002-11-01

    Long-term accumulation of soil phosphorus (P) is becoming a concern on some watersheds heavily populated with animal feeding facilities, including dairy farms. Management changes in crop production and feeding may help reduce the accumulation of excess P, but farm profitability must be maintained or improved to assure adoption of such changes. Whole-farm simulation was used to evaluate the long-term effects of changes in feeding, cropping, and other production strategies on P loading and the economics of 100-cow and 800-cow dairy farms in southeastern New York. Simulated farms maintained a long-term P balance if the following occurred: 1) animals were fed to meet recommended minimum amounts of dietary P, 2) the cropping strategy and land base supplied all of the forage needed, 3) all animals were fed a high forage diet, and 4) replacement heifers were produced on the farm to utilize more forage. The most easily implemented change was to reduce the supplemental mineral P fed to that required to meet current NRC recommended amounts, and this provided an annual increase in farm profit of about $22/cow. Intensifying the use of grassland and improving grazing practices increased profit along with a small reduction in excess P. Conversion from dairy production to heifer raising or expansion from 100 cows to a 250-cow "state-of-the-art" confinement facility (with a 70% increase in land area) were also profitable options. These options provided a long-term P balance for the farm as long as the production and use of forage was maximized and minimum dietary P amounts were those recommended by the NRC. Thus, management changes can be made to prevent the long-term accumulation of soil P on dairy farms while improving farm profitability.

  17. Electronic Switch Arrays for Managing Microbattery Arrays

    NASA Technical Reports Server (NTRS)

    Mojarradi, Mohammad; Alahmad, Mahmoud; Sukumar, Vinesh; Zghoul, Fadi; Buck, Kevin; Hess, Herbert; Li, Harry; Cox, David

    2008-01-01

    Integrated circuits have been invented for managing the charging and discharging of such advanced miniature energy-storage devices as planar arrays of microscopic energy-storage elements [typically, microscopic electrochemical cells (microbatteries) or microcapacitors]. The architecture of these circuits enables implementation of the following energy-management options: dynamic configuration of the elements of an array into a series or parallel combination of banks (subarrarys), each array comprising a series of parallel combination of elements; direct addressing of individual banks for charging/or discharging; and, disconnection of defective elements and corresponding reconfiguration of the rest of the array to utilize the remaining functional elements to obtain the desited voltage and current performance. An integrated circuit according to the invention consists partly of a planar array of field-effect transistors that function as switches for routing electric power among the energy-storage elements, the power source, and the load. To connect the energy-storage elements to the power source for charging, a specific subset of switches is closed; to connect the energy-storage elements to the load for discharging, a different specific set of switches is closed. Also included in the integrated circuit is circuitry for monitoring and controlling charging and discharging. The control and monitoring circuitry, the switching transistors, and interconnecting metal lines are laid out on the integrated-circuit chip in a pattern that registers with the array of energy-storage elements. There is a design option to either (1) fabricate the energy-storage elements in the corresponding locations on, and as an integral part of, this integrated circuit; or (2) following a flip-chip approach, fabricate the array of energy-storage elements on a separate integrated-circuit chip and then align and bond the two chips together.

  18. NASA's asteroid redirect mission: Robotic boulder capture option

    NASA Astrophysics Data System (ADS)

    Abell, P.; Nuth, J.; Mazanek, D.; Merrill, R.; Reeves, D.; Naasz, B.

    2014-07-01

    NASA is examining two options for the Asteroid Redirect Mission (ARM), which will return asteroid material to a Lunar Distant Retrograde Orbit (LDRO) using a robotic solar-electric-propulsion spacecraft, called the Asteroid Redirect Vehicle (ARV). Once the ARV places the asteroid material into the LDRO, a piloted mission will rendezvous and dock with the ARV. After docking, astronauts will conduct two extravehicular activities (EVAs) to inspect and sample the asteroid material before returning to Earth. One option involves capturing an entire small (˜4--10 m diameter) near-Earth asteroid (NEA) inside a large inflatable bag. However, NASA is also examining another option that entails retrieving a boulder (˜1--5 m) via robotic manipulators from the surface of a larger (˜100+ m) pre-characterized NEA. The Robotic Boulder Capture (RBC) option can leverage robotic mission data to help ensure success by targeting previously (or soon to be) well-characterized NEAs. For example, the data from the Japan Aerospace Exploration Agency's (JAXA) Hayabusa mission has been utilized to develop detailed mission designs that assess options and risks associated with proximity and surface operations. Hayabusa's target NEA, Itokawa, has been identified as a valid target and is known to possess hundreds of appropriately sized boulders on its surface. Further robotic characterization of additional NEAs (e.g., Bennu and 1999 JU_3) by NASA's OSIRIS REx and JAXA's Hayabusa 2 missions is planned to begin in 2018. This ARM option reduces mission risk and provides increased benefits for science, human exploration, resource utilization, and planetary defense.

  19. Taking action against ocean acidification: a review of management and policy options.

    PubMed

    Billé, Raphaël; Kelly, Ryan; Biastoch, Arne; Harrould-Kolieb, Ellycia; Herr, Dorothée; Joos, Fortunat; Kroeker, Kristy; Laffoley, Dan; Oschlies, Andreas; Gattuso, Jean-Pierre

    2013-10-01

    Ocean acidification has emerged over the last two decades as one of the largest threats to marine organisms and ecosystems. However, most research efforts on ocean acidification have so far neglected management and related policy issues to focus instead on understanding its ecological and biogeochemical implications. This shortfall is addressed here with a systematic, international and critical review of management and policy options. In particular, we investigate the assumption that fighting acidification is mainly, but not only, about reducing CO2 emissions, and explore the leeway that this emerging problem may open in old environmental issues. We review nine types of management responses, initially grouped under four categories: preventing ocean acidification; strengthening ecosystem resilience; adapting human activities; and repairing damages. Connecting and comparing options leads to classifying them, in a qualitative way, according to their potential and feasibility. While reducing CO2 emissions is confirmed as the key action that must be taken against acidification, some of the other options appear to have the potential to buy time, e.g. by relieving the pressure of other stressors, and help marine life face unavoidable acidification. Although the existing legal basis to take action shows few gaps, policy challenges are significant: tackling them will mean succeeding in various areas of environmental management where we failed to a large extent so far.

  20. Taking Action Against Ocean Acidification: A Review of Management and Policy Options

    NASA Astrophysics Data System (ADS)

    Billé, Raphaël; Kelly, Ryan; Biastoch, Arne; Harrould-Kolieb, Ellycia; Herr, Dorothée; Joos, Fortunat; Kroeker, Kristy; Laffoley, Dan; Oschlies, Andreas; Gattuso, Jean-Pierre

    2013-10-01

    Ocean acidification has emerged over the last two decades as one of the largest threats to marine organisms and ecosystems. However, most research efforts on ocean acidification have so far neglected management and related policy issues to focus instead on understanding its ecological and biogeochemical implications. This shortfall is addressed here with a systematic, international and critical review of management and policy options. In particular, we investigate the assumption that fighting acidification is mainly, but not only, about reducing CO2 emissions, and explore the leeway that this emerging problem may open in old environmental issues. We review nine types of management responses, initially grouped under four categories: preventing ocean acidification; strengthening ecosystem resilience; adapting human activities; and repairing damages. Connecting and comparing options leads to classifying them, in a qualitative way, according to their potential and feasibility. While reducing CO2 emissions is confirmed as the key action that must be taken against acidification, some of the other options appear to have the potential to buy time, e.g. by relieving the pressure of other stressors, and help marine life face unavoidable acidification. Although the existing legal basis to take action shows few gaps, policy challenges are significant: tackling them will mean succeeding in various areas of environmental management where we failed to a large extent so far.

  1. Alternatives to neonicotinoid insecticides for pest control: case studies in agriculture and forestry.

    PubMed

    Furlan, Lorenzo; Kreutzweiser, David

    2015-01-01

    Neonicotinoid insecticides are widely used for control of insect pests around the world and are especially pervasive in agricultural pest management. There is a growing body of evidence indicating that the broad-scale and prophylactic uses of neonicotinoids pose serious risks of harm to beneficial organisms and their ecological function. This provides the impetus for exploring alternatives to neonicotinoid insecticides for controlling insect pests. We draw from examples of alternative pest control options in Italian maize production and Canadian forestry to illustrate the principles of applying alternatives to neonicotinoids under an integrated pest management (IPM) strategy. An IPM approach considers all relevant and available information to make informed management decisions, providing pest control options based on actual need. We explore the benefits and challenges of several options for management of three insect pests in maize crops and an invasive insect pest in forests, including diversifying crop rotations, altering the timing of planting, tillage and irrigation, using less sensitive crops in infested areas, applying biological control agents, and turning to alternative reduced risk insecticides. Continued research into alternatives is warranted, but equally pressing is the need for information transfer and training for farmers and pest managers and the need for policies and regulations to encourage the adoption of IPM strategies and their alternative pest control options.

  2. Decision analysis and drug development portfolio management: uncovering the real options value of your projects.

    PubMed

    Rosati, Nicoletta

    2002-04-01

    Project selection and portfolio management are particularly challenging in the pharmaceutical industry due to the high risk - high stake nature of the drug development process. In the recent years, scholars and industry experts have agreed that traditional Net-Present-Value evaluation of the projects fails to capture the value of managerial flexibility, and encouraged adopting a real options approach to recover the missed value. In this paper, we take a closer look at the drug development process and at the indices currently used to rank projects. We discuss the economic value of information and of real options arising in drug development and present decision analysis as an ideal framework for the implementation of real options valuation.

  3. Advanced Management of Severe Keloids.

    PubMed

    Hagele, Thomas; Nyanda, Hoka; Patel, Nishit; Russell, Nicole; Cohen, George; Nelson, Christopher

    2017-01-01

    Keloids negatively impact the health and quality of life of many affected dermatologic patients. Treating keloids is often difficult, and suboptimal responses are frequent. Fortunately, there are many treatment options available to the clinician that may lead to improved clinical outcomes. We present a review of currently available therapeutic options. Intralesional steroid injection remains the first-line treatment for keloids. Imiquimod, direct interferon therapy, or intralesional 5-flurouracil may alleviate the need for excessive corticosteroid therapy. Radiation and laser therapy are emerging therapeutic options that have demonstrated efficacy in reviewed studies. Given the unsatisfactory outcomes associated with pressure dressings, vitamin E, ablative laser, and surgical excision, these options should be avoided in keloid management. Further research is needed to evaluate the efficacy and recurrence associated with the reviewed therapeutics.

  4. 42 CFR 438.356 - State contract options.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false State contract options. 438.356 Section 438.356 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE External Quality Review § 438.356 State contract options...

  5. Scoping study of integrated resource planning needs in the public utility sector

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

    Garrick, C J; Garrick, J M; Rue, D R

    Integrated resource planning (IRP) is an approach to utility resource planning that integrates the evaluation of supply- and demand-site options for providing energy services at the least cost. Many utilities practice IRP; however, most studies about IRP focus on investor-owned utilities (IOUs). This scoping study investigates the IRP activities and needs of public utilities (not-for-profit utilities, including federal, state, municipal, and cooperative utilities). This study (1) profiles IRP-related characteristics of the public utility sector, (2) articulates the needs of public utilities in understanding and implementing IRP, and (3) identifies strategies to advance IRP principles in public utility planning.

  6. Management of Malignant Pleural Effusion: A Cost-Utility Analysis.

    PubMed

    Shafiq, Majid; Frick, Kevin D; Lee, Hans; Yarmus, Lonny; Feller-Kopman, David J

    2015-07-01

    Malignant pleural effusion (MPE) is associated with a significant impact on health-related quality of life. Palliative interventions abound, with varying costs and degrees of invasiveness. We examined the relative cost-utility of 5 therapeutic alternatives for MPE among adults. Original studies investigating the management of MPE were extensively researched, and the most robust and current data particularly those from the TIME2 trial were chosen to estimate event probabilities. Medicare data were used for cost estimation. Utility estimates were adapted from 2 original studies and kept consistent with prior estimations. The decision tree model was based on clinical guidelines and authors' consensus opinion. Primary outcome of interest was the incremental cost-effectiveness ratio for each intervention over a less effective alternative over an analytical horizon of 6 months. Given the paucity of data on rapid pleurodesis protocol, a sensitivity analysis was conducted to address the uncertainty surrounding its efficacy in terms of achieving long-term pleurodesis. Except for repeated thoracentesis (RT; least effective), all interventions had similar effectiveness. Tunneled pleural catheter was the most cost-effective option with an incremental cost-effectiveness ratio of $45,747 per QALY gained over RT, assuming a willingness-to-pay threshold of $100,000/QALY. Multivariate sensitivity analysis showed that rapid pleurodesis protocol remained cost-ineffective even with an estimated probability of lasting pleurodesis up to 85%. Tunneled pleural catheter is the most cost-effective therapeutic alternative to RT. This, together with its relative convenience (requiring neither hospitalization nor thoracoscopic procedural skills), makes it an intervention of choice for MPE.

  7. Preclinic group education sessions reduce waiting times and costs at public pain medicine units.

    PubMed

    Davies, Stephanie; Quintner, John; Parsons, Richard; Parkitny, Luke; Knight, Paul; Forrester, Elizabeth; Roberts, Mary; Graham, Carl; Visser, Eric; Antill, Tracy; Packer, Tanya; Schug, Stephan A

    2011-01-01

    To assess the effects of preclinic group education sessions and system redesign on tertiary pain medicine units and patient outcomes. Prospective cohort study. Two public hospital multidisciplinary pain medicine units. People with persistent pain. A system redesign from a "traditional" model (initial individual medical appointments) to a model that delivers group education sessions prior to individual appointments. Based on Patient Triage Questionnaires patients were scheduled to attend Self-Training Educative Pain Sessions (STEPS), a two day eight hour group education program, followed by optional patient-initiated clinic appointments. Number of patients completing STEPS who subsequently requested individual outpatient clinic appointment(s); wait-times; unit cost per new patient referred; recurrent health care utilization; patient satisfaction; Global Perceived Impression of Change (GPIC); and utilized pain management strategies. Following STEPS 48% of attendees requested individual outpatient appointments. Wait times reduced from 105.6 to 16.1 weeks at one pain unit and 37.3 to 15.2 weeks at the second. Unit cost per new patient appointed reduced from $1,805 Australian Dollars (AUD) to AUD$541 (for STEPS). At 3 months, patients scored their satisfaction with "the treatment received for their pain" more positively than at baseline (change score=0.88; P=0.0003), GPIC improved (change score=0.46; P<0.0001) and mean number of active strategies utilized increased by 4.12 per patient (P=0.0004). The introduction of STEPS was associated with reduced wait-times and costs at public pain medicine units and increased both the use of active pain management strategies and patient satisfaction. Wiley Periodicals, Inc.

  8. Surgical Management of Hemorrhoids

    PubMed Central

    Agbo, S. P.

    2011-01-01

    Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding. PMID:22413048

  9. Clinical utility of indigenously formulated single-vial lyophilized HYNIC-TOC kit in evaluating Gastro-entero Pancreatic neuro endocrine tumours

    PubMed Central

    Shinto, Ajit S; Kamaleshwaran, K; Vyshak, K; Sudhakar, Natarajan; Banerjee, Sharmila; Korde, Aruna; Samuel, Grace; Mallia, Madhav

    2014-01-01

    Objective(s): The objective of this study was to evaluate the performance and utility of 99mTc HYNIC-TOC planar scintigraphy and SPECT/CT in the diagnosis, staging and management of gastroenteropancreatic neuroendocrine tumors (GPNETs). Methods: 22 patients (median age, 46 years) with histologically proven gastro- entero- pancreatic NETs underwent 99mTc HYNIC-TOC whole body scintigraphy and regional SPECT/CT as indicated. Scanning was performed after injection of 370-550 MBq (10-15 mCi) of 99mTc HYNIC-TOC intravenously. Images were evaluated by two experienced nuclear medicine physicians both qualitatively as well as semi quantitatively (tumor to background and tumor to normal liver ratios on SPECT -CT images). Results of SPECT/CT were compared with the results of conventional imaging. Histopathology results and follow-up somatostatin receptor scintigraphy with 99mTc HYNIC TOC or conventional imaging with biochemical markers were considered to be the reference standards. Results: 99mTc HYNIC TOC showed sensitivity and specificity of 87.5% and 85.7%, respectively, for primary tumor and 100% and 86% for metastases. It was better than conventional imaging modalities for the detection of both primary tumor (P<0.001) and metastases (P<0.0001). It changed the management strategy in 6 patients (31.8%) and supported management decisions in 8 patients (36.3%). Conclusion: 99mTc HYNIC TOC SPECT/CT appears to be a highly sensitive and specific modality for the detection and staging of GPNETs. It is better than conventional imaging for the evaluation of GPNETs and can have a significant impact on patient management and planning further therapeutic options. PMID:27408857

  10. Clinical utility of indigenously formulated single-vial lyophilized HYNIC-TOC kit in evaluating Gastro-entero Pancreatic neuro endocrine tumours.

    PubMed

    Shinto, Ajit S; Kamaleshwaran, K; Vyshak, K; Sudhakar, Natarajan; Banerjee, Sharmila; Korde, Aruna; Samuel, Grace; Mallia, Madhav

    2014-01-01

    The objective of this study was to evaluate the performance and utility of (99m)Tc HYNIC-TOC planar scintigraphy and SPECT/CT in the diagnosis, staging and management of gastroenteropancreatic neuroendocrine tumors (GPNETs). 22 patients (median age, 46 years) with histologically proven gastro- entero- pancreatic NETs underwent (99m)Tc HYNIC-TOC whole body scintigraphy and regional SPECT/CT as indicated. Scanning was performed after injection of 370-550 MBq (10-15 mCi) of (99m)Tc HYNIC-TOC intravenously. Images were evaluated by two experienced nuclear medicine physicians both qualitatively as well as semi quantitatively (tumor to background and tumor to normal liver ratios on SPECT -CT images). Results of SPECT/CT were compared with the results of conventional imaging. Histopathology results and follow-up somatostatin receptor scintigraphy with (99m)Tc HYNIC TOC or conventional imaging with biochemical markers were considered to be the reference standards. (99m)Tc HYNIC TOC showed sensitivity and specificity of 87.5% and 85.7%, respectively, for primary tumor and 100% and 86% for metastases. It was better than conventional imaging modalities for the detection of both primary tumor (P<0.001) and metastases (P<0.0001). It changed the management strategy in 6 patients (31.8%) and supported management decisions in 8 patients (36.3%). (99m)Tc HYNIC TOC SPECT/CT appears to be a highly sensitive and specific modality for the detection and staging of GPNETs. It is better than conventional imaging for the evaluation of GPNETs and can have a significant impact on patient management and planning further therapeutic options.

  11. Spotlight on escitalopram in the management of major depressive disorder.

    PubMed

    Murdoch, David; Keam, Susan J

    2006-01-01

    Escitalopram (Cipralex), Lexapro), the active S-enantiomer of the racemic SSRI citalopram (RS-citalopram), is a highly selective inhibitor of the serotonin transporter protein. It possesses a rapid onset of antidepressant activity, and is an effective and generally well tolerated treatment for moderate-to-severe major depressive disorder (MDD). Pooled analyses from an extensive clinical trial database suggest that escitalopram is consistently more effective than citalopram in moderate-to-severe MDD. Preliminary studies suggest that escitalopram is as effective as other SSRIs and the extended-release (XR) formulation of the serotonin/noradrenaline (norepinephrine) reuptake inhibitor venlafaxine, and may have cost-effectiveness and cost-utility advantages. However, additional longer-term, comparative studies evaluating specific efficacy, tolerability, health-related quality of life and economic indices would be helpful in definitively positioning escitalopram relative to these other agents in the treatment of MDD. Nevertheless, available clinical and pharmacoeconomic data indicate that escitalopram is an effective first-line option in the management of patients with MDD.

  12. Escitalopram: a review of its use in the management of major depressive disorder.

    PubMed

    Murdoch, David; Keam, Susan J

    2005-01-01

    Escitalopram (Cipralex, Lexapro), the active S-enantiomer of the racemic selective serotonin reuptake inhibitor (SSRI) citalopram (RS-citalopram), is a highly selective inhibitor of the serotonin transporter protein. It possesses a rapid onset of antidepressant activity, and is an effective and generally well tolerated treatment for moderate-to-severe major depressive disorder (MDD). Pooled analyses from an extensive clinical trial database suggest that escitalopram is consistently more effective than citalopram in moderate-to-severe MDD. Preliminary studies suggest that escitalopram is as effective as other SSRIs and the extended-release (XR) formulation of the serotonin/noradrenaline (norepinephrine) reuptake inhibitor venlafaxine, and may have cost-effectiveness and cost-utility advantages. However, additional longer-term, comparative studies evaluating specific efficacy, tolerability, health-related quality of life and economic indices would be helpful in definitively positioning escitalopram relative to these other agents in the treatment of MDD. Nevertheless, available clinical and pharmacoeconomic data indicate that escitalopram is an effective first-line option in the management of patients with MDD.

  13. Optimizing management of actinic keratosis and photodamaged skin: utilizing a stepwise approach.

    PubMed

    Lee, Andrew D; Jorizzo, Joseph L

    2009-09-01

    The incidence of photodamaged skin and skin lesions of all degrees of severity, from actinic keratosis (AK) to skin cancers, has dramatically increased. Actinic keratoses are pathologic, reflecting damage of essential skin cell functions and potentially progressing to invasive squamous cell carcinoma (SCC). The rate of progression is uncertain but may be as high as 10%. Because it is impossible to predict which AKs will progress to SCC, all lesions should be treated. Options include topical therapies, cryotherapy, curettage, and photodynamic therapy. Unfortunately, many individuals do not seek treatment or avoid it because of irritation, discomfort, and concern for scarring. Combining field-directed therapy and cryotherapy has been more effective than cryotherapy alone. Incorporating patient education with treatment may optimize outcomes. We propose a comprehensive 5-step approach for managing AK lesions and photodamaged skin that includes periodic clinical skin examinations; treating AK lesions with a combination of field- and lesion-directed therapy; and patient education regarding sun-protective measures and regular skin self-examinations.

  14. An ecological perspective on the changing face of Brucella abortus in the western United States

    USGS Publications Warehouse

    Cross, Paul C.; Maichak, Eric J.; Brennan, Angela; Scurlock, Brandon M.; Henningsen, John C.; Luikart, Gordon

    2013-01-01

    After a hiatus during the 1990s, outbreaks of Brucella abortus in cattle are occurring more frequently in some of the western states of the United States, namely, Montana, Wyoming and Idaho. This increase is coincident with increasing brucellosis seroprevalence in elk (Cervus elaphus), which is correlated with elk density. Vaccines are a seductive solution, but their use in wildlife systems remains limited by logistical, financial, and scientific constraints. Cattle vaccination is ongoing in the region. Livestock regulations, however, tend to be based on serological tests that test for previous exposure and available vaccines do not protect against seroconversion. The authors review recent ecological studies of brucellosis, with particular emphasis on the Greater Yellowstone Area, and highlight the management options and implications of this work, including the potential utility of habitat modifications and targeted hunts, as well as scavengers and predators. Finally, the authors discuss future research directions that will help us to understand and manage brucellosis in wildlife.

  15. Using ProHits to store, annotate and analyze affinity purification - mass spectrometry (AP-MS) data

    PubMed Central

    Liu, Guomin; Zhang, Jianping; Choi, Hyungwon; Lambert, Jean-Philippe; Srikumar, Tharan; Larsen, Brett; Nesvizhskii, Alexey I.; Raught, Brian; Tyers, Mike; Gingras, Anne-Claude

    2012-01-01

    Affinity purification coupled with mass spectrometry (AP-MS) is a robust technique used to identify protein-protein interactions. With recent improvements in sample preparation, and dramatic advances in MS instrumentation speed and sensitivity, this technique is becoming more widely used throughout the scientific community. To meet the needs of research groups both large and small, we have developed software solutions for tracking, scoring and analyzing AP-MS data. Here, we provide details for the installation and utilization of ProHits, a Laboratory Information Management System designed specifically for AP-MS interaction proteomics. This protocol explains: (i) how to install the complete ProHits system, including modules for the management of mass spectrometry files and the analysis of interaction data, and (ii) alternative options for the use of pre-existing search results in simpler versions of ProHits, including a virtual machine implementation of our ProHits Lite software. We also describe how to use the main features of the software to analyze AP-MS data. PMID:22948730

  16. Charting the Emergence of Corporate Procurement of Utility-Scale PV |

    Science.gov Websites

    Jeffrey J. Cook Though most large-scale solar photovoltaic (PV) deployment has been driven by utility corporate interest in renewables as more companies are recognizing that solar PV can provide clean United States highlighting states with utility-scale solar PV purchasing options Figure 2. States with

  17. The use of an automated interactive voice response system to manage medication identification calls to a poison center.

    PubMed

    Krenzelok, Edward P; Mrvos, Rita

    2009-05-01

    In 2007, medication identification requests (MIRs) accounted for 26.2% of all calls to U.S. poison centers. MIRs are documented with minimal information, but they still require an inordinate amount of work by specialists in poison information (SPI). An analysis was undertaken to identify options to reduce the impact of MIRs on both human and financial resources. All MIRs (2003-2007) to a certified regional poison information center were analyzed to determine call patterns and staffing. The data were used to justify an efficient and cost-effective solution. MIRs represented 42.3% of the 2007 call volume. Optimal staffing would require hiring an additional four full-time equivalent SPI. An interactive voice response (IVR) system was developed to respond to the MIRs. The IVR was used to develop the Medication Identification System that allowed the diversion of up to 50% of the MIRs, enhancing surge capacity and allowing specialists to address the more emergent poison exposure calls. This technology is an entirely voice-activated response call management system that collects zip code, age, gender and drug data and stores all responses as .csv files for reporting purposes. The query bank includes the 200 most common MIRs, and the system features text-to-voice synthesis that allows easy modification of the drug identification menu. Callers always have the option of engaging a SPI at any time during the IVR call flow. The IVR is an efficient and effective alternative that creates better staff utilization.

  18. Adaptive Flood Risk Management Under Climate Change Uncertainty Using Real Options and Optimization.

    PubMed

    Woodward, Michelle; Kapelan, Zoran; Gouldby, Ben

    2014-01-01

    It is well recognized that adaptive and flexible flood risk strategies are required to account for future uncertainties. Development of such strategies is, however, a challenge. Climate change alone is a significant complication, but, in addition, complexities exist trying to identify the most appropriate set of mitigation measures, or interventions. There are a range of economic and environmental performance measures that require consideration, and the spatial and temporal aspects of evaluating the performance of these is complex. All these elements pose severe difficulties to decisionmakers. This article describes a decision support methodology that has the capability to assess the most appropriate set of interventions to make in a flood system and the opportune time to make these interventions, given the future uncertainties. The flood risk strategies have been explicitly designed to allow for flexible adaptive measures by capturing the concepts of real options and multiobjective optimization to evaluate potential flood risk management opportunities. A state-of-the-art flood risk analysis tool is employed to evaluate the risk associated to each strategy over future points in time and a multiobjective genetic algorithm is utilized to search for the optimal adaptive strategies. The modeling system has been applied to a reach on the Thames Estuary (London, England), and initial results show the inclusion of flexibility is advantageous, while the outputs provide decisionmakers with supplementary knowledge that previously has not been considered. © 2013 HR Wallingford Ltd.

  19. Incorporating Green Infrastructure into Water Resources Management Plans to Address Water Quality Impairments

    NASA Astrophysics Data System (ADS)

    Piscopo, A. N.; Detenbeck, N. E.

    2017-12-01

    Managers of urban watersheds with excessive nutrient loads are more frequently turning to green infrastructure (GI) to manage their water quality impairments. The effectiveness of GI is dependent on a number of factors, including (1) the type and placement of GI within the watershed, (2) the specific nutrients to be treated, and (3) the uncertainty in future climates. Although many studies have investigated the effectiveness of individual GI units for different types of nutrients, relatively few have considered the effectiveness of GI on a watershed scale, the scale most relevant to management plans. At the watershed scale, endless combinations of GI type and location are possible, each with different effectiveness in reducing nutrient loads, minimizing costs, and maximizing co-benefits such as reducing runoff. To efficiently generate management plan options that balance the tradeoffs between these objectives, we simulate candidate options using EPA's Stormwater Management Model for multiple future climates and determine the Pareto optimal set of solution options using a multi-objective evolutionary algorithm. Our approach is demonstrated for an urban watershed in Rockville, Maryland.

  20. Sickle Cell Disease: Management Options and Challenges in Developing Countries

    PubMed Central

    Ansong, Daniel; Akoto, Alex Osei; Ocloo, Delaena; Ohene-Frempong, Kwaku

    2013-01-01

    Sickle Cell Disease (SCD) is the most common genetic disorder of haemoglobin in sub-Saharan Africa. This commentary focuses on the management options available and the challenges that health care professionals in developing countries face in caring for patients with SCD. In a developing countries like Ghana, new-born screening is now about to be implemented on a national scale. Common and important morbidities associated with SCD are vaso-occlusive episodes, infections, Acute Chest Syndrome (ACS), Stroke and hip necrosis. Approaches to the management of these morbidities are far advanced in the developed countries. The differences in setting and resource limitations in developing countries bring challenges that have a major influence in management options in developing countries. Obviously clinicians in developing countries face challenges in managing SCD patients. However understanding the disease, its progression, and instituting the appropriate preventive methods are paramount in its management. Emphasis should be placed on early counselling, new-born screening, anti-microbial prophylaxis, vaccination against infections, and training of healthcare workers, patients and caregivers. These interventions are affordable in developing countries. PMID:24363877

  1. Proceedings of Small Power Systems Solar Electric Workshop. Volume 2: Invited papers

    NASA Technical Reports Server (NTRS)

    Ferber, R. (Editor)

    1978-01-01

    The focus of this work shop was to present the committment to the development of solar thermal power plants for a variety of applications including utility applications. Workshop activities included panel discussions, formal presentations, small group interactive discussions, question and answer periods, and informal gatherings. Discussion on topics include: (1) solar power technology options; (2) solar thermal power programs currently underway at the DOE, JPL, Electric Power Research Institute (EPRI), and Solar Energy Research Institute (SERI); (3) power options competing with solar; (4) institutional issues; (5) environmental and siting issues; (6) financial issues; (7) energy storage; (8) site requirements for experimental solar installations, and (9) utility planning.

  2. Telepathology in cytopathology: challenges and opportunities.

    PubMed

    Collins, Brian T

    2013-01-01

    Telepathology in cytopathology is becoming more commonly utilized, and newer technologic infrastructures afford the laboratory a variety of options. The options and design of a telepathology system are driven by the clinical needs. This is primarily focused on providing rapid on-site evaluation service for fine needle aspiration. The clinical requirements and needs of a system are described. Available tools to design and implement a telepathology system are covered, including methods of image capture, network connectivity and remote viewing options. The primary telepathology method currently used and described involves the delivery via a network connection of a live video image to a remote site which is passively viewed by an internet web-based browser. By utilizing live video information and a voice connection to the on-site location, the remote viewer can collect clinical information and direct their view of the slides. Telepathology systems for use in cytopathology can be designed and implemented with commercially available infrastructure. It is necessary for the laboratory to validate the designed system and adhere to the required regulatory requirements. Telepathology for cytopathology can be reliably utilized by adapting existing technology, and newer advances hold great promise for further applications in the cytopathology laboratory. Copyright © 2013 S. Karger AG, Basel.

  3. Green Power Marketing in the United States. A Status Report (2008 Data)

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

    Bird, Lori; Kreycik, Claire; Friedman, Barry

    Voluntary consumer decisions to buy electricity supplied from renewable energy sources represent a powerful market support mechanism for renewable energy development. In the early 1990s, a small number of U.S. utilities began offering 'green power' options to their customers. Since then, these products have become more prevalent, both from traditional utilities and from renewable energy marketers operating in states that have introduced competition into their retail electricity markets or offering renewable energy certificates (RECs) online. Today, more than half of all U.S. electricity customers have an option to purchase some type of green power product directly from a retail electricitymore » provider, while all consumers have the option to purchase RECs. This report documents green power marketing activities and trends in the United States including utility green pricing programs offered in regulated electricity markets; green power marketing activity in competitive electricity markets, as well as green power sold to voluntary purchasers in the form of RECs; and renewable energy sold as greenhouse gas offsets in the United States. These sections are followed by a discussion of key market trends and issues. The final section offers conclusions and observations.« less

  4. Green Power Marketing in the United States: A Status Report (2008 Data)

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

    Bird, L.; Kreycik, C.; Friedman, B.

    Voluntary consumer decisions to buy electricity supplied from renewable energy sources represent a powerful market support mechanism for renewable energy development. In the early 1990s, a small number of U.S. utilities began offering 'green power' options to their customers. Since then, these products have become more prevalent, both from traditional utilities and from renewable energy marketers operating in states that have introduced competition into their retail electricity markets or offering renewable energy certificates (RECs) online. Today, more than half of all U.S. electricity customers have an option to purchase some type of green power product directly from a retail electricitymore » provider, while all consumers have the option to purchase RECs. This report documents green power marketing activities and trends in the United States including utility green pricing programs offered in regulated electricity markets; green power marketing activity in competitive electricity markets, as well as green power sold to voluntary purchasers in the form of RECs; and renewable energy sold as greenhouse gas offsets in the United States. These sections are followed by a discussion of key market trends and issues. The final section offers conclusions and observations.« less

  5. Decommissioning the Romanian Water-Cooled Water-Moderated Research Reactor: New Environmental Perspective on the Management of Radioactive Waste

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

    Barariu, G.; Giumanca, R.

    2006-07-01

    Pre-feasibility and feasibility studies were performed for decommissioning of the water-cooled water-moderated research reactor (WWER) located in Bucharest - Magurele, Romania. Using these studies as a starting point, the preferred safe management strategy for radioactive wastes produced by reactor decommissioning is outlined. The strategy must account for reactor decommissioning, as well as for the rehabilitation of the existing Radioactive Waste Treatment Plant and for the upgrade of the Radioactive Waste Disposal Facility at Baita-Bihor. Furthermore, the final rehabilitation of the laboratories and ecological reconstruction of the grounds need to be provided for, in accordance with national and international regulations. Inmore » accordance with IAEA recommendations at the time, the pre-feasibility study proposed three stages of decommissioning. However, since then new ideas have surfaced with regard to decommissioning. Thus, taking into account the current IAEA ideology, the feasibility study proposes that decommissioning of the WWER be done in one stage to an unrestricted clearance level of the reactor building in an Immediate Dismantling option. Different options and the corresponding derived preferred option for waste management are discussed taking into account safety measures, but also considering technical, logistical and economic factors. For this purpose, possible types of waste created during each decommissioning stage are reviewed. An approximate inventory of each type of radioactive waste is presented. The proposed waste management strategy is selected in accordance with the recommended international basic safety standards identified in the previous phase of the project. The existing Radioactive Waste Treatment Plant (RWTP) from the Horia Hulubei Institute for Nuclear Physics and Engineering (IFIN-HH), which has been in service with no significant upgrade since 1974, will need refurbishing due to deterioration, as well as upgrading in order to ensure the plant complies with current safety standards. This plant will also need to be adapted to treat wastes generated by WWER dismantling. The Baita-Bihor National Radioactive Waste Disposal Facility consists of two galleries in an abandoned uranium mine located in the central-western part of the Bihor Mountains in Transylvania. The galleries lie at a depth of 840 m. The facility requires a considerable overhaul. Several steps recommended for the upgrade of the facility are explored. Environmental concerns have lately become a crucial part of the radioactive waste management strategy. As such, all decisions must be made with great regard for land utilization around nuclear objectives. (authors)« less

  6. Moving toward integrated value-based planning: The issues

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

    Chamberlin, J.H.; Braithwait, C.L.

    1988-07-01

    Integrated Value-Based Planning (IVP) is a promising new planning approach that uses value, as well as cost, as the common denominator for evaluating supply and demand resource options. Planning based on value yields an ''apples to apples'' comparison of utility and customer options. The IVP approach can form the cornerstone of a successful market-driven utility planning strategy. This conference will raise questions, discuss issues, and further the exchange of information regarding the tools, concepts, and techniques needed to put IVP into the utility planner's toolbox. This proceedings is more than a compendium of papers. It is designed to let bothmore » participants and non-participants exchange information. To this end, listings and cross-listings of papers, speakers and participant interest areas, along with the ever-invaluable phone number have been included.« less

  7. Management of scars: updated practical guidelines and use of silicones.

    PubMed

    Meaume, Sylvie; Le Pillouer-Prost, Anne; Richert, Bertrand; Roseeuw, Diane; Vadoud, Javid

    2014-01-01

    Hypertrophic scars and keloids resulting from surgery, burns, trauma and infection can be associated with substantial physical and psychological distress. Various non-invasive and invasive options are currently available for the prevention and treatment of these scars. Recently, an international multidisciplinary group of 24 experts on scar management (dermatologists; plastic and reconstructive surgeons; general surgeons; physical medicine, rehabilitation and burns specialists; psychosocial and behavioural researchers; epidemiologists; beauticians) convened to update a set of practical guidelines for the prevention and treatment of hypertrophic and keloid scars on the basis of the latest published clinical evidence on existing scar management options. Silicone-based products such as sheets and gels are recommended as the gold standard, first-line, non-invasive option for both the prevention and treatment of scars. Other general scar preventative measures include avoiding sun exposure, compression therapy, taping and the use of moisturisers. Invasive treatment options include intralesional injections of corticosteroids and/or 5-fluorouracil, cryotherapy, radiotherapy, laser therapy and surgical excision. All of these options may be used alone or as part of combination therapy. Of utmost importance is the regular re-evaluation of patients every four to eight weeks to evaluate whether additional treatment is warranted. The amount of scar management measures that are applied to each wound depends on the patient's risk of developing a scar and their level of concern about the scar's appearance. The practical advice presented in the current guidelines should be combined with clinical judgement when deciding on the most appropriate scar management measures for an individual patient.

  8. A New Frontier: Utilizing Charter Schooling to Strengthen Rural Education

    ERIC Educational Resources Information Center

    Smarick, Andy

    2014-01-01

    This report, the first in the series, points out that, while urban families increasingly have access to a variety of school options--including charter schools--many rural families have just a single school option. There are numerous examples of rural charter schools that have done great things for students while also benefiting the larger…

  9. 77 FR 5751 - Marine Recreational Fisheries of the United States; National Saltwater Angler Registry and State...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-06

    ... in carrying out surveys, it may be appropriate to utilize survey designs in USVI that are different... State under the qualifying regional survey option of the rule; and clarify and update various provisions... be designated as an Exempted State under the qualifying regional survey option of the rule; and (4...

  10. A study of space station needs, attributes and architectural options. Final briefing: Cost working group discussion session

    NASA Technical Reports Server (NTRS)

    1983-01-01

    The economic factors involved in the design and utilization of the space station are investigated. Topics include the economic benefits associated with research and production, the orbit transfer vehicle, and satellite servicing. Program costs and design options are examined. The possibilities of financing from the private sector are discussed.

  11. 43 CFR 2654.1 - Exercise of option.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

  12. 43 CFR 2654.1 - Exercise of option.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

  13. 43 CFR 2654.1 - Exercise of option.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

  14. 43 CFR 2654.1 - Exercise of option.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Exercise of option. 2654.1 Section 2654.1 Public Lands: Interior Regulations Relating to Public Lands (Continued) BUREAU OF LAND MANAGEMENT... Exercise of option. (a) Any village corporation which has not, by December 18, 1973, elected to acquire...

  15. 17 CFR 33.7 - Disclosure.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... introducing broker shall be deemed to be an option customer. (Approved by the Office of Management and Budget..., may open or cause the opening of a commodity option account for an option customer, other than for a customer specified in § 1.55(f) of this chapter, unless the futures commission merchant or introducing...

  16. 77 FR 16879 - Self-Regulatory Organizations; NASDAQ OMX PHLX LLC; Order Granting Approval of Proposed Rule...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-22

    ... financial information for investment advisory services, fund administration, portfolio management, financial... the Exchange will be European-style exercise.\\17\\ Upon exercise, holders of options contracts would... Corporation (``OCC'').\\19\\ \\17\\ Unlike American style options, European style options may be exercised only on...

  17. The Implications of Real Options on ERP-Enabled Adoption

    ERIC Educational Resources Information Center

    Nwankpa, Joseph K.

    2012-01-01

    Current research on Enterprise Resource Planning (ERP) systems and real options focuses on valuation and justification issues that manager's face prior to project approval with existing literature attempting to demonstrate that ERP systems as technology positioning investments have option-like characteristics thus making such ERP systems…

  18. 17 CFR 33.7 - Disclosure.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... introducing broker shall be deemed to be an option customer. (Approved by the Office of Management and Budget..., may open or cause the opening of a commodity option account for an option customer, other than for a customer specified in § 1.55(f) of this chapter, unless the futures commission merchant or introducing...

  19. 17 CFR 33.7 - Disclosure.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... introducing broker shall be deemed to be an option customer. (Approved by the Office of Management and Budget..., may open or cause the opening of a commodity option account for an option customer, other than for a customer specified in § 1.55(f) of this chapter, unless the futures commission merchant or introducing...

  20. Role of endoscopy in recalcitrant intraventricular tuberculoma-innovative novel treatment adjunct.

    PubMed

    Udayakumaran, Suhas; Nair, Prakash; Kumar, Anil; Panikar, Dilip

    2014-09-15

    Introduction. Intraventricular tuberculomas are rare entities. To the best of our knowledge, only 14 cases have been reported in English literature. Medical management of cerebral tuberculomas is well accepted. Intraventricular tuberculomas may be recalcitrant for unclear reasons. An effective management protocol for this entity is unclear. To the best of our knowledge, the definitive indication, timing, and possible role of surgery in these lesions have not been discussed in literature. Materials and methods. A 27-year-old nursing professional who was undergoing treatment for miliary tuberculosis at another center presented to us in 2008 with right hemiparesis, deteriorating vision, and progressive decline in consciousness. In addition to antituberculous therapy (ATT), she underwent multiple CSF diversion procedures for the obstructive hydrocephalus secondary to a recalcitrant third ventricular tuberculoma. Finally, she underwent endoscopic decompression of the lesion with a very good clinical response at 1-year follow-up. Discussion. We discuss a patient with recalcitrant intraventricular tuberculoma managed using neuroendoscopy along with the standard antituberculous therapy. We also discuss in detail the technique we utilized for endoscopic management of this lesion. Conclusion. Being a rare entity, a consensus for management of these lesions is not possible, but we have demonstrated that neuroendoscopic management of these rare entities is an option giving the advantage of definitive diagnosis when required, hastening the resolution, and clearing the CSF pathway.

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