Cost Avoidance vs. Utility Bill Accounting - Explaining theDiscrepancy Between Guaranteed Savings in ESPC Projects and UtilityBills

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

Kumar, S.; Sartor, D.

2005-08-15

Federal agencies often ask if Energy Savings PerformanceContracts (ESPCs) result in the energy and cost savings projected duringthe project development phase. After investing in ESPCs, federal agenciesexpect a reduction in the total energy use and energy cost at the agencylevel. Such questions about the program are common when implementing anESPC project. But is this a fair or accurate perception? Moreimportantly, should the federal agencies evaluate the success or failureof ESPCs by comparing the utility costs before and after projectimplementation?In fact, ESPC contracts employ measurement andverification (M&V) protocols to measure and ensure kilowatt-hour orBTU savings at the project level. In mostmore » cases, the translation toenergy cost savings is not based on actual utility rate structure, but acontracted utility rate that takes the existing utility rate at the timethe contract is signed with a clause to escalate the utility rate by afixed percentage for the duration of the contract. Reporting mechanisms,which advertise these savings in dollars, may imply an impact to budgetsat a much higher level depending on actual utility rate structure. FEMPhas prepared the following analysis to explain why the utility billreduction may not materialize, demonstrate its larger implication onagency s energy reduction goals, and advocate setting the rightexpectations at the outset to preempt the often asked question why I amnot seeing the savings in my utility bill?« less

An economy-ralated equity analysis of health service utilization by women in economically underdeveloped regions of western China.

PubMed

Qian, Yuyan; Zhou, Zhongliang; Yan, Ju'e; Gao, Jianmin; Wang, Yuping; Yang, Xiaowei; Xu, Yongjian; Li, Yanli

2017-10-27

The Chinese government has long been committed to eliminating the inequality in the utilization of health services; however, it still lacks an analysis or measurement of the economy-related inequality in the utilization of women's health services. The economy-related utilization of health services in women aged 15 years and above was assessed by the horizontal inequity index of a two-week outpatient rate and annual inpatient rate from the 5th National Health Service Survey of Shaanxi Province. The concentration index of each factor was decomposed into the contribution of each factor to the economic-related inequality of health service utilization based on the Probit regression model. The horizontal inequity indexes of the two-week outpatient rate was 0.0493, and the horizontal inequity indexes of the annual impatient rate was 0.0869. The contributions of economic status to the two indexes were 190.71% and 115.80%, respectively. Economic status, age, basic medical insurance, educational status, marital status, urban/rural area, and self-rated health were the main impact factors that affected the inequality in women's health services utilization in Shaanxi. Health service utilization was different between women with different social demographic characteristics, and unequal health service utilization is evident among women in Shaanxi.

75 FR 22125 - Market-Based Rates for Wholesale Sales of Electric Energy, Capacity and Ancillary Services by...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-27

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. RM04-7-006] Market-Based Rates for Wholesale Sales of Electric Energy, Capacity and Ancillary Services by Public Utilities... to Order No. 697- C.\\1\\ \\1\\ Market-Based Rates for Wholesale Sales of Electric Energy, Capacity and...

Minimum intravenous thrombolysis utilization rates in acute ischemic stroke to achieve population effects on disability: A discrete-event simulation model.

PubMed

Hoffmeister, Lorena; Lavados, Pablo M; Mar, Javier; Comas, Merce; Arrospide, Arantzazu; Castells, Xavier

2016-06-15

The only pharmacological treatment with proven cost-effectiveness in reducing acute ischemic stroke (AIS) associated disability is intravenous thrombolysis with recombinant tissue plasminogen activator but it's utilization rate is still low in most of the world. We estimated the minimum thrombolysis utilization rate needed to decrease the prevalence of stroke-related disability at a population level by using a discrete-event simulation model. The model included efficacy according to time to treatment up to 4.5h, and four scenarios for the utilization of intravenous thrombolysis in eligible patients with AIS: a) 2%; b) 12% c) 25% and d) 40%. We calculated the prevalence of AIS related disability in each scenario, using population based data. The simulation was performed from 2002 to 2017 using the ARENA software. A 2% utilization rate yielded a prevalence of disability of 359.1 per 100,000. Increasing thrombolysis to 12% avoided 779 disabled patients. If the utilization rate was increased to 25%, 1783 disabled patients would be avoided. The maximum scenario of 40% decreased disability to 335.7 per 100,000, avoiding 17% of AIS-related disability. The current utilization rate of intravenous thrombolysis of 2% has minimal population impact. Increasing the rate of utilization to more than 12% is the minimum to have a significant population effect on disability and should be a public policy aim. Copyright © 2016 Elsevier B.V. All rights reserved.

ESTIMATION OF THE RATE OF VOC EMISSIONS FROM SOLVENT-BASED INDOOR COATING MATERIALS BASED ON PRODUCT FORMULATION

EPA Science Inventory

Two computational methods are proposed for estimation of the emission rate of volatile organic compounds (VOCs) from solvent-based indoor coating materials based on the knowledge of product formulation. The first method utilizes two previously developed mass transfer models with ...

Socioeconomic disparities in the utilization of mechanical thrombectomy for acute ischemic stroke in US hospitals.

PubMed

Brinjikji, W; Rabinstein, A A; McDonald, J S; Cloft, H J

2014-03-01

Previous studies have demonstrated that socioeconomic disparities in the treatment of cerebrovascular diseases exist. We studied a large administrative data base to study disparities in the utilization of mechanical thrombectomy for acute ischemic stroke. With the utilization of the Perspective data base, we studied disparities in mechanical thrombectomy utilization between patient race and insurance status in 1) all patients presenting with acute ischemic stroke and 2) patients presenting with acute ischemic stroke at centers that performed mechanical thrombectomy. We examined utilization rates of mechanical thrombectomy by race/ethnicity (white, black, and Hispanic) and insurance status (Medicare, Medicaid, self-pay, and private). Multivariate logistic regression analysis adjusting for potential confounding variables was performed to study the association between race/insurance status and mechanical thrombectomy utilization. The overall mechanical thrombectomy utilization rate was 0.15% (371/249,336); utilization rate at centers that performed mechanical thrombectomy was 1.0% (371/35,376). In the sample of all patients with acute ischemic stroke, multivariate logistic regression analysis demonstrated that uninsured patients had significantly lower odds of mechanical thrombectomy utilization compared with privately insured patients (OR = 0.52, 95% CI = 0.25-0.95, P = .03), as did Medicare patients (OR = 0.53, 95% CI = 0.41-0.70, P < .0001). Blacks had significantly lower odds of mechanical thrombectomy utilization compared with whites (OR = 0.35, 95% CI = 0.23-0.51, P < .0001). When considering only patients treated at centers performing mechanical thrombectomy, multivariate logistic regression analysis demonstrated that insurance was not associated with significant disparities in mechanical thrombectomy utilization; however, black patients had significantly lower odds of mechanical thrombectomy utilization compared with whites (OR = 0.41, 95% CI = 0.27-0.60, P < .0001). Significant socioeconomic disparities exist in the utilization of mechanical thrombectomy in the United States.

A Cost-Utility Analysis of Prostate Cancer Screening in Australia.

PubMed

Keller, Andrew; Gericke, Christian; Whitty, Jennifer A; Yaxley, John; Kua, Boon; Coughlin, Geoff; Gianduzzo, Troy

2017-02-01

The Göteborg randomised population-based prostate cancer screening trial demonstrated that prostate-specific antigen (PSA)-based screening reduces prostate cancer deaths compared with an age-matched control group. Utilising the prostate cancer detection rates from this study, we investigated the clinical and cost effectiveness of a similar PSA-based screening strategy for an Australian population of men aged 50-69 years. A decision model that incorporated Markov processes was developed from a health system perspective. The base-case scenario compared a population-based screening programme with current opportunistic screening practices. Costs, utility values, treatment patterns and background mortality rates were derived from Australian data. All costs were adjusted to reflect July 2015 Australian dollars (A$). An alternative scenario compared systematic with opportunistic screening but with optimisation of active surveillance (AS) uptake in both groups. A discount rate of 5 % for costs and benefits was utilised. Univariate and probabilistic sensitivity analyses were performed to assess the effect of variable uncertainty on model outcomes. Our model very closely replicated the number of deaths from both prostate cancer and background mortality in the Göteborg study. The incremental cost per quality-adjusted life-year (QALY) for PSA screening was A$147,528. However, for years of life gained (LYGs), PSA-based screening (A$45,890/LYG) appeared more favourable. Our alternative scenario with optimised AS improved cost utility to A$45,881/QALY, with screening becoming cost effective at a 92 % AS uptake rate. Both modelled scenarios were most sensitive to the utility of patients before and after intervention, and the discount rate used. PSA-based screening is not cost effective compared with Australia's assumed willingness-to-pay threshold of A$50,000/QALY. It appears more cost effective if LYGs are used as the relevant outcome, and is more cost effective than the established Australian breast cancer screening programme on this basis. Optimised utilisation of AS increases the cost effectiveness of prostate cancer screening dramatically.

DXA utilization between 2006 and 2012 in commercially insured younger postmenopausal women

PubMed Central

Overman, Robert A.; Farley, Joel F.; Curtis, Jeffrey R.; Zhang, Jie; Gourlay, Margaret L.; Deal, Chad L.

2015-01-01

Introduction Reimbursement for dual energy x-ray absorptiometry (DXA) scans in the outpatient setting has declined significantly since 2006. Research through 2011 has suggested reimbursement reductions for DXA scans have corresponded with an overall decreased utilization of DXA. This study updates utilization estimates for DXAs through 2012 in patients with commercial insurance and compares DXA rates before and after reimbursement changes. Methods We evaluated DXA utilization for women age 50–64 from Marketscan Commercial Claims and Encounter database between January 2006 and December 2012 based on CPT codes. We estimated utilization rates per 1,000 person years. We also employed segmented regression analysis of monthly rates to evaluate the change in utilization rates after a proposed reimbursement reduction in July 2009. Results In women aged 50–64; 451,656 DXAs were performed in 2006, a rate of 144 DXAs per 1,000 person years. This rate increased to 149 DXAs per 1,000 person years in 2009 before decreasing to 110 DXAs per 1,000 person years or 667,982 scans in 2012. DXA utilization increased by 2.24 per 1,000 person years until July 2009 then declined by 12.98 DXAs per 1,000 persons, resulting in 37.5 DXAs per person year fewer performed in 2012 compared to 2006. Conclusion Since July 2009 a significant decline in DXA utilization occurred in a younger postmenopausal commercially insured population. This decline corresponds with a time period of reductions in Medicare DXA reimbursement. PMID:25700662

How often do sensitivity analyses for economic parameters change cost-utility analysis conclusions?

PubMed

Schackman, Bruce R; Gold, Heather Taffet; Stone, Patricia W; Neumann, Peter J

2004-01-01

There is limited evidence about the extent to which sensitivity analysis has been used in the cost-effectiveness literature. Sensitivity analyses for health-related QOL (HR-QOL), cost and discount rate economic parameters are of particular interest because they measure the effects of methodological and estimation uncertainties. To investigate the use of sensitivity analyses in the pharmaceutical cost-utility literature in order to test whether a change in economic parameters could result in a different conclusion regarding the cost effectiveness of the intervention analysed. Cost-utility analyses of pharmaceuticals identified in a prior comprehensive audit (70 articles) were reviewed and further audited. For each base case for which sensitivity analyses were reported (n = 122), up to two sensitivity analyses for HR-QOL (n = 133), cost (n = 99), and discount rate (n = 128) were examined. Article mentions of thresholds for acceptable cost-utility ratios were recorded (total 36). Cost-utility ratios were denominated in US dollars for the year reported in each of the original articles in order to determine whether a different conclusion would have been indicated at the time the article was published. Quality ratings from the original audit for articles where sensitivity analysis results crossed the cost-utility ratio threshold above the base-case result were compared with those that did not. The most frequently mentioned cost-utility thresholds were $US20,000/QALY, $US50,000/QALY, and $US100,000/QALY. The proportions of sensitivity analyses reporting quantitative results that crossed the threshold above the base-case results (or where the sensitivity analysis result was dominated) were 31% for HR-QOL sensitivity analyses, 20% for cost-sensitivity analyses, and 15% for discount-rate sensitivity analyses. Almost half of the discount-rate sensitivity analyses did not report quantitative results. Articles that reported sensitivity analyses where results crossed the cost-utility threshold above the base-case results (n = 25) were of somewhat higher quality, and were more likely to justify their sensitivity analysis parameters, than those that did not (n = 45), but the overall quality rating was only moderate. Sensitivity analyses for economic parameters are widely reported and often identify whether choosing different assumptions leads to a different conclusion regarding cost effectiveness. Changes in HR-QOL and cost parameters should be used to test alternative guideline recommendations when there is uncertainty regarding these parameters. Changes in discount rates less frequently produce results that would change the conclusion about cost effectiveness. Improving the overall quality of published studies and describing the justifications for parameter ranges would allow more meaningful conclusions to be drawn from sensitivity analyses.

The Effect of Increased Travel Reimbursement Rates on Health Care Utilization in the VA

ERIC Educational Resources Information Center

Nelson, Richard E.; Hicken, Bret; West, Alan; Rupper, Randall

2012-01-01

Purpose: The reimbursement rate that eligible veterans receive for travel to Department of Veterans Affairs (VA) facilities increased from 11 to 28.5 cents per mile on February 1, 2008. We examined the effect of this policy change on utilization of outpatient, inpatient, and pharmacy services, stratifying veterans based on distance from a VA…

Organizational Benchmarks for Test Utilization Performance: An Example Based on Positivity Rates for Genetic Tests.

PubMed

Rudolf, Joseph; Jackson, Brian R; Wilson, Andrew R; Smock, Kristi J; Schmidt, Robert L

2017-04-01

Health care organizations are under increasing pressure to deliver value by improving test utilization management. Many factors, including organizational factors, could affect utilization performance. Past research has focused on the impact of specific interventions in single organizations. The impact of organizational factors is unknown. The objective of this study is to determine whether testing patterns are subject to organizational effects, ie, are utilization patterns for individual tests correlated within organizations. Comparative analysis of ordering patterns (positivity rates for three genetic tests) across 659 organizations. Hierarchical regression was used to assess the impact of organizational factors after controlling for test-level factors (mutation prevalence) and hospital bed size. Test positivity rates were correlated within organizations. Organizations have a statistically significant impact on the positivity rate of three genetic tests. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

A value-based medicine cost-utility analysis of idiopathic epiretinal membrane surgery.

PubMed

Gupta, Omesh P; Brown, Gary C; Brown, Melissa M

2008-05-01

To perform a reference case, cost-utility analysis of epiretinal membrane (ERM) surgery using current literature on outcomes and complications. Computer-based, value-based medicine analysis. Decision analyses were performed under two scenarios: ERM surgery in better-seeing eye and ERM surgery in worse-seeing eye. The models applied long-term published data primarily from the Blue Mountains Eye Study and the Beaver Dam Eye Study. Visual acuity and major complications were derived from 25-gauge pars plana vitrectomy studies. Patient-based, time trade-off utility values, Markov modeling, sensitivity analysis, and net present value adjustments were used in the design and calculation of results. Main outcome measures included the number of discounted quality-adjusted-life-years (QALYs) gained and dollars spent per QALY gained. ERM surgery in the better-seeing eye compared with observation resulted in a mean gain of 0.755 discounted QALYs (3% annual rate) per patient treated. This model resulted in $4,680 per QALY for this procedure. When sensitivity analysis was performed, utility values varied from $6,245 to $3,746/QALY gained, medical costs varied from $3,510 to $5,850/QALY gained, and ERM recurrence rate increased to $5,524/QALY. ERM surgery in the worse-seeing eye compared with observation resulted in a mean gain of 0.27 discounted QALYs per patient treated. The $/QALY was $16,146 with a range of $20,183 to $12,110 based on sensitivity analyses. Utility values ranged from $21,520 to $12,916/QALY and ERM recurrence rate increased to $16,846/QALY based on sensitivity analysis. ERM surgery is a very cost-effective procedure when compared with other interventions across medical subspecialties.

A Practice-Based Evaluation of Distress Screening Protocol Adherence and Medical Service Utilization.

PubMed

Zebrack, Brad; Kayser, Karen; Bybee, Deborah; Padgett, Lynne; Sundstrom, Laura; Jobin, Chad; Oktay, Julianne

2017-07-01

Background: This study examined the extent to which cancer programs demonstrated adherence to their own prescribed screening protocol, and whether adherence to that protocol was associated with medical service utilization. The hypothesis is that higher rates of service utilization are associated with lower rates of adherence to screening protocols. Methods: Oncology social workers at Commission on Cancer-accredited cancer programs reviewed electronic health records (EHRs) in their respective cancer programs during a 2-month period in 2014. Rates of overall adherence to a prescribed distress screening protocol were calculated based on documentation in the EHR that screening adherence and an appropriate clinical response had occurred. We examined documentation of emergency department (ED) use and hospitalization within 2 months after the screening visit. Results: Review of 8,409 EHRs across 55 cancer centers indicated that the overall adherence rate to screening protocols was 62.7%. The highest rates of adherence were observed in Community Cancer Programs (76.3%) and the lowest rates were in NCI-designated Cancer Centers (43.3%). Rates of medical service utilization were significantly higher than expected when overall protocol adherence was lacking. After controlling for patient and institutional characteristics, risk ratios for ED use (0.82) and hospitalization (0.81) suggest that when overall protocol adherence was documented, 18% to 19% fewer patients used these medical services. Conclusions: The observed associations between a mandated psychosocial care protocol and medical service utilization suggest opportunities for operational efficiencies and costs savings. Further investigations of protocol integrity, as well as the clinical care models by which psychosocial care is delivered, are warranted. Copyright © 2017 by the National Comprehensive Cancer Network.

75 FR 20796 - Market-Based Rate Affiliate Restrictions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-21

... restrictions that govern the relationship between franchised public utilities with captive customers and their... extent practical, from employees of affiliated franchised utilities with captive customers.\\6\\ Order No... affiliate restrictions provide that [[Page 20797

Impact of Rate Design Alternatives on Residential Solar Customer Bills: Increased Fixed Charges, Minimum Bills and Demand-Based Rates

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

McLaren, Joyce; Davidson, Carolyn; Miller, John

Utilities are proposing changes to residential rate structures to address concerns about lost revenue due to increased adoption of distributed solar generation. An investigation of the impacts of increased fixed charges, minimum bills and residential demand charges on PV and non-PV customer bills suggests that minimum bills more accurately capture utilities' revenue requirement than fixed charges, while not acting as a disincentive to efficiency or negatively impacting low-income customers.

Measuring the Utility of a Basic French Vocabulary.

ERIC Educational Resources Information Center

Savard, Jean-Guy; Richards, Jack C.

Using frequency, range, availability, and coverage as objectively weighted indices of utility in the development of a basic French vocabulary list, the authors describe the technical procedure used in this study and list the resultant first 153 words according to the four indices and the utility rating. Weighting factors for each index, based on…

Revising a priority list based on cost-effectiveness: the role of the prominence effect and distorted utility judgments.

PubMed

Baron, J; Ubel, P A

2001-01-01

People sometimes object to the results of cost-effectiveness analysis when the analysis produces a ranking of options based on both cost and benefit. We suggest 2 new reasons for these objections: the prominence effect, in which people attend mostly to a more prominent attrbute (benefit as opposed to cost), and distortion of utility judgments. We simulated the production of a cost-effectiveness ranking list in 3 experiments using questionnaires on the World Wide Web. Subjects rated the utility of 16 health benefits using either rating scale or person trade-off elicitation methods. In some experiments, subjects were asked to rate the utility of the health benefits with attention also to the cost of achieving the benefits. In all experiments, at the end, subjects were shown a priority list based on their own utility judgments and were asked whether they wanted to move any of the health benefits up or down the list. In all experiments, subjects wanted to give higher priority to treatments with higher benefit, even when they also had higher cost. They thus wanted to give less weight to high cost (which would, by itself, lead to lower ranking) and more weight to benefit than the weight implied by their own prior judgments. The desire for revision was reduced when subjects made their utility judgments after indicating whether the utility was above or below the midpoint of the scale (a manipulation previously found to reduce distortion). The desire to change cost-effectiveness rankings is in part a preference reversal phenomenon that occurs because people attend mainly to the benefit of health interventions as opposed to cost, when they examine the ranking. People should be wary of tinkering with priority lists by examining the lists themselves.

A transferable sucrose utilization approach for non-sucrose-utilizing Escherichia coli strains.

PubMed

Bruschi, Michele; Boyes, Simon J; Sugiarto, Haryadi; Nielsen, Lars K; Vickers, Claudia E

2012-01-01

Sucrose has economic and environmental advantages over glucose as a feedstock for bioprocesses. E. coli is widely used in industry, but the majority of current industrial E. coli strains cannot utilize sucrose. Previous attempts to transfer sucrose catabolic capabilities into non-sucrose-utilizing strains have met with limited success due to low growth rates on sucrose and phenotypic instability of the engineered strains. To address these problems, we developed a transferrable sucrose utilization cassette which confers efficient sucrose catabolism when integrated onto the E. coli chromosome. The cassette was based on the csc genes from E. coli W, a strain which grows very quickly on sucrose. Both plasmid-borne expression and chromosomal integration of a repressor-less sucrose utilizing cassette were investigated in E. coli strains K-12, B and C. In contrast to previous studies, strains harboring chromosomal cassettes could grow at the same rate as they do on glucose. Interestingly, we also discovered that spontaneous chromosomal integration of the csc genes was required to allow efficient growth from plasmid-transformed strains. The ability to engineer industrial strains for efficient sucrose utilization will allow substitution of sucrose for glucose in industrial fermentations. This will encourage the use of sucrose as a carbon source and assist in transition of our petrochemical-based economy to a bio-based economy. Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.

Factors influencing the mammography utilization among Taiwanese women with intellectual disabilities, a nationwide population-based study.

PubMed

Lai, Hsien-Tang; Kung, Pei-Tseng; Tsai, Wen-Chen

2014-12-01

Women with intellectual disabilities (ID) have cognitive impairment and communication difficulties; for both caregivers and clinical personnel, discovering the early symptoms of breast cancer among women with ID is challenging. The mammography utilization rate of women with ID was significantly lower than that of women in the general population. This study employed a 2008 database of people with disabilities in Taiwan as a research target and analyzed the mammography utilization rate of women with ID aged 50–69 years. In addition, relevant factors influencing mammography utilization among women with ID were also investigated. A total of 4370 participants were recruited and the majority were illiterate or had elementary-level educations (82.27%). The majority of the participants had ID that was more severe than mild (83.80%). The mammography utilization rate of women with ID was 4.32%, which was significantly lower than that of women in the general population (12%). The mammography utilization rate among women with ID who were married, had higher education levels, and had been diagnosed with cancer, diabetes, or mild ID was significantly higher. However, the mammography utilization rate among women with ID, who had elementary-level educations or were illiterate, was only 4.03%. The utilization rate among women with profound ID was only 2.65%. Women with ID who had undergone pap smears or had utilized adult preventive health services demonstrated a significantly higher mammography utilization rate. This study identified that education level, a diagnosis of diabetes, and the application of pap smears or adult preventive health services were primary factors that influenced the mammography utilization rate among women with ID. This study also observed that in Taiwan, the mammography utilization rate of women with ID was lower than that of pap smears and adult preventive health services, and was only half of that of people with disabilities. An unequal situation existed in regard to the acceptance of breast cancer screening among women with ID, and a different form of strategic planning must be adopted in public health policy. Because ID differs from other disabilities and most women with ID are illiterate, tailored courses are required to train primary caregivers and clinical personnel in providing knowledge and services. The objectives are to diagnose breast cancer at an early stage to decrease the risk of mortality and ensure their rights to health.

Evaluation of a Stirling Solar Dynamic System for Lunar Oxygen Production

NASA Technical Reports Server (NTRS)

Colozza, Anthony J.; Wong, Wayne A.

2006-01-01

An evaluation of a solar concentrator-based system for producing oxygen from the lunar regolith was performed. The system utilizes a solar concentrator mirror to provide thermal energy for the oxygen production process as well as thermal energy to power a Stirling heat engine for the production of electricity. The electricity produced is utilized to operate the equipment needed in the oxygen production process. The oxygen production method utilized in the analysis was the hydrogen reduction of ilmenite. Utilizing this method of oxygen production a baseline system design was produced. This baseline system had an oxygen production rate of 0.6 kg/hr with a concentrator mirror size of 5 m. Variations were performed on the baseline design to show how changes in the system size and process rate effected the oxygen production rate.

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

NASA Astrophysics Data System (ADS)

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

2014-12-01

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

Baseline Measurement of Running Away among Youth in Foster Care

ERIC Educational Resources Information Center

Witherup, Luanne R.; Vollmer, Timothy R.; Van Camp, Carole M.; Goh, Han-Leong; Borrero, John C.; Mayfield, Kristin

2008-01-01

The current study evaluated the use of various behavioral measures of running away with regard to (a) the differential utility of interval- versus event-based measures, (b) the differential utility of rate versus duration measures, (c) the utility of correcting for occurrence opportunity, and (d) the influence of unit of analysis (i.e.,…

Evaluating the utility of two gestural discomfort evaluation methods

PubMed Central

Son, Minseok; Jung, Jaemoon; Park, Woojin

2017-01-01

Evaluating physical discomfort of designed gestures is important for creating safe and usable gesture-based interaction systems; yet, gestural discomfort evaluation has not been extensively studied in HCI, and few evaluation methods seem currently available whose utility has been experimentally confirmed. To address this, this study empirically demonstrated the utility of the subjective rating method after a small number of gesture repetitions (a maximum of four repetitions) in evaluating designed gestures in terms of physical discomfort resulting from prolonged, repetitive gesture use. The subjective rating method has been widely used in previous gesture studies but without empirical evidence on its utility. This study also proposed a gesture discomfort evaluation method based on an existing ergonomics posture evaluation tool (Rapid Upper Limb Assessment) and demonstrated its utility in evaluating designed gestures in terms of physical discomfort resulting from prolonged, repetitive gesture use. Rapid Upper Limb Assessment is an ergonomics postural analysis tool that quantifies the work-related musculoskeletal disorders risks for manual tasks, and has been hypothesized to be capable of correctly determining discomfort resulting from prolonged, repetitive gesture use. The two methods were evaluated through comparisons against a baseline method involving discomfort rating after actual prolonged, repetitive gesture use. Correlation analyses indicated that both methods were in good agreement with the baseline. The methods proposed in this study seem useful for predicting discomfort resulting from prolonged, repetitive gesture use, and are expected to help interaction designers create safe and usable gesture-based interaction systems. PMID:28423016

Mobile natural gas leak surveys indicate that two utilities have high false negative rates

NASA Astrophysics Data System (ADS)

von Fischer, J. C.; Brewer, P. E.; Chamberlain, S.; Gaylord, A.; von Fischer, J.

2016-12-01

In the distribution systems that carry natural gas to consumers, leaks need to be discovered for safety reasons and to reduce greenhouse gas emissions. However, few utilities have adopted newer laser-based technologies that have greater sensitivity and precision, and instead rely on "industry standard" equipment that is far less sensitive. In partnership with the Environmental Defense Fund and Google, we mapped natural gas leaks in the domains of two anonymous utilities (Utility "A" and "B") using high sensitivity Picarro methane analyzers in Google Street View Cars. Surprisingly, when we shared these results with utilities, their survey crews were unable to find most of the leaks that our survey indicated (84% in A and 80% in B). To investigate this phenomenon, our team visited a subset of the leaks in each utility domain (n=32 in A and n=30 in B), and worked alongside utility surveyors to search the leak indication area, using a Los Gatos Research ultraportable methane analyzer to pinpoint leak locations. We found evidence of natural gas leaks at 69% and 68% of the locations in Utilities A and B respectively where survey crews had found nothing. We describe this as a "false negative" rate for the utility because the utility survey falsely indicated that there was no leak at these locations. Of these false negatives, 7% (n=2 of 32 in A, n=2 of 30 in B) were determined to be Grade 1 leaks requiring immediate repair due to high safety risk. Instrument sensitivity appears to explain some of the false negative rates. In particular, use of some industry standard equipment appears to have created a false sense of confidence among utility surveyors that leaks were not present. However, there was also evidence of communication failures and that surveyors did not use optimal approaches in their search. Based on these findings, we suggest that: 1) mobile deployment of high-precision methane analyzers can help find more natural gas leaks, and 2) use of some hand-held survey instruments may lead to higher rates of false negatives in leak survey and 3) there may be room for improvement in leak survey methodologies.

Hip arthroscopy utilization and associated complications: a population-based analysis

PubMed Central

Bernard, Johnathan A.; Pan, Ting J.; Ranawat, Anil S.; Nawabi, Danyal H.; Kelly, Bryan T.; Lyman, Stephen

2017-01-01

Abstract The purpose of this study is to review the trends in hip arthroscopy using data from a statewide database, focusing on utilization rates, patient demographics and complication rates. The Statewide Planning and Research Cooperative System (SPARCS) database for New York State was queried for cases of hip arthroscopy from 1998 to 2012. Patient demographics and procedural details were collected. Patients were subsequently reviewed for complications and readmissions within 30 and 90 days. In total, 12 194 hip arthroscopy procedures were performed by 295 surgeons in 137 centers between 1998 and 2012. There was a 95-fold increase in the annual frequency of hip arthroscopy procedures between 1998 (n = 24) and 2012 (n = 2296). Thirty-day complication rates were 0.2% (n = 19), whereas the 90-day complication rate was 0.3% (n = 30). The all-cause 30-day readmission rate was 0.5% (n = 66), whereas the 90-day rate was 1.6% (n = 200). The number of surgeons performing hip arthroscopy increased 7-fold over the observation period. However, only 14.9% (n = 44) of surgeons performed more than 30 procedures annually. Lower volume surgeons (<102 cases/year) demonstrated significantly higher 90-day readmission rates, compared with higher volume surgeons (>163 cases/year, P < 0.0060); however, complication rates and readmission rates did not differ based on surgeon volume. Our findings confirm our hypothesis, demonstrating a significant increase in utilization of hip arthroscopy in the State of New York. We did not identify an associated increase in annual complication rates as hypothesized with increasing utilization, although there was an association of higher readmission rates among lower volume surgeons. Further study is needed to define rates of failure requiring revision hip arthroscopy or conversion to arthroplasty, and to clarify the relationship between complication rates and surgeon volume and case complexity. Level of Evidence: III, retrospective cohort series. PMID:28948036

Maneuvering strategies using CMGs

NASA Technical Reports Server (NTRS)

Oh, H. S.; Vadali, S. R.

1988-01-01

This paper considers control strategies for maneuvering spacecraft using Single-Gimbal Control Momentum Gyros (CMGs). A pyramid configuration using four gyros is utilized. Preferred initial gimbal angles for maximum utilization of CMG momentum are obtained for some known torque commands. Feedback control laws are derived from the stability point of view by using the Liapunov's Second Theorem. The gyro rates are obtained by the pseudo-inverse technique. The effect of gimbal rate bounds on controllability are studied for an example maneuver. Singularity avoidance is based on limiting the gyro rates depending on a singularity index.

Cost-utility of cognitive behavioral therapy for low back pain from the commercial payer perspective.

PubMed

Norton, Giulia; McDonough, Christine M; Cabral, Howard; Shwartz, Michael; Burgess, James F

2015-05-15

Markov cost-utility model. To evaluate the cost-utility of cognitive behavioral therapy (CBT) for the treatment of persistent nonspecific low back pain (LBP) from the perspective of US commercial payers. CBT is widely deemed clinically effective for LBP treatment. The evidence is suggestive of cost-effectiveness. We constructed and validated a Markov intention-to-treat model to estimate the cost-utility of CBT, with 1-year and 10-year time horizons. We applied likelihood of improvement and utilities from a randomized controlled trial assessing CBT to treat LBP. The trial randomized subjects to treatment but subjects freely sought health care services. We derived the cost of equivalent rates and types of services from US commercial claims for LBP for a similar population. For the 10-year estimates, we derived recurrence rates from the literature. The base case included medical and pharmaceutical services and assumed gradual loss of skill in applying CBT techniques. Sensitivity analyses assessed the distribution of service utilization, utility values, and rate of LBP recurrence. We compared health plan designs. Results are based on 5000 iterations of each model and expressed as an incremental cost per quality-adjusted life-year. The incremental cost-utility of CBT was $7197 per quality-adjusted life-year in the first year and $5855 per quality-adjusted life-year over 10 years. The results are robust across numerous sensitivity analyses. No change of parameter estimate resulted in a difference of more than 7% from the base case for either time horizon. Including chiropractic and/or acupuncture care did not substantively affect cost-effectiveness. The model with medical but no pharmaceutical costs was more cost-effective ($5238 for 1 yr and $3849 for 10 yr). CBT is a cost-effective approach to manage chronic LBP among commercial health plans members. Cost-effectiveness is demonstrated for multiple plan designs. 2.

Treatment manuals, training and successful provision of stop smoking behavioural support.

PubMed

Brose, Leonie S; McEwen, Andy; Michie, Susan; West, Robert; Chew, Xie Yin; Lorencatto, Fabiana

2015-08-01

Translating evidence-based behaviour change interventions into practice is aided by use of treatment manuals specifying the recommended content and format of interventions, and evidence-based training. This study examined whether outcomes of stop smoking behavioural support differed with practitioner's use and evaluation of treatment manuals, or practitioner's training. English stop smoking practitioners were invited to complete an online survey including questions on: practitioners' training, availability, use and perceived utility of manuals, and annual biochemically-validated success rates of quit attempts supported (practitioner-reported). Mean success rates were compared between practitioners with/without access to manuals, those using/not using manuals, perceived utility ratings of manuals, and consecutive levels of training completed. Success rates were higher if practitioners had a manual (Mean (SD) = 54.0 (24.0) versus 48.0 (25.3), t(838) = 2.48, p = 0.013; n = 840), used a manual (F(2,8237) = 4.78, p = 0.009, n = 840), perceived manuals as more useful (F(3,834) = 2.90, p = 0.034, n = 840), and had completed training (F(3,709) = 4.81, p = 0.002, n = 713). Differences were diminished when adjusting for professional and demographic characteristics and no longer reached statistical significance using a conventional alpha for perceived utility of manuals and training status (both p = 0.1). Practitioners' performance in supporting smokers to quit varied with availability and use of treatment manuals. Evidence was weaker for perceived utility of manuals and practitioners' evidence-based training. Ensuring practitioners have access to treatment manuals within their service, promoting manual use, and training practitioners to competently apply manuals is likely to contribute to higher success rates in clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Assessment of continuous acoustic respiratory rate monitoring as an addition to a pulse oximetry-based patient surveillance system.

PubMed

McGrath, Susan P; Pyke, Joshua; Taenzer, Andreas H

2017-06-01

Technology advances make it possible to consider continuous acoustic respiratory rate monitoring as an integral component of physiologic surveillance systems. This study explores technical and logistical aspects of augmenting pulse oximetry-based patient surveillance systems with continuous respiratory rate monitoring and offers some insight into the impact on patient deterioration detection that may result. Acoustic respiratory rate sensors were introduced to a general care pulse oximetry-based surveillance system with respiratory rate alarms deactivated. Simulation was used after 4324 patient days to determine appropriate alarm thresholds for respiratory rate, which were then activated. Data were collected for an additional 4382 patient days. Physiologic parameters, alarm data, sensor utilization and patient/staff feedback were collected throughout the study and analyzed. No notable technical or workflow issues were observed. Sensor utilization was 57 %, with patient refusal leading reasons for nonuse (22.7 %). With respiratory rate alarm thresholds set to 6 and 40 breaths/min., the majority of nurse pager clinical notifications were triggered by low oxygen saturation values (43 %), followed by low respiratory rate values (21 %) and low pulse rate values (13 %). Mean respiratory rate collected was 16.6 ± 3.8 breaths/min. The vast majority (82 %) of low oxygen saturation states coincided with normal respiration rates of 12-20 breaths/min. Continuous respiratory rate monitoring can be successfully added to a pulse oximetry-based surveillance system without significant technical, logistical or workflow issues and is moderately well-tolerated by patients. Respiratory rate sensor alarms did not significantly impact overall system alarm burden. Respiratory rate and oxygen saturation distributions suggest adding continuous respiratory rate monitoring to a pulse oximetry-based surveillance system may not significantly improve patient deterioration detection.

An equity analysis of health examination service utilization by women from underdeveloped areas in western China

PubMed Central

Gao, Jianmin; Zhou, Zhongliang; Yan, Ju’e; Xu, Yongjian; Yang, Xiaowei; Li, Yanli

2017-01-01

Objective This study sought to examine the sources of inequity in health examination service utilization by women from underdeveloped areas in western China. Methods Based on data from the 5th National Health Service Survey in Shaanxi province, women’s utilization of health examination services was examined according to gynecological, cervical smear, and breast examination rates. The equity of health examination service utilization by 15- to 64-year-old women and the factors contributing to inequity were determined using the health concentration index, decomposition of the concentration index, and the horizontal inequity index. Results The examination rates for gynecological, cervical smear, and breast exams for 15- to 64-year-old women in Shaanxi province were 40.61%, 27.08%, and 24.59%, respectively. The horizontal inequity indices of gynecological, cervical smear, and breast examination rates were 0.0480, 0.0423, and 0.0764, respectively, and each examination rate was higher for wealthy individuals. The contribution rates of economic status to the inequalities in gynecological, cervical smear, and breast examination rates were 65.80%, 74.31%, and 56.49%, respectively. The contribution rates of educational status to the inequalities in gynecological, cervical smear, and breast examination rates were 21.01%, 14.83% and 30.00%, respectively. The contribution rates of age to the inequalities in gynecological, cervical smear, and breast examination rates were 25.77%, 26.55%, and 18.40%, respectively. Conclusions Women’s health examination rates differed between populations with different socio-demographic characteristics. There is pro-wealth inequality in each examination rate. This study found that financial status, age, and education level were the main reasons for the unequal utilization of health examination services. PMID:29065129

Plasma Protein Turnover Rates in Rats Using Stable Isotope Labeling, Global Proteomics, and Activity-Based Protein Profiling

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

Smith, Jordan Ned; Tyrrell, Kimberly J.; Hansen, Joshua R.

Protein turnover is important for general health on cellular and organism scales providing a strategy to replace old, damaged, or dysfunctional proteins. Protein turnover also informs of biomarker kinetics, as a better understanding of synthesis and degradation of proteins increases the clinical utility of biomarkers. Here, turnover rates of plasma proteins in rats were measured in vivo using a pulse-chase stable isotope labeling experiment. During the pulse, rats (n=5) were fed 13C6-labeled lysine (“heavy”) feed for 23 days to label proteins. During the chase, feed was changed to an unlabeled equivalent feed (“light”), and blood was repeatedly sampled from ratsmore » over 10 time points for 28 days. Plasma samples were digested with trypsin, and analyzed with liquid chromatography-tandem mass spectrometry (LC-MS/MS). MaxQuant was used to identify peptides and proteins, and quantify heavy:light lysine ratios. A system of ordinary differential equations was used to calculate protein turnover rates. Using this approach, 273 proteins were identified, and turnover rates were quantified for 157 plasma proteins with half-lives ranging 0.3-103 days. For the ~70 most abundant proteins, variability in turnover rates among rats was low (median coefficient of variation: 0.09). Activity-based protein profiling was applied to pooled plasma samples to enrich serine hydrolases using a fluorophosphonate (FP2) activity-based probe. This enrichment resulted in turnover rates for an additional 17 proteins. This study is the first to measure global plasma protein turnover rates in rats in vivo, measure variability of protein turnover rates in any animal model, and utilize activity-based protein profiling for enhancing measurements of targeted, low-abundant proteins, such as those commonly used as biomarkers. Measured protein turnover rates will be important for understanding of the role of protein turnover in cellular and organism health as well as increasing the utility of protein biomarkers through better understanding of processes governing biomarker kinetics.« less

75 FR 5784 - Guidance on Preparation of Market-Based Rate Filings and Electric Quarterly Reports by Public...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-04

... Preparation of Market-Based Rate Filings and Electric Quarterly Reports by Public Utilities; Notice of Technical Conference January 28, 2010. Take notice that Commission staff will convene a technical conference... final agenda of the technical conference. The March 3, 2010 technical conference will focus on the...

Research utilization among children's mental health providers.

PubMed

Barwick, Melanie A; Boydell, Katherine M; Stasiulis, Elaine; Ferguson, H Bruce; Blase, Karen; Fixsen, Dean

2008-04-09

Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP) relies, in part, on the research utilization practices of mental health care providers. This study reports on a survey of research utilization practices among 80 children's mental health (CMH) service provider organizations in Ontario, Canada. A web-based survey was distributed to 80 CMH service provider organizations, to which 51 executive directors and 483 children's mental health practitioners responded. Research utilization was assessed using questions with Likert-type responses based on the Canadian Health Services Research Foundation's Four-A's approach: access, assess, adapt, apply. There was general agreement among executive directors and practitioners regarding the capacity of their organizations to use - access, assess, adapt, and apply - research evidence. Overall, both groups rated their organizations as using research information 'somewhat well.' The low response rate to the practitioner survey should be noted. These findings provide a useful benchmark from which changes in reported research utilization in the Ontario CMH sector can be tracked over time, as a function of EBP training and implementation initiatives, for instance. The need to improve access to research evidence should be addressed because it relates to the eventual implementation and uptake of evidence-based practices. Communities of practice are recommended as a strategy that would enable practitioners to build capacity in their adaptation and application of research evidence.

Inequalities in Maternal Health Care Utilization in Sub-Saharan African Countries: A Multiyear and Multi-Country Analysis

PubMed Central

Alam, Nazmul; Hajizadeh, Mohammad; Dumont, Alexandre; Fournier, Pierre

2015-01-01

To assess social inequalities in the use of antenatal care (ANC), facility based delivery (FBD), and modern contraception (MC) in two contrasting groups of countries in sub-Saharan Africa divided based on their progress towards maternal mortality reduction. Six countries were included in this study. Three countries (Ethiopia, Madagascar, and Uganda) had <350 MMR in 2010 with >4.5% average annual reduction rate while another three (Cameroon, Zambia, and Zimbabwe) had >550 MMR in 2010 with only <1.5% average annual reduction rate. All of these countries had at least three rounds of Demographic and Health Surveys (DHS) before 2012. We measured rate ratios and differences, as well as relative and absolute concentration indices in order to examine within-country geographical and wealth-based inequalities in the utilization of ANC, FBD, and MC. In the countries which have made sufficient progress (i.e. Ethiopia, Madagascar, and Uganda), ANC use increased by 8.7, 9.3 and 5.7 percent, respectively, while the utilization of FBD increased by 4.7, 0.7 and 20.2 percent, respectively, over the last decade. By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon. Utilization of MC increased in all six countries but remained very low, with a high of 40.5% in Zimbabwe and low of 16.1% in Cameroon as of 2011. In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality. In countries with insufficient progress towards maternal mortality reduction, these indicators remained stagnant or increased. Absolute measures for geographical and wealth-based inequalities remained high invariably in all six countries. The increasing trend in the utilization of maternal care services was found to concur with a steady decline in maternal mortality. Relative inequality declined overtime in countries which made progress towards reducing maternal mortality. PMID:25853423

Optimal rates for phylogenetic inference and experimental design in the era of genome-scale datasets.

PubMed

Dornburg, Alex; Su, Zhuo; Townsend, Jeffrey P

2018-06-25

With the rise of genome- scale datasets there has been a call for increased data scrutiny and careful selection of loci appropriate for attempting the resolution of a phylogenetic problem. Such loci are desired to maximize phylogenetic information content while minimizing the risk of homoplasy. Theory posits the existence of characters that evolve under such an optimum rate, and efforts to determine optimal rates of inference have been a cornerstone of phylogenetic experimental design for over two decades. However, both theoretical and empirical investigations of optimal rates have varied dramatically in their conclusions: spanning no relationship to a tight relationship between the rate of change and phylogenetic utility. Here we synthesize these apparently contradictory views, demonstrating both empirical and theoretical conditions under which each is correct. We find that optimal rates of characters-not genes-are generally robust to most experimental design decisions. Moreover, consideration of site rate heterogeneity within a given locus is critical to accurate predictions of utility. Factors such as taxon sampling or the targeted number of characters providing support for a topology are additionally critical to the predictions of phylogenetic utility based on the rate of character change. Further, optimality of rates and predictions of phylogenetic utility are not equivalent, demonstrating the need for further development of comprehensive theory of phylogenetic experimental design.

Creating an Agent Based Framework to Maximize Information Utility

DTIC Science & Technology

2008-03-01

information utility may be a qualitative description of the information, where one would expect the adjectives low value, fair value , high value. For...operations. Information in this category may have a fair value rating. Finally, many seemingly unrelated events, such as reports of snipers in buildings

Healthcare Utilization After a Children's Health Insurance Program Expansion in Oregon.

PubMed

Bailey, Steffani R; Marino, Miguel; Hoopes, Megan; Heintzman, John; Gold, Rachel; Angier, Heather; O'Malley, Jean P; DeVoe, Jennifer E

2016-05-01

The future of the Children's Health Insurance Program (CHIP) is uncertain after 2017. Survey-based research shows positive associations between CHIP expansions and children's healthcare utilization. To build on this prior work, we used electronic health record (EHR) data to assess temporal patterns of healthcare utilization after Oregon's 2009-2010 CHIP expansion. We hypothesized increased post-expansion utilization among children who gained public insurance. Using EHR data from 154 Oregon community health centers, we conducted a retrospective cohort study of pediatric patients (2-18 years old) who gained public insurance coverage during the Oregon expansion (n = 3054), compared to those who were continuously publicly insured (n = 10,946) or continuously uninsured (n = 10,307) during the 2-year study period. We compared pre-post rates of primary care visits, well-child visits, and dental visits within- and between-groups. We also conducted longitudinal analysis of monthly visit rates, comparing the three insurance groups. After Oregon's 2009-2010 CHIP expansions, newly insured patients' utilization rates were more than double their pre-expansion rates [adjusted rate ratios (95 % confidence intervals); increases ranged from 2.10 (1.94-2.26) for primary care visits to 2.77 (2.56-2.99) for dental visits]. Utilization among the newly insured spiked shortly after coverage began, then leveled off, but remained higher than the uninsured group. This study used EHR data to confirm that CHIP expansions are associated with increased utilization of essential pediatric primary and preventive care. These findings are timely to pending policy decisions that could impact children's access to public health insurance in the United States.

An Efficient Biometric-Based Algorithm Using Heart Rate Variability for Securing Body Sensor Networks

PubMed Central

Pirbhulal, Sandeep; Zhang, Heye; Mukhopadhyay, Subhas Chandra; Li, Chunyue; Wang, Yumei; Li, Guanglin; Wu, Wanqing; Zhang, Yuan-Ting

2015-01-01

Body Sensor Network (BSN) is a network of several associated sensor nodes on, inside or around the human body to monitor vital signals, such as, Electroencephalogram (EEG), Photoplethysmography (PPG), Electrocardiogram (ECG), etc. Each sensor node in BSN delivers major information; therefore, it is very significant to provide data confidentiality and security. All existing approaches to secure BSN are based on complex cryptographic key generation procedures, which not only demands high resource utilization and computation time, but also consumes large amount of energy, power and memory during data transmission. However, it is indispensable to put forward energy efficient and computationally less complex authentication technique for BSN. In this paper, a novel biometric-based algorithm is proposed, which utilizes Heart Rate Variability (HRV) for simple key generation process to secure BSN. Our proposed algorithm is compared with three data authentication techniques, namely Physiological Signal based Key Agreement (PSKA), Data Encryption Standard (DES) and Rivest Shamir Adleman (RSA). Simulation is performed in Matlab and results suggest that proposed algorithm is quite efficient in terms of transmission time utilization, average remaining energy and total power consumption. PMID:26131666

An Efficient Biometric-Based Algorithm Using Heart Rate Variability for Securing Body Sensor Networks.

PubMed

Pirbhulal, Sandeep; Zhang, Heye; Mukhopadhyay, Subhas Chandra; Li, Chunyue; Wang, Yumei; Li, Guanglin; Wu, Wanqing; Zhang, Yuan-Ting

2015-06-26

Body Sensor Network (BSN) is a network of several associated sensor nodes on, inside or around the human body to monitor vital signals, such as, Electroencephalogram (EEG), Photoplethysmography (PPG), Electrocardiogram (ECG), etc. Each sensor node in BSN delivers major information; therefore, it is very significant to provide data confidentiality and security. All existing approaches to secure BSN are based on complex cryptographic key generation procedures, which not only demands high resource utilization and computation time, but also consumes large amount of energy, power and memory during data transmission. However, it is indispensable to put forward energy efficient and computationally less complex authentication technique for BSN. In this paper, a novel biometric-based algorithm is proposed, which utilizes Heart Rate Variability (HRV) for simple key generation process to secure BSN. Our proposed algorithm is compared with three data authentication techniques, namely Physiological Signal based Key Agreement (PSKA), Data Encryption Standard (DES) and Rivest Shamir Adleman (RSA). Simulation is performed in Matlab and results suggest that proposed algorithm is quite efficient in terms of transmission time utilization, average remaining energy and total power consumption.

A Comparison of Dependent Primary Care Utilization Rates Based on Deployments

DTIC Science & Technology

2009-03-09

analysis to obtain the deployment data was completed by ASMR , another contractor used to Health Care Utilization and Deployments 15 complete...2007. The deployment dataset was created by ASMR using all encounter data for active duty Soldiers and running the Social Security numbers of these

Recovery of Utility Fixed Costs: Utility, Consumer, Environmental and Economist Perspectives

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

Wood, Lisa; Hemphill, Ross; Howat, John

Utilities recover costs for providing electric service to retail customers through a combination of rate components that together comprise customers’ monthly electric bills. Rates and rate designs are set by state regulators and vary by jurisdiction, utility and customer class. In addition to the fundamental tenet of setting fair and reasonable rates, rate design balances economic efficiency, equity and fairness, customer satisfaction, utility revenue stability, and customer price and bill stability.1 At the most basic level, retail electricity bills in the United States typically include a fixed monthly customer charge — a set dollar amount regardless of energy usage —more » and a volumetric energy charge for each kilowatt-hour consumed.2 The energy charge may be flat across all hours, vary by usage level (for example, higher rates at higher levels of usage), or vary based on time of consumption.3 While some utility costs, such as fuel costs, clearly vary according to electricity usage, other costs are “fixed” over the short run — generally, those that do not vary over the course of a year. Depending on your point of view, and whether the state’s electricity industry has been restructured or remains vertically integrated, the set of costs that are “fixed” may be quite limited. Or the set may extend to all capacity costs for generation, transmission and distribution. In the long run, all costs are variable. In the context of flat or declining loads in some regions, utilities are proposing a variety of changes to retail rate designs, particularly for residential customers, to recover fixed costs. In this report, authors representing utility (Chapter 1), consumer (Chapter 2), environmentalist (Chapter 3) and economist (Chapter 4) perspectives discuss fixed costs for electric utilities and set out their principles for recovering those costs. The table on the next page summarizes each author’s relative preferences for various options for fixed cost recovery, some of which may be used in combination.4 The specific design of any ratemaking option matters crucially, so a general preference for a given option does not indicate support for any particular application.« less

Characteristics of utility cyclists in Queensland, Australia: an examination of the associations between individual, social, and environmental factors and utility cycling.

PubMed

Sahlqvist, Shannon L; Heesch, Kristiann C

2012-08-01

Initiatives to promote utility cycling in countries like Australia and the US, which have low rates of utility cycling, may be more effective if they first target recreational cyclists. This study aimed to describe patterns of utility cycling and examine its correlates, among cyclists in Queensland, Australia. An online survey was administered to adult members of a state-based cycling community and advocacy group (n=1813). The survey asked about demographic characteristics and cycling behavior, motivators and constraints. Utility cycling patterns were described, and logistic regression modeling was used to examine associations between utility cycling and other variables. Forty-seven percent of respondents reported utility cycling: most did so to commute (86%). Most journeys (83%) were >5 km. Being male, younger, employed full-time, or university-educated increased the likelihood of utility cycling (P<.05). Perceiving cycling to be a cheap or a convenient form of transport was associated with utility cycling (P<.05). The moderate rate of utility cycling among recreational cyclists highlights a potential to promote utility cycling among this group. To increase utility cycling, strategies should target female and older recreational cyclists and focus on making cycling a cheap and convenient mode of transport.

The relationship between motivation, monetary compensation, and data quality among US- and India-based workers on Mechanical Turk.

PubMed

Litman, Leib; Robinson, Jonathan; Rosenzweig, Cheskie

2015-06-01

In this study, we examined data quality among Amazon Mechanical Turk (MTurk) workers based in India, and the effect of monetary compensation on their data quality. Recent studies have shown that work quality is independent of compensation rates, and that compensation primarily affects the quantity but not the quality of work. However, the results of these studies were generally based on compensation rates below the minimum wage, and far below a level that was likely to play a practical role in the lives of workers. In this study, compensation rates were set around the minimum wage in India. To examine data quality, we developed the squared discrepancy procedure, which is a task-based quality assurance approach for survey tasks whose goal is to identify inattentive participants. We showed that data quality is directly affected by compensation rates for India-based participants. We also found that data were of a lesser quality among India-based than among US participants, even when optimal payment strategies were utilized. We additionally showed that the motivation of MTurk users has shifted, and that monetary compensation is now reported to be the primary reason for working on MTurk, among both US- and India-based workers. Overall, MTurk is a constantly evolving marketplace where multiple factors can contribute to data quality. High-quality survey data can be acquired on MTurk among India-based participants when an appropriate pay rate is provided and task-specific quality assurance procedures are utilized.

A guide to FERC regulation and ratemaking of electric utilites and other power suppliers

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

Small, M.E.

1994-12-31

This book is very useful for its thorough survey of issues and cases pertinent to electric utility rate filings at the Federal Energy Regulatory Commission (FERC). As the author states, the book provides a step-by-step analysis of the statutory provisions, regulations and case law that are pertinent to the establishment of electric utility sales and transmission rates. The book takes a nuts and bolts approach to the examination of the ratemaking process for electric utilities. Three chapters cover in detail cost of service, rate of return, functionalization, classification and allocation, and rate design, issues which are at the heart ofmore » traditional cost of service ratemaking. Other chapters explain Title II of the Federal POwer Act and general rate filing procedures. Chapters 7 and 8 address the fuel adjustment clause and price squeeze, respectively. Chapters 9, 10, and 11 largely cover new developments in FERC policies since the previous edition of the book was published in 1989, including market based rates, QF certification issues and transmission issues. This volume is useful to the neophyte to electric utility regulation because of its comprehensiveness in addressing ratemaking issues. Also, it is useful to the seasoned practitioner because of its identification of pertinent case law.« less

Changes in soil microbial functional diversity and biochemical characteristics of tree peony with amendment of sewage sludge compost.

PubMed

Huang, Xiangdong; Xue, Dong; Xue, Lian

2015-08-01

A greenhouse experiment was conducted to investigate the impact of sewage sludge compost application on functional diversity of soil microbial communities, based on carbon source utilization, and biochemical characteristics of tree peony (Paeonia suffruticosa). Functional diversity was estimated with incubations in Biolog EcoPlates and well color development was used as the functional trait for carbon source utilization. The average well color development and Shannon index based on the carbon source utilization pattern in Biolog EcoPlates significantly increased with the increasing sludge compost application in the range of 0-45%, with a decreasing trend above 45%. Principal component analysis of carbon source utilization pattern showed that sludge compost application stimulated the utilization rate of D-cellobiose and α-D-lactose, while the utilization rate of β-methyl-D-glucoside, L-asparagine, L-serine, α-cyclodextrin, γ-hydroxybutyric acid, and itaconic acid gradually increased up to a sludge compost amendment dosage of 45% and then decreased above 45%. The chlorophyll content, antioxidase (superoxide dismutase, catalase, and peroxidase) activities, plant height, flower diameter, and flower numbers per plant of tree peony increased significantly with sludge compost dosage, reaching a peak value at 45 %, and then decreased with the exception that activity of superoxide dismutase and catalase did not vary significantly.

Utility Rate Equations of Group Population Dynamics in Biological and Social Systems

PubMed Central

Yukalov, Vyacheslav I.; Yukalova, Elizaveta P.; Sornette, Didier

2013-01-01

We present a novel system of equations to describe the evolution of self-organized structured societies (biological or human) composed of several trait groups. The suggested approach is based on the combination of ideas employed in the theory of biological populations, system theory, and utility theory. The evolution equations are defined as utility rate equations, whose parameters are characterized by the utility of each group with respect to the society as a whole and by the mutual utilities of groups with respect to each other. We analyze in detail the cases of two groups (cooperators and defectors) and of three groups (cooperators, defectors, and regulators) and find that, in a self-organized society, neither defectors nor regulators can overpass the maximal fractions of about each. This is in agreement with the data for bee and ant colonies. The classification of societies by their distance from equilibrium is proposed. We apply the formalism to rank the countries according to the introduced metric quantifying their relative stability, which depends on the cost of defectors and regulators as well as their respective population fractions. We find a remarkable concordance with more standard economic ranking based, for instance, on GDP per capita. PMID:24386163

Utility rate equations of group population dynamics in biological and social systems.

PubMed

Yukalov, Vyacheslav I; Yukalova, Elizaveta P; Sornette, Didier

2013-01-01

We present a novel system of equations to describe the evolution of self-organized structured societies (biological or human) composed of several trait groups. The suggested approach is based on the combination of ideas employed in the theory of biological populations, system theory, and utility theory. The evolution equations are defined as utility rate equations, whose parameters are characterized by the utility of each group with respect to the society as a whole and by the mutual utilities of groups with respect to each other. We analyze in detail the cases of two groups (cooperators and defectors) and of three groups (cooperators, defectors, and regulators) and find that, in a self-organized society, neither defectors nor regulators can overpass the maximal fractions of about [Formula: see text] each. This is in agreement with the data for bee and ant colonies. The classification of societies by their distance from equilibrium is proposed. We apply the formalism to rank the countries according to the introduced metric quantifying their relative stability, which depends on the cost of defectors and regulators as well as their respective population fractions. We find a remarkable concordance with more standard economic ranking based, for instance, on GDP per capita.

Effects of Geographic Diversification on Risk Pooling to Mitigate Drought-Related Financial Losses for Water Utilities

NASA Astrophysics Data System (ADS)

Baum, Rachel; Characklis, Gregory W.; Serre, Marc L.

2018-04-01

As the costs and regulatory barriers to new water supply development continue to rise, drought management strategies have begun to rely more heavily on temporary conservation measures. While these measures are effective, they often lead to intermittent and unpredictable reductions in revenues that are financially disruptive to water utilities, raising concerns over lower credit ratings and higher rates of borrowing for this capital intensive sector. Consequently, there is growing interest in financial risk management strategies that reduce utility vulnerabilities. This research explores the development of financial index insurance designed to compensate a utility for drought-related losses. The focus is on analyzing candidate hydrologic indices that have the potential to be used by utilities across the US, increasing the potential for risk pooling, which would offer the possibility of both lower risk management costs and more widespread implementation. This work first analyzes drought-related financial risks for 315 publicly operated water utilities across the country and examines the effectiveness of financial contracts based on several indices both in terms of their correlation with utility revenues and their spatial autocorrelation across locations. Hydrologic-based index insurance contracts are then developed and tested over a 120 year period. Results indicate that risk pooling, even under conditions in which droughts are subject to some level of spatial autocorrelation, has the potential to significantly reduce the cost of managing financial risk.

ICD Social Codes: An Underutilized Resource for Tracking Social Needs.

PubMed

Torres, Jacqueline M; Lawlor, John; Colvin, Jeffrey D; Sills, Marion R; Bettenhausen, Jessica L; Davidson, Amber; Cutler, Gretchen J; Hall, Matt; Gottlieb, Laura M

2017-09-01

Social determinants of health (SDH) data collected in health care settings could have important applications for clinical decision-making, population health strategies, and the design of performance-based incentives and penalties. One source for cataloging SDH data is the International Statistical Classification of Diseases and Related Health Problems (ICD). To explore how SDH are captured with ICD Ninth revision SDH V codes in a national inpatient discharge database. Data come from the 2013 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, a national stratified sample of discharges from 4363 hospitals from 44 US states. We estimate the rate of ICD-9 SDH V code utilization overall and by patient demographics and payer categories. We additionally estimate the rate of SDH V code utilization for: (a) the 5 most common reasons for hospitalization; and (b) the 5 conditions with the highest rates of SDH V code utilization. Fewer than 2% of overall discharges in the National Inpatient Sample were assigned an SDH V code. There were statistically significant differences in the rate of overall SDH V code utilization by age categories, race/ethnicity, sex, and payer (all P<0.001). Nevertheless, SDH V codes were assigned to <7% of discharges in any demographic or payer subgroup. SDH V code utilization was highest for major diagnostic categories related to mental health and alcohol/substance use-related discharges. SDH V codes are infrequently utilized in inpatient settings for discharges other than those related to mental health and alcohol/substance use. Utilization incentives will likely need to be developed to realize the potential benefits of cataloging SDH information.

A Weak Value Based QKD Protocol Robust Against Detector Attacks

NASA Astrophysics Data System (ADS)

Troupe, James

2015-03-01

We propose a variation of the BB84 quantum key distribution protocol that utilizes the properties of weak values to insure the validity of the quantum bit error rate estimates used to detect an eavesdropper. The protocol is shown theoretically to be secure against recently demonstrated attacks utilizing detector blinding and control and should also be robust against all detector based hacking. Importantly, the new protocol promises to achieve this additional security without negatively impacting the secure key generation rate as compared to that originally promised by the standard BB84 scheme. Implementation of the weak measurements needed by the protocol should be very feasible using standard quantum optical techniques.

Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival.

PubMed

Barber, Emma L; Dusetzina, Stacie B; Stitzenberg, Karyn B; Rossi, Emma C; Gehrig, Paola A; Boggess, John F; Garrett, Joanne M

2017-06-01

To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006 to 2012. Inclusion criteria were treatment at a high volume hospital (>20 cases/year) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n=2494) of patients and use varied widely by hospital, from 5%-55%. High utilization hospitals (n=1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23-55%), while low utilization hospitals (n=2671, 14 hospitals) had a median rate of 10% (range 5-17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95% CI 0.83-0.97 and HR 0.85 95% CI 0.75-0.95). Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival. Copyright © 2017 Elsevier Inc. All rights reserved.

Variation in Neoadjuvant Chemotherapy Utilization for Epithelial Ovarian Cancer at High Volume Hospitals in the United States and Associated Survival

PubMed Central

Barber, Emma L; Dusetzina, Stacie B; Stitzenberg, Karyn B; Rossi, Emma C; Gehrig, Paola A; Boggess, John F; Garrett, Joanne M

2017-01-01

Objective To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. Methods We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006–2012. Inclusion criteria were treatment at a high volume hospital (>20 cases/yr) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. Results We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n=2494) of patients and use varied widely by hospital, from 5%–55%. High utilization hospitals (n=1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23–55%), while low utilization hospitals (n=2671, 14 hospitals) had a median rate of 10% (range 5–17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95%CI 0.83–0.97 and HR 0.85 95%CI 0.75–0.95). Conclusions Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival. PMID:28366545

Performance efficiency of feed utilization, relative growth rate, and survival rate of common carp (Cyprinus carpio) through the addition of phytase in the feed

NASA Astrophysics Data System (ADS)

Rachmawati, D.; Samidjan, I.

2018-04-01

The purpose of this study was to determine the effect of adding phytase enzyme in the feed on digestibility of feed, efficiency of feed utilization, relative growth rate and survival rate of Common carp (Cyprinus carpio). Fish samples in this research were Common carp with an average - weight of 3.34 ± 0,16 g/fish. The treatments were adding the phytase enzyme in the feed with the different level of doses. Those were A (0 U kg-1 feed), B (500 U kg-1 feed), C (1.000 U kg-1 feed g) and D (1.500 U kg-1 feed). Observation was conducted on digestibility of protein (ADCP), digestibility of phosphor (ADCF), efficiency of feed utilization (EFU), relative growth rate (RGR), protein efficiency ratio (PER), feed conversion ratio (FCR), survival rate (SR) and water quality parameters. The results show that the addition of phytase enzyme significantly (P<0.01) affected on ADCP, ADCF, EFU, RGR, FCR, and PER, on the other hand it insignificantly (P>0.05) affected on SR of common carp. Based on results, it was concluded that optimum doses of phytase enzyme feed in terms of digestibility of feed, efficiency utilization of Feed and growth rate of Common carp ranges from 943 to 1100 U kg-1 feed

Forecasting the need for physicians in the United States: the Health Resources and Services Administration's physician requirements model.

PubMed Central

Greenberg, L; Cultice, J M

1997-01-01

OBJECTIVE: The Health Resources and Services Administration's Bureau of Health Professions developed a demographic utilization-based model of physician specialty requirements to explore the consequences of a broad range of scenarios pertaining to the nation's health care delivery system on need for physicians. DATA SOURCE/STUDY SETTING: The model uses selected data primarily from the National Center for Health Statistics, the American Medical Association, and the U.S. Bureau of Census. Forecasts are national estimates. STUDY DESIGN: Current (1989) utilization rates for ambulatory and inpatient medical specialty services were obtained for the population according to age, gender, race/ethnicity, and insurance status. These rates are used to estimate specialty-specific total service utilization expressed in patient care minutes for future populations and converted to physician requirements by applying per-physician productivity estimates. DATA COLLECTION/EXTRACTION METHODS: Secondary data were analyzed and put into matrixes for use in the mainframe computer-based model. Several missing data points, e.g., for HMO-enrolled populations, were extrapolated from available data by the project's contractor. PRINCIPAL FINDINGS: The authors contend that the Bureau's demographic utilization model represents improvements over other data-driven methodologies that rely on staffing ratios and similar supply-determined bases for estimating requirements. The model's distinct utility rests in offering national-level physician specialty requirements forecasts. Images Figure 1 PMID:9018213

75 FR 9203 - Guidance on Preparation of Market-Based Rate Filings and Electric Quarterly Reports by Public...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-01

... Preparation of Market-Based Rate Filings and Electric Quarterly Reports by Public Utilities; Supplemental Notice of Technical Conference February 22, 2010. As announced in the ``Notice of Technical Conference'' issued on January 28, 2010, a technical conference will be held on March 3, 2010, from 9 a.m. to 3 p.m...

An appraisal of the utility or futility of ENT consultant postal questionnaires.

PubMed

Ryan, Stephen; Saunders, J; Clarke, E; Fenton, J E

2013-03-01

Despite an increase in ENT postal questionnaires, the quality of their methodology has been questioned (Ramphul et al. in J Laryngol Otol 119:175-178, 1). This retrospective study examined whether quality and utility of such questionnaires published since 2005 has improved. Seventeen consultant postal questionnaires published between 2005 and 2012 were reviewed. Quality of questionnaires was assessed using a 30-point score based on compliance with 15 criteria previously established to evaluate postal questionnaire study-design (Ramphul et al. in J Laryngol Otol 119:175-178, 1). Citation rates were used as an indicator of utility. The specific comments made in each citing paper was reviewed providing information on whether questionnaire findings (a) had an impact on clinical practice, (b) were the citing comments positive, (c) negative or (d) non-specific. Recurrent methodological flaws were identified in all questionnaires. The average score assigned was 44 %, versus 32 % previously reported (Ramphul et al. in J Laryngol Otol 119:175-178, 1) (P < 0.01, Student's t test). The low citation rate demonstrates poor utility for postal questionnaires. Citations were general non-specific referencing with no clear indication that questionnaire findings positively impacted clinical practice. In conclusion, although the quality of ENT postal questionnaire has improved since the original study (Ramphul et al. in J Laryngol Otol 119:175-178, 1), important recurring methodological flaws still exist. The poor utility, based on low citation rates, also reflects the continued deficiencies in design quality. It is recommended that authors of questionnaire-based research should ensure that guidelines for questionnaire design are adhered in order to improve the validity of findings and hence impact on clinical practice.

Chiropractic and CAM utilization: a descriptive review.

PubMed

Lawrence, Dana J; Meeker, William C

2007-01-22

To conduct a descriptive review of the scientific literature examining use rates of modalities and procedures used by CAM clinicians to manage chronic LBP and other conditions A literature of PubMed and MANTIS was performed using the key terms Chiropractic; Low Back Pain; Utilization Rate; Use Rate; Complementary and Alternative Medicine; and Health Services in various combinations. A total of 137 papers were selected, based upon including information about chiropractic utilization, CAM utilization and low back pain and other conditions. Information was extracted from each paper addressing use of chiropractic and CAM, and is summarized in tabular form. Thematic analysis of the paper topics indicated that there were 5 functional areas covered by the literature: back pain papers, general chiropractic papers, insurance-related papers, general CAM-related papers; and worker's compensation papers. Studies looking at chiropractic utilization demonstrate that the rates vary, but generally fall into a range from around 6% to 12% of the population, most of whom seek chiropractic care for low back pain and not for organic disease or visceral dysfunction. CAM is itself used by people suffering from a variety of conditions, though it is often used not as a primary intervention, but rather as an additional form of care. CAM and chiropractic often offer lower costs for comparable results compared to conventional medicine.

Effects of a proposed rural dental school on regional dental workforce and access to care.

PubMed

Wanchek, Tanya N; Rephann, Terance J

2013-01-01

Southwest Virginia is a rural, low-income region with a relatively small dentist workforce and poor oral health outcomes. The opening of a dental school in the region has been proposed by policy-makers as one approach to improving the size of the dentist workforce and oral health outcomes. A policy simulation was conducted to assess how a hypothetical dental school in rural Southwest Virginia would affect the availability of dentists and utilization levels of dental services. The simulation focuses on two channels through which the dental school would most likely affect the region. First, the number of graduates who are expected to remain in the region was varied, based on the extensiveness of the education pipeline used to attract local students. Second, the number of patients treated in the dental school clinic under different dental school clinical models, including the traditional model, a patient-centered clinic model and a community-based clinic model, was varied in the simulation to obtain a range of additional dentists and utilization rates under differing dental school models. Under a set of plausible assumptions, the low yield scenario (ie private school with a traditional clinic) would result in three additional dentists residing in the region and a total of 8090 additional underserved patients receiving care. Under the high yield scenario (ie dental pipeline program with community based clinics) nine new dentists would reside in the region and as many as 18 054 underserved patients would receive care. Even with the high yield scenario and the strong assumption that these patients would not otherwise access care, the utilization rate increases to 68.9% from its current 60.1%. While the new dental school in Southwest Virginia would increase the dentist workforce and utilization rates, the high cost combined with the continued low rate of dental utilization suggests that there may be more effective alternatives to improving oral health in rural areas. Alternative policies that have shown considerable promise in expanding access to disadvantaged populations include virtual dental homes, enhanced Medicaid reimbursement programs, and school-based dental care systems.

Selection and Performance in a Gas Utility Company. Final Report.

ERIC Educational Resources Information Center

Joseph, Myron L.

A study of employment procedures at an unnamed gas utility company was made, examining selection procedures, white and blue collar employee performance, promotion rates, and turnover. The data is based on application files, interviews with management personnel, and employee records. The company relied primarily on walk-ins and employee referrals…

Adaptive image coding based on cubic-spline interpolation

NASA Astrophysics Data System (ADS)

Jiang, Jian-Xing; Hong, Shao-Hua; Lin, Tsung-Ching; Wang, Lin; Truong, Trieu-Kien

2014-09-01

It has been investigated that at low bit rates, downsampling prior to coding and upsampling after decoding can achieve better compression performance than standard coding algorithms, e.g., JPEG and H. 264/AVC. However, at high bit rates, the sampling-based schemes generate more distortion. Additionally, the maximum bit rate for the sampling-based scheme to outperform the standard algorithm is image-dependent. In this paper, a practical adaptive image coding algorithm based on the cubic-spline interpolation (CSI) is proposed. This proposed algorithm adaptively selects the image coding method from CSI-based modified JPEG and standard JPEG under a given target bit rate utilizing the so called ρ-domain analysis. The experimental results indicate that compared with the standard JPEG, the proposed algorithm can show better performance at low bit rates and maintain the same performance at high bit rates.

Health state utility instruments compared: inquiring into nonlinearity across EQ-5D-5L, SF-6D, HUI-3 and 15D.

PubMed

Gamst-Klaussen, Thor; Chen, Gang; Lamu, Admassu N; Olsen, Jan Abel

2016-07-01

Different health state utility (HSU) instruments produce different utilities for the same individuals, thereby compromising the intended comparability of economic evaluations of health care interventions. When developing crosswalks, previous studies have indicated nonlinear relationships. This paper inquires into the degree of nonlinearity across the four most widely used HSU-instruments and proposes exchange rates that differ depending on the severity levels of the health state utility scale. Overall, 7933 respondents from six countries, 1760 in a non-diagnosed healthy group and 6173 in seven disease groups, reported their health states using four different instruments: EQ-5D-5L, SF-6D, HUI-3 and 15D. Quantile regressions investigate the degree of nonlinear relationships between these instruments. To compare the instruments across different disease severities, we split the health state utility scale into utility intervals with 0.2 successive decrements in utility starting from perfect health at 1.00. Exchange rates (ERs) are calculated as the mean utility difference between two utility intervals on one HSU-instrument divided by the difference in mean utility on another HSU-instrument. Quantile regressions reveal significant nonlinear relationships across all four HSU-instruments. The degrees of nonlinearities differ, with a maximum degree of difference in the coefficients along the health state utility scale of 3.34 when SF-6D is regressed on EQ-5D. At the lower end of the health state utility scale, the exchange rate from SF-6D to EQ-5D is 2.11, whilst at the upper end it is 0.38. Comparisons at different utility levels illustrate the fallacy of using linear functions as crosswalks between HSU-instruments. The existence of nonlinear relationships between different HSU-instruments suggests that level-specific exchange rates should be used when converting a change in utility on the instrument used, onto a corresponding utility change had another instrument been used. Accounting for nonlinearities will increase the validity of the comparison for decision makers when faced with a choice between interventions whose calculations of QALY gains have been based on different HSU-instruments.

A Kinetic Model Describing Injury-Burden in Team Sports.

PubMed

Fuller, Colin W

2017-12-01

Injuries in team sports are normally characterised by the incidence, severity, and location and type of injuries sustained: these measures, however, do not provide an insight into the variable injury-burden experienced during a season. Injury burden varies according to the team's match and training loads, the rate at which injuries are sustained and the time taken for these injuries to resolve. At the present time, this time-based variation of injury burden has not been modelled. To develop a kinetic model describing the time-based injury burden experienced by teams in elite team sports and to demonstrate the model's utility. Rates of injury were quantified using a large eight-season database of rugby injuries (5253) and exposure (60,085 player-match-hours) in English professional rugby. Rates of recovery from injury were quantified using time-to-recovery analysis of the injuries. The kinetic model proposed for predicting a team's time-based injury burden is based on a composite rate equation developed from the incidence of injury, a first-order rate of recovery from injury and the team's playing load. The utility of the model was demonstrated by examining common scenarios encountered in elite rugby. The kinetic model developed describes and predicts the variable injury-burden arising from match play during a season of rugby union based on the incidence of match injuries, the rate of recovery from injury and the playing load. The model is equally applicable to other team sports and other scenarios.

Recent Initiatives in the Republic of Srpska to Enhance Appropriate Use of Antibiotics in Ambulatory Care; Their Influence and Implications.

PubMed

Bojanić, Ljubica; Marković-Peković, Vanda; Škrbić, Ranko; Stojaković, Nataša; Ðermanović, Mirjana; Bojanić, Janja; Fürst, Jurij; Kurdi, Amanj B; Godman, Brian

2018-01-01

Introduction: There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilization principally assessed according to ESAC, ECDC, and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as vs. neighboring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighboring countries. Amoxicillin and the penicillins accounted for 29-40 and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7-11%), cephalosporins, macrolides, and quinolones, as well as low use of third and fourth generation cephalosporins vs. first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilization of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilization of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities.

Hybrid cooperative spectrum sharing for cognitive radio networks: A contract-based approach

NASA Astrophysics Data System (ADS)

Zhang, Songwei; Mu, Xiaomin; Wang, Ning; Zhang, Dalong; Han, Gangtao

2018-06-01

In order to improve the spectral efficiency, a contract-based hybrid cooperative spectrum sharing approach is proposed in this paper, in which multiple primary users (PUs) and multiple secondary users (SUs) share the primary channels in a hybrid manner. Specifically, the SUs switch their transmission mode between underlay and overlay based on the second-order statistics of the primary links. The average transmission rates of PUs and SUs are analyzed for the two transmission modes, and an optimization problem is formulated to maximize the utility of PUs under the constraint that the utility of SUs is nonnegative, which is further solved by a contract-based approach in global statistical channel statistical information (S-CSI) scenarios and local S-CSI scenarios, individually. Numerical results show that the average transmission rate of the PUs is significantly improved by using the proposed method in both of the two scenarios, and in the meantime, the SUs can achieve a good average rate, especially while the SUs have the same number of the PUs in the local S-CSI scenarios.

Influence of organizational characteristics and context on research utilization.

PubMed

Cummings, Greta G; Estabrooks, Carole A; Midodzi, William K; Wallin, Lars; Hayduk, Leslie

2007-01-01

Despite three decades of empirical investigation into research utilization and a renewed emphasis on evidence-based medicine and evidence-based practice in the past decade, understanding of factors influencing research uptake in nursing remains limited. There is, however, increased awareness that organizational influences are important. To develop and test a theoretical model of organizational influences that predict research utilization by nurses and to assess the influence of varying degrees of context, based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework, on research utilization and other variables. The study sample was drawn from a census of registered nurses working in acute care hospitals in Alberta, Canada, accessed through their professional licensing body (n = 6,526 nurses; 52.8% response rate). Three variables that measured PARIHS dimensions of context (culture, leadership, and evaluation) were used to sort cases into one of four mutually exclusive data sets that reflected less positive to more positive context. Then, a theoretical model of hospital- and unit-level influences on research utilization was developed and tested, using structural equation modeling, and 300 cases were randomly selected from each of the four data sets. Model test results were as follows--low context: chi2= 124.5, df = 80, p <. 001; partially low: chi2= 144.2, p <. 001, df = 80; partially high: chi2= 157.3, df = 80, p <. 001; and partially low: chi2= 146.0, df = 80, p <. 001. Hospital characteristics that positively influenced research utilization by nurses were staff development, opportunity for nurse-to-nurse collaboration, and staffing and support services. Increased emotional exhaustion led to less reported research utilization and higher rates of patient and nurse adverse events. Nurses working in contexts with more positive culture, leadership, and evaluation also reported significantly more research utilization, staff development, and lower rates of patient and staff adverse events than did nurses working in less positive contexts (i.e., those that lacked positive culture, leadership, or evaluation). The findings highlight the combined importance of culture, leadership, and evaluation to increase research utilization and improve patient safety. The findings may serve to strengthen the PARIHS framework and to suggest that, although it is not fully developed, the framework is an appropriate guide to implement research into practice.

Urban Telemedicine Enables Equity in Access to Acute Illness Care.

PubMed

Ronis, Sarah D; McConnochie, Kenneth M; Wang, Hongyue; Wood, Nancy E

2017-02-01

Children with care for acute illness available through the Health-e-Access telemedicine model at childcare and schools were previously found to have 22% less emergency department (ED) use than counterparts without this service, but they also had 24% greater acute care use overall. We assessed the hypothesis that increased utilization reflected improved access among impoverished inner-city children to a level experienced by more affluent suburban children. This observational study compared utilization among children without and with telemedicine access, beginning in 1993, ending in 2007, and based on 84,287 child-months of billing claims-based observation. Health-e-Access Telemedicine was initiated in stepwise manner over 187 study-months among 74 access sites (childcare, schools, community centers), beginning in month 105. Children dwelled in inner city, rest-of-city Rochester, NY, or in surrounding suburbs. Rate of total acute care visits (office, ED, telemedicine) was measured as visits per 100 child-years. Observed utilization rates were adjusted in multivariate analysis for age, sex, insurance type, and season of year. When both suburban and inner-city children lacked telemedicine access, overall acute illness visits were 75% greater among suburban than inner-city children (suburban:inner-city rate ratio 1.75, p < 0.0001). After telemedicine became available to inner-city children, their overall acute visits approximated those of suburban children (suburban:inner-city rate ratio 0.80, p = 0.07), whereas acute visits among suburban children remained at least (worst-case comparison) 56% greater than inner-city children without telemedicine (rate ratio 1.56, p < 0.0001). At baseline, overall acute illness utilization of suburban children exceeded that of inner-city children. Overall utilization for inner-city children increased with telemedicine to that of suburban children at baseline. Without telemedicine, however, inner-city use remained substantially less than for suburban counterparts. Health-e-Access Telemedicine redressed socioeconomic disparities in acute care access in the Rochester area, thus contributing to a more equitable community.

Engineering-Based Problem Solving Strategies in AP Calculus: An Investigation into High School Student Performance on Related Rate Free-Response Problems

ERIC Educational Resources Information Center

Thieken, John

2012-01-01

A sample of 127 high school Advanced Placement (AP) Calculus students from two schools was utilized to study the effects of an engineering design-based problem solving strategy on student performance with AP style Related Rate questions and changes in conceptions, beliefs, and influences. The research design followed a treatment-control multiple…

Emergency medical transport of the elderly: a population-based study.

PubMed

Wofford, J L; Moran, W P; Heuser, M D; Schwartz, E; Velez, R; Mittelmark, M B

1995-05-01

Patterns of utilization of emergency medical services transport (EMS) by the elderly are poorly understood. We determined population-based rates of EMS utilization by the elderly and characterized utilization patterns by age, gender, race, and reason for transport. This observational, population-based study was conducted in Forsyth County, NC, a semi-urban county served by one convalescent ambulance service and one EMS service. Using data on all 1990 EMS transports and the 1990 U.S. census data, age-, gender-, and race-specific transport rates for persons aged 60 or older were calculated. Reasons for transport and frequency of repeat users were established. After exclusion of transports because of an address outside the county, a nonhospital destination, a scheduled transport, or missing data, 4,688 transports (78% of total) remained for analysis. The overall rate of transport was 104/1,000 county residents. Transport rates increased for successively older five-year age groups, demonstrating a 5.7-fold stepwise increase from ages 60-65 to 85+ (51/1,000 to 291/1,000). There was no difference in mean age between patients who were frequent EMS users (more than three transports during the year) (n = 66) and other elderly transportees. Reasons for transport differed little between those 60 to 84 years of age and those 85 years of age and older with the exception of chest pain, cardiac arrest, and seizures, all of which were significantly more prevalent in the younger age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Incidence of utilization- and symptom-defined COPD exacerbations in hospital- and population-recruited patients.

PubMed

Erdal, Marta; Johannessen, Ane; Eagan, Tomas Mikal; Bakke, Per; Gulsvik, Amund; Grønseth, Rune

2016-01-01

The objectives of this study were to estimate the impact of recruitment source and outcome definition on the incidence of acute exacerbations of COPD (AECOPD) and explore possible predictors of AECOPD. During a 1-year follow-up, we performed a baseline visit and four telephone interviews of 81 COPD patients and 132 controls recruited from a population-based survey and 205 hospital-recruited COPD patients. Both a definition based on health care utilization and a symptom-based definition of AECOPD were applied. For multivariate analyses, we chose a negative binomial regression model. COPD patients from the population- and hospital-based samples experienced on average 0.4 utilization-defined and 2.9 symptom-defined versus 1.0 and 5.9 annual exacerbations, respectively. The incidence rate ratios for utilization-defined AECOPD were 2.45 (95% CI 1.22-4.95), 3.43 (95% CI 1.59-7.38), and 5.67 (95% CI 2.58-12.48) with Global Initiative on Obstructive Lung Disease spirometric stages II, III, and IV, respectively. The corresponding incidence rate ratios for the symptom-based definition were 3.08 (95% CI 1.96-4.84), 3.45 (95% CI 1.92-6.18), and 4.00 (95% CI 2.09-7.66). Maintenance therapy (regular long-acting muscarinic antagonists, long-acting beta-2 agonists, inhaled corticosteroids, or theophylline) also increased the risk of AECOPD with both exacerbation definitions (incidence rate ratios 1.65 and 1.73, respectively). The risk of AECOPD was 59%-78% higher in the hospital sample than in the population sample. If externally valid conclusions are to be made regarding incidence and predictors of AECOPD, studies should be based on general population samples or adjustments should be made on account of a likely higher incidence in other samples. Likewise, the effect of different AECOPD definitions should be taken into consideration.

Advance Appropriations for Veteran’s Health Care: Issues and Options for Congress

DTIC Science & Technology

2009-04-28

care system. Utilization Projection Model (UPM) The UPM is based on the Milliman Health Cost Guidelines ( HCGs ), a proprietary set of utilization-rate...benchmarks derived from commercial data.31 The HCGs contain data on utilization for 37 of the 58 EHCPM health service categories. Milliman applies a...complex set of adjustments to the HCG data to reflect the health status of VA enrollees, their reliance on VA, and the relative efficiency of VA

75 FR 4498 - Control and Affiliation for Purposes of Market-Based Rate Requirements Under Section 205 of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-28

... decision- making over sales of electric energy. 16. American Public Power Association (APPA) and National... securities of a public utility. Specifically, the Commission proposes to amend Part 33 of its regulations to... than 20 percent, of the outstanding voting securities of a public utility or holding company, where the...

Participation Rates, Process Monitoring, and Quality Improvement Among Cardiac Rehabilitation Programs in the United States: A NATIONAL SURVEY.

PubMed

Pack, Quinn R; Squires, Ray W; Lopez-Jimenez, Francisco; Lichtman, Steven W; Rodriguez-Escudero, Juan P; Lindenauer, Peter K; Thomas, Randal J

2015-01-01

Although strategies exist for improving cardiac rehabilitation (CR) participation rates, it is unclear how frequently these strategies are used and what efforts are being made by CR programs to improve participation rates. We surveyed all CR program directors in the American Association of Cardiovascular and Pulmonary Rehabilitation's database. Data collection included program characteristics, the use of specific referral and recruitment strategies, and self-reported program participation rates. Between 2007 and 2012, 49% of programs measured referral of inpatients from the hospital, 21% measured outpatient referral from office/clinic, 71% measured program enrollment, and 74% measured program completion rates. Program-reported participation rates (interquartile range) were 68% (32-90) for hospital referral, 35% (15-60) for office/clinic referral, 70% (46-80) for enrollment, and 75% (62-82) for program completion. The majority of programs utilized a hospital-based systematic referral, liaison-facilitated referral, or inpatient CR program referral (64%, 68%, and 60% of the time, respectively). Early appointments (<2 weeks) were utilized by 35%, and consistent phone call appointment reminders were utilized by 50% of programs. Quality improvement (QI) projects were performed by about half of CR programs. Measurement of participation rates was highly correlated with performing QI projects (P < .0001.) : Although programs are aware of participation rate gaps, the monitoring of participation rates is suboptimal, QI initiatives are infrequent, and proven strategies for increasing patient participation are inconsistently utilized. These issues likely contribute to the national CR participation gap and may prove to be useful targets for national QI initiatives.

18 CFR 35.36 - Generally.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Sales of Electric Energy, Capacity and Ancillary Services at Market-Based Rates § 35.36 Generally. (a... authorization to engage in sales for resale of electric energy, capacity or ancillary services at market-based... franchised public utility under cost-based regulation. (7) Market-regulated power sales affiliate means any...

18 CFR 35.36 - Generally.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Sales of Electric Energy, Capacity and Ancillary Services at Market-Based Rates § 35.36 Generally. (a... authorization to engage in sales for resale of electric energy, capacity or ancillary services at market-based... franchised public utility under cost-based regulation. (7) Market-regulated power sales affiliate means any...

18 CFR 35.36 - Generally.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Sales of Electric Energy, Capacity and Ancillary Services at Market-Based Rates § 35.36 Generally. (a... authorization to engage in sales for resale of electric energy, capacity or ancillary services at market-based... franchised public utility under cost-based regulation. (7) Market-regulated power sales affiliate means any...

A liquid cooled garment temperature controller based on sweat rate

NASA Technical Reports Server (NTRS)

Chambers, A. B.; Blackaby, J. R.

1972-01-01

An automatic controller for liquid cooled space suits is reported that utilizes human sweat rate as the primary input signal. The controller is so designed that the coolant inlet temperature is inversely proportional to the subject's latent heat loss as evidenced by evaporative water loss.

78 FR 46177 - Third-Party Provision of Ancillary Services; Accounting and Financial Reporting for New Electric...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-30

...The Federal Energy Regulatory Commission (Commission) is revising its regulations to foster competition and transparency in ancillary services markets. The Commission is revising certain aspects of its current market-based rate regulations, ancillary services requirements under the pro forma open-access transmission tariff (OATT), and accounting and reporting requirements. Specifically, the Commission is revising its regulations to reflect reforms to its Avista policy governing the sale of ancillary services at market-based rates to public utility transmission providers. The Commission is also requiring each public utility transmission provider to add to its OATT Schedule 3 a statement that it will take into account the speed and accuracy of regulation resources in its determination of reserve requirements for Regulation and Frequency Response service, including as it reviews whether a self-supplying customer has made ``alternative comparable arrangements'' as required by the Schedule. The final rule also requires each public utility transmission provider to post certain Area Control Error data as described in the final rule. Finally, the Commission is revising the accounting and reporting requirements under its Uniform System of Accounts for public utilities and licensees and its forms, statements, and reports, contained in FERC Form No. 1, Annual Report of Major Electric Utilities, Licensees and Others, FERC Form No. 1-F, Annual Report for Nonmajor Public Utilities and Licensees, and FERC Form No. 3-Q, Quarterly Financial Report of Electric Utilities, Licensees, and Natural Gas Companies, to better account for and report transactions associated with the use of energy storage devices in public utility operations.

A study of the thermoregulatory characteristics of a liquid-cooled garment with automatic temperature control based on sweat rate: Experimental investigation and biothermal man-model development

NASA Technical Reports Server (NTRS)

Chambers, A. B.; Blackaby, J. R.; Miles, J. B.

1973-01-01

Experimental results for three subjects walking on a treadmill at exercise rates of up to 590 watts showed that thermal comfort could be maintained in a liquid cooled garment by using an automatic temperature controller based on sweat rate. The addition of head- and neck-cooling to an Apollo type liquid cooled garment increased its effectiveness and resulted in greater subjective comfort. The biothermal model of man developed in the second portion of the study utilized heat rates and exchange coefficients based on the experimental data, and included the cooling provisions of a liquid-cooled garment with automatic temperature control based on sweat rate. Simulation results were good approximations of the experimental results.

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

PubMed

Reichard, Kaaren K; Wood, Adam J

2016-03-01

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

Utilization of Radiation Therapy in Norway After the Implementation of The National Cancer Plan—A National, Population-Based Study

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

Åsli, Linn M., E-mail: linn.merete.asli@kreftregisteret.no; Kvaløy, Stein O.; Jetne, Vidar

2014-11-01

Purpose: To estimate actual utilization rates of radiation therapy (RT) in Norway, describe time trends (1997-2010), and compare these estimates with corresponding optimal RT rates. Methods and Materials: Data from the population-based Cancer Registry of Norway was used to identify all patients diagnosed with cancer and/or treated by RT for cancer in 1997-2010. Radiation therapy utilization rates (RURs) were calculated as (1) the proportion of incident cancer cases who received RT at least once within 1 year of diagnosis (RUR{sub 1Y}); and (2) the proportion who received RT within 5 years of diagnosis (RUR{sub 5Y}). The number of RT treatment courses per incidentmore » cancer case (TCI) was also calculated for all cancer sites combined. The actual RURs were compared with corresponding Australian and Canadian epidemiologic- and evidence-based model estimates and criterion-based benchmark estimates of optimal RURs. The TCIs were compared with TCI estimates from the 1997 Norwegian/National Cancer Plan (NCP). Joinpoint regression was used to identify changes in trends and to estimate annual percentage change (APC) in actual RUR{sub 1Y} and actual TCI. Results: The actual RUR{sub 5Y} (all sites) increased significantly to 29% in 2005 but still differed markedly from the Australian epidemiologic- and evidence-based model estimate of 48%. With the exception of RUR{sub 5Y} for breast cancer and RUR{sub 1Y} for lung cancers, all actual RURs were markedly lower than optimal RUR estimates. The actual TCI increased significantly during the study period, reaching 42.5% in 2010, but was still lower than the 54% recommended in the NCP. The trend for RUR{sub 1Y} (all sites) and TCI changed significantly, with the annual percentage change being largest during the first part of the study period. Conclusions: Utilization rates of RT in Norway increased after the NCP was implemented and RT capacity was increased, but they still seem to be lower than optimal levels.« less

Overcoming Communication Restrictions in Collectives

NASA Technical Reports Server (NTRS)

Tumer, Kagan; Agogino, Adrian K.

2004-01-01

Many large distributed system are characterized by having a large number of components (eg., agents, neurons) whose actions and interactions determine a %orld utility which rates the performance of the overall system. Such collectives are often subject to communication restrictions, making it difficult for components which try to optimize their own private utilities, to take actions that also help optimize the world utility. In this article we address that coordination problem and derive four utility functions which present different compromises between how aligned a component s private utility is with the world utility and how readily that component can determine the actions that optimize its utility. The results show that the utility functions specifically derived to operate under communication restrictions outperform both traditional methods and previous collective-based methods by up to 75%.

The influence of IQ stratification on WAIS-III/WMS-III FSIQ-general memory index discrepancy base-rates in the standardization sample.

PubMed

Hawkins, K A; Tulsky, D S

2001-11-01

Since memory performance expectations may be IQ-based, unidirectional base rate data for IQ-Memory Score discrepancies are provided in the WAIS-III/WMS-III Technical Manual. The utility of these data partially rests on the assumption that discrepancy base rates do not vary across ability levels. FSIQ stratified base rate data generated from the standardization sample, however, demonstrate substantial variability across the IQ spectrum. A superiority of memory score over FSIQ is typical at lower IQ levels, whereas the converse is true at higher IQ levels. These data indicate that the use of IQ-memory score unstratified "simple difference" tables could lead to erroneous conclusions for clients with low or high IQ. IQ stratified standardization base rate data are provided as a complement to the "predicted difference" method detailed in the Technical Manual.

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

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

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

2015-01-01

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

Comparison of the Heat Release Rate from the Mass Loss Calorimeter to the Cone Calorimeter for Wood-based Materials

Treesearch

Laura E. Hasburgh; Robert H. White; Mark A. Dietenberger; Charles R. Boardman

2015-01-01

There is a growing demand for material properties to be used as inputs in fi re behavior models designed to address building fire safety. This comparative study evaluates using the mass loss calorimeter as an alternative to the cone calorimeter for obtaining heat release rates of wood-based materials. For this study, a modified mass loss calorimeter utilized an...

Factors influencing utilization of hospital services by adult sickle cell disease patients: a systematic review.

PubMed

Benenson, Irina; Jadotte, Yuri; Echevarria, Mercedes

2017-03-01

Painful vaso-occlusive crisis is a hallmark of sickle cell disease (SCD) that commonly results in utilization of hospital services. Recurrent use of hospital services by SCD patients is associated with high healthcare costs and adverse clinical outcomes. Understanding the factors influencing the pattern of utilization is a first step in improving medical care of this patient population while reducing healthcare expenditures. The primary objective of this systematic review was to determine what modifiable and non-modifiable factors influence utilization of hospital services by adult SCD patients. Adult SCD patients of both sexes who utilized hospital services for acute or emergency care. Non-modifiable and modifiable factors influencing utilization of hospital services. Prospective and retrospective cohort studies, case-control and analytical cross-sectional studies. The primary outcome of interest was high utilization of hospital services by adult SCD patients based on non-modifiable and modifiable factors measured as an odds ratio (analytical outcome). The secondary outcome was the prevalence of non-modifiable and modifiable factors among SCD patients who utilized hospital services measured as an event rate (descriptive outcome). A comprehensive multi-step search was undertaken to find both published and unpublished studies. Only studies published in the English language were included. The search was not limited by year of publication. Retrieved papers were assessed for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument. Data were extracted using a researcher-developed tool. Included studies were combined in a statistical meta-analysis. The meta-analysis was based on a random effect model. For studies that did not allow statistical pooling, the findings have been presented in a narrative form. Fourteen studies were included in this review. The analysis demonstrated that male patients accounted for 40.8% (95% confidence interval [CI] 0.370-0.447) of all utilizing patients. Sickle cell disease patients who were publically insured accounted for 76.5% (95% CI 0.632-0.861) of all patients who had hospital encounters. Patients aged 25-35 years had the highest rate of utilization, and the rate of utilization declined in patients older than 50 years. High utilizing patients had more diagnoses of acute chest syndrome and sepsis than patients who were moderate or low utilizers. The majority of SCD patients who utilized hospital services were women, young people and publically insured individuals. Patients with particularly high level of utilization had more frequent diagnoses of acute chest syndrome and sepsis.

Evidence-based nursing practice: both state of the art in general and specific to pressure sores.

PubMed

Buss, I C; Halfens, R J; Abu-Saad, H H; Kok, G

1999-01-01

The importance of research-based practice in nursing has been frequently stressed, and a number of nursing studies have been conducted whose results enable nursing to improve knowledge and practice. This study reports a literature review in which the current status of knowledge and research utilization with regard to pressure sores is described. This review first gives an overview of studies on knowledge utilization in general and shows that the spontaneous diffusion of knowledge is inappropriate. Furthermore, an overview of planned research utilization activities focusing on pressure sore prevention and treatment in nursing is presented. The results of these studies show that planned research utilization activities performed in individual organizations lead to positive outcomes in almost all cases. Therefore, it could be concluded that implementing planned research utilization activities in individual health care institutions seems to be an effective strategy to decrease pressure sore incidence and prevalence rates.

The validity and clinical utility of the Disabilities of the Arm Shoulder and Hand questionnaire for hand injuries in developing country contexts: A systematic review.

PubMed

de Klerk, Susan; Buchanan, Helen; Jerosch-Herold, Christina

Systematic review. The Disabilities of the Arm Shoulder and Hand Questionnaire has multiple language versions from many countries around the world. In addition there is extensive research evidence of its psychometric properties. The purpose of this study was to systematically review the evidence available on the validity and clinical utility of the Disabilities of the Arm Shoulder and Hand as a measure of activity and participation in patients with musculoskeletal hand injuries in developing country contexts. We registered the review with international prospective register of systematic reviews prior to conducting a comprehensive literature search and extracting descriptive data. Two reviewers independently assessed methodological quality with the Consensus-Based Standards for the Selection of Health Measurement Instruments critical appraisal tool, the checklist to operationalize measurement characteristics of patient-rated outcome measures and the multidimensional model of clinical utility. Fourteen studies reporting 12 language versions met the eligibility criteria. Two language versions (Persian and Turkish) had an overall rating of good, and one (Thai) had an overall rating of excellent for cross-cultural validity. The remaining 9 language versions had an overall poor rating for cross-cultural validity. Content and construct validity and clinical utility yielded similar results. Poor quality ratings for validity and clinical utility were due to insufficient documentation of results and inadequate psychometric testing. With the increase in migration and globalization, hand therapists are likely to require a range of culturally adapted and translated versions of the Disabilities of the Arm Shoulder and Hand. Recommendations include rigorous application and reporting of cross-cultural adaptation, appropriate psychometric testing, and testing of clinical utility in routine clinical practice. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

The "PHS Increased Risk" Label Is Associated With Nonutilization of Hundreds of Organs per Year.

PubMed

Volk, Michael L; Wilk, Amber R; Wolfe, Cameron; Kaul, Daniel R

2017-07-01

The Public Health Service "Increased Risk" (PHS IR) designation identifies donors at increased risk of transmitting hepatitis B, C, and human immunodeficiency virus. Although the risk remains very low in the era of nucleic acid testing, we hypothesized that this label may result in decreased organ utilization. Organ Procurement and Transplantation Network data were used to compare utilization rates between PHS-IR and non-PHS-IR donors, as well as to compare export rates and variation in utilization. Among adult standard criteria donors between 2010 and 2013 with a known PHS-IR status, covariate-adjusted utilization rates were lower among PHS-IR donors than non-PHS-IR donors for all organs. For example, 4073 (76.7%) of 5314 PHS-IR kidneys were used, compared with 25 490 (83.7%) of 30 456 non-PHS-IR kidneys-an absolute difference of 7%. Furthermore, all PHS-IR organs had higher export rates than non-PHS-IR organs. For example, 28.7% of PHS-IR kidneys were exported versus 19.7% of non-PHS-IR kidneys. Finally, the utilization rate of PHS-IR organs varied by Donation Service Area; utilization ranged from 20% to 100% among adult kidneys, suggesting significant variation in practices. Similar patterns were seen among pediatric donors. Based on the covariate-adjusted model, if the PHS-IR label did not exist, there could be an additional 313 transplants performed in the United States each year. The PHS "increased risk" label appears to be associated with nonutilization of hundreds of organs per year, despite the very low risk of disease transmission. Better tools are needed to communicate the magnitude of risk to patients and their families.

The Impact of Rate Design and Net Metering on the Bill Savings from Distributed PV for Residential Customers in California

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

Energy and Resources Group, University of California, Berkeley; Darghouth, Naim R.; Barbose, Galen

2011-06-01

Net metering has become a widespread mechanism in the U.S. for supporting customer adoption of distributed photovoltaics (PV), but has faced challenges as PV installations grow to a larger share of generation in a number of states. This paper examines the value of the bill savings that customers receive under net metering, and the associated role of retail rate design, based on a sample of approximately two hundred residential customers of California's two largest electric utilities. We find that the bill savings per kWh of PV electricity generated varies by more than a factor of four across the customers inmore » the sample, which is largely attributable to the inclining block structure of the utilities' residential retail rates. We also compare the bill savings under net metering to that received under three potential alternative compensation mechanisms, based on California's Market Price Referent (MPR). We find that net metering provides significantly greater bill savings than a full MPR-based feed-in tariff, but only modestly greater savings than alternative mechanisms under which hourly or monthly net excess generation is compensated at the MPR rate.« less

Single-Frequency Ultrasound-Based Respiration Rate Estimation with Smartphones.

PubMed

Ge, Linfei; Zhang, Jin; Wei, Jing

2018-01-01

Respiration monitoring is helpful in disease prevention and diagnosis. Traditional respiration monitoring requires users to wear devices on their bodies, which is inconvenient for them. In this paper, we aim to design a noncontact respiration rate detection system utilizing off-the-shelf smartphones. We utilize the single-frequency ultrasound as the media to detect the respiration activity. By analyzing the ultrasound signals received by the built-in microphone sensor in a smartphone, our system can derive the respiration rate of the user. The advantage of our method is that the transmitted signal is easy to generate and the signal analysis is simple, which has lower power consumption and thus is suitable for long-term monitoring in daily life. The experimental result shows that our system can achieve accurate respiration rate estimation under various scenarios.

Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data : Brief Description: A Longitudinal Retrospective Analyses of healthcare utilization rates in older patients using Personal Emergency Response Systems from 2011 to 2015.

PubMed

Agboola, Stephen; Golas, Sara; Fischer, Nils; Nikolova-Simons, Mariana; Op den Buijs, Jorn; Schertzer, Linda; Kvedar, Joseph; Jethwani, Kamal

2017-04-18

Personal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization. Retrospective, longitudinal analyses of healthcare and PERS utilization records of older patients over a 5-years period from 2011-2015. The primary outcome was to characterize the healthcare utilization of PERS patients. This outcome was assessed by 30-, 90-, and 180-day readmission rates, frequency of principal admitting diagnoses, and prevalence of conditions leading to potentially avoidable admissions based on Centers for Medicare and Medicaid Services classification criteria. The overall 30-day readmission rate was 14.2%, 90-days readmission rate was 34.4%, and 180-days readmission rate was 42.2%. While 30-day readmission rates did not increase significantly (p = 0.16) over the study period, 90-days (p = 0.03) and 180-days (p = 0.04) readmission rates did increase significantly. The top 5 most frequent principal diagnoses for inpatient admissions included congestive heart failure (5.7%), chronic obstructive pulmonary disease (4.6%), dysrhythmias (4.3%), septicemia (4.1%), and pneumonia (4.1%). Additionally, 21% of all admissions were due to conditions leading to potentially avoidable admissions in either institutional or non-institutional settings (16% in institutional settings only). Chronic medical conditions account for the majority of healthcare utilization in older patients using PERS. Results suggest that PERS data combined with electronic medical records data can provide useful insights that can be used to improve health outcomes in older patients.

Intensive Care Unit Utilization Among Medicare Patients Hospitalized with Non-ST-Segment Elevation Myocardial Infarction

PubMed Central

Fanaroff, Alexander C; Peterson, Eric D; Chen, Anita Y; Thomas, Laine; Doll, Jacob D; Fordyce, Christopher B; Newby, L Kristin; Amsterdam, Ezra A; Kosiborod, Mikhail N; de Lemos, James A; Wang, Tracy Y

2018-01-01

Importance Intensive care unit (ICU) utilization may have important implications for the care and outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI). Objectives To examine inter-hospital variation in ICU utilization in the United States for older adults with hemodynamically stable NSTEMI and outcomes associated with ICU utilization among patients with at low, moderate, or high mortality risk. Design, Settings and Participants Retrospective analysis of 28,018 Medicare patients ≥65 years old admitted with NSTEMI to 346 hospitals participating in ACTION Registry-GWTG between April 1, 2011 and December 31, 2012. Patients with cardiogenic shock or cardiac arrest on presentation were excluded. Exposure Hospitals with high (>70% NSTEMI patients treated in an ICU during the index hospitalization), intermediate (30–70%), or low (< 30%) ICU utilization rates Main Outcome and Measure 30-day mortality Results Of NSTEMI patients ≥ 65 years old, 11,934 (43%) had an ICU stay. The proportion of NSTEMI patients treated in the ICU varied across hospitals (median 38% [26%, 54%]), but there were no significant differences in hospital characteristics or NSTEMI patient characteristics between hospitals with high, intermediate, or low ICU utilization rates. Compared with high ICU utilization hospitals, hospitals with low or intermediate ICU utilizations rates were only marginally more selective of higher risk patients, as determined by ACTION in-hospital mortality risk score or initial troponin level. Thirty-day mortality rates did not significantly differ based on hospital ICU utilization (high vs. low: 8.7% vs. 8.7%, adjusted OR 0.91, 95% CI 0.76–1.08; intermediate vs. low: 9.6% vs. 8.7%, adjusted OR 1.06, 95% CI 0.94–1.20). The relationship between hospital ICU utilization and mortality was similar in analyses stratified by low, moderate, or high ACTION risk score categories (adjusted interaction p 0.86). Conclusions and Relevance ICU utilization for older NSTEMI patients varied significantly among hospitals. This variability was not explained by hospital characteristics nor driven by patient risk. Post-MI mortality did not significantly differ among hospitals with high, intermediate, or low ICU utilization. PMID:27806171

Capturing Functional Independence Measure (FIM®) Ratings.

PubMed

Torres, Audrey

The aim of the study was to identify interventions to capture admission functional independence measure (FIM®) ratings on the day of admission to an inpatient rehabilitation facility. A quantitative evidence-based practice quality improvement study utilizing descriptive statistics. Admission FIM® ratings from patients discharged in June 2012 (retrospective review) were compared to admission FIM® ratings from patients discharged in June 2014 (prospective review). The logic model was utilized to determine the project inputs, outputs, and outcomes. Interventions to capture admission FIM® ratings on the day of admission are essential to accurately predict the patient's burden of care, length of stay, and reimbursement. Waiting until Day 2 or Day 3 after admission to capture the admission FIM® assessment resulted in inflated admission FIM® ratings and suboptimal quality outcomes. Interventions to capture admission FIM® ratings on the day of admission were successful at improving the quality of care, length of stay efficiency, and accurately recording admission FIM® ratings to determine the patient's burden of care.

Layer-based buffer aware rate adaptation design for SHVC video streaming

NASA Astrophysics Data System (ADS)

Gudumasu, Srinivas; Hamza, Ahmed; Asbun, Eduardo; He, Yong; Ye, Yan

2016-09-01

This paper proposes a layer based buffer aware rate adaptation design which is able to avoid abrupt video quality fluctuation, reduce re-buffering latency and improve bandwidth utilization when compared to a conventional simulcast based adaptive streaming system. The proposed adaptation design schedules DASH segment requests based on the estimated bandwidth, dependencies among video layers and layer buffer fullness. Scalable HEVC video coding is the latest state-of-art video coding technique that can alleviate various issues caused by simulcast based adaptive video streaming. With scalable coded video streams, the video is encoded once into a number of layers representing different qualities and/or resolutions: a base layer (BL) and one or more enhancement layers (EL), each incrementally enhancing the quality of the lower layers. Such layer based coding structure allows fine granularity rate adaptation for the video streaming applications. Two video streaming use cases are presented in this paper. The first use case is to stream HD SHVC video over a wireless network where available bandwidth varies, and the performance comparison between proposed layer-based streaming approach and conventional simulcast streaming approach is provided. The second use case is to stream 4K/UHD SHVC video over a hybrid access network that consists of a 5G millimeter wave high-speed wireless link and a conventional wired or WiFi network. The simulation results verify that the proposed layer based rate adaptation approach is able to utilize the bandwidth more efficiently. As a result, a more consistent viewing experience with higher quality video content and minimal video quality fluctuations can be presented to the user.

Percutaneous adhesiolysis procedures in the medicare population: analysis of utilization and growth patterns from 2000 to 2011.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Pampati, Vidyasagar; Racz, Gabor B

2014-01-01

Multiple reviews have shown that interventional techniques for chronic pain have increased dramatically over the years. Of these interventional techniques, both sacroiliac joint injections and facet joint interventions showed explosive growth, followed by epidural procedures. Percutaneous adhesiolysis procedures have not been assessed for their utilization patterns separately from epidural injections. An analysis of the utilization patterns of percutaneous adhesiolysis procedures in managing chronic low back pain in the Medicare population from 2000 to 2011. To assess the utilization and growth patterns of percutaneous adhesiolysis in managing chronic low back pain. The study was performed utilizing the Centers for Medicare and Medicaid Services (CMS) Physician Supplier Procedure Summary Master of Fee-For-Service (FFS) Data from 2000 to 2011. Percutaneous adhesiolysis procedures increased 47% with an annual growth rate of 3.6% in the FFS Medicare population from 2000 to 2011. These growth rates are significantly lower than the growth rates for sacroiliac joint injections (331%), facet joint interventions (308%), and epidural injections (130%), but substantially lower than lumbar transforaminal injections (665%) and lumbar facet joint neurolysis (544%). Study limitations include lack of inclusion of Medicare Advantage patients. In addition, the statewide data is based on claims which may include the contiguous or other states. Percutaneous adhesiolysis utilization increased moderately in Medicare beneficiaries from 2000 to 2011. Overall, there was an increase of 47% in the utilization of adhesiolysis procedures per 100,000 Medicare beneficiaries, with an annual geometric average increase of 3.6%.

Fixed-rate layered multicast congestion control

NASA Astrophysics Data System (ADS)

Bing, Zhang; Bing, Yuan; Zengji, Liu

2006-10-01

A new fixed-rate layered multicast congestion control algorithm called FLMCC is proposed. The sender of a multicast session transmits data packets at a fixed rate on each layer, while receivers each obtain different throughput by cumulatively subscribing to deferent number of layers based on their expected rates. In order to provide TCP-friendliness and estimate the expected rate accurately, a window-based mechanism implemented at receivers is presented. To achieve this, each receiver maintains a congestion window, adjusts it based on the GAIMD algorithm, and from the congestion window an expected rate is calculated. To measure RTT, a new method is presented which combines an accurate measurement with a rough estimation. A feedback suppression based on a random timer mechanism is given to avoid feedback implosion in the accurate measurement. The protocol is simple in its implementation. Simulations indicate that FLMCC shows good TCP-friendliness, responsiveness as well as intra-protocol fairness, and provides high link utilization.

Validation of a scale for network therapy: a technique for systematic use of peer and family support in addition treatment.

PubMed

Keller, D S; Galanter, M; Weinberg, S

1997-02-01

Substance abuse treatments are increasingly employing standardized formats. This is especially the case for approaches that utilize an individual psychotherapy format but less so for family-based approaches. Network therapy, an approach that involves family members and peers in the patient's relapse prevention efforts, is theoretically and clinically differentiated in this paper from family systems therapy for addiction. Based on these conceptual differences, a Network Therapy Rating Scale (NTRS) was developed to measure the integrity and differentiability of network therapy from other family-based approaches to addiction treatment. Seven addictions faculty and 10 third- and fourth-year psychiatry residents recently trained in the network approach used the NTRS to rate excerpts of network and family systems therapy sessions. Data revealed the NTRS had high internal consistency reliability when utilized by both groups of raters. In addition, network and nonnetwork subscales within the NTRS rated congruent therapy excerpts significantly higher than noncongruent therapy excerpts, indicating that the NTRS subscales measure what they are designed to measure. Implications for research and training are discussed.

Mental health outcomes of burn: A longitudinal population-based study of adults hospitalized for burns.

PubMed

Logsetty, Sarvesh; Shamlou, Amir; Gawaziuk, Justin P; March, Justin; Doupe, Malcolm; Chateau, Dan; Hoppensack, Mike; Khan, Sazzadul; Medved, Maria; Leslie, William D; Enns, Murray W; Stein, Murray B; Asmundson, Gordon J G; Sareen, Jitender

2016-06-01

This study investigates the increased risk of mental health outcomes and health care utilization associated with burn with two year of follow-up using a longitudinal population-based matched cohort design. Adult burn survivors (n=157) were identified from a provincial burn registry and matched 1:5 with non-burn control subjects from the general population (matching variables age and gender). The prevalence of mental health outcomes and the rates of health care utilization between the groups were compared for the 2years pre and post index date using anonymously linked population-based administrative health care data. Rates were adjusted for age, gender and sociodemographic characteristics. While the burn cohort had an increased prevalence of mental health problems after burn compared to the control cohort, the burn group also had an increased prevalence of pre-burn depression (16.6% vs 7.8%; p=0.0005) and substance use disorders (8.9% vs 3.2%; p=0.001) when compared to controls. Once the pre-existing prevalence of mental illness was taken into account there was no significant change in the prevalence of mental health problems when comparing the burn group to controls over time. Although burns may not increase rates of mental health issues and health care utilization, burn survivors are a vulnerable group who already demonstrate increased rates of psychopathology and need for care. The present study highlights the importance of assessment and treatment of mental health outcomes in this population. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Assessment of the Appropriateness of Inpatient Mental Health Services at Naval Hospital Camp Pendleton Given the Global War on Terrorism Environment

DTIC Science & Technology

2006-06-01

assumption of similar rates is based on no vast advances in inpatient mental health sciences in the past five years that would decrease utilization, as...admission rates that were used to forecast demand. The assumption of similar rates is based on no vast advances in inpatient mental health sciences in...E 0 0 , C0CflC Q_ _ a__ a)_ ~ . SMe Nam: INaval HoptlCamp Pendton11111 InritathIv Name: Ilvlaino nain etlHat tNC All fnaricia results ame fully

[Water utilization characteristics of the degraded poplar shelterbelts in Zhangbei, Hebei, China.

PubMed

Zhang, Huan; Cao, Jun; Wang, Hua Bing; Song, Bo; Jia, Guo Dong; Liu, Zi Qiang; Yu, Xin Xiao; Zeng, Jia

2018-05-01

In Zhangbei County, Hebei Province, poplar-dominated shelterbelts are degraded to different extents. Water availability is the main limiting factor for plant survival in arid areas. The purpose of this study was to reveal the relationship between water availability and poplar degradation. Based on the hydrogen and oxygen stable isotope techniques, we explored the water sources of Populus simonii under different degradation degrees by comparing the isotopic values of P. simonii xylem water with that in potential water source, and calculated the utilization ratio of each water source. The results showed that the water sources of poplar trees varied with degradation degree. The water sources of P. simonii gradually transferred from the deep layer to the surface layer with the increases of degradation. P. simonii with no degradation mainly absorbed soil water in the range of 320-400 cm, with the utilization rate being 25.1%. P. simonii with slight degradation mainly used soil water at depth of 120-180, 180-240 and 240-320 cm. The total utilization rate of three layers was close to 50.0%, with less utilization of water from other layers. The moderately degraded P. simonii mainly used soil water at depth of 20-40, 40-60 and 60-80 cm. The utilization rate of each layer was 17.5%-20.9%, and the contribution rate of soil water under 120 cm was less than 10.0%. The severely degraded P. simonii mainly used water from surface soil layer (0-20 cm), with the utilization rate being 30.4%, which was significantly higher than that of other water sources. The water sources of poplar shelter forests were gradually shallower during the process of degradation. However, the low soil water content in the shallow layer could not meet the normal water demand of poplar, which would accelerate the degradation and even decline of poplar.

Impact of Rate Design Alternatives on Residential Solar Customer Bills. Increased Fixed Charges, Minimum Bills and Demand-based Rates

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

Bird, Lori; Davidson, Carolyn; McLaren, Joyce

With rapid growth in energy efficiency and distributed generation, electric utilities are anticipating stagnant or decreasing electricity sales, particularly in the residential sector. Utilities are increasingly considering alternative rates structures that are designed to recover fixed costs from residential solar photovoltaic (PV) customers with low net electricity consumption. Proposed structures have included fixed charge increases, minimum bills, and increasingly, demand rates - for net metered customers and all customers. This study examines the electricity bill implications of various residential rate alternatives for multiple locations within the United States. For the locations analyzed, the results suggest that residential PV customers offset,more » on average, between 60% and 99% of their annual load. However, roughly 65% of a typical customer's electricity demand is non-coincidental with PV generation, so the typical PV customer is generally highly reliant on the grid for pooling services.« less

Physical therapists familiarity and beliefs about health services utilization and health seeking behaviour.

PubMed

Clewley, Derek; Rhon, Dan; Flynn, Tim; Koppenhaver, Shane; Cook, Chad

2018-02-21

Physical therapists' familiarity, perceptions, and beliefs about health services utilization and health seeking behaviour have not been previously assessed. The purposes of this study were to identify physical therapists' characteristics related to familiarity of health services utilization and health seeking behaviour, and to assess what health seeking behaviour factors providers felt were related to health services utilization. We administered a survey based on the Andersen behavioural model of health services utilization to physical therapists using social media campaigns and email between March and June of 2017. In addition to descriptive statistics, we performed binomial logistic regression analysis. We asked respondents to rate familiarity with health services utilization and health seeking behaviour and collected additional characteristic variables. Physical therapists are more familiar with health services utilization than health seeking behaviour. Those who are familiar with either construct tend to be those who assess for health services utilization, use health services utilization for a prognosis, and believe that health seeking behaviour is measurable. Physical therapists rated need and enabling factors as having more influence on health services utilization than predisposing and health belief factors. Physical therapists are generally familiar with health services utilization and health seeking behaviour; however, there appears to be a disconnect between what is familiar, what is perceived to be important, and what can be assessed for both health services utilization and health seeking behaviour. Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. All rights reserved.

Can an economist find happiness setting public utility rates

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

Kahn, A.E.

Alfred E. Kahn describes his applications of economic theories to rate level regulatory policies during his career as a public utilities regulator. Two shifts in regulatory thinking have responded to the intent to have rates set to reflect rising costs that will be occuring while the rates are in effect rather than on past costs and have recognized that varying the allowable rate of return can be as effective as changing the rate base. Pressures have been exerted on economists to place too much emphasis on regulatory lag, full-cost pricing, sunk cost, and other factors affecting capital formation. A rationalmore » policy recognizes differences between the needs of individual companies to raise capital and the variations that occur during a given accounting period. Rates based on trends that recognize returns over a time span is one solution. Anticipated cost increases have been included in rate levels so that automatic cost adjustments can be made during times of inflation. Because of increases in the marginal cost of capital, regulators must decide how to selectively vary cash flow during construction periods in a way that will give adequate signals to consumers. Situations in which a water company is associated with a real estate developer can avoid a double recovery of investment by granting rate increases in relation to cost over time.« less

Participation, Retention, and Utilization of a Web-Based Chronic Disease Self-Management Intervention Among Older Adults.

PubMed

Portz, Jennifer Dickman; LaMendola, Walter F

2018-05-21

Web-based self-management (web-based SM) interventions provide a potential resource for older adults to engage in their own chronic disease management. The purpose of this study is to investigate the effect of age on participation, retention, and utilization of a web-based SM intervention. This study reports the results of a secondary data analysis of the effects of age in a randomized trial of a web-based diabetes SM intervention. Participation, reasons for nonenrollment, retention, reasons for disenrollment, and website utilization were examined by age using discriminant function, survival analysis, and multivariate analysis of variance as appropriate. Website utilization by all participants dropped after 6 months but did not vary significantly with age. Though older adults (>60 of age) were less likely to choose to participate (F = 57.20, p < 0.001), a slight majority of participants in the experiment (53%) were over 66 years of age. Enrolled older adults utilized website management tools at a rate equivalent to younger participants. At termination, they often reported the experiment as burdensome, but tended to stay in the study longer than younger participants. Web-based SM offers a feasible approach for older adults with chronic disease to engage in their health management, but it needs to be improved. Those older adults who passed the rigorous screens for this experiment and chose to participate may have been more likely than younger participants to utilize web-based SM intervention tools. They were more persistent in their use of the web-based SM to try to improve health outcomes and formed definitive opinions about its utility before termination.

Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection.

PubMed

Shea, Katherine M; Hobbs, Athena L V; Jaso, Theresa C; Bissett, Jack D; Cruz, Christopher M; Douglass, Elizabeth T; Garey, Kevin W

2017-06-01

Fluoroquinolones are one of the most commonly prescribed antibiotic classes in the United States despite their association with adverse consequences, including Clostridium difficile infection (CDI). We sought to evaluate the impact of a health care system antimicrobial stewardship-initiated respiratory fluoroquinolone restriction program on utilization, appropriateness of quinolone-based therapy based on institutional guidelines, and CDI rates. After implementation, respiratory fluoroquinolone utilization decreased from a monthly mean and standard deviation (SD) of 41.0 (SD = 4.4) days of therapy (DOT) per 1,000 patient days (PD) preintervention to 21.5 (SD = 6.4) DOT/1,000 PD and 4.8 (SD = 3.6) DOT/1,000 PD posteducation and postrestriction, respectively. Using segmented regression analysis, both education (14.5 DOT/1,000 PD per month decrease; P = 0.023) and restriction (24.5 DOT/1,000 PD per month decrease; P < 0.0001) were associated with decreased utilization. In addition, the CDI rates decreased significantly ( P = 0.044) from preintervention using education (3.43 cases/10,000 PD) and restriction (2.2 cases/10,000 PD). Mean monthly CDI cases/10,000 PD decreased from 4.0 (SD = 2.1) preintervention to 2.2 (SD = 1.35) postrestriction. A significant increase in appropriate respiratory fluoroquinolone use occurred postrestriction versus preintervention in patients administered at least one dose (74/130 [57%] versus 74/232 [32%]; P < 0.001), as well as in those receiving two or more doses (47/65 [72%] versus 67/191 [35%]; P < 0.001). A significant reduction in the annual acquisition cost of moxifloxacin, the formulary respiratory fluoroquinolone, was observed postrestriction compared to preintervention within the health care system ($123,882 versus $12,273; P = 0.002). Implementation of a stewardship-initiated respiratory fluoroquinolone restriction program can increase appropriate use while reducing overall utilization, acquisition cost, and CDI rates within a health care system. Copyright © 2017 American Society for Microbiology.

Variation in practice and resource utilization associated with the diagnosis and management of appendicitis at freestanding children's hospitals: implications for value-based comparative analysis.

PubMed

Rice-Townsend, Samuel; Barnes, Jeff N; Hall, Matthew; Baxter, Jessica L; Rangel, Shawn J

2014-06-01

To characterize the scope and magnitude of practice variation associated with the diagnosis and treatment of appendicitis at freestanding children's hospitals. Variation in care has been associated with poor outcomes and is believed to be a key driver of excess health care spending. Retrospective cohort study of 13,328 patients treated with appendicitis at 34 children's hospitals (9/2010-9/2011). Patients were divided into complicated and uncomplicated cohorts and examined for interhospital variation in the use of diagnostic imaging (computed tomography or ultrasonography), laboratory tests, parenteral nutrition (PN), peripherally inserted central catheters (PICC), and hospital cost. The number and distribution of statistical outliers were calculated for all measures. Significant variation was found for all measures, including a 3.5-fold difference in preoperative imaging (aggregate rate: 49.0%, range across hospitals: 21.2%-73.5%, P < 0.001) and a 5-fold difference in preoperative laboratory utilization (aggregate median: 2 tests/encounter, range: 1-5 tests/encounter, P < 0.001). For patients with complicated appendicitis, we characterized a 12-fold difference in postoperative imaging (aggregate rate: 19.4%, range: 4.9%-61.6%, P < 0.001), a 48-fold difference in PICC lines (aggregate rate: 18.9%, range: 1.7%-81.8%, P < 0.001), and a 100-fold difference in PN utilization (aggregate rate: 9.3%, range: 0.4%-42.0%, P < 0.001). Median hospital cost differed 4-fold for patients with uncomplicated disease (aggregate median: $6804, range: $4200-$16,796, P < 0.001) and 4.6-fold for patients with complicated disease (aggregate median: $13,138, range: $5419-$24,779, P < 0.001). Statistical outliers on the basis of high and low utilization were identified for all measures. Significant variation exists in practice, resource utilization, and treatment-related cost associated with the management of appendicitis at freestanding children's hospitals. Value-based measures are needed for benchmarking and to prioritize collaborative quality improvement efforts.

The value-based medicine comparative effectiveness and cost-effectiveness of penetrating keratoplasty for keratoconus.

PubMed

Roe, Richard H; Lass, Jonathan H; Brown, Gary C; Brown, Melissa M

2008-10-01

To perform a base case, comparative effectiveness, and cost-effectiveness (cost-utility) analysis of penetrating keratoplasty for patients with severe keratoconus. Visual acuity data were obtained from a large, retrospective multicenter study in which patients with keratoconus with less than 20/40 best corrected visual acuity and/or the inability to wear contact lenses underwent penetrating keratoplasty, with an average follow-up of 2.1 years. The results were combined with other retrospective studies investigating complication rates of penetrating keratoplasty. The data were then incorporated into a cost-utility model using patient preference-based, time trade-off utilities, computer-based decision analysis, and a net present value model to account for the time value of outcomes and money. The comparative effectiveness of the intervention is expressed in quality-of-life gain and QALYs (quality-adjusted life-years), and the cost-effectiveness results are expressed in the outcome of $/QALY (dollars spent per QALY). Penetrating keratoplasty in 1 eye for patients with severe keratoconus results in a comparative effectiveness (value gain) of 16.5% improvement in quality of life every day over the 44-year life expectancy of the average patient with severe keratoconus. Discounting the total value gain of 5.36 QALYs at a 3% annual discount rate yields 3.05 QALYs gained. The incremental cost for penetrating keratoplasty, including all complications, is $5934 ($5913 discounted at 3% per year). Thus, the incremental cost-utility (discounted at 3% annually) for this intervention is $5913/3.05 QALYs = $1942/QALY. If both eyes undergo corneal transplant, the total discounted value gain is 30% and the overall cost-utility is $2003. Surgery on the second eye confers a total discounted value gain of 2.5 QALYs, yielding a quality-of-life gain of 11.6% and a discounted cost-utility of $2238/QALY. Penetrating keratoplasty for patients with severe keratoconus seems to be a comparatively effective and cost-effective procedure when compared with other interventions across different medical specialties.

New secondary batteries utilizing electronically conductive polymer cathodes

NASA Technical Reports Server (NTRS)

Martin, Charles R.; White, Ralph E.

1987-01-01

The objectives are to optimize the transport rates in electronically conductive polypyrrole films by controlling the morphology of the film and to assess the utility of these films as cathodes in a lithium/polypyrrole secondary battery. During this research period, a better understanding was gained of the fundamental electrochemical switching processes within the polypyrrole film. Three publications were submitted based on the work completed.

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

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

Washington State Energy Office.

The Public Utilities Regulatory Policies Act (PURPA) of 1979 requires that electrical utilities interconnect with qualifying facilities (QFs) and purchase electricity at a rate based upon their full avoided cost of providing both capacity and energy. Facilities that qualify for PURPA benefits include solar or geothermal electric units, hydropower, municipal solid waste or biomass-fired power plants, and cogeneration projects that satisfy maximum size, fuel use, ownership, location, and/or efficiency criteria. The mandate of PURPA, coupled with the electrical energy deficits projected to occur in the Pacific Northwest by the mid 1980s, led to resurgence of interest in the development ofmore » small, decentralized, non-utility owned and operated generating stations. A variety of would-be developers conducted feasibility studies and initiated environmental permitting and power marketing discussions with appropriate authorities. While many proposed PURPA projects fill by the wayside, others were successfully brought on-line. A variety of public and private sector developers, including cities, counties, irrigation districts, utilities, ranchers, timber companies, and food processing plants, successfully negotiated PURPA-based, or share-the-savings'' power purchase contracts. Other developers run their meter backwards'' or provide energy to their local utilities at the same rate that would otherwise be paid to Bonneville. This document provides a summary resource development of these renewable projects in the Pacific Northwest.« less

Health IT and inappropriate utilization of outpatient imaging: A cross-sectional study of U.S. hospitals.

PubMed

Appari, Ajit; Johnson, M Eric; Anthony, Denise L

2018-01-01

To determine whether the use of information technology (IT), measured by Meaningful Use capability, is associated with lower rates of inappropriate utilization of imaging services in hospital outpatient settings. A retrospective cross-sectional analysis of 3332 nonfederal U.S. hospitals using data from: Hospital Compare (2011 outpatient imaging efficiency measures), HIMSS Analytics (2009 health IT), and Health Indicator Warehouse (market characteristics). Hospitals were categorized for their health IT infrastructure including EHR Stage-1 capability, and three advanced imaging functionalities/systems including integrated picture archiving and communication system, Web-based image distribution, and clinical decision support (CDS) with physician pathways. Three imaging efficiency measures suggesting inappropriate utilization during 2011 included: percentage of "combined" (with and without contrast) computed tomography (CT) studies out of all CT studies for abdomen and chest respectively, and percentage of magnetic resonance imaging (MRI) studies of lumbar spine without antecedent conservative therapy within 60days. For each measure, three separate regression models (GLM with gamma-log link function, and denominator of imaging measure as exposure) were estimated adjusting for hospital characteristics, market characteristics, and state fixed effects. Additionally, Heckman's Inverse Mills Ratio and propensity for Stage-1 EHR capability were used to account for selection bias. We find support for association of each of the four health IT capabilities with inappropriate utilization rates of one or more imaging modality. Stage-1 EHR capability is associated with lower inappropriate utilization rates for chest CT (incidence rate ratio IRR=0.72, p-value <0.01) and lumbar MRI (IRR=0.87, p-value <0.05). Integrated PACS is associated with lower inappropriate utilization rate of abdomen CT (IRR=0.84, p-value <0.05). Imaging distribution over Web capability is associated with lower inappropriate utilization rates for chest CT (IRR=0.66, p-value <0.05) and lumbar MRI (IRR=0.86, p-value <0.05). CDS with physician pathways is associated with lower inappropriate utilization rates for abdomen CT (IRR=0.87, p-value <0.01) and lumbar MRI (IRR=0.90, p-value <0.05). All other cases showed no association. The study offers mixed results. Taken together, the results suggest that the use of Stage-1 Meaningful Use capable EHR systems along with advanced imaging related functionalities could have a beneficial impact on reducing some of the inappropriate utilization of outpatient imaging. Copyright © 2017 Elsevier B.V. All rights reserved.

Single-Frequency Ultrasound-Based Respiration Rate Estimation with Smartphones

PubMed Central

Wei, Jing

2018-01-01

Respiration monitoring is helpful in disease prevention and diagnosis. Traditional respiration monitoring requires users to wear devices on their bodies, which is inconvenient for them. In this paper, we aim to design a noncontact respiration rate detection system utilizing off-the-shelf smartphones. We utilize the single-frequency ultrasound as the media to detect the respiration activity. By analyzing the ultrasound signals received by the built-in microphone sensor in a smartphone, our system can derive the respiration rate of the user. The advantage of our method is that the transmitted signal is easy to generate and the signal analysis is simple, which has lower power consumption and thus is suitable for long-term monitoring in daily life. The experimental result shows that our system can achieve accurate respiration rate estimation under various scenarios. PMID:29853985

Providing Effective Access to Shared Resources: A COIN Approach

NASA Technical Reports Server (NTRS)

Airiau, Stephane; Wolpert, David H.

2004-01-01

Managers of systems of shared resources typically have many separate goals. Examples are efficient utilization of the resources among its users and ensuring no user s satisfaction in the system falls below a preset minimal level. Since such goals will usually conflict with one another, either implicitly or explicitly the manager must determine the relative importance of the goals, encapsulating that into an overall utility function rating the possible behaviors of the entire system. Here we demonstrate a distributed, robust, and adaptive way to optimize that overall function. Our approach is to interpose adaptive agents between each user and the system, where each such agent is working to maximize its own private utility function. In turn, each such agent's function should be both relatively easy for the agent to learn to optimize, and "aligned" with the overall utility function of the system manager - an overall function that is based on but in general different from the satisfaction functions of the individual users. To ensure this we enhance the Collective INtelligence (COIN) framework to incorporate user satisfaction functions in the overall utility function of the system manager and accordingly in the associated private utility functions assigned to the users agents. We present experimental evaluations of different COIN-based private utility functions and demonstrate that those COIN-based functions outperform some natural alternatives.

Providing Effective Access to Shared Resources: A COIN Approach

NASA Technical Reports Server (NTRS)

Airiau, Stephane; Wolpert, David H.; Sen, Sandip; Tumer, Kagan

2003-01-01

Managers of systems of shared resources typically have many separate goals. Examples are efficient utilization of the resources among its users and ensuring no user's satisfaction in the system falls below a preset minimal level. Since such goals will usually conflict with one another, either implicitly or explicitly the manager must determine the relative importance of the goals, encapsulating that into an overall utility function rating the possible behaviors of the entire system. Here we demonstrate a distributed, robust, and adaptive way to optimize that overall function. Our approach is to interpose adaptive agents between each user and the system, where each such agent is working to maximize its own private utility function. In turn, each such agent's function should be both relatively easy for the agent to learn to optimize, and 'aligned' with the overall utility function of the system manager - an overall function that is based on but in general different from the satisfaction functions of the individual users. To ensure this we enhance the COllective INtelligence (COIN) framework to incorporate user satisfaction functions in the overall utility function of the system manager and accordingly in the associated private utility functions assigned to the users agents. We present experimental evaluations of different COIN-based private utility functions and demonstrate that those COIN-based functions outperform some natural alternatives.

Peritoneal dialysis in Asia.

PubMed

Cheng, I K

1996-01-01

The socioeconomic status of Asian countries is diverse, and government reimbursement policies for treatment of patients suffering from end-stage renal disease (ESRD) vary greatly from one country to another. Both of these factors have a major impact not only on the choice of treatment for ESRD but also on the utilization of peritoneal dialysis (PD) in this region. Based on the data collected from 11 representative Asian countries, several observations can be made. First, the treatment rates for ESRD in these countries correlated closely with their gross domestic product (GDP) per capita income. Second, the PD utilization rate appeared to have a biphasic relationship with the GDP per capita income and treatment rate, in that countries with the highest and the lowest treatment rates tended to have lower PD utilization rates, whereas countries with modest treatment rates tended to have higher PD utilization rates. The reason for low PD utilization in countries with the highest treatment rates differs from that in countries with low treatment rates. In the former, because of full government reimbursement, there is little physician incentive to introduce PD as an alternative form of ESRD treatment to in-center hemodialysis (HD), whereas in the latter, the complete lack of government reimbursement prevents the introduction of PD as a form of treatment. This pattern is likely to change in the future because, of the 11 countries surveyed, all except Thailand have recorded a growth rate which is higher for PD than HD over the last three years. The rate of utilization of different PD systems varies greatly among different Asian countries. Automated PD has yet to gain popularity in Asia. Conventional straight-line systems remain the dominant PD systems in use in Hong Kong, Korea, Thailand, and the Philippines, while in Malaysia and Singapore UV germicidal connection devices are most popular. However, in all these countries there has been a progressive shift over the last three years from the straight-line systems with or without germicidal connection devices to the disconnect systems. In China and India, where PD has been introduced only recently, the disconnect systems are used almost exclusively. The disconnect systems are also the most popular systems in use in Japan and Taiwan. As data concerning the cost-effectiveness of different PD systems becomes available, it is likely that trend towards a more liberal use of disconnect systems will continue in the future. The usage of low calcium peritoneal dialysate and the average number of daily CAPD exchanges also vary among the Asian countries. Low calcium peritoneal dialysate has been introduced only in Japan, Hong Kong, and Singapore, with the highest utilization rate (90%) recorded in Singapore. The Philippines had the lowest average number of daily peritoneal exchanges (6L) among the countries surveyed, followed by Hong Kong (6.4L), China and Indonesia (7L), and the rest (8L). The use of a lower number of exchanges was introduced in some countries, initially, mainly as a cost-saving measure based on the assumption that Asians are of small body build. The justification for the continued use of a lower number of exchanges among Asian patients is debatable, but is supported by the acceptable, long-term clinical outcome of patients given this form of dialysis prescription. It is suggested that long-term prospective studies on dialysis adequacy and clinical outcome should be done in different ethnic groups in Asia to see if the similar guidelines with regard to dialysis adequacy can be applied uniformly to Orientals and Caucasians.

Complete genome sequence, metabolic model construction and phenotypic characterization of Geobacillus LC300, an extremely thermophilic, fast growing, xylose-utilizing bacterium.

PubMed

Cordova, Lauren T; Long, Christopher P; Venkataramanan, Keerthi P; Antoniewicz, Maciek R

2015-11-01

We have isolated a new extremely thermophilic fast-growing Geobacillus strain that can efficiently utilize xylose, glucose, mannose and galactose for cell growth. When grown aerobically at 72 °C, Geobacillus LC300 has a growth rate of 2.15 h(-1) on glucose and 1.52 h(-1) on xylose (doubling time less than 30 min). The corresponding specific glucose and xylose utilization rates are 5.55 g/g/h and 5.24 g/g/h, respectively. As such, Geobacillus LC300 grows 3-times faster than E. coli on glucose and xylose, and has a specific xylose utilization rate that is 3-times higher than the best metabolically engineered organism to date. To gain more insight into the metabolism of Geobacillus LC300 its genome was sequenced using PacBio's RS II single-molecule real-time (SMRT) sequencing platform and annotated using the RAST server. Based on the genome annotation and the measured biomass composition a core metabolic network model was constructed. To further demonstrate the biotechnological potential of this organism, Geobacillus LC300 was grown to high cell-densities in a fed-batch culture, where cells maintained a high xylose utilization rate under low dissolved oxygen concentrations. All of these characteristics make Geobacillus LC300 an attractive host for future metabolic engineering and biotechnology applications. Copyright © 2015 International Metabolic Engineering Society. Published by Elsevier Inc. All rights reserved.

Phone and Web-Based Tobacco Cessation Treatment: Real-World Utilization Patterns and Outcomes for 11,000 Tobacco Users

PubMed Central

Hapgood, Jenny; Smucker Barnwell, Sara; McAfee, Tim

2008-01-01

Background Phone-based tobacco cessation programs have been proven effective and widely adopted. Web-based solutions exist; however, the evidence base is not yet well established. Many cessation treatments are commercially available, but few integrate the phone and Web for delivery and no published studies exist for integrated programs. Objective This paper describes a comprehensive integrated phone/Web tobacco cessation program and the characteristics, experience, and outcomes of smokers enrolled in this program from a real-world evaluation. Methods We tracked program utilization (calls completed, Web log-ins), quit status, satisfaction, and demographics of 11,143 participants who enrolled in the Free & Clear Quit For Life Program between May 2006 and October 2007. All participants received up to five proactive phone counseling sessions with Quit Coaches, unlimited access to an interactive website, up to 20 tailored emails, printed Quit Guides, and cessation medication information. The program was designed to encourage use of all program components rather than asking participants to choose which components they wanted to use while quitting. Results We found that participants tended to use phone services more than Web services. On average, participants completed 2-2.5 counseling calls and logged in to the online program 1-2 times. Women were more adherent to the overall program; women utilized Web and phone services significantly (P = .003) more than men. Older smokers (> 26 years) and moderate smokers (15-20 cigarettes/day) utilized services more (P < .001) than younger (< 26 years) and light or heavy smokers. Satisfaction with services was high (92% to 95%) and varied somewhat with Web utilization. Thirty-day quit rates at the 6-month follow-up were 41% using responder analysis and 21% using intent-to-treat analysis. Web utilization was significantly associated with increased call completion and tobacco abstinence rates at the 6-month follow-up evaluation. Conclusions This paper expands our understanding of a real-world treatment program combining two mediums, phone and Web. Greater adherence to the program, as defined by using both the phone and Web components, is associated with higher quit rates. This study has implications for reaching and treating tobacco users with an integrated phone/Web program and offers evidence regarding the effectiveness of integrated cessation programs. PMID:19017583

Preferences and Utilities for Health States after Treatment of Olfactory Groove Meningioma: Endoscopic versus Open.

PubMed

Yao, Christopher M; Kahane, Alyssa; Monteiro, Eric; Gentili, Fred; Zadeh, Gelareh; de Almeida, John R

2017-08-01

Objectives  The purpose of this study is to report health utility scores for patients with olfactory groove meningiomas (OGM) treated with either the standard transcranial approach, or the expanded endonasal endoscopic approach. Design  The time trade-off technique was used to derive health utility scores. Setting  Healthy individuals without skull base tumors were surveyed. Main Outcome Measures  Participants reviewed and rated scenarios describing treatment (endoscopic, open, stereotactic radiation, watchful waiting), remission, recurrence, and complications associated with the management of OGMs. Results  There were 51 participants. The endoscopic approach was associated with higher utility scores compared with an open craniotomy approach (0.88 vs. 0.74; p  < 0.001) and watchful waiting (0.88 vs.0.74; p  = 0.002). If recurrence occurred, revision endoscopic resection continued to have a higher utility score compared with revision open craniotomy (0.68; p  = 0.008). On multivariate analysis, older individuals were more likely to opt for watchful waiting ( p  = 0.001), whereas participants from higher income brackets were more likely to rate stereotactic radiosurgery with higher utility scores ( p  = 0.017). Conclusion  The endoscopic approach was associated with higher utility scores than craniotomy for primary and revision cases. The present utilities can be used for future cost-utility analyses.

Developing hydropower in Washington state. Volume 2: An electricity marketing manual

NASA Astrophysics Data System (ADS)

James, J. W.; McCoy, G. A.

1982-03-01

An electricity marketing manual for the potential small and micro-hydroelectric project developer within the state of Washington is presented. Public utility regulatory policies (PURPA) requires electric utilities to interconnect with and pay a rate based on their full avoided costs for the purchase of electrical output from qualifying small power production facilities. The determination of avoided costs, as business organizational considerations, utility interface concerns, interconnection requirements, metering options, and liability and wheeling are discussed. The utility responses are summarized, legislation which is of importance to hydropower developers and the powers and functions of the authorities responsible for enforcing the mandate of PURPA are described.

Sociodemographic characterization of ECT utilization in Hawaii.

PubMed

Ona, Celia M; Onoye, Jane M; Goebert, Deborah; Hishinuma, Earl; Bumanglag, R Janine; Takeshita, Junji; Carlton, Barry; Fukuda, Michael

2014-03-01

Minimal research has been done on sociodemographic differences in utilization of electroconvulsive therapy (ECT) for refractory depression, especially among Asian Americans and Pacific Islanders. This study examined sociodemographic and diagnostic variables using retrospective data from Hawaii, an island state with predominantly Asian Americans and Pacific Islanders. Retrospective data were obtained from an inpatient and outpatient database of ECT patients from 2008 to 2010 at a tertiary care community hospital on O'ahu, Hawaii. There was a significant increase in overall ECT utilization from 2008 to 2009, with utilization remaining stable from 2009 to 2010. European Americans (41%) and Japanese Americans (29%) have relatively higher rates of receiving ECT, and Filipino Americans and Native Hawaiians have relatively lower rates in comparison with their population demographics. Japanese Americans received significantly more ECT procedures than European Americans. Electroconvulsive therapy is underutilized by certain sociodemographic groups that may benefit most from the treatment. There are significant differences in ECT usage based on ethnicity. Such differences may be related to help-seeking behavior, economic differences, and/or attitudes regarding mental illness. Further research is needed to elucidate the reasons for differences in utilization.

Solar Energy Systems for Lunar Oxygen Generation

NASA Technical Reports Server (NTRS)

Colozza, Anthony J.; Heller, Richard S.; Wong, Wayne A.; Hepp, Aloysius F.

2010-01-01

An evaluation of several solar concentrator-based systems for producing oxygen from lunar regolith was performed. The systems utilize a solar concentrator mirror to provide thermal energy for the oxygen production process. Thermal energy to power a Stirling heat engine and photovoltaics are compared for the production of electricity. The electricity produced is utilized to operate the equipment needed in the oxygen production process. The initial oxygen production method utilized in the analysis is hydrogen reduction of ilmenite. Utilizing this method of oxygen production a baseline system design was produced. This baseline system had an oxygen production rate of 0.6 kg/hr with a concentrator mirror size of 5 m. Variations were performed on the baseline design to show how changes in the system size and process (rate) affected the oxygen production rate. An evaluation of the power requirements for a carbothermal lunar regolith reduction reactor has also been conducted. The reactor had a total power requirement between 8,320 to 9,961 W when producing 1000 kg/year of oxygen. The solar concentrator used to provide the thermal power (over 82 percent of the total energy requirement) would have a diameter of less than 4 m.

The Effect of Utilization Review on Emergency Department Operations.

PubMed

Desai, Shoma; Gruber, Phillip F; Eiting, Erick; Seabury, Seth A; Mack, Wendy J; Voyageur, Christian; Vasquez, Veronica; Kim, Hyung T; Terp, Sophie

2017-11-01

Increasingly, hospitals are using utilization review software to reduce hospital admissions in an effort to contain costs. Such practices have the potential to increase the number of unsafe discharges, particularly in public safety-net hospitals. Utilization review software tools are not well studied with regard to their effect on emergency department (ED) operations. We study the effect of prospectively used admission decision support on ED operations. In 2012, Los Angeles County + University of Southern California Medical Center implemented prospective use of computerized admission criteria. After implementation, only ED patients meeting primary review (diagnosis-based criteria) or secondary review (medical necessity as determined by an on-site emergency physician) were assigned inpatient beds. Data were extracted from electronic medical records from September 2011 through December 2013. Outcomes included operational metrics, 30-day ED revisits, and 30-day admission rates. Excluding a 6-month implementation period, monthly summary metrics were compared pre- and postimplementation with nonparametric and negative binomial regression methods. All adult ED visits, excluding incarcerated and purely behavioral health visits, were analyzed. The primary outcomes were disposition rates. Secondary outcomes were 30-day ED revisits, 30-day admission rate among return visitors to the ED, and estimated cost. Analysis of 245,662 ED encounters was performed. The inpatient admission rate decreased from 14.2% to 12.8%. Increases in discharge rate (82.4% to 83.4%) and ED observation unit utilization (2.5% to 3.4%) were found. Thirty-day revisits increased (20.4% to 24.4%), although the 30-day admission rate decreased (3.2% to 2.8%). Estimated cost savings totaled $193.17 per ED visit. The prospective application of utilization review software in the ED led to a decrease in the admission rate. This was tempered by a concomitant increase in ED observation unit utilization and 30-day ED revisits. Cost savings suggest that resources should be redirected to the more highly affected ED and ED observation unit, although more work is needed to confirm the generalizability of these findings. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

The diagnostic utility of the Rarely Missed Index of the Wechsler Memory Scale-Third Edition in detecting response bias in an adult male incarcerated setting.

PubMed

D'Amato, Christopher P; Denney, Robert L

2008-09-01

The purpose of this study was to utilize a known-group research design to evaluate the diagnostic utility of the Rarely Missed Index (RMI) of the Wechsler Memory Scale-Third Edition [Wechsler, D. (1997). Wechsler Adult Intelligence Test-3rd Edition. San Antonio, TX: The Psychological Corporation] in assessing response bias in an adult male incarcerated setting. Archival data from a sample of 60 adult male inmates who presented for neuropsychological testing were reviewed. Evaluees were assigned to one of two groups; probable malingerers (PM; n=30) and a group of valid test responders (n=30) (1999). Using the recommended cut-off score of 136 or less, the sensitivity of the RMI was extremely low at 33%. Its specificity was 83%. The positive predictive power of the RMI with the published base rate of 22.8 was 38%; with a negative predictive power of 81%. The positive predictive power of the RMI with a published base rate of 70.5 was 82%. The negative predictive power using a base rate of 70.5% was 34%. Results of the receiver operating characteristics (ROC) analysis indicated that the RMI score with a cut-off 136 or less performed only slightly better than chance in delineating probable malingerers from valid responders in this setting. Overall, the findings suggest that the RMI may not be a reliable index for detecting response bias in this setting and perhaps in similar settings.

Joint Machine Learning and Game Theory for Rate Control in High Efficiency Video Coding.

PubMed

Gao, Wei; Kwong, Sam; Jia, Yuheng

2017-08-25

In this paper, a joint machine learning and game theory modeling (MLGT) framework is proposed for inter frame coding tree unit (CTU) level bit allocation and rate control (RC) optimization in High Efficiency Video Coding (HEVC). First, a support vector machine (SVM) based multi-classification scheme is proposed to improve the prediction accuracy of CTU-level Rate-Distortion (R-D) model. The legacy "chicken-and-egg" dilemma in video coding is proposed to be overcome by the learning-based R-D model. Second, a mixed R-D model based cooperative bargaining game theory is proposed for bit allocation optimization, where the convexity of the mixed R-D model based utility function is proved, and Nash bargaining solution (NBS) is achieved by the proposed iterative solution search method. The minimum utility is adjusted by the reference coding distortion and frame-level Quantization parameter (QP) change. Lastly, intra frame QP and inter frame adaptive bit ratios are adjusted to make inter frames have more bit resources to maintain smooth quality and bit consumption in the bargaining game optimization. Experimental results demonstrate that the proposed MLGT based RC method can achieve much better R-D performances, quality smoothness, bit rate accuracy, buffer control results and subjective visual quality than the other state-of-the-art one-pass RC methods, and the achieved R-D performances are very close to the performance limits from the FixedQP method.

Comparing The Effects Of Reference Pricing And Centers-Of-Excellence Approaches To Value-Based Benefit Design.

PubMed

Zhang, Hui; Cowling, David W; Facer, Matthew

2017-12-01

Various health insurance benefit designs based on value-based purchasing have been promoted to steer patients to high-value providers, but little is known about the designs' relative effectiveness and underlying mechanisms. We compared the impact of two designs implemented by the California Public Employees' Retirement System on inpatient hospital total hip or knee replacement: a reference-based pricing design for preferred provider organizations (PPOs) and a centers-of-excellence design for health maintenance organizations (HMOs). Payment and utilization data for the procedures in the period 2008-13 were evaluated using pre-post and quasi-experimental designs at the system and health plan levels, adjusting for demographic characteristics, case-mix, and other confounders. We found that both designs prompted higher use of designated low-price high-quality facilities and reduced average replacement expenses per member at the plan and system levels. However, the designs used different routes: The reference-based pricing design reduced average replacement payments per case in PPOs by 26.7 percent in the first year, compared to HMOs, but did not lower PPO members' utilization rates. In contrast, the centers-of-excellence design lowered HMO members' utilization rates by 29.2 percent in the first year, compared to PPOs, but did not reduce HMO average replacement payments per case. The reference-based pricing design appears more suitable for reducing price variation, and the centers-of-excellence design for addressing variation in use.

The Research of Utilization Hours of Coal-Fired Power Generation Units Based on Electric Energy Balance

NASA Astrophysics Data System (ADS)

Liu, Junhui; Yang, Jianlian; Wang, Jiangbo; Yang, Meng; Tian, Chunzheng; He, Xinhui

2018-01-01

With grid-connected scale of clean energy such as wind power and photovoltaic power expanding rapidly and cross-province transmission scale being bigger, utilization hours of coal-fired power generation units become lower and lower in the context of the current slowdown in electricity demand. This paper analyzes the influencing factors from the three aspects of demand, supply and supply and demand balance, and the mathematical model has been constructed based on the electric energy balance. The utilization hours of coal-fired power generation units have been solved considering the relationship among proportion of various types of power installed capacity, the output rate and utilization hours. By carrying out empirical research in Henan Province, the utilization hours of coal-fired units of Henan Province in 2020 has been achieved. The example validates the practicability and the rationality of the model, which can provide a basis for the decision-making for coal-fired power generation enterprises.

Effective utilization of ozone in plasma-based advanced oxidation process

NASA Astrophysics Data System (ADS)

Takeuchi, Nozomi; Ishibashi, Naoto; Sugiyama, Tsuyoshi; Kim, Hyun-Ha

2018-05-01

Decomposition of acetic acid in water was conducted using multiple plasmas generated within oxygen bubbles. Ballast capacitors were used to control the plasma input power, allowing hydrogen peroxide and ozone to be produced at different rates in each plasma by adjusting the capacitance. By using an ozone absorber connected to the plasma reactor, OH radicals, both generated by the plasmas directly and reproduced from hydrogen peroxide through reactions with ozone, could be effectively utilized for the reduction of total organic carbon (TOC). Under the condition with the highest ozone production rate, higher processing speed and energy efficiency for the TOC reduction were achieved compared with other plasma methods.

Burden of emergency conditions and emergency care utilization: New estimates from 40 countries

PubMed Central

Chang, Cindy Y.; Abujaber, Samer; Reynolds, Teri A.; Camargo, Carlos A.; Obermeyer, Ziad

2016-01-01

Objective To estimate the global and national burden of emergency conditions, and compare them to emergency care utilization rates. Methods We coded all 291 Global Burden of Disease 2010 conditions into three categories to estimate emergency burden: conditions that, if not addressed within hours to days of onset, commonly lead to serious disability or death; conditions with common acute decompensations that lead to serious disability or death; and non-emergencies. Emergency care utilization rates were obtained from a systematic literature review on emergency care facilities in low- and middle-income countries (LMICs), supplemented by national health system reports. Findings All 15 leading causes of death and DALYs globally were conditions with potential emergent manifestations. We identified 41 facility-based reports in 23 countries, 12 of which were in LMICs; data for 17 additional countries were obtained from national or regional reports on emergency utilization. Burden of emergency conditions was the highest in low-income countries, with median DALYs of 47,728 per 100,000 population (IQR 45,253-50,085) in low-income, 25,186 (IQR 21,982-40,480) in middle-income, and 15,691 (IQR 14,649-16,382) in high-income countries. Patterns were similar using deaths to measure burden and excluding acute decompensations from the definition of emergency conditions. Conversely, emergency utilization rates were the lowest in low-income countries, with median 8 visits per 1,000 population (IQR 6-10), 78 (IQR 25-197) in middle-income, and 264 (IQR 177-341) in high-income countries. Conclusion Despite higher burden of emergency conditions, emergency utilization rates are substantially lower in LMICs, likely due to limited access to emergency care. PMID:27334758

GLOBE Study Culture Clusters: Can They Be Found in Importance Ratings of Managerial Competencies?

ERIC Educational Resources Information Center

Clark, Jeremy Michael; Quast, Louis N.; Jang, Soebin; Wohkittel, Joseph; Center, Bruce; Edwards, Katherine; Bovornusvakool, Witsinee

2016-01-01

Purpose: The purpose of this study is to explore patterns of importance ratings of managerial competencies in 22 countries in different regions around the globe, to guide specificity in assessing and developing managers in multiple geographies. Additionally, this study examined the utility of clustering countries based on shared culture, as…

Improving Donor Conversion Rates at a Level One Trauma Center: Impact of Best Practice Guidelines.

PubMed

Alban, Rodrigo F; Gibbons, Bobby L; Bershad, Vanessa L

2016-11-22

Organ availability is a consistently limiting factor in transplant surgery. A primary driver of this limitation is donor conversion rate, which is defined as the percentage of eligible donors for whom procurement is actually performed. An alternative way to increase organ availability is through improved utilization of organs from donors after cardiac death (DCD). Recently, a concerted, multidisciplinary effort has been made within our system to improve conversion rates and DCD utilization, thus increasing organ availability. Retrospective analysis of a prospectively collected database from TransLife, our local organ procurement organization (OPO), as well as the Orlando Regional Medical Center (ORMC) trauma registry, from 2009-2012 (up to 2013 for DCD). During which time, this organization implemented best practice guidelines to improve conversions and DCD utilization. We analyzed yearly conversion rates, DCD donations and population demographics before and after implementation of these policies. During the study period, donor conversion rates significantly improved from 58% in 2009 to 82% percent in 2012 hospital-wide (P<0.05); and from 50% in 2009 to 81% in 2012 among trauma patients alone (P<0.05). In addition, total organs transplanted increased from 13 to 31 organs (P<0.05) after implementation of best practice guidelines. No significant differences in trauma population demographics were noted during the study period. Based on our experience, the establishment of best practice policies for referral of potential donors, coupled with programs to educate hospital staff on the existence and importance of these policies, leads to significant improvement in donor conversion rates and increased utilization of DCD donors.

Home-Based Screening for Biliary Atresia Using Infant Stool Color Cards in Canada: Quebec Feasibility Study.

PubMed

Morinville, Véronique; Ahmed, Najma; Ibberson, Cindy; Kovacs, Lajos; Kaczorowski, Janusz; Bryan, Stirling; Collet, Jean-Paul; Schreiber, Richard

2016-04-01

Biliary atresia (BA) is a leading cause of liver failure and liver transplantation in pediatrics. BA manifests by 3 weeks of life with jaundice and pale stools. Delayed diagnosis and surgical intervention with Kasai portoenterostomy after 3 months of age is significantly associated with poor prognosis for native liver survival. A national Taiwan infant stool color card (SCC) screening program has entirely eliminated late Kasai portoenterostomy >90 days of age and improved native liver survival. A recent large-scale prospective cohort study in British Columbia, Canada, indicated that distribution of SCC on the maternity ward was feasible, led to high utilization rate, and was cost-effective. The aim of the present study was to assess the generalizability of this screening strategy in another Canadian jurisdiction with a different sociodemographic profile. An SCC was distributed to families of newborns discharged at St Mary's Hospital Center, Montreal, Quebec. Families were instructed to monitor their infant's stool color for 21 days and then complete and mail the SCC to the study center. Phone surveys to families who did not return cards were used to estimate total card utilization rate. Two thousand two hundred forty-six infants were eligible for inclusion; 99.9% were enrolled. Mail SCC return rate was 63.3%. No cases of BA were identified. All of the 118 families who completed the phone survey reported that they had utilized the SCC. Conservative and optimistic estimates for total card utilization rates were 82% and 100%, respectively. The high enrollment and utilization rates in this screening study strongly support the feasibility of implementing a Canadian SCC screening program to improve outcomes of children with BA.

Regulators to the rescue: PSC's restrain runaway utilities. [Missouri PSC and Kansas City Power and Light Co

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

Morgan, R.

1980-07-01

The Missouri Public Service Commission's refusal to let the Kansas City utility include a new plant in its rate base because the utility already has excess capacity could set a precedent for halting expansion plans across the country. The Missouri PSC staff accused the utility of ignoring conservation goals, distorting facts, and planning to speculate on the wholesale power market at the ratepayers' expense. Other state regulators unhappy with poor utility planning can be expected to take a good look at the Missouri decision. Regulators in New Jersey and Pennsylvania have already taken a hard line with the nuclear industrymore » since the Three Mile Island accident. (DCK)« less

Value of the distant future: Model-independent results

NASA Astrophysics Data System (ADS)

Katz, Yuri A.

2017-01-01

This paper shows that the model-independent account of correlations in an interest rate process or a log-consumption growth process leads to declining long-term tails of discount curves. Under the assumption of an exponentially decaying memory in fluctuations of risk-free real interest rates, I derive the analytical expression for an apt value of the long run discount factor and provide a detailed comparison of the obtained result with the outcome of the benchmark risk-free interest rate models. Utilizing the standard consumption-based model with an isoelastic power utility of the representative economic agent, I derive the non-Markovian generalization of the Ramsey discounting formula. Obtained analytical results allowing simple calibration, may augment the rigorous cost-benefit and regulatory impact analysis of long-term environmental and infrastructure projects.

Utilization of services in a randomized trial testing phone- and web-based interventions for smoking cessation.

PubMed

Zbikowski, Susan M; Jack, Lisa M; McClure, Jennifer B; Deprey, Mona; Javitz, Harold S; McAfee, Timothy A; Catz, Sheryl L; Richards, Julie; Bush, Terry; Swan, Gary E

2011-05-01

Phone counseling has become standard for behavioral smoking cessation treatment. Newer options include Web and integrated phone-Web treatment. No prior research, to our knowledge, has systematically compared the effectiveness of these three treatment modalities in a randomized trial. Understanding how utilization varies by mode, the impact of utilization on outcomes, and predictors of utilization across each mode could lead to improved treatments. One thousand two hundred and two participants were randomized to phone, Web, or combined phone-Web cessation treatment. Services varied by modality and were tracked using automated systems. All participants received 12 weeks of varenicline, printed guides, an orientation call, and access to a phone supportline. Self-report data were collected at baseline and 6-month follow-up. Overall, participants utilized phone services more often than the Web-based services. Among treatment groups with Web access, a significant proportion logged in only once (37% phone-Web, 41% Web), and those in the phone-Web group logged in less often than those in the Web group (mean = 2.4 vs. 3.7, p = .0001). Use of the phone also was correlated with increased use of the Web. In multivariate analyses, greater use of the phone- or Web-based services was associated with higher cessation rates. Finally, older age and the belief that certain treatments could improve success were consistent predictors of greater utilization across groups. Other predictors varied by treatment group. Opportunities for enhancing treatment utilization exist, particularly for Web-based programs. Increasing utilization more broadly could result in better overall treatment effectiveness for all intervention modalities.

Incentivizing Decentralized Sanitation: The Role of Discount Rates.

PubMed

Wood, Alison; Blackhurst, Michael; Garland, Jay L; Lawler, Desmond F

2016-06-21

In adoption decisions for decentralized sanitation technologies, two decision makers are involved: the public utility and the individual homeowner. Standard life cycle cost is calculated from the perspective of the utility, which uses a market-based discount rate in these calculations. However, both decision-makers must be considered, including their differing perceptions of the time trade-offs inherent in a stream of costs and benefits. This study uses the discount rate as a proxy for these perceptions and decision-maker preferences. The results in two case studies emphasize the dependence on location of such analyses. Falmouth, Massachusetts, appears to be a good candidate for incentivizing decentralized sanitation while the Allegheny County Sanitary Authority service area in Pennsylvania appears to have no need for similar incentives. This method can be applied to any two-party decision in which the parties are expected to have different discount rates.

Algae-based biofilm productivity utilizing dairy wastewater: effects of temperature and organic carbon concentration.

PubMed

Fica, Zachary T; Sims, Ronald C

2016-01-01

Biofilm-based microalgal growth was determined as functions of organic chemical loading and water temperature utilizing dairy wastewater from a full-scale dairy farm. The dairy industry is a significant source of wastewater worldwide that could provide an inexpensive and nutrient rich feedstock for the cultivation of algae biomass for use in downstream processing of animal feed and aquaculture applications. Algal biomass was cultivated using a Rotating Algal Biofilm Reactor (RABR) system. The RABR is a biofilm-based technology that has been designed and used to remediate municipal wastewater and was applied to treat dairy wastewater through nutrient uptake, and simultaneously provide biomass for the production of renewable bioproducts. Aerial algal biofilm growth rates in dairy wastewater at 7 and 27 °C temperatures were shown to be 4.55 ± 0.17 g/m 2 -day and 7.57 ± 1.12 g/m 2 -day ash free dry weight (AFDW), respectively. Analysis of Variance (ANOVA) calculations indicated that both an increase in temperature of the wastewater and an increase in the level of organic carbon, from 300 to 1200 mg L -1 , contributed significantly to an increase in the rate of biomass growth in the system. However, ANOVA results indicated that the interaction of temperature and organic carbon content was not significantly related to the biofilm-based growth rate. A microalgae-based biofilm reactor was successfully used to treat turbid dairy wastewater. Temperature and organic carbon concentration had a statistically significant effect on algae-based biofilm productivity and treatment of dairy wastewater. The relationships between temperature, TOC, and productivity developed in this study may be used in the design and assessment of wastewater remediation systems and biomass production systems utilizing algae-based biofilm reactors for treating dairy wastes.

Reduction of costs for anemia-management drugs associated with the use of ferric citrate

PubMed Central

Thomas, Anila; Peterson, Leif E

2014-01-01

Background Ferric citrate is a novel phosphate binder which has the potential to reduce usage of erythropoietin-stimulating agents (ESAs) and intravenous (IV) iron used for anemia management during hemodialysis (HD) among patients with end-stage renal disease (ESRD). Currently, the potential health care cost savings on a national scale due to the use of ferric citrate in ESRD are undetermined. Methods Per-patient-per-year costs of ESAs (Epogen® and Aranesp® [Amgen Inc., CA, USA]) and IV iron (Venofer® [American Regent, Inc., NY, USA] and Ferrlecit® [Sanofi US, Bridgewater, NJ, USA]) were based on RED BOOK™ (Truven Health Analytics New York, NY, USA) costs combined with the Centers for Medicare and Medicaid Services (CMS) base rate and actual usage in 2011 for the four drugs. The annual number of outpatients undergoing HD in the US was based on frequencies reported by the USRDS (United States Renal Data System). Monte Carlo uncertainty analysis was performed to determine total annual costs and cost reduction based on ferric citrate usage. Results Total annual cost of ESAs and IV iron for anemia management in ESRD determined by Monte Carlo analysis assuming CMS base rate value was 5.127 (3.664–6.260) billion USD. For actual utilization in 2011, total annual cost of ESAs and IV iron was 3.981 (2.780–4.930) billion USD. If ferric citrate usage reduced ESA utilization by 20% and IV iron by 40%, then total cost would be reduced by 21.2% to 4.038 (2.868–4.914) billion USD for the CMS base rate, and by 21.8% to 3.111 (2.148–3.845) billion USD, based on 2011 actual utilization. Conclusion It is likely that US health care costs for anemia-management drugs associated with ESRD among HD patients can be reduced by using ferric citrate as a phosphate binder. PMID:24899820

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

Menikoff, Ralph

Previously the SURFplus reactive burn model was calibrated for the TATB based explosive PBX 9502. The calibration was based on fitting Pop plot data, the failure diameter and the limiting detonation speed, and curvature effect data for small curvature. The model failure diameter is determined utilizing 2-D simulations of an unconfined rate stick to find the minimum diameter for which a detonation wave propagates. Here we examine the effect of mesh resolution on an unconfined rate stick with a diameter (10mm) slightly greater than the measured failure diameter (8 to 9 mm).

Impact of pharmacy benefit design on prescription drug utilization: a fixed effects analysis of plan sponsor data.

PubMed

Roebuck, M Christopher; Liberman, Joshua N

2009-06-01

To study the impact of various elements of pharmacy benefit design on both the absolute and relative utilization of generics, brands, retail pharmacy, and mail service. Panel data on 1,074 plan sponsors covering 21.6 million individuals over 12 calendar quarters (2005-2007). A retrospective analysis of pharmacy claims. To control for potential endogeneity, linear fixed effects models were estimated for each of six dependent variables: the generic utilization rate, the brand utilization rate, the generic dispensing rate (GDR), the retail pharmacy utilization rate, the mail service utilization rate, and the mail distribution rate. Most member cost-share variables were nonlinearly associated with changes in prescription drug utilization. Marginal effects were generally greater in magnitude for brand out-of-pocket costs than for generic out-of-pocket costs. Time dummies, as well as other pharmacy benefit design elements, also yielded significant results. Prior estimates of the effect of member cost sharing on prescription drug utilization may be biased if complex benefit designs, mail service fulfillment, and unmeasured factors such as pharmaceutical pipelines are not accounted for. Commonly cited relative utilization metrics, such as GDR, may be misleading if not examined alongside absolute prescription drug utilization.

American Recovery and Reinvestment Act of 2009. Experiences from the Consumer Behavior Studies on Engaging Customers

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

Cappers, Peter; Scheer, Richard

2014-09-01

One of the most important aspects for the successful implementation of customer-facing programs is to better understand how to engage and communicate with consumers. Customer-facing programs include time-based rates, information and feedback, load management, and energy efficiency. This report presents lessons learned by utilities through consumer behavior studies (CBS) conducted as part of the Department of Energy’s (DOE) Smart Grid Investment Grant (SGIG) program. The SGIG CBS effort presents a unique opportunity to advance the understanding of consumer behaviors in terms of customer acceptance and retention, and electricity consumption and peak demand impacts. The effort includes eleven comprehensive studies withmore » the aim of evaluating the response of residential and small commercial customers to time-based rate programs implemented in conjunction with advanced metering infrastructure and customer systems such as in-home displays, programmable communicating thermostats, and web portals. DOE set guidelines and protocols that sought to help the utilities design studies that would rigorously test and more precisely estimate the impact of time-based rates on customers’ energy usage patterns, as well as identify the key drivers that motivate behavioral changes.« less

Time-Extended Payoffs for Collectives of Autonomous Agents

NASA Technical Reports Server (NTRS)

Tumer, Kagan; Agogino, Adrian K.

2002-01-01

A collective is a set of self-interested agents which try to maximize their own utilities, along with a a well-defined, time-extended world utility function which rates the performance of the entire system. In this paper, we use theory of collectives to design time-extended payoff utilities for agents that are both aligned with the world utility, and are "learnable", i.e., the agents can readily see how their behavior affects their utility. We show that in systems where each agent aims to optimize such payoff functions, coordination arises as a byproduct of the agents selfishly pursuing their own goals. A game theoretic analysis shows that such payoff functions have the net effect of aligning the Nash equilibrium, Pareto optimal solution and world utility optimum, thus eliminating undesirable behavior such as agents working at cross-purposes. We then apply collective-based payoff functions to the token collection in a gridworld problem where agents need to optimize the aggregate value of tokens collected across an episode of finite duration (i.e., an abstracted version of rovers on Mars collecting scientifically interesting rock samples, subject to power limitations). We show that, regardless of the initial token distribution, reinforcement learning agents using collective-based payoff functions significantly outperform both natural extensions of single agent algorithms and global reinforcement learning solutions based on "team games".

The Effects of State-Mandated Abstinence-Based Sex Education on Teen Health Outcomes.

PubMed

Carr, Jillian B; Packham, Analisa

2017-04-01

In 2011, the USA had the second highest teen birth rate of any developed nation, according to the World Bank, . In an effort to lower teen pregnancy rates, several states have enacted policies requiring abstinence-based sex education. In this study, we utilize a difference-in-differences research design to analyze the causal effects of state-level sex education policies from 2000-2011 on various teen sexual health outcomes. We find that state-level abstinence education mandates have no effect on teen birth rates or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease rates in some states. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The Optimization of In-Memory Space Partitioning Trees for Cache Utilization

NASA Astrophysics Data System (ADS)

Yeo, Myung Ho; Min, Young Soo; Bok, Kyoung Soo; Yoo, Jae Soo

In this paper, a novel cache conscious indexing technique based on space partitioning trees is proposed. Many researchers investigated efficient cache conscious indexing techniques which improve retrieval performance of in-memory database management system recently. However, most studies considered data partitioning and targeted fast information retrieval. Existing data partitioning-based index structures significantly degrade performance due to the redundant accesses of overlapped spaces. Specially, R-tree-based index structures suffer from the propagation of MBR (Minimum Bounding Rectangle) information by updating data frequently. In this paper, we propose an in-memory space partitioning index structure for optimal cache utilization. The proposed index structure is compared with the existing index structures in terms of update performance, insertion performance and cache-utilization rate in a variety of environments. The results demonstrate that the proposed index structure offers better performance than existing index structures.

Classification of Chemicals Based On Structured Toxicity ...

EPA Pesticide Factsheets

Thirty years and millions of dollars worth of pesticide registration toxicity studies, historically stored as hardcopy and scanned documents, have been digitized into highly standardized and structured toxicity data within the Toxicity Reference Database (ToxRefDB). Toxicity-based classifications of chemicals were performed as a model application of ToxRefDB. These endpoints will ultimately provide the anchoring toxicity information for the development of predictive models and biological signatures utilizing in vitro assay data. Utilizing query and structured data mining approaches, toxicity profiles were uniformly generated for greater than 300 chemicals. Based on observation rate, species concordance and regulatory relevance, individual and aggregated effects have been selected to classify the chemicals providing a set of predictable endpoints. ToxRefDB exhibits the utility of transforming unstructured toxicity data into structured data and, furthermore, into computable outputs, and serves as a model for applying such data to address modern toxicological problems.

Exploration of sustainable development by applying green economy indicators.

PubMed

Chen, Yungkun; Chen, Chia-Yon; Hsieh, Tsuifang

2011-11-01

Following the global trend of sustainable development, development of green economy is the best way of slowing the negative ecological and environmental impact. This research establishes the Taiwan's green economic indicators based on the ecological footprint and energy analysis. The results are as follows: Taiwan's ecological footprint in 2008 intensity index was at 4.364; ecological overshoot index was at 3.364, showing that Taiwan's ecological system is in overload state. Moreover, this study utilizes energy analysis model to study the sustainable development of Taiwan. Findings showed that total energy use in 2008 was 3.14 × 10(23) sej (solar energy joule, sej), energy of renewable resources was 1.30 × 10(22) sej, energy of nonrenewable resources was 2.26 × 10(23) sej, energy of products from renewable resources was 1.30 × 10(22)sej, energy of currency flow was 8.02 × 10(22) sej and energy of wastes flow was 6.55 × 10(22) sej. Taiwan's energy per capita and the utilization rate of energy is lower while the environmental loading rate is significantly higher comparing to some other countries. The foregoing findings indicate that Taiwan currently belongs to an economic development pattern based on high resource consumption. The economic development is mainly established on the exploitation and utilization of nonrenewable resources. Therefore, Taiwan should change the development pattern, regulate the industrial structure, promote the utilization rate of resources, develop green pollution-free products, and enhance the sustainable development of ecological economic system.

Quantifying Risk of Financial Incapacity and Financial Exploitation in Community-dwelling Older Adults: Utility of a Scoring System for the Lichtenberg Financial Decision-making Rating Scale.

PubMed

Lichtenberg, Peter A; Gross, Evan; Ficker, Lisa J

2018-06-08

This work examines the clinical utility of the scoring system for the Lichtenberg Financial Decision-making Rating Scale (LFDRS) and its usefulness for decision making capacity and financial exploitation. Objective 1 was to examine the clinical utility of a person centered, empirically supported, financial decision making scale. Objective 2 was to determine whether the risk-scoring system created for this rating scale is sufficiently accurate for the use of cutoff scores in cases of decisional capacity and cases of suspected financial exploitation. Objective 3 was to examine whether cognitive decline and decisional impairment predicted suspected financial exploitation. Two hundred independently living, non-demented community-dwelling older adults comprised the sample. Participants completed the rating scale and other cognitive measures. Receiver operating characteristic curves were in the good to excellent range for decisional capacity scoring, and in the fair to good range for financial exploitation. Analyses supported the conceptual link between decision making deficits and risk for exploitation, and supported the use of the risk-scoring system in a community-based population. This study adds to the empirical evidence supporting the use of the rating scale as a clinical tool assessing risk for financial decisional impairment and/or financial exploitation.

A heart failure initiative to reduce the length of stay and readmission rates.

PubMed

White, Sabrina Marie; Hill, Alethea

2014-01-01

The purpose of this pilot was to improve multidisciplinary coordination of care and patient education and foster self-management behaviors. The primary and secondary outcomes achieved from this pilot were to decrease the 30-day readmission rate and heart failure length of stay. The primary practice site was an inpatient medical-surgical nursing unit. The length of stay decreased from 6.05% to 4.42% for heart failure diagnostic-related group 291 as a result of utilizing the model. The length of stay decreased from 3.9% to 3.09%, which was also less than the national rate of 3.8036% for diagnostic-related group 292. In addition, the readmission rate decreased from 23.1% prior to January 2013 to 12.9%. Implementation of standards of care coordination can decrease length of stay, readmission rate, and improve self-management. Implementation of evidence-based heart failure guidelines, improved interdisciplinary coordination of care, patient education, self-management skills, and transitional care at the time of discharge improved overall heart failure outcome measures. Utilizing the longitudinal model of care to transition patients to home aided in evaluating social support, resource allocation and utilization, access to care postdischarge, and interdisciplinary coordination of care. The collaboration between disciplines improved continuity of care, patient compliance to their discharge regimen, and adequate discharge follow-up.

Spatial Characteristics of Geothermal Spring Temperatures and Discharge Rates in the Tatun Volcanic Area, Taiwan

NASA Astrophysics Data System (ADS)

Jang, C. S.; Liu, C. W.

2014-12-01

The Tatun volcanic area is the only potential volcanic geothermal region in the Taiwan island, and abundant in hot spring resources owing to stream water mixing with fumarolic gases. According to the Meinzer's classification, spring temperatures and discharge rates are the most important properties for characterizing spring classifications. This study attempted to spatially characterize spring temperatures and discharge rates in the Tatun volcanic area, Taiwanusing indicator kriging (IK). First, data on spring temperatures and discharge rates, which were collected from surveyed data of the Taipei City Government, were divided into high, moderate and low categories according to spring classification criteria, and the various categories were regarded as estimation thresholds. Then, IK was adopted to model occurrence probabilities of specified temperatures and discharge rates in springs, and to determine their classifications based on estimated probabilities. Finally, nine combinations were obtained from the classifications of temperatures and discharge rates in springs. Moreover, the combinations and features of spring water were spatially quantified according to seven sub-zones of spring utilization. A suitable and sustainable development strategy of the spring area was proposed in each sub-zone based on probability-based combinations and features of spring water.The research results reveal that the probability-based classifications using IK provide an excellent insight in exploring the uncertainty of spatial features in springs, and can provide Taiwanese government administrators with detailed information on sustainable spring utilization and conservation in the overexploited spring tourism areas. The sub-zones BT (Beitou), RXY (Rd. Xingyi), ZSL (Zhongshanlou) and LSK (Lengshuikeng) with high or moderate discharge rates are suitable to supply spring water for tourism hotels.Local natural hot springs should be planned in the sub-zones DBT (Dingbeitou), ZSL, XYK (Xiayoukeng), and MC (Macao) with low discharge rates, and low or moderate temperatures, particularly in riverbeds or valleys.Keywords: Spring; Temperature; Discharge rate; Indicator kriging; Uncertainty

Calculating utilization rates for rubber tired grapple skidders in the Southern United States

Treesearch

Jason D. Thompson

2001-01-01

Utilization rate is an important factor in calculating machine rates for forest harvesting machines. Machine rates allow an evaluation of harvesting system costs and facilitate comparisons between different systems and machines. There are many factors that affect utilization rate. These include mechanical delays, non-mechanical delays, operational lost time, and...

Utilization rates of knee-arthroplasty in OECD countries.

PubMed

Pabinger, C; Lothaller, H; Geissler, A

2015-10-01

The number of knee arthroplasties and the prevalence of obesity are increasing exponentially. To date there have been no published reviews on utilization rates of knee arthroplasty in OECD countries. We analysed economic, medical and population data relating to knee arthroplasty surgeries performed in OECD countries. Gross domestic product (GDP), health expenditures, obesity prevalence, knee arthroplasty utilization rates and growth in knee arthroplasty rates per 100,000 population were assessed for total population, for patients aged 65 years and over, and patients aged 64 years and younger. Obesity prevalence and utilization of knee arthroplasty have increased significantly in the past. The mean utilization rate of knee arthroplasty was 150 (22-235) cases per 100,000 total population in 2011. The strongest annual increase (7%) occurred in patients 64 years and under. Differences between individual countries can be explained by economic and medical patterns, with countries with higher medical expenditures and obesity prevalence having significantly higher utilization rates. Countries with lower utilization rates have significantly higher growth in utilization rates. The future demand for knee prostheses will increase x-fold by 2030, with exact rates dependant upon economic, social and medical factors. We observed a 10-fold variation in the utilization of knee arthroplasty among OECD countries. A significant and strong correlation of GDP, health expenditures and obesity prevalence with utilization of knee arthroplasty was found. Patients aged 64 years and younger show a two-fold higher growth rate in knee arthroplasty compared to the older population. This trend could result in a four-fold demand for knee arthroplasty in OECD countries by 2030. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Quantifying the utilization of medical devices necessary to detect postmarket safety differences: A case study of implantable cardioverter defibrillators.

PubMed

Bates, Jonathan; Parzynski, Craig S; Dhruva, Sanket S; Coppi, Andreas; Kuntz, Richard; Li, Shu-Xia; Marinac-Dabic, Danica; Masoudi, Frederick A; Shaw, Richard E; Warner, Frederick; Krumholz, Harlan M; Ross, Joseph S

2018-06-12

To estimate medical device utilization needed to detect safety differences among implantable cardioverter defibrillators (ICDs) generator models and compare these estimates to utilization in practice. We conducted repeated sample size estimates to calculate the medical device utilization needed, systematically varying device-specific safety event rate ratios and significance levels while maintaining 80% power, testing 3 average adverse event rates (3.9, 6.1, and 12.6 events per 100 person-years) estimated from the American College of Cardiology's 2006 to 2010 National Cardiovascular Data Registry of ICDs. We then compared with actual medical device utilization. At significance level 0.05 and 80% power, 34% or fewer ICD models accrued sufficient utilization in practice to detect safety differences for rate ratios <1.15 and an average event rate of 12.6 events per 100 person-years. For average event rates of 3.9 and 12.6 events per 100 person-years, 30% and 50% of ICD models, respectively, accrued sufficient utilization for a rate ratio of 1.25, whereas 52% and 67% for a rate ratio of 1.50. Because actual ICD utilization was not uniformly distributed across ICD models, the proportion of individuals receiving any ICD that accrued sufficient utilization in practice was 0% to 21%, 32% to 70%, and 67% to 84% for rate ratios of 1.05, 1.15, and 1.25, respectively, for the range of 3 average adverse event rates. Small safety differences among ICD generator models are unlikely to be detected through routine surveillance given current ICD utilization in practice, but large safety differences can be detected for most patients at anticipated average adverse event rates. Copyright © 2018 John Wiley & Sons, Ltd.

76 FR 3625 - Sunshine Act Meeting Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-20

... Integration of Variable Renewable Generation. ELECTRIC E-1 RM04-7-009 Market-Based Rates for Wholesale Sales of Electric Energy, Capacity and Ancillary Services by Public Utilities. E-2 RM10-20-000 Market-Based..., Eagle Creek Water Resources, LLC, Eagle Creek Land Resources, LLC. CERTIFICATES C-1 CP10-496-000 Cameron...

Estimating and validating harvesting system production through computer simulation

Treesearch

John E. Baumgras; Curt C. Hassler; Chris B. LeDoux

1993-01-01

A Ground Based Harvesting System Simulation model (GB-SIM) has been developed to estimate stump-to-truck production rates and multiproduct yields for conventional ground-based timber harvesting systems in Appalachian hardwood stands. Simulation results reflect inputs that define harvest site and timber stand attributes, wood utilization options, and key attributes of...

Construction and application of Red5 cluster based on OpenStack

NASA Astrophysics Data System (ADS)

Wang, Jiaqing; Song, Jianxin

2017-08-01

With the application and development of cloud computing technology in various fields, the resource utilization rate of the data center has been improved obviously, and the system based on cloud computing platform has also improved the expansibility and stability. In the traditional way, Red5 cluster resource utilization is low and the system stability is poor. This paper uses cloud computing to efficiently calculate the resource allocation ability, and builds a Red5 server cluster based on OpenStack. Multimedia applications can be published to the Red5 cloud server cluster. The system achieves the flexible construction of computing resources, but also greatly improves the stability of the cluster and service efficiency.

Evaluation of TRMM Ground-Validation Radar-Rain Errors Using Rain Gauge Measurements

NASA Technical Reports Server (NTRS)

Wang, Jianxin; Wolff, David B.

2009-01-01

Ground-validation (GV) radar-rain products are often utilized for validation of the Tropical Rainfall Measuring Mission (TRMM) spaced-based rain estimates, and hence, quantitative evaluation of the GV radar-rain product error characteristics is vital. This study uses quality-controlled gauge data to compare with TRMM GV radar rain rates in an effort to provide such error characteristics. The results show that significant differences of concurrent radar-gauge rain rates exist at various time scales ranging from 5 min to 1 day, despite lower overall long-term bias. However, the differences between the radar area-averaged rain rates and gauge point rain rates cannot be explained as due to radar error only. The error variance separation method is adapted to partition the variance of radar-gauge differences into the gauge area-point error variance and radar rain estimation error variance. The results provide relatively reliable quantitative uncertainty evaluation of TRMM GV radar rain estimates at various times scales, and are helpful to better understand the differences between measured radar and gauge rain rates. It is envisaged that this study will contribute to better utilization of GV radar rain products to validate versatile spaced-based rain estimates from TRMM, as well as the proposed Global Precipitation Measurement, and other satellites.

Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries.

PubMed

Hagen, Terje P; Häkkinen, Unto; Belicza, Eva; Fatore, Giovanni; Goude, Fanny

2015-12-01

Percutaneous coronary interventions (PCI) on acute myocardial infarction (AMI) patients have increased substantially in the last 12-15 years because of its clinical effectiveness. The expansion of PCI treatment for AMI patients raises two questions: How did PCI utilization rates vary across European regions, and which healthcare system and regional characteristic variables correlated with the utilization rate? Were the differences in use of PCI associated with differences in outcome, operationalized as 30-day mortality? We obtained our results from a dataset based on the administrative information systems of the populations of seven European countries. PCI rates were highest in the Netherlands, followed by Sweden and Hungary. The probability of receiving PCI was highest in regions with their own PCI facilities and in healthcare systems with activity-based reimbursement systems. Thirty-day mortality rates differed considerably between the countries with the highest rates in Hungary, Scotland, and Finland. Mortality was lowest in Sweden and Norway. The associations between PCI and mortality were remarkable in all age groups and across most countries. Despite extensive risk adjustment, we interpret the associations both as effects of selection and treatments. We observed a lower effect of PCI in the higher age groups in Hungary. Copyright © 2015 John Wiley & Sons, Ltd.

High data rate modem simulation for the space station multiple-access communications system

NASA Technical Reports Server (NTRS)

Horan, Stephen

1987-01-01

The communications system for the space station will require a space based multiple access component to provide communications between the space based program elements and the station. A study was undertaken to investigate two of the concerns of this multiple access system, namely, the issues related to the frequency spectrum utilization and the possibilities for higher order (than QPSK) modulation schemes for use in possible modulators and demodulators (modems). As a result of the investigation, many key questions about the frequency spectrum utilization were raised. At this point, frequency spectrum utilization is seen as an area requiring further work. Simulations were conducted using a computer aided communications system design package to provide a straw man modem structure to be used for both QPSK and 8-PSK channels.

Utilizing tenets of inoculation theory to develop and evaluate a preventive alcohol education intervention.

PubMed

Duryea, E J

1983-04-01

With the advent of the Surgeon General's Report, Healthy People, a renewed interest in and concern for the health-risky practices of the school aged has emerged. Moreover, because the mortality rates for the 15 to 24 year age group continues to increase while the mortality rates for every other age group continues to decline, a school health education imperative has become prevention-based interventions. The experimental, prevention-based alcohol education program reported here describes one such intervention directed at 9th grade students. The program was grounded on the principles of Inoculation Theory and evaluated using a Solomon Four-Group Design. Results indicate that the formulation of preventive alcohol education programs utilizing Inoculation Theory in a school setting is both feasible and productive in achieving designated objectives. Longitudinal assessment of the subjects with regard to their alcohol-related behavior is continuing throughout their high school careers.

Primary zinc-air batteries for space power

NASA Technical Reports Server (NTRS)

Bragg, Bobby J.; Bourland, Deborah S.; Merry, Glenn; Putt, Ron

1992-01-01

Prismatic HR and LC cells and batteries were built and tested, and they performed well with respect to the program goals of high capacity and high rate capability at specific energies. The HR batteries suffered reduced utilizations owing to dryout at the 2 and 3 A rates for the 50 C tests owing to the requirement for forced convection. The LC batteries suffered reduced utilizations under all conditions owing to the chimney effect at 1 G, although this effect would not occur at 0 G. An empirical model was developed which accurately predicted utilizations and average voltages for single cells, although thermal effects encountered during battery testing caused significant deviations, both positive and negative, from the model. Based on the encouraging results of the test program, we believe that the zinc-air primary battery of a flat, stackable configuration can serve as a high performance and safe power source for a range of space applications.

Predicting Health Care Utilization in Marginalized Populations: Black, Female, Street-based Sex Workers

PubMed Central

Varga, Leah M.; Surratt, Hilary L.

2014-01-01

Background Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health. Methods The outcome variable was utilization of health care services in the previous 12 months. Using Andersen’s Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables. Findings The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization. Conclusions Any type of resource, link, or connection to or with an institution, or any consistent point of care contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health. PMID:24657047

Utilization rates of hip arthroplasty in OECD countries.

PubMed

Pabinger, C; Geissler, A

2014-06-01

Hip arthroplasty and revision surgery is growing exponentially in OECD countries, but rates vary between countries. We extracted economic data and utilization rates data about hip arthroplasty done in OECD countries between 1990 and 2011. Absolute number of implantations and compound annual growth rates were computed per 100,000 population and for patients aged 65 years old and over and for patients aged 64 years and younger. In the majority of OECD countries, there has been a significant increase in the utilization of total hip arthroplasty in the last 10 years, but rates vary to a great extent: In the United States, Switzerland, and Germany the utilization rate exceeds 200/100,000 population whereas in Spain and Mexico rates are 102 and 8, respectively. There is a strong correlation between gross domestic product (GDP) and health care expenditures per capita with utilization rate. Utilization rates in all age groups have continued to rise up to present day. A seven fold higher growth rate was seen in patients aged 64 years and younger as compared to older patients. We observed a 38-fold variation in the utilization of hip arthroplasty among OECD countries, correlating with GDP and health care expenditures. Over recent years, there has been an increase in the utilization rate in most countries. This was particularly evident in the younger patients. Due to increasing life expectancy and the disproportionally high use of arthroplasty in younger patients we expect an exponential increase of revision rate in the future. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Productivity improvement using discrete events simulation

NASA Astrophysics Data System (ADS)

Hazza, M. H. F. Al; Elbishari, E. M. Y.; Ismail, M. Y. Bin; Adesta, E. Y. T.; Rahman, Nur Salihah Binti Abdul

2018-01-01

The increasing in complexity of the manufacturing systems has increased the cost of investment in many industries. Furthermore, the theoretical feasibility studies are not enough to take the decision in investing for that particular area. Therefore, the development of the new advanced software is protecting the manufacturer from investing money in production lines that may not be sufficient and effective with their requirement in terms of machine utilization and productivity issue. By conducting a simulation, using accurate model will reduce and eliminate the risk associated with their new investment. The aim of this research is to prove and highlight the importance of simulation in decision-making process. Delmia quest software was used as a simulation program to run a simulation for the production line. A simulation was first done for the existing production line and show that the estimated production rate is 261 units/day. The results have been analysed based on utilization percentage and idle time. Two different scenarios have been proposed based on different objectives. The first scenario is by focusing on low utilization machines and their idle time, this was resulted in minimizing the number of machines used by three with the addition of the works who maintain them without having an effect on the production rate. The second scenario is to increase the production rate by upgrading the curing machine which lead to the increase in the daily productivity by 7% from 261 units to 281 units.

Risk Decision Making Model for Reservoir Floodwater resources Utilization

NASA Astrophysics Data System (ADS)

Huang, X.

2017-12-01

Floodwater resources utilization(FRU) can alleviate the shortage of water resources, but there are risks. In order to safely and efficiently utilize the floodwater resources, it is necessary to study the risk of reservoir FRU. In this paper, the risk rate of exceeding the design flood water level and the risk rate of exceeding safety discharge are estimated. Based on the principle of the minimum risk and the maximum benefit of FRU, a multi-objective risk decision making model for FRU is constructed. Probability theory and mathematical statistics method is selected to calculate the risk rate; C-D production function method and emergy analysis method is selected to calculate the risk benefit; the risk loss is related to flood inundation area and unit area loss; the multi-objective decision making problem of the model is solved by the constraint method. Taking the Shilianghe reservoir in Jiangsu Province as an example, the optimal equilibrium solution of FRU of the Shilianghe reservoir is found by using the risk decision making model, and the validity and applicability of the model are verified.

(PURPA grants to state utility regulatory commissions and electric utilities). Final report

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

Lambert, E.S.

The Utah Commission considered fully in hearings each of the eleven regulatory and ratemaking standards. In addition, the Commission held hearings concerning the lifeline rates provision of PURPA and the cogeneration and small power production provision. The Utah Commission has taken action with respect to each of these standards. In its Order concerning cases numbered 80-999-09 and 81-999-01, 02, 03, 04, and 05, issued May 14, 1982, and appended to this report, the Utah Commission adopted each of the ratemaking standards. Its actions concerning adoption of the regulatory standards have been the subject of hearings and orders issued during themore » period of time prior to the issuance of the May 14, 1982 Order. After full hearing on the subject, the Utah Commission declined to adopt lifeline rates. In an Order issued April 9, 1981, the Commission implemented the FERC regulations issued pursuant to PURPA Sections 201 and 210. Contained in that Order were interim rates based upon the avoided costs of the electric utilities under this Commission's jurisdiction that are subject to PURPA.« less

Hardware implementation of CMAC neural network with reduced storage requirement.

PubMed

Ker, J S; Kuo, Y H; Wen, R C; Liu, B D

1997-01-01

The cerebellar model articulation controller (CMAC) neural network has the advantages of fast convergence speed and low computation complexity. However, it suffers from a low storage space utilization rate on weight memory. In this paper, we propose a direct weight address mapping approach, which can reduce the required weight memory size with a utilization rate near 100%. Based on such an address mapping approach, we developed a pipeline architecture to efficiently perform the addressing operations. The proposed direct weight address mapping approach also speeds up the computation for the generation of weight addresses. Besides, a CMAC hardware prototype used for color calibration has been implemented to confirm the proposed approach and architecture.

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.

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

Improving Donor Conversion Rates at a Level One Trauma Center: Impact of Best Practice Guidelines

PubMed Central

Gibbons, Bobby L; Bershad, Vanessa L

2016-01-01

Background Organ availability is a consistently limiting factor in transplant surgery. A primary driver of this limitation is donor conversion rate, which is defined as the percentage of eligible donors for whom procurement is actually performed. An alternative way to increase organ availability is through improved utilization of organs from donors after cardiac death (DCD). Recently, a concerted, multidisciplinary effort has been made within our system to improve conversion rates and DCD utilization, thus increasing organ availability. Study design Retrospective analysis of a prospectively collected database from TransLife, our local organ procurement organization (OPO), as well as the Orlando Regional Medical Center (ORMC) trauma registry, from 2009-2012 (up to 2013 for DCD). During which time, this organization implemented best practice guidelines to improve conversions and DCD utilization. We analyzed yearly conversion rates, DCD donations and population demographics before and after implementation of these policies. Results During the study period, donor conversion rates significantly improved from 58% in 2009 to 82% percent in 2012 hospital-wide (P<0.05); and from 50% in 2009 to 81% in 2012 among trauma patients alone (P<0.05). In addition, total organs transplanted increased from 13 to 31 organs (P<0.05) after implementation of best practice guidelines. No significant differences in trauma population demographics were noted during the study period. Conclusions Based on our experience, the establishment of best practice policies for referral of potential donors, coupled with programs to educate hospital staff on the existence and importance of these policies, leads to significant improvement in donor conversion rates and increased utilization of DCD donors. PMID:28018761

Energy efficiency in wireless communication systems

DOEpatents

Caffrey, Michael Paul; Palmer, Joseph McRae

2012-12-11

Wireless communication systems and methods utilize one or more remote terminals, one or more base terminals, and a communication channel between the remote terminal(s) and base terminal(s). The remote terminal applies a direct sequence spreading code to a data signal at a spreading factor to provide a direct sequence spread spectrum (DSSS) signal. The DSSS signal is transmitted over the communication channel to the base terminal which can be configured to despread the received DSSS signal by a spreading factor matching the spreading factor utilized to spread the data signal. The remote terminal and base terminal can dynamically vary the matching spreading factors to adjust the data rate based on an estimation of operating quality over time between the remote terminal and base terminal such that the amount of data being transmitted is substantially maximized while providing a specified quality of service.

Use of hospital-based health care services among children aged 1 through 9 years who were born very preterm - a population-based study.

PubMed

Klitkou, Søren T; Iversen, Tor; Stensvold, Hans J; Rønnestad, Arild

2017-08-17

Very preterm (VPT) children, with a birth weight below 1500 g or delivered before 32 weeks of gestational age, are at increased risk of poorer long-term health outcomes and higher rates of hospitalization in childhood. However, considerable variation exists in the need for in-hospital care within this population. We assessed the utilization and distribution of hospital-based care from ages 1 through 9 years for a nationwide population. This was a population-based cohort of VPT children born in the period 2001-2009. We evaluated their utilization of hospital care in 2008-2010, when aged 1-9 years old. Outcomes were the incidence of hospital admissions and outpatient visits. We used Poisson regression models with multiple imputation of missing data. Children born VPT had more hospital admissions compared with the general population of children aged 1-9 years. The rates of hospital admissions and outpatient visits were strongly related to clinical characteristics of the child at birth and age at admission/outpatient visit but to only a variable and minor degree to characteristics pertaining to maternal health, the sociodemographic factors, and geographical proximity to hospital services. Prior to this study, hospital utilization during the period 5-9 years old has been poorly documented. We found that excess utilization of hospital resources on average declines with increasing age. We also noted substantial differences in the use of hospital care across age groups and clinical factors for VPT children. The added information from the health status of mothers, social background, and geographic measures of access was limited.

A watershed scale spatially-distributed model for streambank erosion rate driven by channel curvature

NASA Astrophysics Data System (ADS)

McMillan, Mitchell; Hu, Zhiyong

2017-10-01

Streambank erosion is a major source of fluvial sediment, but few large-scale, spatially distributed models exist to quantify streambank erosion rates. We introduce a spatially distributed model for streambank erosion applicable to sinuous, single-thread channels. We argue that such a model can adequately characterize streambank erosion rates, measured at the outsides of bends over a 2-year time period, throughout a large region. The model is based on the widely-used excess-velocity equation and comprised three components: a physics-based hydrodynamic model, a large-scale 1-dimensional model of average monthly discharge, and an empirical bank erodibility parameterization. The hydrodynamic submodel requires inputs of channel centerline, slope, width, depth, friction factor, and a scour factor A; the large-scale watershed submodel utilizes watershed-averaged monthly outputs of the Noah-2.8 land surface model; bank erodibility is based on tree cover and bank height as proxies for root density. The model was calibrated with erosion rates measured in sand-bed streams throughout the northern Gulf of Mexico coastal plain. The calibrated model outperforms a purely empirical model, as well as a model based only on excess velocity, illustrating the utility of combining a physics-based hydrodynamic model with an empirical bank erodibility relationship. The model could be improved by incorporating spatial variability in channel roughness and the hydrodynamic scour factor, which are here assumed constant. A reach-scale application of the model is illustrated on ∼1 km of a medium-sized, mixed forest-pasture stream, where the model identifies streambank erosion hotspots on forested and non-forested bends.

Efficacy of education followed by computerized provider order entry with clinician decision support to reduce red blood cell utilization.

PubMed

Zuckerberg, Gabriel S; Scott, Andrew V; Wasey, Jack O; Wick, Elizabeth C; Pawlik, Timothy M; Ness, Paul M; Patel, Nishant D; Resar, Linda M S; Frank, Steven M

2015-07-01

Two necessary components of a patient blood management program are education regarding evidence-based transfusion guidelines and computerized provider order entry (CPOE) with clinician decision support (CDS). This study examines changes in red blood cell (RBC) utilization associated with each of these two interventions. We reviewed 5 years of blood utilization data (2009-2013) for 70,118 surgical patients from 10 different specialty services at a tertiary care academic medical center. Three distinct periods were compared: 1) before blood management, 2) education alone, and 3) education plus CPOE. Changes in RBC unit utilization were assessed over the three periods stratified by surgical service. Cost savings were estimated based on RBC acquisition costs. For all surgical services combined, RBC utilization decreased by 16.4% with education alone (p = 0.001) and then changed very little (2.5% increase) after subsequent addition of CPOE (p = 0.64). When we compared the period of education plus CPOE to the pre-blood management period, the overall decrease was 14.3% (p = 0.008; 2102 fewer RBC units/year, or a cost avoidance of $462,440/year). Services with the highest massive transfusion rates (≥10 RBC units) exhibited the least reduction in RBC utilization. Adding CPOE with CDS after a successful education effort to promote evidence-based transfusion practice did not further reduce RBC utilization. These findings suggest that education is an important and effective component of a patient blood management program and that CPOE algorithms may serve to maintain compliance with evidence-based transfusion guidelines. © 2015 AABB.

Utilization of Services in a Randomized Trial Testing Phone- and Web-Based Interventions for Smoking Cessation

PubMed Central

Jack, Lisa M.; McClure, Jennifer B.; Deprey, Mona; Javitz, Harold S.; McAfee, Timothy A.; Catz, Sheryl L.; Richards, Julie; Bush, Terry; Swan, Gary E.

2011-01-01

Introduction: Phone counseling has become standard for behavioral smoking cessation treatment. Newer options include Web and integrated phone–Web treatment. No prior research, to our knowledge, has systematically compared the effectiveness of these three treatment modalities in a randomized trial. Understanding how utilization varies by mode, the impact of utilization on outcomes, and predictors of utilization across each mode could lead to improved treatments. Methods: One thousand two hundred and two participants were randomized to phone, Web, or combined phone–Web cessation treatment. Services varied by modality and were tracked using automated systems. All participants received 12 weeks of varenicline, printed guides, an orientation call, and access to a phone supportline. Self-report data were collected at baseline and 6-month follow-up. Results: Overall, participants utilized phone services more often than the Web-based services. Among treatment groups with Web access, a significant proportion logged in only once (37% phone–Web, 41% Web), and those in the phone–Web group logged in less often than those in the Web group (mean = 2.4 vs. 3.7, p = .0001). Use of the phone also was correlated with increased use of the Web. In multivariate analyses, greater use of the phone- or Web-based services was associated with higher cessation rates. Finally, older age and the belief that certain treatments could improve success were consistent predictors of greater utilization across groups. Other predictors varied by treatment group. Conclusions: Opportunities for enhancing treatment utilization exist, particularly for Web-based programs. Increasing utilization more broadly could result in better overall treatment effectiveness for all intervention modalities. PMID:21330267

Recombinant protein expression in Pichia pastoris strains with an engineered methanol utilization pathway

PubMed Central

2012-01-01

Βackground The methylotrophic yeast Pichia pastoris has become an important host organism for recombinant protein production and is able to use methanol as a sole carbon source. The methanol utilization pathway describes all the catalytic reactions, which happen during methanol metabolism. Despite the importance of certain key enzymes in this pathway, so far very little is known about possible effects of overexpressing either of these key enzymes on the overall energetic behavior, the productivity and the substrate uptake rate in P. pastoris strains. Results A fast and easy-to-do approach based on batch cultivations with methanol pulses was used to characterize different P. pastoris strains. A strain with MutS phenotype was found to be superior over a strain with Mut+ phenotype in both the volumetric productivity and the efficiency in expressing recombinant horseradish peroxidase C1A. Consequently, either of the enzymes dihydroxyacetone synthase, transketolase or formaldehyde dehydrogenase, which play key roles in the methanol utilization pathway, was co-overexpressed in MutS strains harboring either of the reporter enzymes horseradish peroxidase or Candida antarctica lipase B. Although the co-overexpression of these enzymes did not change the stoichiometric yields of the recombinant MutS strains, significant changes in the specific growth rate, the specific substrate uptake rate and the specific productivity were observed. Co-overexpression of dihydroxyacetone synthase yielded a 2- to 3-fold more efficient conversion of the substrate methanol into product, but also resulted in a reduced volumetric productivity. Co-overexpression of formaldehyde dehydrogenase resulted in a 2-fold more efficient conversion of the substrate into product and at least similar volumetric productivities compared to strains without an engineered methanol utilization pathway, and thus turned out to be a valuable strategy to improve recombinant protein production. Conclusions Co-overexpressing enzymes of the methanol utilization pathway significantly affected the specific growth rate, the methanol uptake and the specific productivity of recombinant P. pastoris MutS strains. A recently developed methodology to determine strain specific parameters based on dynamic batch cultivations proved to be a valuable tool for fast strain characterization and thus early process development. PMID:22330134

Predictive onboard flow control for packet switching satellites

NASA Technical Reports Server (NTRS)

Bobinsky, Eric A.

1992-01-01

We outline two alternate approaches to predicting the onset of congestion in a packet switching satellite, and argue that predictive, rather than reactive, flow control is necessary for the efficient operation of such a system. The first method discussed is based on standard, statistical techniques which are used to periodically calculate a probability of near-term congestion based on arrival rate statistics. If this probability exceeds a present threshold, the satellite would transmit a rate-reduction signal to all active ground stations. The second method discussed would utilize a neural network to periodically predict the occurrence of buffer overflow based on input data which would include, in addition to arrival rates, the distributions of packet lengths, source addresses, and destination addresses.

The Association Between Stimulant, Opioid, and Multiple Drug Use on Behavioral Health Care Utilization in a Safety-Net Health System.

PubMed

Calcaterra, Susan L; Keniston, Angela; Blum, Joshua; Crume, Tessa; Binswanger, Ingrid A

2015-01-01

Prior studies show an association between drug use and health care utilization. The relationship between specific drug type and emergent/urgent, inpatient, outpatient, and behavioral health care utilization has not been examined. We aimed to determine if multiple drug use was associated with increased utilization of behavioral health care. To assess health care utilization, we conducted a retrospective cohort study of patients who accessed health care at a safety-net medical center and affiliated clinics. Using electronic health records, we categorized patients who used stimulants, opioids, or multiple drugs based on urine toxicology screening tests and/or International Classification of Diseases, 9th Revision (ICD-9). Remaining patients were categorized as patients without identified drug use. Health care utilization by drug use group and visit type was determined using a negative binomial regression model. Associations were reported as incidence rate ratios. Utilization was described by rates of health care-related visits for inpatient, emergent/urgent, outpatient, and behavioral health care among patients who used drugs, categorized by drug types, compared with patients without identified drug use. Of 95,198 index visits, 4.6% (n=4340) were by patients who used drugs. Opioid and multiple drug users had significantly higher rates of behavioral health care visits than patients without identified drug use (opioid incidence rate ratio [IRR]=7.2; 95% confidence interval [CI]: 3.8-13.8; multiple drug use IRR=5.6, 95% CI: 3.3-9.7). Patients who used stimulants were less likely to use behavioral health services (IRR=1.3, 95% CI: 0.9-2.0) when compared with opioid and multiple drug users, but were more likely to use inpatient (IRR=1.6, 95% CI: 1.4-1.8) and emergent/urgent care (IRR=1.4, 95% CI: 1.3-1.5) services as compared with patients without identified drug use. Integrated medical and mental health care and drug treatment may reduce utilization of costly health care services and improve patient outcomes. How to capture and deliver primary care and behavioral health care to patients who use stimulants needs further investigation.

Sleep quality and health service utilization in Chinese general population: a cross-sectional study in Dongguan, China.

PubMed

Zhang, Hui-Shan; Mai, Yan-Bing; Li, Wei-Da; Xi, Wen-Tao; Wang, Jin-Ming; Lei, Yi-Xiong; Wang, Pei-Xi

The aims of this study were to explore the Pittsburgh Sleep Quality Index (PSQI) and health service utilization in Chinese general population, to investigate the association between PSQI and health service utilization and to identify the independent contributions of social demographic variables, health related factors and PSQI to health service utilization. In a cross-sectional community-based health survey using a multi-instrument questionnaire, 4067 subjects (≥15 years old) were studied. The Chinese version of the PSQI was used to assess sleep quality. Health service utilization was measured by recent two-week physician visit and annual hospitalization rates. Higher PSQI scores were associated with more frequent health service utilization. Higher scores in subjective sleep quality were associated with higher rate of recent two-week physician visit (adjusted OR = 1.24 per SD increase, P = 0.015). Higher scores in habitual sleep efficiency (adjusted OR = 1.24 per SD increase, P = 0.038) and sleep disturbances (adjusted OR = 2.09 per SD increase, P < 0.001) were associated with more frequent annual hospitalization. The independent influence of PSQI on the risk of recent two-week physician visit was 0.7%, and that of annual hospitalization 31.4%. Poorer sleep quality predicted more frequent health service utilization. The independent contribution of PSQI on health service utilization was smaller than social demographic variables. Copyright © 2016. Published by Elsevier B.V.

Performance-Based Regulation In A High Distributed Energy Resources Future

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

Newton Lowry, Mark; Woolf, Tim; Schwartz, Lisa C.

Performance-based regulation (PBR) of utilities has emerged as an important ratemaking option in the last 25 years. It has been implemented in numerous jurisdictions across the United States and is common in many other advanced industrialized countries. PBR’s appeal lies chiefly in its ability to strengthen utility performance incentives relative to traditional cost-of-service regulation (COSR). Some forms of PBR can streamline regulation and provide utilities with greater operating flexibility. Ideally, the benefits of better performance are shared by the utility and its customers. The shortcomings of traditional COSR in providing electric utilities with incentives that are aligned with certain regulatorymore » goals are becoming increasingly clear. In particular, COSR can provide strong incentives to increase electricity sales and utility rate base. Further, some parties express concern that traditional COSR does not provide utilities with appropriate financial incentives to address evolving industry challenges such as changing customer demands for electricity services, increased levels of distributed energy resources (DERs), and growing pressure to mitigate carbon dioxide emissions. In addition, attention to potential new regulatory models to support the “utility of the future” has renewed interest in PBR. This report describes key elements of PBR and explains some of the advantages and disadvantages of various PBR options. We present pertinent issues from the perspectives of utilities and customers. In practice, these different perspectives are not diametrically opposed. Nonetheless, this framework is useful for illustrating how various aspects of PBR may be viewed by those key groups. Regulators have a unique perspective, in that they must balance consumer, utility, and other interests with the goal of achieving a result that is in the overall public interest.« less

Building Energy Asset Score for Utilities and Energy Efficiency Program Administrators

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

Building Technologies Office

2015-01-01

The Building Energy Asset Score is a national standardized tool for evaluating the physical and structural energy efficiency of commercial and multifamily residential buildings. The Asset Score generates a simple energy efficiency rating that enables comparison among buildings, and identifies opportunities for users to invest in energy efficiency upgrades. It is web-based and free to use. This fact sheet discusses the value of the score for utilities and energy efficiency program administrators.

Female Health Workers at the Doorstep: A Pilot of Community-Based Maternal, Newborn, and Child Health Service Delivery in Northern Nigeria

PubMed Central

Uzondu, Charles A; Doctor, Henry V; Findley, Sally E; Afenyadu, Godwin Y; Ager, Alastair

2015-01-01

ABSTRACT Introduction: Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services. Methods: Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008–2010 (before introduction of the pilot) with data from 2011–2013 (during and after the pilot) to gauge sustainability of the model. Results: Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years. Conclusion: Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas. PMID:25745123

Bit-rate transparent DPSK demodulation scheme based on injection locking FP-LD

NASA Astrophysics Data System (ADS)

Feng, Hanlin; Xiao, Shilin; Yi, Lilin; Zhou, Zhao; Yang, Pei; Shi, Jie

2013-05-01

We propose and demonstrate a bit-rate transparent differential phase shift-keying (DPSK) demodulation scheme based on injection locking multiple-quantum-well (MQW) strained InGaAsP FP-LD. By utilizing frequency deviation generated by phase modulation and unstable injection locking state with Fabry-Perot laser diode (FP-LD), DPSK to polarization shift-keying (PolSK) and PolSK to intensity modulation (IM) format conversions are realized. We analyze bit error rate (BER) performance of this demodulation scheme. Experimental results show that different longitude modes, bit rates and seeding power have influences on demodulation performance. We achieve error free DPSK signal demodulation under various bit rates of 10 Gbit/s, 5 Gbit/s, 2.5 Gbit/s and 1.25 Gbit/s with the same demodulation setting.

Photovoltaics as a terrestrial energy source. Volume 2: System value

NASA Technical Reports Server (NTRS)

Smith, J. L.

1980-01-01

Assumptions and techniques employed by the electric utility industry and other electricity planners to make estimates of the future value of photovoltaic (PV) systems interconnected with U.S. electric utilities were examined. Existing estimates of PV value and their interpretation and limitations are discussed. PV value is defined as the marginal private savings accruing to potential PV owners. For utility-owned PV systems, these values are shown to be the after-tax savings in conventional fuel and capacity displaced by the PV output. For non-utility-owned (distributed) systems, the utility's savings in fuel and capacity must first be translated through the electric rate structure (prices) to the potential PV system owner. Base-case estimates of the average value of PV systems to U.S. utilities are presented. The relationship of these results to the PV Program price goals and current energy policy is discussed; the usefulness of PV output quantity goals is also reviewed.

Association Between Intensive Care Unit Utilization During Hospitalization and Costs, Use of Invasive Procedures, and Mortality.

PubMed

Chang, Dong W; Shapiro, Martin F

2016-10-01

Maximizing the value of critical care services requires understanding the relationship between intensive care unit (ICU) utilization, clinical outcomes, and costs. To examine whether hospitals had consistent patterns of ICU utilization across 4 common medical conditions and the association between higher use of the ICU and hospital costs, use of invasive procedures, and mortality. Retrospective cohort study of 156 842 hospitalizations in 94 acute-care nonfederal hospitals for diabetic ketoacidosis (DKA), pulmonary embolism (PE), upper gastrointestinal bleeding (UGIB), and congestive heart failure (CHF) in Washington state and Maryland from 2010 to 2012. Hospitalizations for DKA, PE, UGIB, and CHF were identified from the presence of compatible International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Multilevel logistic regression models were used to determine the predicted hospital-level ICU utilization during hospitalizations for the 4 study conditions. For each condition, hospitals were ranked based on the predicted ICU utilization rate to examine the variability in ICU utilization across institutions. The primary outcomes were associations between hospital-level ICU utilization rates and risk-adjusted hospital mortality, use of invasive procedures, and hospital costs. The 94 hospitals and 156 842 hospitalizations included in the study represented 4.7% of total hospitalizations in this study. ICU admission rates ranged from 16.3% to 81.2% for DKA, 5.0% to 44.2% for PE, 11.5% to 51.2% for UGIB, and 3.9% to 48.8% for CHF. Spearman rank coefficients between DKA, PE, UGIB, and CHF showed significant correlations in ICU utilization for these 4 medical conditions among hospitals (ρ ≥ 0.90 for all comparisons; P < .01 for all). For each condition, hospital-level ICU utilization rate was not associated with hospital mortality. Use of invasive procedures and costs of hospitalization were greater in institutions with higher ICU utilization for all 4 conditions. For medical conditions where ICU care is frequently provided, but may not always be necessary, institutions that utilize ICUs more frequently are more likely to perform invasive procedures and have higher costs but have no improvement in hospital mortality. Hospitals had similar ICU utilization patterns across the 4 medical conditions, suggesting that systematic institutional factors may influence decisions to potentially overutilize ICU care. Interventions that seek to improve the value of critical care services will need to address these factors that lead clinicians to admit patients to higher levels of care when equivalent care can be delivered elsewhere in the hospital.

Links between social environment and health care utilization and costs.

PubMed

Brault, Marie A; Brewster, Amanda L; Bradley, Elizabeth H; Keene, Danya; Tan, Annabel X; Curry, Leslie A

2018-01-01

The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.

Implementation of a VLSI Level Zero Processing system utilizing the functional component approach

NASA Technical Reports Server (NTRS)

Shi, Jianfei; Horner, Ward P.; Grebowsky, Gerald J.; Chesney, James R.

1991-01-01

A high rate Level Zero Processing system is currently being prototyped at NASA/Goddard Space Flight Center (GSFC). Based on state-of-the-art VLSI technology and the functional component approach, the new system promises capabilities of handling multiple Virtual Channels and Applications with a combined data rate of up to 20 Megabits per second (Mbps) at low cost.

Neuroimaging correlates of parent ratings of working memory in typically developing children

PubMed Central

Mahone, E. Mark; Martin, Rebecca; Kates, Wendy R.; Hay, Trisha; Horská, Alena

2009-01-01

The purpose of the present study was to investigate construct validity of parent ratings of working memory in children, using a multi-trait/multi-method design including neuroimaging, rating scales, and performance-based measures. Thirty-five typically developing children completed performance-based tests of working memory and nonexecutive function (EF) skills, received volumetric MRI, and were rated by parents on both EF-specific and broad behavior rating scales. After controlling for total cerebral volume and age, parent ratings of working memory were significantly correlated with frontal gray, but not temporal, parietal, or occipital gray, or any lobar white matter volumes. Performance-based measures of working memory were also moderately correlated with frontal lobe gray matter volume; however, non-EF parent ratings and non-EF performance-based measures were not correlated with frontal lobe volumes. Results provide preliminary support for the convergent and discriminant validity of parent ratings of working memory, and emphasize their utility in exploring brain–behavior relationships in children. Rating scales that directly examine EF skills may potentially have ecological validity, not only for “everyday” function, but also as correlates of brain volume. PMID:19128526

A high performance hybrid battery based on aluminum anode and LiFePO4 cathode.

PubMed

Sun, Xiao-Guang; Bi, Zhonghe; Liu, Hansan; Fang, Youxing; Bridges, Craig A; Paranthaman, M Parans; Dai, Sheng; Brown, Gilbert M

2016-01-28

A novel hybrid battery utilizing an aluminum anode, a LiFePO4 cathode and an acidic ionic liquid electrolyte based on 1-ethyl-3-methylimidazolium chloride (EMImCl) and aluminum trichloride (AlCl3) (EMImCl-AlCl3, 1-1.1 in molar ratio) with or without LiAlCl4 is proposed. The hybrid ion battery delivers an initial high capacity of 160 mA h g(-1) at a current rate of C/5. It also shows good rate capability and cycling performance.

A high performance hybrid battery based on aluminum anode and LiFePO 4 cathode

DOE PAGES

Sun, Xiao-Guang; Bi, Zhonghe; Liu, Hansan; ...

2015-12-07

A unique battery hybrid utilizes an aluminum anode, a LiFePO 4 cathode and an acidic ionic liquid electrolyte based on 1-ethyl-3-methylimidazolium chloride (EMImCl) and aluminum trichloride (AlCl 3) (EMImCl-AlCl 3, 1-1.1 in molar ratio) with or without LiAlCl 4 is proposed. This hybrid ion battery delivers an initial high capacity of 160 mAh g -1 at a current rate of C/5. It also shows good rate capability and cycling performance.

Do more hospital beds lead to higher hospitalization rates? a spatial examination of Roemer's Law.

PubMed

Delamater, Paul L; Messina, Joseph P; Grady, Sue C; WinklerPrins, Vince; Shortridge, Ashton M

2013-01-01

Roemer's Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer's Law. We pose the question, "Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?" We employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions. We find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis. This study provides evidence for the effects of Roemer's Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings suggest continued regulation of hospital bed supply to assist in controlling hospital utilization is justified.

Base drive circuit for a four-terminal power Darlington

DOEpatents

Lee, Fred C.; Carter, Roy A.

1983-01-01

A high power switching circuit which utilizes a four-terminal Darlington transistor block to improve switching speed, particularly in rapid turn-off. Two independent reverse drive currents are utilized during turn off in order to expel the minority carriers of the Darlington pair at their own charge sweep-out rate. The reverse drive current may be provided by a current transformer, the secondary of which is tapped to the base terminal of the power stage of the Darlington block. In one application, the switching circuit is used in each power switching element in a chopper-inverter drive of an electric vehicle propulsion system.

Official statistics and claims data records indicate non-response and recall bias within survey-based estimates of health care utilization in the older population

PubMed Central

2013-01-01

Background The validity of survey-based health care utilization estimates in the older population has been poorly researched. Owing to data protection legislation and a great number of different health care insurance providers, the assessment of recall and non-response bias is challenging to impossible in many countries. The objective of our study was to compare estimates from a population-based study in older German adults with external secondary data. Methods We used data from the German KORA-Age study, which included 4,127 people aged 65–94 years. Self-report questions covered the utilization of long-term care services, inpatient services, outpatient services, and pharmaceuticals. We calculated age- and sex-standardized mean utilization rates in each domain and compared them with the corresponding estimates derived from official statistics and independent statutory health insurance data. Results The KORA-Age study underestimated the use of long-term care services (−52%), in-hospital days (−21%) and physician visits (−70%). In contrast, the assessment of drug consumption by postal self-report questionnaires yielded similar estimates to the analysis of insurance claims data (−9%). Conclusion Survey estimates based on self-report tend to underestimate true health care utilization in the older population. Direct validation studies are needed to disentangle the impact of recall and non-response bias. PMID:23286781

[High utilization of health insurance services by the elderly--analysis of hospital and drug utilization data].

PubMed

Nordheim, Johanna; Maaz, Asja; Winter, Maik H J; Kuhlmey, Adelheid; Hofmann, Werner

2006-01-01

The present contribution discusses the utilization of the healthcare system by elderly patients in Germany. First, the paper focuses on the detailed characterization of a group of people aged 60 years or more (N = 73,454). Second, the objective is to analyze the data for high utilization of healthcare services by older men and women. The analysis is based on data regularly recorded by a German health insurance agency for the year 2000. High utilization is operationalized by a 10% cutoff for users with the highest number of treatments, highest costs and/or other criteria depending on the respective health service sector. The insured group investigated received approximately 1.4 million prescriptions, producing costs of 42 million E. High utilizers account for 32% of all prescriptions and 44% of the costs, respectively. At the same time, the age groups with the highest prescription rates do not cause the highest costs: So the relationship between age and prescription drug expenses as well as between age and prescription rates does not display an arithmetically increasing pattern. Within the timeframe investigated 26,000 hospital treatments were accounted for by 21.75% of the elderly under research. In total, they caused expenses of 88 million E. High utilization in the hospital sector was operationalized by four criteria. Sex- and age-specific analysis of high utilization of hospital treatment revealed that the four different criteria apply to different insured groups. In summary, the high utilization of healthcare services appears to be a multidimensional phenomenon.

Development of a risk-adjustment model for antimicrobial utilization data in 21 public hospitals in Queensland, Australia (2006-11).

PubMed

Rajmokan, M; Morton, A; Marquess, J; Playford, E G; Jones, M

2013-10-01

Making valid comparisons of antimicrobial utilization between hospitals requires risk adjustment for each hospital's case mix. Data on individual patients may be unavailable or difficult to process. Therefore, risk adjustment for antimicrobial usage frequently needs to be based on a hospital's services. This study evaluated such a strategy for hospital antimicrobial utilization. Data were obtained on five broad subclasses of antibiotics [carbapenems, β-lactam/β-lactamase inhibitor combinations (BLBLIs), fluoroquinolones, glycopeptides and third-generation cephalosporins] from the Queensland pharmacy database (MedTrx) for 21 acute public hospitals (2006-11). Eleven clinical services and a variable for hospitals from the tropical region were employed for risk adjustment. Multivariable regression models were used to identify risk and protective services for these antibiotics. Funnel plots were used to display hospitals' antimicrobial utilization. Total inpatient antibiotic utilization for these antibiotics increased from 130.6 defined daily doses (DDDs)/1000 patient-days in 2006 to 155.8 DDDs/1000 patient-days in 2011 (P < 0.0001). Except for third-generation cephalosporins, the average utilization rate was higher for intensive care, renal/nephrology, cardiac, burns/plastic surgery, neurosurgery, transplant and acute spinal services than for the respective reference group (no service). In addition, oncology, high-activity infectious disease and coronary care services were associated with higher utilization of carbapenems, BLBLIs and glycopeptides. Our model predicted antimicrobial utilization rates by hospital services. The funnel plots displayed hospital utilization data after adjustment for variation among the hospitals. However, the methodology needs to be validated in other populations, ideally using a larger group of hospitals.

The Roles of Chronic Disease Complexity, Health System Integration, and Care Management in Post-Discharge Healthcare Utilization in a Low-Income Population.

PubMed

Hewner, Sharon; Casucci, Sabrina; Castner, Jessica

2016-08-01

Economically disadvantaged individuals with chronic disease have high rates of in-patient (IP) readmission and emergency department (ED) utilization following initial hospitalization. The purpose of this study was to explore the relationships between chronic disease complexity, health system integration (admission to accountable care organization [ACO] hospital), availability of care management interventions (membership in managed care organization [MCO]), and 90-day post-discharge healthcare utilization. We used de-identified Medicaid claims data from two counties in western New York. The study population was 114,295 individuals who met inclusion criteria, of whom 7,179 had index hospital admissions in the first 9 months of 2013. Individuals were assigned to three disease complexity segments based on presence of 12 prevalent conditions. The 30-day inpatient (IP) readmission rates ranged from 6% in the non-chronic segment to 12% in the chronic disease complexity segment and 21% in the organ system failure complexity segment. Rehospitalization rates (both inpatient and emergency department [ED]) were lower for patients in MCOs and ACOs than for those in fee-for-service care. Complexity of chronic disease, initial hospitalization in a facility that was part of an ACO, MCO membership, female gender, and longer length of stay were associated with a significantly longer time to readmission in the first 90 days, that is, fewer readmissions. Our results add to evidence that high-value post-discharge utilization (fewer IP or ED rehospitalizations and early outpatient follow-up) require population-based transitional care strategies that improve continuity between settings and take into account the illness complexity of the Medicaid population. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Comparing UK, USA and Australian values for EQ-5D as a health utility measure of oral health.

PubMed

Brennan, D S; Teusner, D N

2015-09-01

Using generic measures to examine outcomes of oral disorders can add additional information relating to health utility. However, different algorithms are available to generate health states. The aim was to assess UK-, US- and Australian-based algorithms for the EuroQol (EQ-5D) in relation to their discriminative and convergent validity. Methods: Data were collected from adults in Australia aged 30-61 years by mailed survey in 2009-10, including the EQ-5D and a range of self-reported oral health variables, and self-rated oral and general health. Responses were collected from n=1,093 persons (response rate 39.1%). UK-based EQ-5D estimates were lower (0.85) than the USA and Australian estimates (0.91). EQ-5D was associated (p<0.01) with all seven oral health variables, with differences in utility scores ranging from 0.03 to 0.06 for the UK, from 0.04 to 0.07 for the USA, and from 0.05 to 0.08 for the Australian-based estimates. The effect sizes (ESs) of the associations with all seven oral health variables were similar for the UK (ES=0.26 to 0.49), USA (ES=0.31 to 0.48) and Australian-based (ES=0.31 to 0.46) estimates. EQ-5D was correlated with global dental health for the UK (rho=0.29), USA (rho=0.30) and Australian-based estimates (rho=0.30), and correlations with global general health were the same (rho=0.42) for the UK, USA and Australian-based estimates. EQ-5D exhibited equivalent discriminative validity and convergent validity in relation to oral health variables for the UK, USA and Australian-based estimates.

Optimal weight based on energy imbalance and utility maximization

NASA Astrophysics Data System (ADS)

Sun, Ruoyan

2016-01-01

This paper investigates the optimal weight for both male and female using energy imbalance and utility maximization. Based on the difference of energy intake and expenditure, we develop a state equation that reveals the weight gain from this energy gap. We ​construct an objective function considering food consumption, eating habits and survival rate to measure utility. Through applying mathematical tools from optimal control methods and qualitative theory of differential equations, we obtain some results. For both male and female, the optimal weight is larger than the physiologically optimal weight calculated by the Body Mass Index (BMI). We also study the corresponding trajectories to steady state weight respectively. Depending on the value of a few parameters, the steady state can either be a saddle point with a monotonic trajectory or a focus with dampened oscillations.

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

PubMed

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

2016-09-21

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

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

PubMed Central

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

2016-01-01

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

Project appleseed electric rate incentives

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

Manak, J.R.

1988-11-01

Consolidated Edison Co. of N.Y., Inc. (Con Edison) has an economic development program to assist business grow and prosper in New York City and Westchester County. In 1981, the utility introduced a program of reduced electric rates (Area Development Rate) for economic development to help revitalize eight areas of the South Bronx and Brooklyn that were economically disadvantaged neighborhoods. This program has been very successful. It has helped produce jobs; it has helped to raise business activity in some of the most economically depressed areas of the nation; and, by increasing the usage of underutilized Company distribution facilities, it hasmore » increased Con Edison's efficiency to benefit all customers. It is established that this program resulted in a more than 24 percent average reduction of electric costs for participating companies. After recognition of this successful area development program, in late 1983, the N.Y. State legislature announced that as a matter of public policy electric utility rate incentives should, where appropriate, be used to foster economic activity in the state. The legislature found that ''the cost of utility services can be a significant factor in retaining and attracting healthy businesses and the employment opportunities and economic activity that they provide. The Law empowered the N.Y. State Public Service Commission to approve (after joint consideration with the Department of Commerce) economic incentive electricity rates that are cost based and will lead to jobs and economic vitality.« less

Fair and efficient network congestion control based on minority game

NASA Astrophysics Data System (ADS)

Wang, Zuxi; Wang, Wen; Hu, Hanping; Deng, Zhaozhang

2011-12-01

Low link utility, RTT unfairness and unfairness of Multi-Bottleneck network are the existing problems in the present network congestion control algorithms at large. Through the analogy of network congestion control with the "El Farol Bar" problem, we establish a congestion control model based on minority game(MG), and then present a novel network congestion control algorithm based on the model. The result of simulations indicates that the proposed algorithm can make the achievements of link utility closing to 100%, zero packet lose rate, and small of queue size. Besides, the RTT unfairness and the unfairness of Multi-Bottleneck network can be solved, to achieve the max-min fairness in Multi-Bottleneck network, while efficiently weaken the "ping-pong" oscillation caused by the overall synchronization.

Healthcare Costs for Chronic Hepatitis C in South Korea from 2009 to 2013: An Analysis of the National Health Insurance Claims' Data.

PubMed

Ki, Moran; Choi, Hwa Young; Kim, Kyung-Ah; Jang, Eun Sun; Jeong, Sook-Hyang

2017-11-15

The introduction of direct-acting antivirals (DAA) in 2013 revolutionized hepatitis C virus (HCV) treatment, offering a cure rate >90%. However, this therapy is expensive, and estimations of the number of chronic HCV-infected (CHC) patients and their treatment costs pre-2013 are therefore essential for creating policies and expanding drug access. Herein, we aimed to investigate the number of HCV-related liver disease patients, their healthcare utilization, their annual direct medical costs, and the interferon-based antiviral treatment rates and costs from 2009 to 2013 in South Korea. The National Health Insurance database was reviewed, and patients diagnosed with CHC from 2009 to 2013 were extracted. Data regarding detailed healthcare utilization, prescribed drugs, and direct medical costs were obtained. For annual direct healthcare cost calculations, a prevalence-based approach was used. Overall, 181,768 CHC patients were identified. In 2013, the annual per-patient costs for chronic hepatitis, liver cirrhosis, hepatocellular carcinoma, and the first year post-liver transplant were 895, 1,873, 6,945, and 67,359 United States dollars, respectively. Interferon-based antiviral therapeutics were prescribed to 25,223 patients (13.9%). Healthcare costs have increased remarkably with increasing liver disease severity. Thus, efforts to stop disease progression are needed. Moreover, the low rate of interferon-based therapy indicates an unmet need for DAA.

Patterns of Mental Health Care Utilization Among Sexual Orientation Minority Groups.

PubMed

Platt, Lisa F; Wolf, Julia Kay; Scheitle, Christopher P

2018-01-01

Prior studies of the utilization of mental health professionals by sexual minority populations have relied on data that are now dated or not nationally representative. These studies have also provided mixed findings regarding gender differences in the utilization of mental health professionals among sexual minority individuals. Using data from the 2013-2015 National Health Interview Surveys, this study investigates (1) how sexual minority individuals compare to heterosexual participants in their utilization of mental health professionals; and (2) gender differences in that utilization. The results indicate sexual minority individuals utilize mental health care professionals at higher rates than heterosexual individuals even after controlling for measures of mental health and other demographic characteristics; this is true for both men and women. However, gender moderates the sexual minority effect on utilization rates. Sexual minority men utilize mental health professionals at a high rate, such that their utilization rates are similar to sexual minority women, contrary to the gender gap seen among heterosexuals.

Experiences of Vulnerable Residential Customer Subpopulations with Critical Peak Pricing

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

Cappers, Peter; Spurlock, C. Anna; Todd, Annika

DOE decided to co-fund ten utilities to undertake eleven experimentally-designed Consumer Behavior Studies (CBS) that proposed to examine a wide range of the topics of interest to the electric utility industry. Each chosen utility was to design, implement and evaluate their own study in order to address questions of interest both to itself and to its applicable regulatory authority, whose approval was generally necessary for the study to proceed. The DOE Office of Energy Delivery and Electricity Reliability (OE), however, did set guidelines, both in the FOA and subsequently during the contracting period, for what would constitute an acceptable studymore » under the Grant. To assist in ensuring these guidelines were adhered to, OE requested that LBNL act as project manager for these Consumer Behavior Studies to achieve consistency of experimental design and adherence to data collection and reporting protocols across the ten utilities. As part of its role, LBNL formed technical advisory groups (TAG) to separately assist each of the utilities by providing technical assistance in all aspects of the design, implementation and evaluation of their studies. LBNL was also given a unique opportunity to perform a comprehensive, cross-study analysis that uses the customer-level interval meter and demographic data made available by these utilities due to SGIG-imposed reporting requirements, in order to analyze critical policy issues associated with AMI-enabled rates and control/information technology. LBNL will publish the results of these analyses in a series of research reports, of which this is one, that attempt to address critical policy issues relating to a variety of topics including customer acceptance, retention and load response to time-based rates and various forms of enabling control and information technologies. This report extends the existing empirical literature on the experiences of low-income customers exposed to critical peak pricing, and provides the first glimpses into the experiences of the elderly and those who reported being chronically ill. Specifically, we analyzed two of the time-based rate consumer behavior studies, which were co-funded by the Department of Energy as part of the Smart Grid Investment Grant program.« less

Generic functional requirements for a NASA general-purpose data base management system

NASA Technical Reports Server (NTRS)

Lohman, G. M.

1981-01-01

Generic functional requirements for a general-purpose, multi-mission data base management system (DBMS) for application to remotely sensed scientific data bases are detailed. The motivation for utilizing DBMS technology in this environment is explained. The major requirements include: (1) a DBMS for scientific observational data; (2) a multi-mission capability; (3) user-friendly; (4) extensive and integrated information about data; (5) robust languages for defining data structures and formats; (6) scientific data types and structures; (7) flexible physical access mechanisms; (8) ways of representing spatial relationships; (9) a high level nonprocedural interactive query and data manipulation language; (10) data base maintenance utilities; (11) high rate input/output and large data volume storage; and adaptability to a distributed data base and/or data base machine configuration. Detailed functions are specified in a top-down hierarchic fashion. Implementation, performance, and support requirements are also given.

Recombinant vesicular stomatitis virus-based vaccines against Ebola and Marburg virus infections.

PubMed

Geisbert, Thomas W; Feldmann, Heinz

2011-11-01

The filoviruses, Marburg virus and Ebola virus, cause severe hemorrhagic fever with a high mortality rate in humans and nonhuman primates. Among the most-promising filovirus vaccines under development is a system based on recombinant vesicular stomatitis virus (rVSV) that expresses a single filovirus glycoprotein (GP) in place of the VSV glycoprotein (G). Importantly, a single injection of blended rVSV-based filovirus vaccines was shown to completely protect nonhuman primates against Marburg virus and 3 different species of Ebola virus. These rVSV-based vaccines have also shown utility when administered as a postexposure treatment against filovirus infections, and a rVSV-based Ebola virus vaccine was recently used to treat a potential laboratory exposure. Here, we review the history of rVSV-based vaccines and pivotal animal studies showing their utility in combating Ebola and Marburg virus infections.

Recombinant Vesicular Stomatitis Virus–Based Vaccines Against Ebola and Marburg Virus Infections

PubMed Central

Feldmann, Heinz

2011-01-01

The filoviruses, Marburg virus and Ebola virus, cause severe hemorrhagic fever with a high mortality rate in humans and nonhuman primates. Among the most-promising filovirus vaccines under development is a system based on recombinant vesicular stomatitis virus (rVSV) that expresses a single filovirus glycoprotein (GP) in place of the VSV glycoprotein (G). Importantly, a single injection of blended rVSV-based filovirus vaccines was shown to completely protect nonhuman primates against Marburg virus and 3 different species of Ebola virus. These rVSV-based vaccines have also shown utility when administered as a postexposure treatment against filovirus infections, and a rVSV-based Ebola virus vaccine was recently used to treat a potential laboratory exposure. Here, we review the history of rVSV-based vaccines and pivotal animal studies showing their utility in combating Ebola and Marburg virus infections. PMID:21987744

Acoustically based fetal heart rate monitor

NASA Technical Reports Server (NTRS)

Baker, Donald A.; Zuckerwar, Allan J.

1991-01-01

The acoustically based fetal heart rate monitor permits an expectant mother to perform the fetal Non-Stress Test in her home. The potential market would include the one million U.S. pregnancies per year requiring this type of prenatal surveillance. The monitor uses polyvinylidene fluoride (PVF2) piezoelectric polymer film for the acoustic sensors, which are mounted in a seven-element array on a cummerbund. Evaluation of the sensor ouput signals utilizes a digital signal processor, which performs a linear prediction routine in real time. Clinical tests reveal that the acoustically based monitor provides Non-Stress Test records which are comparable to those obtained with a commercial ultrasonic transducer.

Method to monitor HC-SCR catalyst NOx reduction performance for lean exhaust applications

DOEpatents

Viola, Michael B [Macomb Township, MI; Schmieg, Steven J [Troy, MI; Sloane, Thompson M [Oxford, MI; Hilden, David L [Shelby Township, MI; Mulawa, Patricia A [Clinton Township, MI; Lee, Jong H [Rochester Hills, MI; Cheng, Shi-Wai S [Troy, MI

2012-05-29

A method for initiating a regeneration mode in selective catalytic reduction device utilizing hydrocarbons as a reductant includes monitoring a temperature within the aftertreatment system, monitoring a fuel dosing rate to the selective catalytic reduction device, monitoring an initial conversion efficiency, selecting a determined equation to estimate changes in a conversion efficiency of the selective catalytic reduction device based upon the monitored temperature and the monitored fuel dosing rate, estimating changes in the conversion efficiency based upon the determined equation and the initial conversion efficiency, and initiating a regeneration mode for the selective catalytic reduction device based upon the estimated changes in conversion efficiency.

Effect of an Internet-based Curriculum on Postgraduate Education

PubMed Central

Sisson, Stephen D; Hughes, Mark T; Levine, David; Brancati, Frederick L

2004-01-01

We hypothesized that the Internet could be used to disseminate and evaluate a curriculum in ambulatory care, and that internal medicine residency program directors would value features made possible by online dissemination. An Internet-based ambulatory care curriculum was developed and marketed to internal medicine residency program directors. Utilization and knowledge outcomes were tracked by the website; opinions of program directors were measured by paper surveys. Twenty-four programs enrolled with the online curriculum. The curriculum was rated favorably by all programs, test scores on curricular content improved significantly, and program directors rated highly features made possible by an Internet-based curriculum. PMID:15109313

An informatics approach to assess pediatric pharmacotherapy: design and implementation of a hospital drug utilization system.

PubMed

Zuppa, Athena; Vijayakumar, Sundararajan; Jayaraman, Bhuvana; Patel, Dimple; Narayan, Mahesh; Vijayakumar, Kalpana; Mondick, John T; Barrett, Jeffrey S

2007-09-01

Drug utilization in the inpatient setting can provide a mechanism to assess drug prescribing trends, efficiency, and cost-effectiveness of hospital formularies and examine subpopulations for which prescribing habits may be different. Such data can be used to correlate trends with time-dependent or seasonal changes in clinical event rates or the introduction of new pharmaceuticals. It is now possible to provide a robust, dynamic analysis of drug utilization in a large pediatric inpatient setting through the creation of a Web-based hospital drug utilization system that retrieves source data from our accounting database. The production implementation provides a dynamic and historical account of drug utilization at the authors' institution. The existing application can easily be extended to accommodate a multi-institution environment. The creation of a national or even global drug utilization network would facilitate the examination of geographical and/or socioeconomic influences in drug utilization and prescribing practices in general.

Predicting health care utilization in marginalized populations: Black, female, street-based sex workers.

PubMed

Varga, Leah M; Surratt, Hilary L

2014-01-01

Patterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health. The outcome variable was utilization of health care services in the previous 12 months. Using Andersen's Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based, female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables. The most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization. Any type of resource, link, or connection to or with an institution, or any consistent point of care, contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

A Novel 24 Ghz One-Shot Rapid and Portable Microwave Imaging System (Camera)

NASA Technical Reports Server (NTRS)

Ghasr, M.T.; Abou-Khousa, M.A.; Kharkovsky, S.; Zoughi, R.; Pommerenke, D.

2008-01-01

A novel 2D microwave imaging system at 24 GHz based on MST techniques. Enhanced sensitivity and SNR by utilizing PIN diode-loaded resonant slots. Specific slot and array design to increase transmission and reduce cross -coupling. Real-time imaging at a rate in excess of 30 images per second. Reflection as well transmission mode capabilities. Utility and application for electric field distribution mapping related to: Nondestructive Testing (NDT), imaging applications (SAR, Holography), and antenna pattern measurements.

Performance-based measures and behavioral ratings of executive function in diagnosing attention-deficit/hyperactivity disorder in children.

PubMed

Tan, Alexander; Delgaty, Lauren; Steward, Kayla; Bunner, Melissa

2018-04-16

Deficits in real-world executive functioning (EF) are a frequent characteristic of attention-deficit/hyperactivity disorder (ADHD). However, the predictive value of using performance-based and behavioral rating measures of EF when diagnosing ADHD remains unclear. The current study investigates the use of performance-based EF measures and a parent-report questionnaire with established ecological validity and clinical utility when diagnosing ADHD. Participants included 21 healthy controls, 21 ADHD-primary inattentive, and 21 ADHD-combined type subjects aged 6-15 years. A brief neuropsychological battery was administered to each subject including common EF assessment measures. Significant differences were not found between groups on most performance-based EF measures, whereas significant differences (p < 0.05) were found on most parent-report behavioral rating scales. Furthermore, performance-based measures did not predict group membership above chance levels. Results further support differences in predictive value of EF performance-based measures compared to parent-report questionnaires when diagnosing ADHD. Further research must investigate the relationship between performance-based and behavioral rating measures when assessing EF in ADHD.

A citation-based assessment of the performance of U.S. boiling water reactors following extended power up-rates

NASA Astrophysics Data System (ADS)

Heidrich, Brenden J.

Nuclear power plants produce 20 percent of the electricity generated in the U.S. Nuclear generated electricity is increasingly valuable to a utility because it can be produced at a low marginal cost and it does not release any carbon dioxide. It can also be a hedge against uncertain fossil fuel prices. The construction of new nuclear power plants in the U.S. is cautiously moving forward, restrained by high capital costs. Since 1998, nuclear utilities have been increasing the power output of their reactors by implementing extended power up-rates. Power increases of up to 20 percent are allowed under this process. The equivalent of nine large power plants has been added via extended power up-rates. These up-rates require the replacement of large capital equipment and are often performed in concert with other plant life extension activities such as license renewals. This dissertation examines the effect of these extended power up-rates on the safety performance of U.S. boiling water reactors. Licensing event reports are submitted by the utilities to the Nuclear Regulatory Commission, the federal nuclear regulator, for a wide range of abnormal events. Two methods are used to examine the effect of extended power up-rates on the frequency of abnormal events at the reactors. The Crow/AMSAA model, a univariate technique is used to determine if the implementation of an extended power up-rate affects the rate of abnormal events. The method has a long history in the aerospace industry and in the military. At a 95-percent confidence level, the rate of events requiring the submission of a licensing event report decreases following the implementation of an extended power up-rate. It is hypothesized that the improvement in performance is tied to the equipment replacement and refurbishment that is performed as part of the up-rate process. The reactor performance is also analyzed using the proportional hazards model. This technique allows for the estimation of the effects of multiple independent variables on the event rate. Both the Cox and Weibull formulations were tested. The Cox formulation is more commonly used in survival analysis because of its flexibility. The best Cox model included fixed effects at the multi-reactor site level. The Weibull parametric formulation has the same base hazard rate as the Crow/AMSAA model. This theoretical connection was confirmed through a series of tests that demonstrated both models predicted the same base hazard rates. The Weibull formulation produced a model with most of the same statistically significant variables as the Cox model. The beneficial effect of extended power up-rates was predicted in the proportional hazards models as well as the Crow/AMSAA model. The Weibull model also indicated an effect that can be traced back to a plant’s construction. Performance was also found to improve in plants that had been divested from their original owners. This research developed a consistent evaluation toolkit for nuclear power plant performance using either a univariate method that allows for simple graphical evaluation at its heart or a more complex multivariate method that includes the effects of several independent variables with data that are available from public sources. Utilities or regulators with access to proprietary data may be able to expand upon this research with additional data that is not readily available to an academic researcher. Even without access to special data, the methods developed are valuable tools in evaluating and predicting nuclear power plant reliability performance.

Effects of substrate concentrations on the growth of heterotrophic bacteria and algae in secondary facultative ponds.

PubMed

Kayombo, S; Mbwette, T S A; Katima, J H Y; Jorgensen, S E

2003-07-01

This paper presents the effect of substrate concentration on the growth of a mixed culture of algae and heterotrophic bacteria in secondary facultative ponds (SFPs) utilizing settled domestic sewage as a sole source of organic carbon. The growth of the mixed culture was studied at the concentrations ranging between 200 and 800 mg COD/l in a series of batch chemostat reactors. From the laboratory data, the specific growth rate (micro) was determined using the modified Gompertz model. The maximum specific growth rate ( micro(max)) and half saturation coefficients (K(s)) were calculated using the Monod kinetic equation. The maximum observed growth rate ( micro(max)) for heterotrophic bacteria was 3.8 day(-1) with K(s) of 200 mg COD/l. The micro(max) for algal biomass based on suspended volatile solids was 2.7 day(-1) with K(s) of 110 mg COD/l. The micro(max) of algae based on the chlorophyll-a was 3.5 day(-1) at K(s) of 50mg COD/l. The observed specific substrate removal by heterotrophic bacteria varied between the concentrations of substrate used and the average value was 0.82 (mg COD/mg biomass). The specific substrate utilization rate in the bioreactors was direct proportional to the specific growth rate. Hence, the determined Monod kinetic parameters are useful for the definition of the operation of SFPs.

Impact of residential PV adoption on Retail Electricity Rates

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

Cai, DWH; Adlakha, S; Low, SH

2013-11-01

The price of electricity supplied from home rooftop photo voltaic (PV) solar cells has fallen below the retail price of grid electricity in some areas. A number of residential households have an economic incentive to install rooftop PV systems and reduce their purchases of electricity from the grid. A significant portion of the costs incurred by utility companies are fixed costs which must be recovered even as consumption falls. Electricity rates must increase in order for utility companies to recover fixed costs from shrinking sales bases. Increasing rates will, in turn, result in even more economic incentives for customers tomore » adopt rooftop PV. In this paper, we model this feedback between PV adoption and electricity rates and study its impact on future PV penetration and net-metering costs. We find that the most important parameter that determines whether this feedback has an effect is the fraction of customers who adopt PV in any year based solely on the money saved by doing so in that year, independent of the uncertainties of future years. These uncertainties include possible changes in rate structures such as the introduction of connection charges, the possibility of PV prices dropping significantly in the future, possible changes in tax incentives, and confidence in the reliability and maintainability of PV. (C) 2013 Elsevier Ltd. All rights reserved.« less

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.

Utilization of Non-Dentist Providers and Attitudes Toward New Provider Models: Findings from The National Dental Practice-Based Research Network

PubMed Central

Blue, Christine M.; Funkhouser, D. Ellen; Riggs, Sheila; Rindal, D. Brad; Worley, Donald; Pihlstrom, Daniel J.; Benjamin, Paul; Gilbert, Gregg H.

2014-01-01

Objectives The purpose of this study was to quantify within The National Dental Practice-Based Research Network current utilization of dental hygienists and assistants with expanded functions and quantify network dentists’ attitudes toward a new non-dentist provider model - the dental therapist. Methods Dental practice-based research network practitioner-investigators participated in a single, cross-sectional administration of a questionnaire. Results Current non-dentist providers are not being utilized by network practitioner-investigators to the fullest extent allowed by law. Minnesota practitioners, practitioners in large group practices, and those with prior experience with expanded function non-dentist providers delegate at a higher rate and had more-positive perceptions of the new dental therapist model. Conclusions Expanding scopes of practice for dental hygienists and assistants has not translated to the maximal delegation allowed by law among network practices. This finding may provide insight into dentists’ acceptance of newer non-dentist provider models. PMID:23668892

Army Incentives for the PCMH

DTIC Science & Technology

2011-01-24

Performance Metrics Community Based Medical Homes Slide 8 of 10 2011 MHS Conference  Increase our primary care market share Net increase in primary... Sharing Knowledge: Achieving Breakthrough Performance 2011 Military Health System Conference Army Incentives for the PCMH 24 January 2011 Mr. Ken...enroll as soon as fully staffed  Operate at economic advantage to DoD Improve ER/ UCC usage rates Improve utilization rates Business Rules Army

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

None

This bibliography provides documentation for use by state public utility commissions and major nonregulated utilities in evaluating the applicability of a wide range of electric utility rate design and regulatory concepts in light of certain regulatory objectives. Part I, Utility Regulatory Objectives, contains 2084 citations on conservation of energy and capital; efficient use of facilities and resources; and equitable rates to electricity consumers. Part II, Rate Design Concepts, contains 1238 citations on time-of-day rates; seasonally-varying rates; cost-of-service rates; interruptible rates (including the accompanying use of load management techniques); declining block rates; and lifeline rates. Part III, Regulatory Concepts, contains 1282more » references on restrictions on master metering; procedures for review of automatic adjustment clauses; prohibitions of rate or regulatory discrimination against solar, wind, or other small energy systems; treatment of advertising expenses; and procedures to protect ratepayers from abrupt termination of service.« less

18 CFR 35.35 - Transmission infrastructure investment.

Code of Federal Regulations, 2014 CFR

2014-04-01

... base; (iii) Recovery of prudently incurred pre-commercial operations costs; (iv) Hypothetical capital structure; (v) Accelerated depreciation used for rate recovery; (vi) Recovery of 100 percent of prudently... of the public utility; (vii) Deferred cost recovery; and (viii) Any other incentives approved by the...

18 CFR 35.35 - Transmission infrastructure investment.

Code of Federal Regulations, 2012 CFR

2012-04-01

... base; (iii) Recovery of prudently incurred pre-commercial operations costs; (iv) Hypothetical capital structure; (v) Accelerated depreciation used for rate recovery; (vi) Recovery of 100 percent of prudently... of the public utility; (vii) Deferred cost recovery; and (viii) Any other incentives approved by the...

18 CFR 35.35 - Transmission infrastructure investment.

Code of Federal Regulations, 2013 CFR

2013-04-01

... base; (iii) Recovery of prudently incurred pre-commercial operations costs; (iv) Hypothetical capital structure; (v) Accelerated depreciation used for rate recovery; (vi) Recovery of 100 percent of prudently... of the public utility; (vii) Deferred cost recovery; and (viii) Any other incentives approved by the...

A NASA SHARP Mentoring Experience Utilizing GP-B

NASA Technical Reports Server (NTRS)

Estes, Howard

2004-01-01

The goal of this program is to increase the participation and success rates of students who are traditionally underrepresented in science, mathematics, technology , and geography. Students are selected based on aptitude and oi nterests. It is a NASA sponsored, 8 week program.

Areas with High Rates of Police-Reported Violent Crime Have Higher Rates of Childhood Asthma Morbidity.

PubMed

Beck, Andrew F; Huang, Bin; Ryan, Patrick H; Sandel, Megan T; Chen, Chen; Kahn, Robert S

2016-06-01

To assess whether population-level violent (and all) crime rates were associated with population-level child asthma utilization rates and predictive of patient-level risk of asthma reutilization after a hospitalization. A retrospective cohort study of 4638 pediatric asthma-related emergency department visits and hospitalizations between 2011 and 2013 was completed. For population-level analyses, census tract asthma utilization rates were calculated by dividing the number of utilization events within a tract by the child population. For patient-level analyses, hospitalized patients (n = 981) were followed until time of first asthma-related reutilization. The primary predictor was the census tract rate of violent crime as recorded by the police; the all crime (violent plus nonviolent) rate was also assessed. Census tract-level violent and all crime rates were significantly correlated with asthma utilization rates (both P < .0001). The violent crime rate explained 35% of the population-level asthma utilization variance and remained associated with increased utilization after adjustment for census tract poverty, unemployment, substandard housing, and traffic exposure (P = .002). The all crime rate explained 28% of the variance and was similarly associated with increased utilization after adjustment (P = .02). Hospitalized children trended toward being more likely to reutilize if they lived in higher violent (P = .1) and all crime areas (P = .01). After adjustment, neither relationship was significant. Crime data could help facilitate early identification of potentially toxic stressors relevant to the control of asthma for populations and patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Areas with high rates of police-reported violent crime have higher rates of childhood asthma morbidity

PubMed Central

Beck, Andrew F.; Huang, Bin; Ryan, Patrick H.; Sandel, Megan T.; Chen, Chen; Kahn, Robert S.

2016-01-01

Objectives To assess whether population-level violent (and all) crime rates were associated with population-level child asthma utilization rates and predictive of patient-level risk of asthma reutilization after a hospitalization. Study design A retrospective cohort study of 4,638 pediatric asthma-related emergency department visits and hospitalizations between 2011 and 2013 was completed. For population-level analyses, census tract asthma utilization rates were calculated by dividing the number of utilization events within a tract by the child population. For patient-level analyses, hospitalized patients (n=981) were followed until time of first asthma-related reutilization. The primary predictor was the census tract rate of violent crime as recorded by the police; the all crime (violent plus non-violent) rate was also assessed. Results Census tract-level violent and all crime rates were significantly correlated with asthma utilization rates (both p<.0001). The violent crime rate explained 35% of the population-level asthma utilization variance and remained associated with increased utilization after adjustment for census tract poverty, unemployment, substandard housing, and traffic exposure (p=.002). The all crime rate explained 28% of the variance and was similarly associated with increased utilization after adjustment (p=.02). Hospitalized children trended toward being more likely to reutilize if they lived in higher violent (p=.1) and all crime areas (p=.01). After adjustment, neither relationship was significant. Conclusions Crime data could help facilitate early identification of potentially toxic stressors relevant to the control of asthma for populations and patients. PMID:26960918

The influence of calcium supplementation on substrate metabolism during exercise in humans: a randomized controlled trial.

PubMed

Gonzalez, J T; Green, B P; Campbell, M D; Rumbold, P L S; Stevenson, E J

2014-06-01

High calcium intakes enhance fat loss under restricted energy intake. Mechanisms explaining this may involve reduced dietary fat absorption, enhanced lipid utilization and (or) reductions in appetite. This study aimed to assess the impact of 2 weeks of calcium supplementation on substrate utilization during exercise and appetite sensations at rest. Thirteen physically active males completed two 14-d supplemental periods, in a double-blind, randomized crossover design separated by a ⩾4-week washout period. During supplementation, a test-drink was consumed daily containing 400 and 1400 mg of calcium during control (CON) and high-calcium (CAL) periods, respectively. Cycling-based exercise tests were conducted before and after each supplemental period to determine substrate utilization rates and circulating metabolic markers (non-esterified fatty acid, glycerol, glucose and lactate concentrations) across a range of exercise intensities. Visual analog scales were completed in the fasting, rested state to determine subjective appetite sensations. No significant differences between supplements were observed in lipid or carbohydrate utilization rates, nor in circulating metabolic markers (both P>0.05). Maximum rates of lipid utilization were 0.47±0.05 and 0.44±0.05 g/min for CON and CAL, respectively, prior to supplementation and 0.44±0.05 and 0.42±0.05 g/min, respectively, post-supplementation (main effects of time, supplement and time x supplement interaction effect all P>0.05). Furthermore, no significant differences were detected in any subjective appetite sensations (all P>0.05). Two weeks of calcium supplementation does not influence substrate utilization during exercise in physically active males.

Population trends and disparities in outpatient utilization of neurologists for ischemic stroke.

PubMed

Karve, Sudeep; Balkrishnan, Rajesh; Seiber, Eric; Nahata, Milap; Levine, Deborah A

2013-10-01

Inpatient stroke utilization may be decreasing over time and may vary by patient demographics. Less is known about temporal trends and demographic variations in outpatient stroke utilization. We assessed ischemic stroke (IS)-related outpatient utilization across physician specialty and time, exploring any demographic variability, using recent US population-based data. We identified all outpatient medical visits for IS by adults (≥ 18 years) using the National Ambulatory Medical Care Survey (NAMCS) years 1998 to 2009. Physician numbers were derived from American Medical Association or American Osteopathic Association data by NAMCS. We assessed IS-related outpatient visits to neurologists and generalists over time and by patient demographics. We identified 9.7 million IS-related visits from 1998 to 2009. The rate of IS-related visits to neurologists increased from 0.56 million visits in 1998 to 2000 to 0.90 million visits in 2007 to 2009, representing a 62% increase over the study period. The rate of IS-related visits to generalists declined from 2.0 million visits in 1998 to 2000 to 1.6 million visits in 2007 to 2009 (18% decrease). Between 1998 and 2009, the number of neurologists increased by 23% and the number of generalists grew by 19%. The IS visit rate per 100 physicians increased by 90% for neurologists but decreased by 31% for generalists. Fewer ambulatory IS-related visits to neurologists were reported among stroke survivors who were older, female, nonwhite, or living in rural areas. Between 1998 and 2009, IS-related outpatient utilization increased substantially to neurologists but declined to generalists. We identified demographic variations in outpatient utilization of neurologists that potentially lead to disparities in stroke evaluation and management. Published by Elsevier Inc.

A Predictive Algorithm to Detect Opioid Use Disorder: What Is the Utility in a Primary Care Setting?

PubMed

Lee, Chee; Sharma, Maneesh; Kantorovich, Svetlana; Brenton, Ashley

2018-01-01

The purpose of this study was to determine the clinical utility of an algorithm-based decision tool designed to assess risk associated with opioid use in the primary care setting. A prospective, longitudinal study was conducted to assess the utility of precision medicine testing in 1822 patients across 18 family medicine/primary care clinics in the United States. Using the profile, patients were categorized into low, moderate, and high risk for opioid use. Physicians who ordered testing were asked to complete patient evaluations and document their actions, decisions, and perceptions regarding the utility of the precision medicine tests. Approximately 47% of primary care physicians surveyed used the profile to guide clinical decision-making. These physicians rated the benefit of the profile on patient care an average of 3.6 on a 5-point scale (1 indicating no benefit and 5 indicating significant benefit). Eighty-eight percent of all clinicians surveyed felt the test exhibited some benefit to their patient care. The most frequent utilization for the profile was to guide a change in opioid prescribed. Physicians reported greater benefit of profile utilization for minority patients. Patients whose treatment was guided by the profile had pain levels that were reduced, on average, 2.7 levels on the numeric rating scale. The profile provided primary care physicians with a useful tool to stratify the risk of opioid use disorder and was rated as beneficial for decision-making and patient improvement by the majority of physicians surveyed. Physicians reported the profile resulted in greater clinical improvement for minorities, highlighting the objective use of this profile to guide judicial use of opioids in high-risk patients. Significantly, when physicians used the profile to guide treatment decisions, patient-reported pain was greatly reduced.

Medicare Cancer Screening in the Context of Clinical Guidelines: 2000 to 2012.

PubMed

Maroongroge, Sean; Yu, James B

2018-04-01

Cancer screening is a ubiquitous and controversial public health issue, particularly in the elderly population. Despite extensive evidence-based guidelines for screening, it is unclear how cancer screening has changed in the Medicare population over time. We characterize trends in cancer screening for the most common cancer types in the Medicare fee-for-service (FFS) program in the context of conflicting guidelines from 2000 to 2012. We performed a descriptive analysis of retrospective claims data from the Medicare FFS program based on billing codes. Our data include all claims for Medicare part B beneficiaries who received breast, colorectal (CRC), or prostate cancer screening from 2000 to 2012 based on billing codes. We utilize a Monte Carlo permutation method to detect changes in screening trends. In total, 231,416,732 screening tests were analyzed from 2000 to 2012, representing an average of 436.8 tests per 1000 beneficiaries per year. Mammography rates declined 7.4%, with digital mammography extensively replacing film. CRC cancer screening rates declined overall. As a percentage of all CRC screening tests, colonoscopy grew from 32% to 71%. Prostate screening rates increased 16% from 2000 to 2007, and then declined to 7% less than its 2000 rate by 2012. Both the aggressiveness of screening guidelines and screening rates for the Medicare FFS population peaked and then declined from 2000 to 2012. However, guideline publications did not consistently precede utilization trend shifts. Technology adoption, practical and financial concerns, and patient preferences may have also contributed to the observed trends. Further research should be performed on the impact of multiple, conflicting guidelines in cancer screening.

Towards Smart Grid Dynamic Ratings

NASA Astrophysics Data System (ADS)

Cheema, Jamal; Clark, Adrian; Kilimnik, Justin; Pavlovski, Chris; Redman, David; Vu, Maria

2011-08-01

The energy distribution industry is giving greater attention to smart grid solutions as a means for increasing the capabilities, efficiency and reliability of the electrical power network. The smart grid makes use of intelligent monitoring and control devices throughout the distribution network to report on electrical properties such as voltage, current and power, as well as raising network alarms and events. A further aspect of the smart grid embodies the dynamic rating of electrical assets of the network. This fundamentally involves a rating of the load current capacity of electrical assets including feeders, transformers and switches. The mainstream approach to rate assets is to apply the vendor plate rating, which often under utilizes assets, or in some cases over utilizes when environmental conditions reduce the effective rated capacity, potentially reducing lifetime. Using active intelligence we have developed a rating system that rates assets in real time based upon several events. This allows for a far more efficient and reliable electrical grid that is able to extend further the life and reliability of the electrical network. In this paper we describe our architecture, the observations made during development and live deployment of the solution into operation. We also illustrate how this solution blends with the smart grid by proposing a dynamic rating system for the smart grid.

Weighted Feature Gaussian Kernel SVM for Emotion Recognition

PubMed Central

Jia, Qingxuan

2016-01-01

Emotion recognition with weighted feature based on facial expression is a challenging research topic and has attracted great attention in the past few years. This paper presents a novel method, utilizing subregion recognition rate to weight kernel function. First, we divide the facial expression image into some uniform subregions and calculate corresponding recognition rate and weight. Then, we get a weighted feature Gaussian kernel function and construct a classifier based on Support Vector Machine (SVM). At last, the experimental results suggest that the approach based on weighted feature Gaussian kernel function has good performance on the correct rate in emotion recognition. The experiments on the extended Cohn-Kanade (CK+) dataset show that our method has achieved encouraging recognition results compared to the state-of-the-art methods. PMID:27807443

Geospatial Relationships between Awareness and Utilization of Community Exercise Resources and Physical Activity Levels in Older Adults.

PubMed

Dondzila, Christopher J; Swartz, Ann M; Keenan, Kevin G; Harley, Amy E; Azen, Razia; Strath, Scott J

2014-01-01

Introduction. It is unclear if community-based fitness resources (CBFR) translate to heightened activity levels within neighboring areas. The purpose of this study was to determine whether awareness and utilization of fitness resources and physical activity differed depending on residential distance from CBFR. Methods. Four hundred and seventeen older adults (72.9 ± 7.7 years) were randomly recruited from three spatial tiers (≤1.6, >1.6 to ≤3.2, and >3.2 to 8.0 km) surrounding seven senior centers, which housed CBFR. Participants completed questionnaires on health history, CBFR, and physical activity, gathering data on CBFR awareness, utilization, and barriers, overall levels, and predictors to engagement in moderate to vigorous physical activity (MVPA). Results. Across spatial tiers, there were no differences in positive awareness rates of CBFR or CBFR utilization. Engagement in MVPA differed across spatial tiers (P < 0.001), with the >3.2 to 8.0 km radius having the highest mean energy expenditure. Across all sites, age and income level (P < 0.05) were significant predictors of low and high amounts of MVPA, respectively, and current health status and lack of interest represented barriers to CBFR utilization (P < 0.05). Conclusion. Closer proximity to CBFR did not impact awareness or utilization rates and had an inverse relationship with physical activity.

Optimization-based Approach to Cross-layer Resource Management in Wireless Networked Control Systems

DTIC Science & Technology

2013-05-01

interest from both academia and industry [37], finding applications in un- manned robotic vehicles, automated highways and factories, smart homes and...is stable when the scaler varies slowly. The algorithm is further extended to utilize the slack resource in the network, which leads to the...model . . . . . . . . . . . . . . . . 66 Optimal sampling rate allocation formulation . . . . . 67 Price-based algorithm

Analytical sizing methods for behind-the-meter battery storage

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

Wu, Di; Kintner-Meyer, Michael; Yang, Tao

In behind-the-meter application, battery storage system (BSS) is utilized to reduce a commercial or industrial customer’s payment for electricity use, including energy charge and demand charge. The potential value of BSS in payment reduction and the most economic size can be determined by formulating and solving standard mathematical programming problems. In this method, users input system information such as load profiles, energy/demand charge rates, and battery characteristics to construct a standard programming problem that typically involve a large number of constraints and decision variables. Such a large scale programming problem is then solved by optimization solvers to obtain numerical solutions.more » Such a method cannot directly link the obtained optimal battery sizes to input parameters and requires case-by-case analysis. In this paper, we present an objective quantitative analysis of costs and benefits of customer-side energy storage, and thereby identify key factors that affect battery sizing. Based on the analysis, we then develop simple but effective guidelines that can be used to determine the most cost-effective battery size or guide utility rate design for stimulating energy storage development. The proposed analytical sizing methods are innovative, and offer engineering insights on how the optimal battery size varies with system characteristics. We illustrate the proposed methods using practical building load profile and utility rate. The obtained results are compared with the ones using mathematical programming based methods for validation.« less

Energy utilization rates during shuttle extravehicular activities.

PubMed

Waligora, J M; Kumar, K V

1995-01-01

The work rates or energy utilization rates during EVA are major factors in sizing of life support systems. These rates also provide a measure of ease of EVA and its cost in crew fatigue. From the first Shuttle EVA on the STS-6 mission in 1983, we have conducted 59 man-EVA and 341 man-hours of EVA. Energy utilization rates have been measured on each of these EVA. Metabolic rate was measured during each EVA using oxygen utilization corrected for suit leakage. From 1981-1987, these data were available for average data over the EVA or over large segments of the EVA. Since 1987, EVA oxygen utilization data were available at 2-minute intervals. The average metabolic rate on Shuttle EVA (194 kcal/hr.) has been significantly lower than metabolic rates during Apollo and Skylab missions. Peak rates have been below design levels, infrequent, and of short duration. The data suggest that the energy cost of tasks may be inversely related to the degree of training for the task. The data provide insight on the safety margins provided by life support designs and on the energy cost of Station construction EVA.

Enabling an Integrated Rate-temporal Learning Scheme on Memristor

NASA Astrophysics Data System (ADS)

He, Wei; Huang, Kejie; Ning, Ning; Ramanathan, Kiruthika; Li, Guoqi; Jiang, Yu; Sze, Jiayin; Shi, Luping; Zhao, Rong; Pei, Jing

2014-04-01

Learning scheme is the key to the utilization of spike-based computation and the emulation of neural/synaptic behaviors toward realization of cognition. The biological observations reveal an integrated spike time- and spike rate-dependent plasticity as a function of presynaptic firing frequency. However, this integrated rate-temporal learning scheme has not been realized on any nano devices. In this paper, such scheme is successfully demonstrated on a memristor. Great robustness against the spiking rate fluctuation is achieved by waveform engineering with the aid of good analog properties exhibited by the iron oxide-based memristor. The spike-time-dependence plasticity (STDP) occurs at moderate presynaptic firing frequencies and spike-rate-dependence plasticity (SRDP) dominates other regions. This demonstration provides a novel approach in neural coding implementation, which facilitates the development of bio-inspired computing systems.

State formulating lifeline program

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

Not Available

1978-09-01

The Board of Public Utilities (BPU) of New Jersey is formulating a lifeline program which would provide low-income and elderly customers with reduced utility rates. It is estimated that 30% of the households in New Jersey will qualify for the program. While the legislation calls for the lowest effective rate of any customer class, each utility would have its own lifeline program because of differing rates among utility companies. Eligibility requirements would be applied statewide. The utilities will fund the new program by restructuring the existing rates for regular customers. In which case lifeline recipients' rate would decrease while regularmore » customers' bills would increase. Eventually, the BPU expects to fund about 10% of the senior citizens' portion of the program with the state's casino gambling revenues.« less

Joint source-channel coding for motion-compensated DCT-based SNR scalable video.

PubMed

Kondi, Lisimachos P; Ishtiaq, Faisal; Katsaggelos, Aggelos K

2002-01-01

In this paper, we develop an approach toward joint source-channel coding for motion-compensated DCT-based scalable video coding and transmission. A framework for the optimal selection of the source and channel coding rates over all scalable layers is presented such that the overall distortion is minimized. The algorithm utilizes universal rate distortion characteristics which are obtained experimentally and show the sensitivity of the source encoder and decoder to channel errors. The proposed algorithm allocates the available bit rate between scalable layers and, within each layer, between source and channel coding. We present the results of this rate allocation algorithm for video transmission over a wireless channel using the H.263 Version 2 signal-to-noise ratio (SNR) scalable codec for source coding and rate-compatible punctured convolutional (RCPC) codes for channel coding. We discuss the performance of the algorithm with respect to the channel conditions, coding methodologies, layer rates, and number of layers.

Geography, Not Health System Affiliations, Determines Patients' Revisits to the Emergency Department.

PubMed

Rising, Kristin L; Karp, David N; Powell, Rhea E; Victor, Timothy W; Carr, Brendan G

2018-04-01

To determine how frequently patients revisit the emergency department after an initial encounter, and to describe revisit capture rates for the same hospital, health system, and geographic region. Florida state data from January 1, 2010, to June 30, 2011, from the Healthcare Cost and Utilization Project. This is a retrospective cohort study of emergency department return visits among Florida adults over an 18-month period. We evaluated pairs of index and 30-day return emergency department visits and compared capture rates for hospital, health system, and geographic units. Data were obtained from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project and the American Hospital Association Annual Survey Database. Among 9,416,212 emergency department visits, 22.6 percent (2,124,441) were associated with a 30-day return. Seventy percent (1,477,772) of 30-day returns occurred to the same hospital. The 30-day return capture rates were highest within the same geographic area: county-level capture at 92 percent (IQR=86-96 percent) versus health system capture at 75 percent (IQR = 68-81 percent). Acute care utilization patterns are often independent of health system boundaries. Current population-based health care models that attribute patients to a single provider or health system may be strengthened by considering geographic patterns of acute care utilization. © Health Research and Educational Trust.

Utilization of professional mental health services according to recognition rate of mental health centers.

PubMed

Lee, Hyo Jung; Ju, Young Jun; Park, Eun-Cheol

2017-04-01

Despite the positive effect of community-based mental health centers, the utilization of professional mental health services appears to be low. Therefore, we analyzed the relationship between regional recognition of mental health centers and utilization of professional mental health services. We used data from the Community Health Survey (2014) and e-provincial indicators. Only those living in Seoul, who responded that they were either feeling a lot of stress or depression, were included in the study. Multiple logistic regression analysis using generalized estimating equations was performed to examine both individual- and regional-level variables associated with utilization of professional mental health services. Among the 7338 participants who reported depression or stress, 646 (8.8%) had consulted a mental health professional for their symptoms. A higher recognition rate of mental health centers was associated with more utilization of professional mental health services (odds ratio [OR]=1.05, 95% confidence interval [CI]=1.03-1.07). Accessibility to professional mental health services could be improved depending on the general population's recognition and attitudes toward mental health centers. Therefore, health policy-makers need to plan appropriate strategies for changing the perception of mental health services and informing the public about both the benefits and functions of mental health centers. Copyright © 2017. Published by Elsevier B.V.

Snowfall Rate Retrieval using NPP ATMS Passive Microwave Measurements

NASA Technical Reports Server (NTRS)

Meng, Huan; Ferraro, Ralph; Kongoli, Cezar; Wang, Nai-Yu; Dong, Jun; Zavodsky, Bradley; Yan, Banghua; Zhao, Limin

2014-01-01

Passive microwave measurements at certain high frequencies are sensitive to the scattering effect of snow particles and can be utilized to retrieve snowfall properties. Some of the microwave sensors with snowfall sensitive channels are Advanced Microwave Sounding Unit (AMSU), Microwave Humidity Sounder (MHS) and Advance Technology Microwave Sounder (ATMS). ATMS is the follow-on sensor to AMSU and MHS. Currently, an AMSU and MHS based land snowfall rate (SFR) product is running operationally at NOAA/NESDIS. Based on the AMSU/MHS SFR, an ATMS SFR algorithm has been developed recently. The algorithm performs retrieval in three steps: snowfall detection, retrieval of cloud properties, and estimation of snow particle terminal velocity and snowfall rate. The snowfall detection component utilizes principal component analysis and a logistic regression model. The model employs a combination of temperature and water vapor sounding channels to detect the scattering signal from falling snow and derive the probability of snowfall (Kongoli et al., 2014). In addition, a set of NWP model based filters is also employed to improve the accuracy of snowfall detection. Cloud properties are retrieved using an inversion method with an iteration algorithm and a two-stream radiative transfer model (Yan et al., 2008). A method developed by Heymsfield and Westbrook (2010) is adopted to calculate snow particle terminal velocity. Finally, snowfall rate is computed by numerically solving a complex integral. The ATMS SFR product is validated against radar and gauge snowfall data and shows that the ATMS algorithm outperforms the AMSU/MHS SFR.

A comparison of ground-based and aircraft-based methane emission flux estimates in a western oil and natural gas production basin

NASA Astrophysics Data System (ADS)

Snare, Dustin A.

Recent increases in oil and gas production from unconventional reservoirs has brought with it an increase of methane emissions. Estimating methane emissions from oil and gas production is complex due to differences in equipment designs, maintenance, and variable product composition. Site access to oil and gas production equipment can be difficult and time consuming, making remote assessment of emissions vital to understanding local point source emissions. This work presents measurements of methane leakage made from a new ground-based mobile laboratory and a research aircraft around oil and gas fields in the Upper Green River Basin (UGRB) of Wyoming in 2014. It was recently shown that the application of the Point Source Gaussian (PSG) method, utilizing atmospheric dispersion tables developed by US EPA (Appendix B), is an effective way to accurately measure methane flux from a ground-based location downwind of a source without the use of a tracer (Brantley et al., 2014). Aircraft measurements of methane enhancement regions downwind of oil and natural gas production and Planetary Boundary Layer observations are utilized to obtain a flux for the entire UGRB. Methane emissions are compared to volumes of natural gas produced to derive a leakage rate from production operations for individual production sites and basin-wide production. Ground-based flux estimates derive a leakage rate of 0.14 - 0.78 % (95 % confidence interval) per site with a mass-weighted average (MWA) of 0.20 % for all sites. Aircraft-based flux estimates derive a MWA leakage rate of 0.54 - 0.91 % for the UGRB.

Distributed Fair Auto Rate Medium Access Control for IEEE 802.11 Based WLANs

NASA Astrophysics Data System (ADS)

Zhu, Yanfeng; Niu, Zhisheng

Much research has shown that a carefully designed auto rate medium access control can utilize the underlying physical multi-rate capability to exploit the time-variation of the channel. In this paper, we develop a simple analytical model to elucidate the rule that maximizes the throughput of RTS/CTS based multi-rate wireless local area networks. Based on the discovered rule, we propose two distributed fair auto rate medium access control schemes called FARM and FARM+ from the view-point of throughput fairness and time-share fairness, respectively. With the proposed schemes, after receiving a RTS frame, the receiver selectively returns the CTS frame to inform the transmitter the maximum feasible rate probed by the signal-to-noise ratio of the received RTS frame. The key feature of the proposed schemes is that they are capable of maintaining throughput/time-share fairness in asymmetric situation where the distribution of SNR varies with stations. Extensive simulation results show that the proposed schemes outperform the existing throughput/time-share fair auto rate schemes in time-varying channel conditions.

Comparison of slope instability screening tools following a large storm event and application to forest management and policy

NASA Astrophysics Data System (ADS)

Whittaker, Kara A.; McShane, Dan

2012-04-01

The objective of this study was to assess and compare the ability of two slope instability screening tools developed by the Washington State Department of Natural Resources (WDNR) to assess landslide risks associated with forestry activities. HAZONE is based on a semi-quantitative method that incorporates the landslide frequency rate and landslide area rate for delivery of mapped landforms. SLPSTAB is a GIS-based model of inherent landform characteristics that utilizes slope geometry derived from DEMs and climatic data. Utilization of slope instability screening tools by geologists, land managers, and regulatory agencies can reduce the frequency and magnitude of landslides. Aquatic habitats are negatively impacted by elevated rates and magnitudes of landslides associated with forest management practices due to high sediment loads and alteration of stream channels and morphology. In 2007 a large storm with heavy rainfall impacted southwestern Washington State trigging over 2500 landslides. This storm event and accompanying landslides provides an opportunity to assess the slope stability screening tools developed by WDNR. Landslide density (up to 6.5 landslides per km2) from the storm was highest in the areas designated by the screening tools as high hazard areas, and both of the screening tools were equal in their ability to predict landslide locations. Landslides that initiated in low hazard areas may have resulted from a variety of site-specific factors that deviated from assumed model values, from the inadequate identification of potentially unstable landforms due to low resolution DEMs, or from the inadequate implementation of the state Forest Practices Rules. We suggest that slope instability screening tools can be better utilized by forest management planners and regulators to meet policy goals regarding minimizing landslide rates and impacts to sensitive aquatic species.

Strategy Guideline. Proper Water Heater Selection

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

Hoeschele, M.; Springer, D.; German, A.

2015-04-09

This Strategy Guideline on proper water heater selection was developed by the Building America team Alliance for Residential Building Innovation to provide step-by-step procedures for evaluating preferred cost-effective options for energy efficient water heater alternatives based on local utility rates, climate, and anticipated loads.

Strategy Guideline: Proper Water Heater Selection

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

Hoeschele, M.; Springer, D.; German, A.

2015-04-01

This Strategy Guideline on proper water heater selection was developed by the Building America team Alliance for Residential Building Innovation to provide step-by-step procedures for evaluating preferred cost-effective options for energy efficient water heater alternatives based on local utility rates, climate, and anticipated loads.

Cardio-Vascular Disease and Cancer

PubMed Central

Mitchell-Fearon, K.; Willie-Tyndale, D.; Waldron, N.; Holder-Nevins, D.; James, K.; Laws, H.; Eldemire-Shearer, D.

2015-01-01

Objective: To report the level of utilization of clinical preventive services by older adults in Jamaica and to identify independent factors associated with utilization. Method: A nationally representative, community-based survey of 2,943 older adults was undertaken. Utilization frequency for six preventive, cardiovascular or cancer-related services was calculated. Logistic regression models were used to determine the independent factors associated with each service. Results: A dichotomy in annual utilization rates exists with cardiovascular services having much higher uptake than those for cancer (83.1% for blood pressure, 76.7% blood glucose, 68.1% cholesterol, 35.1% prostate, 11.3% mammograms, and 9.6% papanicolaou smears). Age, source of routine care, and having a chronic disease were most frequently associated with uptake. Discussion: Education of providers and patients on the need for utilizing preventive services in older adults is important. Improved access to services in the public sector may also help increase uptake of services. PMID:28138475

Robot-assisted versus open radical prostatectomy utilization in hospitals offering robotics.

PubMed

Yanamadala, Swati; Chung, Benjamin I; Hernandez-Boussard, Tina M

2016-06-01

Prostate cancer is an extremely prevalent cause of morbidity and mortality among American men. Several different treatments exist, but differences in utilization between these treatments are not well understood. We performed an observational study using administrative datasets linked to hospital survey data, which included non-metastatic prostate cancer patients receiving robot-assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP) in California, Florida, or New York from 2009-2011. We developed two hierarchical regression models with fixed effect accounting for hospital clustering and physician clustering to determine factors associated with utilization of RARP versus ORP at hospitals offering robotic surgery. A total of 36,694 patients were identified, with 77.13% receiving RARP and 22.87% receiving ORP. African American patients had lower RARP rates than White patients (OR = 0.80, p < 0.001). Patients using Medicare (OR = 0.91, p = 0.028), Medicaid (OR = 0.68, p < 0.001), or self-pay (OR = 0.72, p = 0.046) had lower RARP rates than patients using private insurance. Patients in Florida had lower RARP rates than patients in California (OR = 0.48, p = 0.010). Patients treated at teaching hospitals had lower RARP rates than patients treated at non-teaching hospitals (OR = 0.50, p = 0.006). The average cost of RARP was $13,614.83, and the average cost of ORP was $12,167.44 (p < 0.001). This population based study suggests that both patient and hospital characteristics are associated with utilization of RARP versus ORP in hospitals where robotic surgery is offered.

Case manager-reported utilization of support group, substance use and mental health services among HIV-positive women in New York City.

PubMed

Kupprat, Sandra A; Dayton, Alex; Guschlbauer, Andrea; Halkitis, Perry N

2009-07-01

A retrospective, longitudinal analysis of case management and medical charts was used to evaluate utilization of support group, mental health, and substance abuse treatment services among HIV-positive women in New York City. Analyses of 4134 case management and supportive service transactions revealed that 70% utilized support groups over the two-year study period. In contrast, only 35% utilized mental health services (therapy) and of those identified as using substances, only 48% utilized substance abuse treatment services. Considering the high prevalence of mental illness (63%, n=29) and substance use (54%, n=25) in the sample, the low utilization rates highlight unmet needs for service. Significant differences were found in utilization of mental health and substance abuse treatment services, with those who received services at a medical model agency (integrated care) being more likely to receive both types of treatment. In contrast, participants attending support groups in non-medical model agencies (77.8%, n=7) were significantly more likely to be retained in group (i.e., attend 11 or more sessions) than those at medical model agencies (39.1%, n=9). Based on the higher utilization rates of support groups among seropositive women, perhaps these groups could be a vehicle for establishing rapport between mental health professionals and group members to bridge the utilization gap and reduce the stigma associated with therapy and substance abuse treatment services. These findings both taut the success and highlight weaknesses regarding accessing mental health and substance abuse care, and support group retention. Sharing of information regarding recruitment and retention efforts between agencies of different modalities would be beneficial and also could identify service niches that capitalize on their subsequent strengths.

Checkerboard seed-blanket thorium fuel core concepts for heavy water moderated reactors

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

Bromley, B.P.; Hyland, B.

2013-07-01

New reactor concepts to implement thorium-based fuel cycles have been explored to achieve maximum resource utilization. Pressure tube heavy water reactors (PT-HWR) are highly advantageous for implementing the use of thorium-based fuels because of their high neutron economy and on-line re-fuelling capability. The use of heterogeneous seed-blanket core concepts in a PT-HWR where higher-fissile-content seed fuel bundles are physically separate from lower-fissile-content blanket bundles allows more flexibility and control in fuel management to maximize the fissile utilization and conversion of fertile fuel. The lattice concept chosen was a 35-element bundle made with a homogeneous mixture of reactor grade Pu (aboutmore » 67 wt% fissile) and Th, and with a central zirconia rod to help reduce coolant void reactivity. Several checkerboard heterogeneous seed-blanket core concepts with plutonium-thorium-based fuels in a 700-MWe-class PT-HWR were analyzed, using a once-through thorium (OTT) cycle. Different combinations of seed and blanket fuel were tested to determine the impact on core-average burnup, fissile utilization, power distributions, and other performance parameters. It was found that various checkerboard core concepts can achieve a fissile utilization that is up to 26% higher than that achieved in a PT-HWR using more conventional natural uranium fuel bundles. Up to 60% of the Pu is consumed; up to 43% of the energy is produced from thorium, and up to 303 kg/year of Pa-233/U-233/U-235 are produced. Checkerboard cores with about 50% of low-power blanket bundles may require power de-rating (65% to 74%) to avoid exceeding maximum limits for channel and bundle powers and linear element ratings. (authors)« less

Annular seed-blanket thorium fuel core concepts for heavy water moderated reactors

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

Bromley, B.P.; Hyland, B.

2013-07-01

New reactor concepts to implement thorium-based fuel cycles have been explored to achieve maximum resource utilization. Pressure tube heavy water reactors (PT-HWR) are highly advantageous for implementing the use of thorium-based fuels because of their high neutron economy and on-line re-fuelling capability. The use of heterogeneous seed-blanket core concepts in a PT-HWR where higher-fissile-content seed fuel bundles are physically separate from lower-fissile-content blanket bundles allows more flexibility and control in fuel management to maximize the fissile utilization and conversion of fertile fuel. The lattice concept chosen is a 35-element bundle made with a homogeneous mixture of reactor grade Pu andmore » Th, and with a central zirconia rod to help reduce coolant void reactivity. Several annular heterogeneous seed-blanket core concepts with plutonium-thorium-based fuels in a 700-MWe-class PT-HWR were analyzed, using a once-through thorium (OTT) cycle. Different combinations of seed and blanket fuel were tested to determine the impact on core-average burnup, fissile utilization, power distributions, and other performance parameters. It was found that the various core concepts can achieve a fissile utilization that is up to 30% higher than is currently achieved in a PT-HWR using conventional natural uranium fuel bundles. Up to 67% of the Pu is consumed; up to 43% of the energy is produced from thorium, and up to 363 kg/year of U-233 is produced. Seed-blanket cores with ∼50% content of low-power blanket bundles may require power de-rating (∼58% to 65%) to avoid exceeding maximum limits for peak channel power, bundle power and linear element ratings. (authors)« less

Trends in antibiotic utilization in Vancouver associated with a community education program on antibiotic use.

PubMed

Fuertes, Elaine Isabelle; Henry, Bonnie; Marra, Fawziah; Wong, Hubert; Patrick, David M

2010-01-01

"Do Bugs Need Drugs" (DBND) is a community education program that was implemented in British Columbia (BC) in September 2005 to decrease inappropriate antibiotic use. This study conducted descriptive analyses of the association between DBND and changes in overall, pediatric, drug-specific, and indication-specific antibiotic utilization rates in Vancouver, BC. Utilization data on all oral solid and liquid antibiotics classified as "antibacterials for systemic use" were obtained from BC PharmaNet for the years 1996 to 2008. Utilization data were linked to physician billing data to allow indication-specific analyses. Following conversion to the defined daily dose (DDD), the Holt-Winters exponential smoothing method was used to project expected antibiotic use in the period after implementation based on use prior to implementation. Differences between expected and observed utilization rates were calculated. Overall antibiotic use has stabilized in recent years (16.2 DDD/1000 population/day in 2008). Fluoroquinolone use remains high (1.5 DDD/1000 population/day), as does the steadily increasing use of newer macrolides (1.1 to 2.7 DDD/1000 population/day between 1996 and 2008). Encouraging declines in overall and indication-specific prescription rates among children were observed. Following 3 years of DBND activities, antibiotic use was 5.8% lower than expected and the number of prescriptions dispensed to children was 10.6% lower than expected. This ecological study reports improvements in antibiotic use that occurred simultaneously to the delivery of the DBND program in Vancouver. However, we did not find a lowering of all targeted classes. Policy directives limiting the use of certain antibiotics may be required.

A national examination of pharmacy-based immunization statutes and their association with influenza vaccinations and preventive health.

PubMed

McConeghy, Kevin W; Wing, Coady

2016-06-24

A series of state-level statute changes have allowed pharmacists to provide influenza vaccinations in community pharmacies. The study aim was to estimate the effects of pharmacy-based immunization statutes changes on per capita influenza vaccine prescriptions, adult vaccination rates, and the utilization of other preventive health services. A quasi-experimental study that compares vaccination outcomes over time before and after states allowed pharmacy-based immunization. Measures of per capita pharmacy prescriptions for influenza vaccines in each state came from a proprietary pharmacy prescription database. Data on adult vaccination rates and preventive health utilization were studied using multiple waves of the Behavioral Risk Factor Surveillance System (BRFSS). The primary outcomes were changes in per capita influenza vaccine pharmacy prescriptions, adult vaccination rates, and preventive health interventions following changes. Between 2007 and 2013, the number of influenza vaccinations dispensed in community pharmacies increased from 3.2 to 20.9 million. After one year, adopting pharmacist immunization statutes increased per capita influenza vaccine prescriptions by an absolute difference (AD) of 2.6% (95% CI: 1.1-4.2). Adopting statutes did not lead to a significant absolute increase in adult vaccination rates (AD 0.9%, 95% CI: -0.3, 2.2). There also was no observed difference in adult vaccination rates among adults at high-risk of influenza complications (AD 0.8%, 95% CI: -0.2, 1.8) or among standard demographic subgroups. There also was no observed difference in the receipt of preventive health services, including routine physician office visits (AD -1.9%, 95% CI: -4.9, 1.1). Pharmacists are providing millions of influenza vaccines as a consequence of immunization statutes, but we do not observe significant differences in adult influenza vaccination rates. The main gains from pharmacy-based immunization may be in providing a more convenient way to obtain an important health service. Published by Elsevier Ltd.

γ' Precipitation Study of a Co-Ni-Based Alloy

NASA Astrophysics Data System (ADS)

Locq, D.; Martin, M.; Ramusat, C.; Fossard, F.; Perrut, M.

2018-05-01

A Co-Ni-based alloy strengthened by γ'-(L12) precipitates was utilized to investigate the precipitation evolution after various cooling rates and several aging conditions. In this study, the precipitate size and volume fraction have been studied via scanning electron microscopy and transmission electron microscopy. The influence of the precipitation evolution was measured via microhardness tests. The cooling rate study shows a more sluggish γ' precipitation reaction compared to that observed in a Ni-based superalloy. Following a rapid cooling rate, the application of appropriate double aging treatments allows for the increase of the γ' volume fraction as well as the control of the size and distribution of the precipitates. The highest hardness values reach those measured on supersolvus cast and wrought Ni-based superalloys. The observed γ' precipitation behavior should have implications for the production, the heat treatment, the welding, or the additive manufacturing of this new class of high-temperature materials.

The cost-utility of photodynamic therapy in eyes with neovascular macular degeneration--a value-based reappraisal with 5-year data.

PubMed

Brown, Gary C; Brown, Melissa M; Campanella, Joseph; Beauchamp, George R

2005-10-01

To assess the value conferred by photodynamic therapy (PDT) and the cost-utility of PDT for the treatment of classic, subfoveal choroidal neovascularization associated with age-related macular degeneration (ARMD). Average cost-utility analysis utilizing clinical trial data, patient-based time tradeoff utility preferences, and a third party insurer cost perspective. Five-year visual acuity data from the TAP (Treatment of Age-related Macular Degeneration With Photodynamic Therapy) Investigation were modeled into a 12-year, value-based, reference case, cost-utility model utilizing year 2004 Medicare costs and an outcome of dollar/QALY (dollars/quality-adjusted life-year). Discounting of outcomes and costs using net present value analysis with a 3% annual rate was performed as recommended by the Panel for Cost-Effectiveness in Health and Medicine. PDT with verteporfin (Visudyne) dye for classic subfoveal choroidal neovascularization confers an 8.1% quality of life (value) improvement over the 12-year life expectancy of the reference case, while during the last 8 years the value improvement is 9.5%. The average cost-utility of the intervention is dollar 31,103/QALY (quality-adjusted life-year). Extensive one-way sensitivity analysis values range from dollar 20,736/QALY if treatment efficacy is increased by 50% to dollar 62,207 if treatment efficacy is decreased by 50%, indicating robustness of the model. PDT using verteporfin dye to treat classic subfoveal choroidal neovascularization is a very cost-effective treatment by conventional standards. The marked improvement in cost-effectiveness compared with a previous report results from the facts that the treatment benefit increasingly accrues during 5 years of follow-up while the number of yearly treatments diminishes markedly during that time.

Biodegradability and platelets adhesion assessment of magnesium-based alloys using a microfluidic system

PubMed Central

Liu, Lumei; Koo, Youngmi; Collins, Boyce; Xu, Zhigang; Sankar, Jagannathan

2017-01-01

Magnesium (Mg)-based stents are extensively explored to alleviate atherosclerosis due to their biodegradability and relative hemocompatibility. To ensure the quality, safety and cost-efficacy of bioresorbable scaffolds and full utilization of the material tunability afforded by alloying, it is critical to access degradability and thrombosis potential of Mg-based alloys using improved in vitro models that mimic as closely as possible the in vivo microenvironment. In this study, we investigated biodegradation and initial thrombogenic behavior of Mg-based alloys at the interface between Mg alloys’ surface and simulated physiological environment using a microfluidic system. The degradation properties of Mg-based alloys WE43, AZ31, ZWEK-L, and ZWEK-C were evaluated in complete culture medium and their thrombosis potentials in platelet rich plasma, respectively. The results show that 1) physiological shear stress increased the corrosion rate and decreased platelets adhesion rate as compared to static immersion; 2) secondary phases and impurities in material composition induced galvanic corrosion, resulting in higher corrosion resistance and platelet adhesion rate; 3) Mg-based alloys with higher corrosion rate showed higher platelets adhesion rate. We conclude that a microfluidic-based in vitro system allows evaluation of biodegradation behaviors and platelets responses of Mg-based alloys under specific shear stress, and degradability is related to platelets adhesion. PMID:28797069

The impact of complex chronic diseases on care utilization among assisted living residents

PubMed Central

McNabney, Matthew K.; Onyike, Chiadi; Johnston, Deirdre; Mayer, Lawrence; Lyketsos, Constantine; Brandt, Jason; Rosenblatt, Adam; Samus, Quincy

2014-01-01

Purpose Many residents of assisted living (AL) have chronic diseases that are difficult to manage, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). We estimated the amount and intensity of care delivered by the staff for residents with these conditions. Methods We performed a secondary data analysis from the Maryland Assisted Living (MDAL) Study (399 residents, 29 facilities). In-person assessments included measures of cognition, function, depression, and general medical health. Diagnosis of CHF, COPD, and DM, as well as current medications was abstracted from AL medical charts. Measures of care utilization were operationalized at the resident level as: 1) minutes per day of direct care (caregiver activity scale [CAS]), 2) subjective staff ratings of care burden, and 3) assigned AL “level of care” (based on state regulatory criteria). Results In best fit regression models, CHF and DM were not significant predictors of the evaluated care utilization measures; however, COPD was independently associated with increased minutes per day of direct care – 34% of the variance in the caregiver activity scale was explained by degree of functional dependency, cognitive impairment, age, and presence of COPD. Functional dependency, depressive symptoms, and age explained almost a quarter (23%) of the variance of staff care burden rating. For the AL level of care intensity rating, degree of functional dependency, level of cognition, and age were significant correlates, together explaining about 28% of the variance. Conclusion The presence of COPD was a significant predictor of time per day of direct care. However, CHF and DM were not correlates of care utilization measures. Functional and cognitive impairment was associated with measures of care utilization, reiterating the importance of these characteristics in the utilization and intensity of care consumed by AL residents. Further study of this population could reveal other forms and amounts of care utilization. PMID:24139207

Social foraging with partial (public) information.

PubMed

Mann, Ofri; Kiflawi, Moshe

2014-10-21

Group foragers can utilize public information to better estimate patch quality and arrive at more efficient patch-departure rules. However, acquiring such information may come at a cost; e.g. reduced search efficiency. We present a Bayesian group-foraging model in which social foragers do not require full awareness of their companions' foraging success; only of their number. In our model, patch departure is based on direct estimates of the number of remaining items. This is achieved by considering all likely combinations of initial patch-quality and group foraging-success; given the individual forager's experience within the patch. Slower rates of information-acquisition by our 'partially-aware' foragers lead them to over-utilize poor patches; more than fully-aware foragers. However, our model suggests that the ensuing loss in long-term intake-rates can be matched by a relatively low cost to the acquisition of full public information. In other words, we suggest that group-size offers sufficient information for optimal patch utilization by social foragers. We suggest, also, that our model is applicable to other situations where resources undergo 'background depletion', which is coincident but independent of the consumer's own utilization. Copyright © 2014 Elsevier Ltd. All rights reserved.

Time series modeling for syndromic surveillance.

PubMed

Reis, Ben Y; Mandl, Kenneth D

2003-01-23

Emergency department (ED) based syndromic surveillance systems identify abnormally high visit rates that may be an early signal of a bioterrorist attack. For example, an anthrax outbreak might first be detectable as an unusual increase in the number of patients reporting to the ED with respiratory symptoms. Reliably identifying these abnormal visit patterns requires a good understanding of the normal patterns of healthcare usage. Unfortunately, systematic methods for determining the expected number of (ED) visits on a particular day have not yet been well established. We present here a generalized methodology for developing models of expected ED visit rates. Using time-series methods, we developed robust models of ED utilization for the purpose of defining expected visit rates. The models were based on nearly a decade of historical data at a major metropolitan academic, tertiary care pediatric emergency department. The historical data were fit using trimmed-mean seasonal models, and additional models were fit with autoregressive integrated moving average (ARIMA) residuals to account for recent trends in the data. The detection capabilities of the model were tested with simulated outbreaks. Models were built both for overall visits and for respiratory-related visits, classified according to the chief complaint recorded at the beginning of each visit. The mean absolute percentage error of the ARIMA models was 9.37% for overall visits and 27.54% for respiratory visits. A simple detection system based on the ARIMA model of overall visits was able to detect 7-day-long simulated outbreaks of 30 visits per day with 100% sensitivity and 97% specificity. Sensitivity decreased with outbreak size, dropping to 94% for outbreaks of 20 visits per day, and 57% for 10 visits per day, all while maintaining a 97% benchmark specificity. Time series methods applied to historical ED utilization data are an important tool for syndromic surveillance. Accurate forecasting of emergency department total utilization as well as the rates of particular syndromes is possible. The multiple models in the system account for both long-term and recent trends, and an integrated alarms strategy combining these two perspectives may provide a more complete picture to public health authorities. The systematic methodology described here can be generalized to other healthcare settings to develop automated surveillance systems capable of detecting anomalies in disease patterns and healthcare utilization.

Health-related quality of life measured using the EQ-5D-5L: South Australian population norms.

PubMed

McCaffrey, Nikki; Kaambwa, Billingsley; Currow, David C; Ratcliffe, Julie

2016-09-20

Although a five level version of the widely-used EuroQol 5 dimensions (EQ-5D) instrument has been developed, population norms are not yet available for Australia to inform the future valuation of health in economic evaluations. The aim of this study was to estimate HrQOL normative values for the EQ-5D-5L preference-based measure in a large, randomly selected, community sample in South Australia. The EQ-5D-5L instrument was included in the 2013 South Australian Health Omnibus Survey, an interviewer-administered, face-to-face, cross-sectional survey. Respondents rated their level of impairment across dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and global health rating on a visual analogue scale (EQ-VAS). Utility scores were derived using the newly-developed UK general population-based algorithm and relationships between utility and EQ-VAS scores and socio-demographic factors were also explored using multivariate regression analyses. Ultimately, 2,908 adults participated in the survey (63.4 % participation rate). The mean utility and EQ-VAS scores were 0.91 (95 CI 0.90, 0.91) and 78.55 (95 % CI 77.95, 79.15), respectively. Almost half of respondents reported no problems across all dimensions (42.8 %), whereas only 7.2 % rated their health >90 on the EQ-VAS (100 = the best health you can imagine). Younger age, male gender, longer duration of education, higher annual household income, employment and marriage/de facto relationships were all independent, statistically significant predictors of better health status (p < 0.01) measured with the EQ-VAS. Only age and employment status were associated with higher utility scores, indicating fundamental differences between these measures of health status. This is the first Australian study to apply the EQ-5D-5L in a large, community sample. Overall, findings are consistent with EQ-5D-5L utility and VAS scores reported for other countries and indicate that the majority of South Australian adults report themselves in full health. When valuing health in Australian economic evaluations, the utility population norms can be used to estimate HrQOL. More generally, the EQ-VAS score may be a better measure of population health given the smaller ceiling effect and broader coverage of HrQOL dimensions. Further research is recommended to update EQ-5D-5L population norms using the Australian general population specific scoring algorithm once this becomes publically available.

75 FR 65315 - Combined Notice of Filings #2

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-22

.... Applicants: Black Hills Power, Inc., Black Hills/Colorado Electric Utility Co, Black Hills Wyoming, LLC, Cheyenne Light, Fuel and Power Company. Description: Updated Market Power Analysis of the Black Hills... LLC submits tariff filing per 35.17(b): Amendment to Market-Based Rate Application Reflecting Change...

75 FR 9189 - Notice of Proposed Information Collection Requests

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-01

... mandated standardized test scores); follow-up surveys for students; teacher and parent rating/observation on various student aspects (e.g., student social skills); baseline and follow-up surveys for teachers... Character (LIC) program. This study is based on an experimental design that utilizes the random assignment...

The future prospects of supply and demand for urologists in Korea

PubMed Central

2017-01-01

Purpose The purpose of this study was to forecast the future supply and demand for urologists and to discuss the possible policy implications. Materials and Methods A demographic utilization-based model was used to calculate the total urologist requirements for Korea. Utilization rates for ambulatory and inpatient genitourinary specialty services were estimated according to age, sex, and insurance status. These rates were used to estimate genitourinary specialty-specific total service utilization expressed in patient care minutes for future populations and converted to genitourinary physician requirements by applying per-genitourinary-physician productivity estimates. An in-and-out movement model for urologist supply was used. Results Depending on assumptions about data at each step in the method, the supply of urologic surgeons is expected to exceed the demand by 2025 under the current enrollment rate of specialists (43.5% in 2012) when comparing the results of the projections under demand scenarios 3 and 4. However, if the current enrollment rate persists, the imbalance in supply and demand will be not severe by 2030. The degree of imbalance can be alleviated by 2030 by maintaining the current occupancy rate of urologic residents of 43.5%. Conclusions This study shows that the number of residents needs to be reduced according to the supply and demand for urologic surgeons. Moreover, a policy should be established to maintain the current occupancy rate of residents. The factors affecting the supply and demand of urologic surgeons are complicated. Thus, comprehensive policies encompassing these factors should be established with appropriate solutions. PMID:29124238

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

Parmesano, Hethie; Kury, Theodore J.

The price of CO{sub 2} emissions allowances affects the structure of the utility's costs, which has implications for rate design and load management programs. Depending on the design of the program to recover these costs, utility total revenue requirements - and the rate design utilized to recover these requirements - may be impacted. A new way to think about rate design may be required. (author)

Healthcare Utilization Rates after Oregon's 2008 Medicaid Expansion: Within-and between-group differences over time among New, Returning, and Continuously Insured Enrollees

PubMed Central

O'Malley, Jean P.; Rosetti, Maureen O'Keeffe; Lowe, Robert A.; Angier, Heather; Gold, Rachel; Marino, Miguel; Hatch, Brigit; Hoopes, Megan; Bailey, Steffani R.; Heintzman, John; Gallia, Charles; DeVoe, Jennifer E.

2016-01-01

Background Although past research demonstrated that Medicaid expansions were associated with increased emergency department (ED) and primary care (PC) utilization, little is known about how long this increased utilization persists or whether post-coverage utilization is affected by prior insurance status. Objectives (1) To assess changes in ED, PC, mental and behavioral health care (MBHC), and specialty care visit rates among individuals gaining Medicaid over 24 months post-insurance gain; (2) To evaluate the association of previous insurance with utilization. Methods Using claims data, we conducted a retrospective cohort analysis of adults insured for 24 months following Oregon's 2008 Medicaid expansion. Utilization rates among 1,124 new and 1,587 returning enrollees were compared to those among 5,126 enrollees with continuous Medicaid coverage (≥1 year pre-expansion). Visit rates were adjusted for propensity score classes and geographic region. Results PC visit rates in both newly and returning insured individuals significantly exceeded those in the continuously insured in months four through 12, but were not significantly elevated in the second year. In contrast, ED utilization rates were significantly higher in returning insured compared to newly or continuously insured individuals and remained elevated over time. New visits to PC and specialist care were higher among those who gained Medicaid compared to the continuously insured throughout the study period. Conclusions Predicting the effect of insurance expansion on healthcare utilization should account for the prior coverage history of new enrollees. Additionally, utilization of outpatient services changes with time after insurance, so expansion evaluations should allow for rate stabilization. PMID:27547943

Changes in morbidity and medical care utilization after the recent economic crisis in the Republic of Korea.

PubMed

Kim, Hanjoong; Chung, Woo Jin; Song, Young Jong; Kang, Dae Ryong; Yi, Jee Jeon; Nam, Chung Mo

2003-01-01

To examine and quantify the impact of the recent economic crisis on morbidity and medical care utilization in the Republic of Korea. 22 675 people from 6791 households and 43 682 people from 12 283 households were questioned for two nationwide surveys that took place in 1995 and 1998, respectively. A separate sample pretest-posttest design was used and we conducted c2 test and logistic regression analysis after controlling for the maturation effect of the morbidity and medical care utilization. The morbidity rates of chronic disease and acute disease increased significantly by 27.1% and 9.5%, respectively, whereas the utilization rates of outpatient and inpatient services decreased by 15.1% and 5.2%, respectively. In particular, the pace of decline in the utilization rate of outpatient services varied depending on the type of disease: morbidity rates for mental and behavioural disorders were 13.7%; for cardiovascular disease, 7.1%; and for injury, 31.6%. After the Republic of Korean economic crisis, the morbidity and medical care utilization rates changed significantly but the degree of change depended on the type of disease or service. The time-dependent relationship between the national economy and the morbidity and medical care utilization rates needs to be further investigated.

Capnography and chest wall impedance algorithms for ventilation detection during cardiopulmonary resuscitation

PubMed Central

Edelson, Dana P.; Eilevstjønn, Joar; Weidman, Elizabeth K.; Retzer, Elizabeth; Vanden Hoek, Terry L.; Abella, Benjamin S.

2009-01-01

Objective Hyperventilation is both common and detrimental during cardiopulmonary resuscitation (CPR). Chest wall impedance algorithms have been developed to detect ventilations during CPR. However, impedance signals are challenged by noise artifact from multiple sources, including chest compressions. Capnography has been proposed as an alternate method to measure ventilations. We sought to assess and compare the adequacy of these two approaches. Methods Continuous chest wall impedance and capnography were recorded during consecutive in-hospital cardiac arrests. Algorithms utilizing each of these data sources were compared to a manually determined “gold standard” reference ventilation rate. In addition, a combination algorithm, which utilized the highest of the impedance or capnography values in any given minute, was similarly evaluated. Results Data were collected from 37 cardiac arrests, yielding 438 min of data with continuous chest compressions and concurrent recording of impedance and capnography. The manually calculated mean ventilation rate was 13.3±4.3/min. In comparison, the defibrillator’s impedance-based algorithm yielded an average rate of 11.3±4.4/min (p=0.0001) while the capnography rate was 11.7±3.7/min (p=0.0009). There was no significant difference in sensitivity and positive predictive value between the two methods. The combination algorithm rate was 12.4±3.5/min (p=0.02), which yielded the highest fraction of minutes with respiratory rates within 2/min of the reference. The impedance signal was uninterpretable 19.5% of the time, compared with 9.7% for capnography. However, the signals were only simultaneously non-interpretable 0.8% of the time. Conclusions Both the impedance and capnography-based algorithms underestimated the ventilation rate. Reliable ventilation rate determination may require a novel combination of multiple algorithms during resuscitation. PMID:20036047

Computational Simulation of the High Strain Rate Tensile Response of Polymer Matrix Composites

NASA Technical Reports Server (NTRS)

Goldberg, Robert K.

2002-01-01

A research program is underway to develop strain rate dependent deformation and failure models for the analysis of polymer matrix composites subject to high strain rate impact loads. Under these types of loading conditions, the material response can be highly strain rate dependent and nonlinear. State variable constitutive equations based on a viscoplasticity approach have been developed to model the deformation of the polymer matrix. The constitutive equations are then combined with a mechanics of materials based micromechanics model which utilizes fiber substructuring to predict the effective mechanical and thermal response of the composite. To verify the analytical model, tensile stress-strain curves are predicted for a representative composite over strain rates ranging from around 1 x 10(exp -5)/sec to approximately 400/sec. The analytical predictions compare favorably to experimentally obtained values both qualitatively and quantitatively. Effective elastic and thermal constants are predicted for another composite, and compared to finite element results.

A Comprehensive Assessment of Health Care Utilization Among Homeless Adults Under a System of Universal Health Insurance

PubMed Central

Chambers, Catharine; Chiu, Shirley; Katic, Marko; Kiss, Alex; Redelmeier, Donald A.; Levinson, Wendy

2013-01-01

Objectives. We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. Methods. We assessed health care utilization by 1165 homeless single men and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and 95% confidence intervals (CIs). Results. Homeless participants had mean rates of 9.1 ambulatory care encounters (maximum = 141.1), 2.0 emergency department (ED) encounters (maximum = 104.9), 0.2 medical–surgical hospitalizations (maximum = 14.9), and 0.1 psychiatric hospitalizations per person-year (maximum = 4.8). Rate ratios for homeless participants compared with matched controls were 1.76 (95% CI = 1.58, 1.96) for ambulatory care encounters, 8.48 (95% CI = 6.72, 10.70) for ED encounters, 4.22 (95% CI = 2.99, 5.94) for medical–surgical hospitalizations, and 9.27 (95% CI = 4.42, 19.43) for psychiatric hospitalizations. Conclusions. In a universal health insurance system, homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services. PMID:24148051

How gender, age, and geography influence the utilization of radiation therapy in the management of malignant melanoma

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

French, John; McGahan, Colleen; Duncan, Graeme

2006-11-15

Purpose: Comparing radiation therapy utilization rates (RTUR) to those predicted by best evidence is a useful measure of the equity and accessibility of service delivery. In this study the RTUR for melanoma was established for British Columbia, Canada, and compared with the rate suggested by the evidence. Demographic variables, specifically age, gender, and geography that influenced the RTUR were examined with a view to identifying methods of improving underutilization. Methods and Materials: The RTUR in the management of malignant melanoma was taken from British Columbia Cancer registry data for 1986 to 1998. Variations in utilization based on age, gender, healthmore » authority, stage of disease, and referral patterns were analyzed. Results: An RTUR of 11% was identified. This was consistent over time. Referral rates decreased between 1986 and 1998. RT is used mostly for later stage disease. Males were more likely to receive RT than females, related to later stage of disease in men. Referral rates decreased, but RTUR for referred cases increased, in health authorities that did not have a cancer center. Conclusions: Use of RT is influenced by age and by stage of disease. Overall RTUR in British Columbia is lower than suggested by best evidence. Referral patterns are influenced by geography. RTUR was higher in males, consistent with a different pattern of disease in males compared with females.« less

Hubble Space Telescope Angular Velocity Estimation During the Robotic Servicing Mission

NASA Technical Reports Server (NTRS)

Thienel, Julie K.; Queen, Steven Z.; VanEepoel, John M.; Sanner, Robert M.

2005-01-01

During the Hubble Robotic Servicing Mission, the Hubble Space Telescope (HST) attitude and rates are necessary to achieve the capture of HST by the Hubble Robotic Vehicle (HRV). The attitude and rates must be determined without the HST gyros or HST attitude estimates. The HRV will be equipped with vision-based sensors, capable of estimating the relative attitude between HST and HRV. The HST attitude is derived from the measured relative attitude and the HRV computed inertial attitude. However, the relative rate between HST and HRV cannot be measured directly. Therefore, the HST rate with respect to inertial space is not known. Two approaches are developed to estimate the HST rates. Both methods utilize the measured relative attitude and the HRV inertial attitude and rates. First, a nonlinear estimator is developed. The nonlinear approach estimates the HST rate through an estimation of the inertial angular momentum. Second, a linearized approach is developed. The linearized approach is based on more traditional Extended Kalman filter techniques. Simulation test results for both methods are given.

System-Wide Water Resources Program Nutrient Sub-Model (SWWRP-NSM) Version 1.1

DTIC Science & Technology

2008-09-01

species including crops, native grasses, and trees . The process descriptions utilize a single plant growth model to simulate all types of land covers...characteristics: • Multi- species , multi-phase, and multi-reaction system • Fast (equilibrium-based) and slow (non-equilibrium-based or rate- based...Transformation and loading of N and P species in the overland flow • Simulation of the N and P cycle in the water column (both overland and

How well do General EMS 911 dispatch protocols predict ED resource utilization for pediatric patients?

PubMed

Fessler, Stephanie J; Simon, Harold K; Yancey, Arthur H; Colman, Michael; Hirsh, Daniel A

2014-03-01

The use of Emergency Medical Services (EMS) for low-acuity pediatric problems is well documented. Attempts have been made to curb potentially unnecessary transports, including using EMS dispatch protocols, shown to predict acuity and needs of adults. However, there are limited data about this in children. The primary objective of this study is to determine the pediatric emergency department (PED) resource utilization (surrogate of acuity level) for pediatric patients categorized as "low-acuity" by initial EMS protocols. Records of all pediatric patients classified as "low acuity" and transported to a PED in winter and summer of 2010 were reviewed. Details of the PED visit were recorded. Patients were categorized and compared based on chief complaint group. Resource utilization was defined as requiring any prescription medications, labs, procedures, consults, admission or transfer. "Under-triage" was defined as a "low-acuity" EMS transport subsequently requiring emergent interventions. Of the 876 eligible cases, 801 were included; 392/801 had no resource utilization while 409 of 801 had resource utilization. Most (737/801) were discharged to home; however, 64/801 were admitted, including 1 of 801 requiring emergent intervention (under-triage rate 0.12%). Gastroenterology and trauma groups had a significant increase in resource utilization, while infectious disease and ear-nose-throat groups had decreased resource utilization. While this EMS system did not well predict overall resource utilization, it safely identified most low-acuity patients, with a low under-triage rate. This study identifies subgroups of patients that could be managed without emergent transport and can be used to further refine current protocols or establish secondary triage systems. © 2013.

Predictive Optimal Control of Active and Passive Building Thermal Storage Inventory

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

Gregor P. Henze; Moncef Krarti

2005-09-30

Cooling of commercial buildings contributes significantly to the peak demand placed on an electrical utility grid. Time-of-use electricity rates encourage shifting of electrical loads to off-peak periods at night and weekends. Buildings can respond to these pricing signals by shifting cooling-related thermal loads either by precooling the building's massive structure or the use of active thermal energy storage systems such as ice storage. While these two thermal batteries have been engaged separately in the past, this project investigated the merits of harnessing both storage media concurrently in the context of predictive optimal control. To pursue the analysis, modeling, and simulationmore » research of Phase 1, two separate simulation environments were developed. Based on the new dynamic building simulation program EnergyPlus, a utility rate module, two thermal energy storage models were added. Also, a sequential optimization approach to the cost minimization problem using direct search, gradient-based, and dynamic programming methods was incorporated. The objective function was the total utility bill including the cost of reheat and a time-of-use electricity rate either with or without demand charges. An alternative simulation environment based on TRNSYS and Matlab was developed to allow for comparison and cross-validation with EnergyPlus. The initial evaluation of the theoretical potential of the combined optimal control assumed perfect weather prediction and match between the building model and the actual building counterpart. The analysis showed that the combined utilization leads to cost savings that is significantly greater than either storage but less than the sum of the individual savings. The findings reveal that the cooling-related on-peak electrical demand of commercial buildings can be considerably reduced. A subsequent analysis of the impact of forecasting uncertainty in the required short-term weather forecasts determined that it takes only very simple short-term prediction models to realize almost all of the theoretical potential of this control strategy. Further work evaluated the impact of modeling accuracy on the model-based closed-loop predictive optimal controller to minimize utility cost. The following guidelines have been derived: For an internal heat gain dominated commercial building, reasonable geometry simplifications are acceptable without a loss of cost savings potential. In fact, zoning simplification may improve optimizer performance and save computation time. The mass of the internal structure did not show a strong effect on the optimization. Building construction characteristics were found to impact building passive thermal storage capacity. It is thus advisable to make sure the construction material is well modeled. Zone temperature setpoint profiles and TES performance are strongly affected by mismatches in internal heat gains, especially when they are underestimated. Since they are a key factor in determining the building cooling load, efforts should be made to keep the internal gain mismatch as small as possible. Efficiencies of the building energy systems affect both zone temperature setpoints and active TES operation because of the coupling of the base chiller for building precooling and the icemaking TES chiller. Relative efficiencies of the base and TES chillers will determine the balance of operation of the two chillers. The impact of mismatch in this category may be significant. Next, a parametric analysis was conducted to assess the effects of building mass, utility rate, building location and season, thermal comfort, central plant capacities, and an economizer on the cost saving performance of optimal control for active and passive building thermal storage inventory. The key findings are: (1) Heavy-mass buildings, strong-incentive time-of-use electrical utility rates, and large on-peak cooling loads will likely lead to attractive savings resulting from optimal combined thermal storage control. (2) By using economizer to take advantage of the cool fresh air during the night, the building electrical cost can be reduced by using less mechanical cooling. (3) Larger base chiller and active thermal storage capacities have the potential of shifting more cooling loads to off-peak hours and thus higher savings can be achieved. (4) Optimal combined thermal storage control with a thermal comfort penalty included in the objective function can improve the thermal comfort levels of building occupants when compared to the non-optimized base case. Lab testing conducted in the Larson HVAC Laboratory during Phase 2 showed that the EnergyPlus-based simulation was a surprisingly accurate prediction of the experiment. Therefore, actual savings of building energy costs can be expected by applying optimal controls from simulation results.« less

Methodological Review of Intimate Partner Violence Prevention Research

ERIC Educational Resources Information Center

Murray, Christine E.; Graybeal, Jennifer

2007-01-01

The authors present a methodological review of empirical program evaluation research in the area of intimate partner violence prevention. The authors adapted and utilized criterion-based rating forms to standardize the evaluation of the methodological strengths and weaknesses of each study. The findings indicate that the limited amount of…

Interaction of bale size and preservative rate for large-round bales of alfalfa hay

USDA-ARS?s Scientific Manuscript database

Recently, two studies conducted at the US Dairy Forage Research Center have reported inconsistent storage responses following the application of propionic-acid-based preservatives to alfalfa or alfalfa-orchardgrass hays. One of these studies utilized 5-foot-diameter round bales, and produced disappo...

Satellite retrievals of leaf chlorophyll and photosynthetic capacity for improved modeling of GPP

USDA-ARS?s Scientific Manuscript database

This study investigates the utility of in-situ and satellite-based leaf chlorophyll (Chl) estimates for quantifying leaf photosynthetic capacity and for constraining model simulations of Gross Primary Productivity (GPP) over a corn field in Maryland, U.S.A. The maximum rate of carboxylation (Vmax) r...

Relationship Between Vehicle Size and Fatality Risk in Model Year 1985-93 Passenger Cars and Light Trucks

DOT National Transportation Integrated Search

1997-01-01

Fatality rates per million exposure years are computed by make, model and model year, : based on the crash experience of model year 1985-93 passenger cars and light trucks (pickups) vans : and sport utility vehicles) in the United States during calen...

The Effect of Project-Based Learning on Student Self-Efficacy in a Developmental Mathematics Course

ERIC Educational Resources Information Center

Deutsch, Melissa

2017-01-01

Each year, post-secondary institutions across the nation enroll thousands of students into developmental mathematics courses. Success rates are low for students placed in developmental mathematics courses employing traditional teaching practices. Secondary institutions utilizing more engaging pedagogies and high impact practices, such as…

25 CFR 161.204 - How are carrying capacities and stocking rates established?

Code of Federal Regulations, 2010 CFR

2010-04-01

... be based on forage production, range utilization, the application of land management practices, and range improvements in place to achieve uniformity of grazing under sustained yield management principles... agricultural resource management plan and range unit management plan. (b) BIA, with the concurrence of the...

Trends and outcome predictors after traumatic brain injury surgery: a nationwide population-based study in Taiwan.

PubMed

Shi, Hon-Yi; Hwang, Shiuh-Lin; Lee, I-Chen; Chen, I-Te; Lee, King-Teh; Lin, Chih-Lung

2014-12-01

The authors sought to analyze trends in hospital resource utilization and mortality rates in a population of patients who had received traumatic brain injury (TBI) surgery. This nationwide population-based cohort study retrospectively analyzed 18,286 patients who had received surgical treatment for TBI between 1998 and 2010. The multiple linear regression model and Cox proportional hazards model were used for multivariate assessment of outcome predictors. The prevalence rate of surgical treatment for patients with TBI gradually but significantly (p < 0.001) increased by 47.6% from 5.0 per 100,000 persons in 1998 to 7.4 per 100,000 persons in 2010. Age, sex, Deyo-Charlson comorbidity index score, hospital volume, and surgeon volume were significantly associated with TBI surgery outcomes (p < 0.05). Over the 12-year period analyzed, the estimated mean hospital treatment cost increased 19.06%, whereas the in-hospital mortality rate decreased 10.9%. The estimated mean time of overall survival after TBI surgery (± SD) was 83.0 ± 4.2 months, and the overall in-hospital and 1-, 3-, and 5-year survival rates were 74.5%, 67.3%, 61.1%, and 57.8%, respectively. These data reveal an increased prevalence of TBI, especially in older patients, and an increased hospital treatment cost but a decreased in-hospital mortality rate. Health care providers and patients should recognize that attributes of the patient and of the hospital may affect hospital resource utilization and the mortality rate. These results are relevant not only to other countries with similar population sizes but also to countries with larger populations.

Wealth inhomogeneity applied to crash rate theory.

PubMed

Shuler, Robert L

2015-11-01

A crash rate theory based on corporate economic utility maximization is applied to individual behavior in U.S. and German motorway death rates, by using wealth inhomogeneity data in ten-percentile bins to account for variations of utility maximization in the population. Germany and the U.S. have similar median wealth figures, a well-known indicator of accident risk, but different motorway death rates. It is found that inhomogeneity in roughly the 10(th) to 30(th) percentile, not revealed by popular measures such as the Gini index which focus on differences at the higher percentiles, provides a satisfactory explanation of the data. The inhomogeneity analysis reduces data disparity from a factor of 2.88 to 1.75 as compared with median wealth assumed homogeneity, and further to 1.09 with average wealth assumed homogeneity. The first reduction from 2.88 to 1.75 is attributable to inequality at lower percentiles and suggests it may be as important in indicating socioeconomic risk as extremes in the upper percentile ranges, and that therefore the U.S. socioeconomic risk may be higher than generally realized.

Size-Based Separation of Particles and Cells Utilizing Viscoelastic Effects in Straight Microchannels.

PubMed

Liu, Chao; Xue, Chundong; Chen, Xiaodong; Shan, Lei; Tian, Yu; Hu, Guoqing

2015-06-16

Viscoelasticity-induced particle migration has recently received increasing attention due to its ability to obtain high-quality focusing over a wide range of flow rates. However, its application is limited to low throughput regime since the particles can defocus as flow rate increases. Using an engineered carrier medium with constant and low viscosity and strong elasticity, the sample flow rates are improved to be 1 order of magnitude higher than those in existing studies. Utilizing differential focusing of particles of different sizes, here, we present sheathless particle/cell separation in simple straight microchannels that possess excellent parallelizability for further throughput enhancement. The present method can be implemented over a wide range of particle/cell sizes and flow rates. We successfully separate small particles from larger particles, MCF-7 cells from red blood cells (RBCs), and Escherichia coli (E. coli) bacteria from RBCs in different straight microchannels. The proposed method could broaden the applications of viscoelastic microfluidic devices to particle/cell separation due to the enhanced sample throughput and simple channel design.

Robust analysis of semiparametric renewal process models

PubMed Central

Lin, Feng-Chang; Truong, Young K.; Fine, Jason P.

2013-01-01

Summary A rate model is proposed for a modulated renewal process comprising a single long sequence, where the covariate process may not capture the dependencies in the sequence as in standard intensity models. We consider partial likelihood-based inferences under a semiparametric multiplicative rate model, which has been widely studied in the context of independent and identical data. Under an intensity model, gap times in a single long sequence may be used naively in the partial likelihood with variance estimation utilizing the observed information matrix. Under a rate model, the gap times cannot be treated as independent and studying the partial likelihood is much more challenging. We employ a mixing condition in the application of limit theory for stationary sequences to obtain consistency and asymptotic normality. The estimator's variance is quite complicated owing to the unknown gap times dependence structure. We adapt block bootstrapping and cluster variance estimators to the partial likelihood. Simulation studies and an analysis of a semiparametric extension of a popular model for neural spike train data demonstrate the practical utility of the rate approach in comparison with the intensity approach. PMID:24550568

Structure and Utility of Blind Speed Intervals Associated with Doppler Measurements of Range Rate

DTIC Science & Technology

1993-02-01

computer programming concepts of speed, memory , and data structures that can be exploited to fabricate efficient software realizations of two phase range...to the effect that it is possible to derive a reasonable unambiguous estimate of range rate from the measurement of the pulse-to-pulse phase shift in...the properties of the blind speed intervals generated by the base speeds involved in two measurement equations. Sections 12 through 18 make up the

Chiropractic Attitudes and Utilization of Evidence-Based Practice: The Use of the EBASE Questionnaire.

PubMed

Alcantara, Joel; Leach, Matthew J

2015-01-01

To examine the attitudes and utilization of evidence-based practice by chiropractors. Utilizing a descriptive survey implemented as an online questionnaire, we examined chiropractors׳ perception, skills, and level of training, their engagement in, the barriers and facilitators to, and possible interventions to evidence-based practice. A total of 162 of 500 chiropractors completed the survey, providing a response rate of 32.4%. The majority of respondents were 30-39 years old, female, and worked in solo practice. A high proportion agreed/strongly agreed that evidence-based practice was necessary in the practice of chiropractic. Most respondents considered themselves to have above-average skills in locating professional literature, identifying answerable clinical questions, and identifying knowledge gaps in practice. However, many indicated receiving either no training or minimal education for conducting clinical research and systematic reviews and meta-analyses Most respondents had read or reviewed one to five professional articles and/or clinical research reports pertinent to their practice in the preceding month. Identified minor to moderate barriers to evidence-based practice were lack of time and lack of clinical evidence. Activities "very useful" in participating in evidence-based practice were access to free online databases and the ability to download full-text journal articles. The responders of our survey embraced and considered themselves skillful in evidence-based practice. They utilized a number of resources to practice in such a manner and were not deterred by identified barriers. We support continued research in this field. Copyright © 2015 Elsevier Inc. All rights reserved.

Do More Hospital Beds Lead to Higher Hospitalization Rates? A Spatial Examination of Roemer’s Law

PubMed Central

Delamater, Paul L.; Messina, Joseph P.; Grady, Sue C.; WinklerPrins, Vince; Shortridge, Ashton M.

2013-01-01

Background Roemer’s Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer’s Law. We pose the question, “Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?” Methods We employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions. Results We find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis. Conclusions This study provides evidence for the effects of Roemer’s Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings suggest continued regulation of hospital bed supply to assist in controlling hospital utilization is justified. PMID:23418432

Economic evaluation of prostate cancer screening test as a national cancer screening program in South Korea.

PubMed

Shin, Sangjin; Kim, Youn Hee; Hwang, Jin Sub; Lee, Yoon Jae; Lee, Sang Moo; Ahn, Jeonghoon

2014-01-01

Prostate cancer is rapidly increasing in Korea and professional societies have requested adding prostate specific antigen (PSA) testing to the National Cancer Screening Program (NCSP), but this started a controversy in Korea and neutral evidence on this issue is required more than ever. The purpose of this study was to provide economic evidence to the decision makers of the NCSP. A cost-utility analysis was performed on the adoption of PSA screening program among men aged 50-74-years in Korea from the healthcare system perspective. Several data sources were used for the cost-utility analysis, including general health screening data, the Korea Central Cancer Registry, national insurance claims data, and cause of mortality from the National Statistical Office. To solicit the utility index of prostate cancer, a face-to-face interview for typical men aged 40 to 69 was conducted using a Time-Trade Off method. As a result, the increase of effectiveness was estimated to be very low, when adopting PSA screening, and the incremental cost effectiveness ratio (ICER) was analyzed as about 94 million KRW. Sensitivity analyses were performed on the incidence rate, screening rate, cancer stage distribution, utility index, and treatment costs but the results were consistent with the base analysis. Under Korean circumstances with a relatively low incidence rate of prostate cancer, PSA screening is not cost-effective. Therefore, we conclude that adopting national prostate cancer screening would not be beneficial until further evidence is provided in the future.

Corrosivities in a pilot-scale combustor of a British and two Illinois coals with varying chlorine contents

USGS Publications Warehouse

Chou, I.-Ming; Lytle, J.M.; Kung, S.C.; Ho, K.K.

2000-01-01

Many US boiler manufacturers have recommended limits on the chlorine (Cl) content (< 0.25% or < 0.3%) of coals to be used in their boilers. These limits were based primarily on extrapolation of British coal data to predict the probable corrosion behavior of US coals. Even though Cl-related boiler corrosion has not been reported by US utilities burning high-Cl Illinois coals, the manufacturer's limits affect the marketability of high-Cl Illinois coals. This study measured the relative rates of corrosion caused by two high-Cl coals (British and Illinois) and one low-Cl Illinois baseline coal under identical pilot-scale combustion conditions for about 1000 h which gave reliable comparisons. Temperatures used reflected conditions in boiler superheaters. The corrosion probes were fabricated from commercial alloy 304SS frequently used at the hottest superheater section of utility boilers. The results showed no evidence of direct correlation between the coal chlorine content and rate of corrosion. A correlation between the rate of corrosion and the metal temperature was obvious. The results suggested that the different field histories of corrosivity from burning high-Cl Illinois coal and high-Cl British coal occurred because of different metal temperatures operated in US and UK utility boilers. The results of this study can be combined into a database, which could be used for lifting the limits on chlorine contents of coals burned in utility boilers in the US.

Accuracy of the Estimated Core Temperature (ECTemp) Algorithm in Estimating Circadian Rhythm Indicators

DTIC Science & Technology

2017-04-12

measurement of CT outside of stringent laboratory environments. This study evaluated ECTempTM, a heart rate-based extended Kalman Filter CT...based CT-estimation algorithms [7, 13, 14]. One notable example is ECTempTM, which utilizes an extended Kalman Filter to estimate CT from...3. The extended Kalman filter mapping function variance coefficient (Ct) was computed using the following equation: = −9.1428 ×

Environmental Assessment for Vandenberg Gate Complex Construction, Dorm Construction and Demolition at Hanscom Air Force Base, Massachusetts

DTIC Science & Technology

2014-12-01

MA January 2015 3 There are no existing underground stormwater drains in the area of the new Vandenberg Gate Complex. The addition of... stormwater management systems that utilize the pervious landscape, vegetative filtration, sediment removal, infiltration via bioswales, deep sump...Airmen Dormitory construction, a base-wide stormwater standard requires redevelopment projects to reduce stormwater rate and volume by 10% over the

Flow control for a paper-based microfluidic device by adjusting permeability of paper

NASA Astrophysics Data System (ADS)

Jang, Ilhoon; Kim, Gangjune; Song, Simon

2014-11-01

The paper-based microfluidics has attracted intensive attention as a prospective substitute for conventional microfluidic substrates used for a point-of-care diagnostics due to its superior advantages such as the cost effectiveness and production simplicity. Generally, a paper-based microfluidic device utilizes capillary force to drive a flow. Recent studies on flow control in such a device aimed at obtaining accurate and quantitative results by varying a channel geometry like width and length. According to the Darcy's law describing a flow in a porous media like paper, a flow rate can be adjusted the permeability of paper. In this study, we investigate a flow control method by adjusting the permeability of paper. We utilize the wax printing for the adjustment and the fabrication of paper channels. A rectangular wax pattern was printed on one inlet channel of a Y-channel geometry. By varying the brightness of the wax pattern, a relationship between the flow rate and permeability changes due to the wax was investigated. As a result, we obtained an effective permeability contour with respect to the wax pattern length and brightness. In addition, we developed a paper-based micromixer of which the mixing ratio was controlled precisely by adjusting the permeability.

NPP ATMS Snowfall Rate Product

NASA Technical Reports Server (NTRS)

Meng, Huan; Ferraro, Ralph; Kongoli, Cezar; Wang, Nai-Yu; Dong, Jun; Zavodsky, Bradley; Yan, Banghua

2015-01-01

Passive microwave measurements at certain high frequencies are sensitive to the scattering effect of snow particles and can be utilized to retrieve snowfall properties. Some of the microwave sensors with snowfall sensitive channels are Advanced Microwave Sounding Unit (AMSU), Microwave Humidity Sounder (MHS) and Advance Technology Microwave Sounder (ATMS). ATMS is the follow-on sensor to AMSU and MHS. Currently, an AMSU and MHS based land snowfall rate (SFR) product is running operationally at NOAA/NESDIS. Based on the AMSU/MHS SFR, an ATMS SFR algorithm has been developed recently. The algorithm performs retrieval in three steps: snowfall detection, retrieval of cloud properties, and estimation of snow particle terminal velocity and snowfall rate. The snowfall detection component utilizes principal component analysis and a logistic regression model. The model employs a combination of temperature and water vapor sounding channels to detect the scattering signal from falling snow and derive the probability of snowfall (Kongoli et al., 2015). In addition, a set of NWP model based filters is also employed to improve the accuracy of snowfall detection. Cloud properties are retrieved using an inversion method with an iteration algorithm and a two-stream radiative transfer model (Yan et al., 2008). A method developed by Heymsfield and Westbrook (2010) is adopted to calculate snow particle terminal velocity. Finally, snowfall rate is computed by numerically solving a complex integral. NCEP CMORPH analysis has shown that integration of ATMS SFR has improved the performance of CMORPH-Snow. The ATMS SFR product is also being assessed at several NWS Weather Forecast Offices for its usefulness in weather forecast.

Development of a Portfolio Management Approach with Case Study of the NASA Airspace Systems Program

NASA Technical Reports Server (NTRS)

Neitzke, Kurt W.; Hartman, Christopher L.

2012-01-01

A portfolio management approach was developed for the National Aeronautics and Space Administration s (NASA s) Airspace Systems Program (ASP). The purpose was to help inform ASP leadership regarding future investment decisions related to its existing portfolio of advanced technology concepts and capabilities (C/Cs) currently under development and to potentially identify new opportunities. The portfolio management approach is general in form and is extensible to other advanced technology development programs. It focuses on individual C/Cs and consists of three parts: 1) concept of operations (con-ops) development, 2) safety impact assessment, and 3) benefit-cost-risk (B-C-R) assessment. The first two parts are recommendations to ASP leaders and will be discussed only briefly, while the B-C-R part relates to the development of an assessment capability and will be discussed in greater detail. The B-C-R assessment capability enables estimation of the relative value of each C/C as compared with all other C/Cs in the ASP portfolio. Value is expressed in terms of a composite weighted utility function (WUF) rating, based on estimated benefits, costs, and risks. Benefit utility is estimated relative to achieving key NAS performance objectives, which are outlined in the ASP Strategic Plan.1 Risk utility focuses on C/C development and implementation risk, while cost utility focuses on the development and implementation portions of overall C/C life-cycle costs. Initial composite ratings of the ASP C/Cs were successfully generated; however, the limited availability of B-C-R information, which is used as inputs to the WUF model, reduced the meaningfulness of these initial investment ratings. Development of this approach, however, defined specific information-generation requirements for ASP C/C developers that will increase the meaningfulness of future B-C-R ratings.

Threshold analysis of reimbursing physicians for the application of fluoride varnish in young children.

PubMed

Hendrix, Kristin S; Downs, Stephen M; Brophy, Ginger; Carney Doebbeling, Caroline; Swigonski, Nancy L

2013-01-01

Most state Medicaid programs reimburse physicians for providing fluoride varnish, yet the only published studies of cost-effectiveness do not show cost-savings. Our objective is to apply state-specific claims data to an existing published model to quickly and inexpensively estimate the cost-savings of a policy consideration to better inform decisions - specifically, to assess whether Indiana Medicaid children's restorative service rates met the threshold to generate cost-savings. Threshold analysis was based on the 2006 model by Quiñonez et al. Simple calculations were used to "align" the Indiana Medicaid data with the published model. Quarterly likelihoods that a child would receive treatment for caries were annualized. The probability of a tooth developing a cavitated lesion was multiplied by the probability of using restorative services. Finally, this rate of restorative services given cavitation was multiplied by 1.5 to generate the threshold to attain cost-savings. Restorative services utilization rates, extrapolated from available Indiana Medicaid claims, were compared with these thresholds. For children 1-2 years old, restorative services utilization was 2.6 percent, which was below the 5.8 percent threshold for cost-savings. However, for children 3-5 years of age, restorative services utilization was 23.3 percent, exceeding the 14.5 percent threshold that suggests cost-savings. Combining a published model with state-specific data, we were able to quickly and inexpensively demonstrate that restorative service utilization rates for children 36 months and older in Indiana are high enough that fluoride varnish regularly applied by physicians to children starting at 9 months of age could save Medicaid funds over a 3-year horizon. © 2013 American Association of Public Health Dentistry.

The healthcare utilization and cost of treating patients experiencing inappropriate implantable cardioverter defibrillator shocks: a propensity score study.

PubMed

Bhavnani, Sanjeev P; Giedrimiene, Dalia; Coleman, Craig I; Guertin, Danette; Azeem, Meena; Kluger, Jeffrey

2014-10-01

Inappropriate shocks (IASs) from implantable cardioverter defibrillators (ICDs) are associated with decreased quality of life, but whether they increase healthcare utilization and treatment costs is unknown. We sought to determine the impact of IASs on subsequent healthcare utilization and treatment costs. We conducted a case-control analysis of ICD patients at a single institution from 1997 to 2010 and who had ≥12 months of post-ICD implant follow-up. Cases included all patients experiencing an IAS during the first 12 months after implantation. Eligible control patients did not receive a shock of any kind during the 12 months after implantation. Propensity scores based on 36 covariates (area under curve = 0.78) were used to match cases to controls. We compared the rate (occurrences/person year [PY]) of healthcare utilization immediately following IAS to the end of the 12-month follow-up period to the rate in the no-shock group over 12 months of follow-up. We also compared 12-month postimplant treatment (outpatient clinic, emergency room, and hospitalization) costs in both groups. A total of 76 patients experiencing ≥1 IAS during the first 12 months after implant (contributing 48 PYs) were matched to 76 no-shock patients (contributing 76 PYs). Cardiovascular (CV)-related clinic visit and hospitalization rates were increased following an IAS compared to those not receiving a shock (4.0 vs 3.3 and 0.7 vs 0.5, respectively, P = 0.02 for both). CV-related emergency room visitation (0.15 vs 0.08) rates were also numerically higher following an IAS, but did not reach statistical significance (P = 0.26). Patients experiencing an IAS accrued greater treatment costs during the 12 months postimplant compared to no-shock patients ($13,973 ± $46,345 vs $6,790 ± $19,091, P = 0.001). Recipients of IAS utilize the healthcare system more frequently following an IAS than patients not experiencing a shock. This increased utilization results in higher costs of treating IAS patients during the 12 months postimplant. ©2014 Wiley Periodicals, Inc.

Analysis of regional brain mitochondrial bioenergetics and susceptibility to mitochondrial inhibition utilizing a microplate based system

PubMed Central

Sauerbeck, Andrew; Pandya, Jignesh; Singh, Indrapal; Bittman, Kevin; Readnower, Ryan; Bing, Guoying; Sullivan, Patrick

2012-01-01

The analysis of mitochondrial bioenergetic function typically has required 50–100 μg of protein per sample and at least 15 min per run when utilizing a Clark-type oxygen electrode. In the present work we describe a method utilizing the Seahorse Biosciences XF24 Flux Analyzer for measuring mitochondrial oxygen consumption simultaneously from multiple samples and utilizing only 5 μg of protein per sample. Utilizing this method we have investigated whether regionally based differences exist in mitochondria isolated from the cortex, striatum, hippocampus, and cerebellum. Analysis of basal mitochondrial bioenergetics revealed that minimal differences exist between the cortex, striatum, and hippocampus. However, the cerebellum exhibited significantly slower basal rates of Complex I and Complex II dependent oxygen consumption (p < 0.05). Mitochondrial inhibitors affected enzyme activity proportionally across all samples tested and only small differences existed in the effect of inhibitors on oxygen consumption. Investigation of the effect of rotenone administration on Complex I dependent oxygen consumption revealed that exposure to 10 pM rotenone led to a clear time dependent decrease in oxygen consumption beginning 12 min after administration (p < 0.05). These studies show that the utilization of this microplate based method for analysis of mitochondrial bioenergetics is effective at quantifying oxygen consumption simultaneously from multiple samples. Additionally, these studies indicate that minimal regional differences exist in mitochondria isolated from the cortex, striatum, or hippocampus. Furthermore, utilization of the mitochondrial inhibitors suggests that previous work indicating regionally specific deficits following systemic mitochondrial toxin exposure may not be the result of differences in the individual mitochondria from the affected regions. PMID:21402103

Direct coupling of a genome-scale microbial in silico model and a groundwater reactive transport model.

PubMed

Fang, Yilin; Scheibe, Timothy D; Mahadevan, Radhakrishnan; Garg, Srinath; Long, Philip E; Lovley, Derek R

2011-03-25

The activity of microorganisms often plays an important role in dynamic natural attenuation or engineered bioremediation of subsurface contaminants, such as chlorinated solvents, metals, and radionuclides. To evaluate and/or design bioremediated systems, quantitative reactive transport models are needed. State-of-the-art reactive transport models often ignore the microbial effects or simulate the microbial effects with static growth yield and constant reaction rate parameters over simulated conditions, while in reality microorganisms can dynamically modify their functionality (such as utilization of alternative respiratory pathways) in response to spatial and temporal variations in environmental conditions. Constraint-based genome-scale microbial in silico models, using genomic data and multiple-pathway reaction networks, have been shown to be able to simulate transient metabolism of some well studied microorganisms and identify growth rate, substrate uptake rates, and byproduct rates under different growth conditions. These rates can be identified and used to replace specific microbially-mediated reaction rates in a reactive transport model using local geochemical conditions as constraints. We previously demonstrated the potential utility of integrating a constraint-based microbial metabolism model with a reactive transport simulator as applied to bioremediation of uranium in groundwater. However, that work relied on an indirect coupling approach that was effective for initial demonstration but may not be extensible to more complex problems that are of significant interest (e.g., communities of microbial species and multiple constraining variables). Here, we extend that work by presenting and demonstrating a method of directly integrating a reactive transport model (FORTRAN code) with constraint-based in silico models solved with IBM ILOG CPLEX linear optimizer base system (C library). The models were integrated with BABEL, a language interoperability tool. The modeling system is designed in such a way that constraint-based models targeting different microorganisms or competing organism communities can be easily plugged into the system. Constraint-based modeling is very costly given the size of a genome-scale reaction network. To save computation time, a binary tree is traversed to examine the concentration and solution pool generated during the simulation in order to decide whether the constraint-based model should be called. We also show preliminary results from the integrated model including a comparison of the direct and indirect coupling approaches and evaluated the ability of the approach to simulate field experiment. Published by Elsevier B.V.

Image-based multichannel vaginal cylinder brachytherapy for the definitive treatment of gynecologic malignancies in the vagina.

PubMed

Gebhardt, Brian J; Vargo, John A; Kim, Hayeon; Houser, Christopher J; Glaser, Scott M; Sukumvanich, Paniti; Olawaiye, Alexander B; Kelley, Joseph L; Edwards, Robert P; Comerci, John T; Courtney-Brooks, Madeleine; Beriwal, Sushil

2018-06-18

Brachytherapy is integral to vaginal cancer treatment and is typically delivered using an intracavitary single-channel vaginal cylinder (SCVC) or an interstitial brachytherapy (ISBT) applicator. Multi-channel vaginal cylinder (MCVC) applicators allow for improved organ-at-risk (OAR) sparing compared to SCVC while maintaining target coverage. We present clinical outcomes of patients treated with image-based high dose-rate (HDR) brachytherapy using a MCVC. Sixty patients with vaginal cancer (27% primary vaginal and 73% recurrence from other primaries) were treated with combination external beam radiotherapy (EBRT) and image-based HDR brachytherapy utilizing a MCVC if residual disease thickness was 7 mm or less after EBRT. All pts received 3D image-based BT to a total equivalent dose of 70-80 Gy. The median high-risk clinical target volume was 24.4 cm 3 (interquartile range [IQR], 14.1), with a median dose to 90% of 77.2 Gy (IQR, 2.8). After a median follow-up of 45 months (range, 11-78), the 4-year local-regional control, distant control, DFS, and OS rates were 92.6%, 76.1%, 64.0%, and 67.2%, respectively. The 4-year LRC rates were similar between the primary vaginal (92%) and recurrent (93%) groups (p = 0.290). Pts with lymph node positive disease had a lower rate of distant control at 4 years (22.7% vs. 89.0%, p < 0.001). There were no Grade 3 or higher acute complications. The 4-year rate of late Grade 3 or higher toxicity was 2.7%. Clinical outcomes of pts with primary and recurrent vaginal cancer treated definitively in a systematic manner with combination EBRT with image-guided HDR BT utilizing a MCVC applicator demonstrate high rates of local control and low rates of severe morbidity. The MCVC technique allows interstitial implantation to be avoided in select pts with ≤7 mm residual disease thickness following EBRT while maintaining excellent clinical outcomes with extended 4-year follow-up in this rare malignancy. Copyright © 2018. Published by Elsevier Inc.

A GPU-based mipmapping method for water surface visualization

NASA Astrophysics Data System (ADS)

Li, Hua; Quan, Wei; Xu, Chao; Wu, Yan

2018-03-01

Visualization of water surface is a hot topic in computer graphics. In this paper, we presented a fast method to generate wide range of water surface with good image quality both near and far from the viewpoint. This method utilized uniform mesh and Fractal Perlin noise to model water surface. Mipmapping technology was enforced to the surface textures, which adjust the resolution with respect to the distance from the viewpoint and reduce the computing cost. Lighting effect was computed based on shadow mapping technology, Snell's law and Fresnel term. The render pipeline utilizes a CPU-GPU shared memory structure, which improves the rendering efficiency. Experiment results show that our approach visualizes water surface with good image quality at real-time frame rates performance.

The 1992-1993 advanced design program. Part 1: The Mars methane engine project. Part 2: The Mars oxygen processor new furnace

NASA Astrophysics Data System (ADS)

Lauer, Stephen; Hoover, Scott; Lawrence, Lori; Paparistodemou, Christos; Taylor, Doug

1993-04-01

Three constituents of the Martian atmosphere, methane, carbon dioxide, and oxygen, can be used for internal combustion in engines utilized for future space exploration on Mars. These three gases, considered as the test case in this research, will be examined to determine required flow rates needed for combustion and optimization of engine performance. Results of the test case are examined in relation to a base case of methane and air for comparative purposes. Testing of exhaust temperatures, cylinder pressure, and exhaust gas analysis were performed for the base case and test case. Also described is a study utilizing a zirconia cell to convert carbon dioxide into usable oxygen to help support future Mars missions.

The 1992-1993 advanced design program. Part 1: The Mars methane engine project. Part 2: The Mars oxygen processor new furnace

NASA Technical Reports Server (NTRS)

Lauer, Stephen; Hoover, Scott; Lawrence, Lori; Paparistodemou, Christos; Taylor, Doug

1993-01-01

Three constituents of the Martian atmosphere, methane, carbon dioxide, and oxygen, can be used for internal combustion in engines utilized for future space exploration on Mars. These three gases, considered as the test case in this research, will be examined to determine required flow rates needed for combustion and optimization of engine performance. Results of the test case are examined in relation to a base case of methane and air for comparative purposes. Testing of exhaust temperatures, cylinder pressure, and exhaust gas analysis were performed for the base case and test case. Also described is a study utilizing a zirconia cell to convert carbon dioxide into usable oxygen to help support future Mars missions.

Pay-for-performance in a community substance abuse clinic

PubMed Central

Vandrey, Ryan; Stitzer, Maxine L.; Acquavita, Shauna P.; Quinn-Stabile, Patricia

2011-01-01

Pay-for-performance (P4P) strategies improve employee productivity and morale in business settings and are increasingly being implemented in medical care settings. This study investigated whether P4P could improve treatment utilization and retention at a community drug treatment clinic. Counselors had the opportunity to earn cash bonuses based on therapy attendance rates of individual clients as well as the quarterly retention rates of their caseload. Using a pre-post study design, average therapy sessions attended during the first month of treatment increased from 4.6 sessions prior to the intervention to 5.5 sessions per client during the intervention. The 90-day client retention rate increased from 40% to 53%. Additional analyses suggest that the improvement in 90-day retention was mediated by the increase in attendance during the first month of treatment. This project demonstrates that implementing a P4P incentive program in community drug abuse treatment clinics is feasible and effective at improving utilization and retention. PMID:21489739

A Predictive Algorithm to Detect Opioid Use Disorder

PubMed Central

Lee, Chee; Sharma, Maneesh; Kantorovich, Svetlana

2018-01-01

Purpose: The purpose of this study was to determine the clinical utility of an algorithm-based decision tool designed to assess risk associated with opioid use in the primary care setting. Methods: A prospective, longitudinal study was conducted to assess the utility of precision medicine testing in 1822 patients across 18 family medicine/primary care clinics in the United States. Using the profile, patients were categorized into low, moderate, and high risk for opioid use. Physicians who ordered testing were asked to complete patient evaluations and document their actions, decisions, and perceptions regarding the utility of the precision medicine tests. Results: Approximately 47% of primary care physicians surveyed used the profile to guide clinical decision-making. These physicians rated the benefit of the profile on patient care an average of 3.6 on a 5-point scale (1 indicating no benefit and 5 indicating significant benefit). Eighty-eight percent of all clinicians surveyed felt the test exhibited some benefit to their patient care. The most frequent utilization for the profile was to guide a change in opioid prescribed. Physicians reported greater benefit of profile utilization for minority patients. Patients whose treatment was guided by the profile had pain levels that were reduced, on average, 2.7 levels on the numeric rating scale. Conclusions: The profile provided primary care physicians with a useful tool to stratify the risk of opioid use disorder and was rated as beneficial for decision-making and patient improvement by the majority of physicians surveyed. Physicians reported the profile resulted in greater clinical improvement for minorities, highlighting the objective use of this profile to guide judicial use of opioids in high-risk patients. Significantly, when physicians used the profile to guide treatment decisions, patient-reported pain was greatly reduced. PMID:29383324

Comparison of pediatric self reports and parent proxy reports utilizing PROMIS: Results from a chiropractic practice-based research network.

PubMed

Alcantara, Joel; Ohm, Jeanne; Alcantara, Junjoe

2017-11-01

To measure the cross-informant variant of pediatric quality of life (QoL) based on self-reports and parent proxy measures. A secondary analysis of baseline data obtained from two independent studies measuring the QoL based on the pediatric PROMIS-25 self-report and the PROMIS parent-proxy items banks. A scoring manual associated raw scores to a T score metric (mean = 50; SD = 10). Reliability of QoL ratings utilized the ICC while comparison of mean T Scores utilized the unpaired t-test. A total of 289 parent-child dyads comprised our study responders. Average age for parents and children was 41.27 years and 12.52 years, respectively. The mean T score (child self-report: parent proxy) for each QoL domains were: mobility (50.82:52.58), anxiety (46.73:44.21), depression (45.18:43.60), fatigue (45.59:43.92), peer-relationships (52.15:52.88) and pain interference (47.47:44.80). Parents tend to over-estimate their child's QoL based on measures of anxiety, depression, fatigue, peer-relationships and pain interference. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Peritoneal dialysis catheter implantation by nephrologists is associated with higher rates of peritoneal dialysis utilization: a population-based study.

PubMed

Perl, Jeffrey; Pierratos, Andreas; Kandasamy, Gokulan; McCormick, Brendan B; Quinn, Robert R; Jain, Arsh K; Huang, Anjie; Paterson, J Michael; Oliver, Matthew J

2015-02-01

The likelihood of peritoneal dialysis (PD) utilization following a PD catheter insertion attempt is poorly described. We explored the risk factors for PD nonuse, focusing on the method of PD catheter implantation. This population-based retrospective cohort study employed Ontario administrative health data to identify 3886 predialysis adults who had an incident PD catheter implantation between 2002 and 2010. The impact of the method of catheter implantation including open-surgical (open, n = 1884), surgical-laparoscopic (laparoscopic, n = 1154), nephrology-percutaneous (nephrology, n = 498) and radiology-percutaneous (radiology, n = 350) on rates of PD utilization (defined as four consecutive weeks of PD) was examined. Eighty-three percent of study patients received PD. After adjustment, relative to patients with openly inserted catheters, PD utilization was greater for those with nephrology-inserted catheters [adjusted hazard ratio (aHR) 1.59, 95% confidence interval (CI) 1.29-1.95] and similar for radiology-inserted catheters [aHR 1.16, 95% CI 0.94-1.43] or laparoscopic-inserted catheters [aHR 0.97 (95% CI 0.86-1.09)]. Among PD nonusers, death occurred in 10% of the open group, 6% of the laparoscopic group, 27% of the radiology group and in fewer than 3% of the nephrology group. Sixty-nine percent received hemodialysis in the open group, 63% in the laparoscopic group, 61% in the radiology group and 88% in the nephrology group. Those remaining predialysis comprised 12% of the open group, 22% of the laparoscopic group, 11% of the radiology group and <3% of the nephrology group. Nephrology insertion resulted in lower overall rates of PD nonuse, particularly due to death or remaining predialysis. Greater use may be related to insertion timing, technique or greater commitment on the part of nephrologists to the success of PD. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

The economic impact of state ordered avoided cost rates for photovoltaic generated electricity

NASA Astrophysics Data System (ADS)

Bottaro, D.; Wheatley, N. J.

Various methods the states have devised to implement federal policy regarding the Public Utility Regulatory Policies Act (PURPA) of 1978, which requires that utilities pay their full 'avoided costs' to small power producers for the energy and capacity provided, are examined. The actions of several states are compared with rates estimated using utility expansion and rate-setting models, and the potential break-even capital costs of a photovoltaic system are estimated using models which calculate photovoltaic worth. The potential for the development of photovoltaics has been increased by the PURPA regulations more from the guarantee of utility purchase of photovoltaic power than from the high buy-back rates paid. The buy-back rate is high partly because of the surprisingly high effective capacity of photovoltaic systems in some locations.

Base rates, multiple indicators, and comprehensive forensic evaluations: why sexualized behavior still counts in assessments of child sexual abuse allegations.

PubMed

Everson, Mark D; Faller, Kathleen Coulborn

2012-01-01

Developmentally inappropriate sexual behavior has long been viewed as a possible indicator of child sexual abuse. In recent years, however, the utility of sexualized behavior in forensic assessments of alleged child sexual abuse has been seriously challenged. This article addresses a number of the concerns that have been raised about the diagnostic value of sexualized behavior, including the claim that when population base rates for abuse are properly taken into account, the diagnostic value of sexualized behavior is insignificant. This article also identifies a best practice comprehensive evaluation model with a methodology that is effective in mitigating such concerns.

Segmented wind energy harvester based on contact-electrification and as a self-powered flow rate sensor

NASA Astrophysics Data System (ADS)

Su, Yuanjie; Xie, Guangzhong; Xie, Fabiao; Xie, Tao; Zhang, Qiuping; Zhang, Hulin; Du, Hongfei; Du, Xiaosong; Jiang, Yadong

2016-06-01

A single-electrode-based segmented triboelectric nanogenerator (S-TENG) was developed. By utilizing the wind-induced vibration of a fluorinated ethylene propylene (FEP) film between two copper electrodes, the S-TENG delivers an open-circuit voltage up to 36 V and a short-circuit current of 11.8 μA, which can simultaneously light up 20 LEDs and charge capacitors. Moreover, the S-TENG holds linearity between output current and flow rate, revealing its feasibility as a self-powered wind speed sensor. This work demonstrates potential applications of S-TENG in wind energy harvester, self-powered gas sensor, high altitude air navigation.

Analysis of potential benefits of integrated-gasifier combined cycles for a utility system

NASA Technical Reports Server (NTRS)

Choo, Y. K.

1983-01-01

Potential benefits of integrated gasifier combined cycle (IGCC) units were evaluated for a reference utility system by comparing long range expansion plans using IGCC units and gas turbine peakers with a plan using only state of the art steam turbine units and gas turbine peakers. Also evaluated was the importance of the benefits of individual IGCC unit characteristics, particularly unit efficiency, unit equivalent forced outage rate, and unit size. A range of IGCC units was analyzed, including cases achievable with state of the art gas turbines and cases assuming advanced gas turbine technology. All utility system expansion plans that used IGCC units showed substantial savings compared with the base expansion plan using the steam turbine units.

Aluminum corrosion mitigation in alkaline electrolytes containing hybrid inorganic/organic inhibitor system for power sources applications

NASA Astrophysics Data System (ADS)

Gelman, Danny; Lasman, Itay; Elfimchev, Sergey; Starosvetsky, David; Ein-Eli, Yair

2015-07-01

The severe corrosion accompanied with hydrogen evolution process is the main obstacle preventing the implementation of Al as an anode in alkaline batteries. It impairs the functionality of alkaline battery, due to a drastic capacity loss and a short shelf life. The possibility to reduce Al corrosion rate in alkaline solution with the use of hybrid organic∖inorganic inhibitor based on poly (ethylene glycol) di-acid (PEG di-acid) and zinc oxide (ZnO) was examined in this work. A correlation between an Al corrosion rates and the concentrations of both PEG di-acid and ZnO in alkaline is shown. Selecting 5000 ppm PEG di-acid and 16 gr/l ZnO provides substantial corrosion protection of Al, reducing the corrosion rate in a strong alkaline solution by more than one order of magnitude. Moreover, utilizing the same formulation results in increase in Al-air battery discharge capacity, from 44.5 (for a battery utilizing only KOH in the electrolyte) to 70 mhA/cm2 (for a battery utilizing ZnO/PEG di-acid hybrid inhibitor in the electrolyte). The morphology and composition of the Al electrode surface (studied by SEM, EDS, and XRD) depend on PEG di-acid and ZnO concentrations.

Utility of de-escalatory confidence-building measures

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

Nation, J.

1989-06-01

This paper evaluates the utility of specific confidence-building de-escalatory measures and pays special attention to the evaluation of measures which place restrictions on or establish procedures for strategic forces. Some measures appear more promising than others. Potentially useful confidence-building measures largely satisfy defined criteria and include the phased return of strategic nuclear forces to peacetime bases and operations, the termination of interference with communications and NTMs (National Technical Means) and the termination of civil defense preparations. Less-promising CBMs include the standing down of supplemental early warning systems, the establishment of SSBN keep-out zones, and decreases in bomber alert rates. Establishmentmore » of SSBN keep-out zones and reduction in bomber rates are difficult to verify, while the standing-down of early warning systems provides little benefit at potentially large costs. Particular confidence-building measures (CBMs) may be most useful in building superpower confidence at specific points in the crisis termination phase. For example, a decrease in strategic bomber alert rates may provide some decrease in perception of the likelihood of war, but its potential costs, particularly in increasing bomber vulnerability, may limit its utility and implementation to the final crisis stages when the risks of re-escalation and surprise attack are lower.« less

The Effects of Rising Interest Rates on Electric Utility Stock Prices: Regulatory Considerations and Approaches

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

Kihm, Steve; Satchwell, Andrew; Cappers, Peter

This technical brief identifies conditions under which utility regulators should consider implementing policy approaches that seek to mitigate negative outcomes due to an increase in interest rates. Interest rates are a key factor in determining a utility’s cost of equity and investors find value when returns exceed the cost of equity. Through historical observations of periods of rising and falling interest rates and application of a pro forma financial tool, we identify the key drivers of utility stock valuations and estimate the degree to which those valuations might be affected by increasing interest rates.3 We also analyze the efficacy ofmore » responses by utility regulators to mitigate potential negative financial impacts. We find that regulators have several possible approaches to mitigate a decline in value in an environment of increasing interest rates, though regulators must weigh the tradeoffs of improving investor value with potential increases in customer costs. Furthermore, the range of approaches reflects today’s many different electric utility regulatory models and regulatory responses to a decline in investor value will fit within state-specific models.« less

SibRank: Signed bipartite network analysis for neighbor-based collaborative ranking

NASA Astrophysics Data System (ADS)

Shams, Bita; Haratizadeh, Saman

2016-09-01

Collaborative ranking is an emerging field of recommender systems that utilizes users' preference data rather than rating values. Unfortunately, neighbor-based collaborative ranking has gained little attention despite its more flexibility and justifiability. This paper proposes a novel framework, called SibRank that seeks to improve the state of the art neighbor-based collaborative ranking methods. SibRank represents users' preferences as a signed bipartite network, and finds similar users, through a novel personalized ranking algorithm in signed networks.

A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents.

PubMed

Mody, Lona; Greene, M Todd; Meddings, Jennifer; Krein, Sarah L; McNamara, Sara E; Trautner, Barbara W; Ratz, David; Stone, Nimalie D; Min, Lillian; Schweon, Steven J; Rolle, Andrew J; Olmsted, Russell N; Burwen, Dale R; Battles, James; Edson, Barbara; Saint, Sanjay

2017-08-01

Catheter-associated urinary tract infection (UTI) in nursing home residents is a common cause of sepsis, hospital admission, and antimicrobial use leading to colonization with multidrug-resistant organisms. To develop, implement, and evaluate an intervention to reduce catheter-associated UTI. A large-scale prospective implementation project was conducted in community-based nursing homes participating in the Agency for Healthcare Research and Quality Safety Program for Long-Term Care. Nursing homes across 48 states, Washington DC, and Puerto Rico participated. Implementation of the project was conducted between March 1, 2014, and August 31, 2016. The project was implemented over 12-month cohorts and included a technical bundle: catheter removal, aseptic insertion, using regular assessments, training for catheter care, and incontinence care planning, as well as a socioadaptive bundle emphasizing leadership, resident and family engagement, and effective communication. Urinary catheter use and catheter-associated UTI rates using National Healthcare Safety Network definitions were collected. Facility-level urine culture order rates were also obtained. Random-effects negative binomial regression models were used to examine changes in catheter-associated UTI, catheter utilization, and urine cultures and adjusted for covariates including ownership, bed size, provision of subacute care, 5-star rating, presence of an infection control committee, and an infection preventionist. In 4 cohorts over 30 months, 568 community-based nursing homes were recruited; 404 met inclusion criteria for analysis. The unadjusted catheter-associated UTI rates decreased from 6.78 to 2.63 infections per 1000 catheter-days. With use of the regression model and adjustment for facility characteristics, the rates decreased from 6.42 to 3.33 (incidence rate ratio [IRR], 0.46; 95% CI, 0.36-0.58; P < .001). Catheter utilization was 4.5% at baseline and 4.9% at the end of the project. Catheter utilization remained unchanged (4.50 at baseline, 4.45 at conclusion of project; IRR, 0.95; 95% CI, 0.88-1.03; P = .26) in adjusted analyses. The number of urine cultures ordered for all residents decreased from 3.49 per 1000 resident-days to 3.08 per 1000 resident-days. Similarly, after adjustment, the rates were shown to decrease from 3.52 to 3.09 (IRR, 0.85; 95% CI, 0.77-0.94; P = .001). In a large-scale, national implementation project involving community-based nursing homes, combined technical and socioadaptive catheter-associated UTI prevention interventions successfully reduced the incidence of catheter-associated UTIs.

[Comparison of potential yield and resource utilization efficiency of main food crops in three provinces of Northeast China under climate change].

PubMed

Wang, Xiao-yu; Yang, Xiao-guang; Sun, Shuang; Xie, Wen-juan

2015-10-01

Based on the daily data of 65 meteorological stations from 1961 to 2010 and the crop phenology data in the potential cultivation zones of thermophilic and chimonophilous crops in Northeast China, the crop potential yields were calculated through step-by-step correction method. The spatio-temporal distribution of the crop potential yields at different levels was analyzed. And then we quantified the limitations of temperature and precipitation on the crop potential yields and compared the differences in the climatic resource utilization efficiency. The results showed that the thermal potential yields of six crops (including maize, rice, spring wheat, sorghum, millet and soybean) during the period 1961-2010 deceased from west to east. The climatic potential yields of the five crops (spring wheat not included) were higher in the south than in the north. The potential yield loss rate due to temperature limitations of the six crops presented a spatial distribution pattern and was higher in the east than in the west. Among the six main crops, the yield potential loss rate due to temperature limitation of the soybean was the highest (51%), and those of the other crops fluctuated within the range of 33%-41%. The potential yield loss rate due to water limitation had an obvious regional difference, and was high in Songnen Plain and Changbai Mountains. The potential yield loss rate of spring wheat was the highest (50%), and those of the other four rainfed crops fluctuated within the range of 8%-10%. The solar energy utilization efficiency of the six main crops ranged from 0.9% to 2.7%, in the order of maize> sorghum>rice>millet>spring wheat>soybean. The precipitation utilization efficiency of the maize, sorghum, spring wheat, millet and soybean under rainfed conditions ranged from 8 to 35 kg . hm-2 . mm-1, in the order of maize>sorghum>spring wheat>millet>soybean. In those areas with lower efficiency of solar energy utilization and precipitation utilization, such as Changbai Mountains and the south of Lesser Khingan Mountains, measures could be taken to increase the efficiency of resource utilization such as rational close-planting, selection of droughtresistant varieties, proper and timely fertilization, farming for soil water storage, optimization of crop layout and so on.

A Critical Assessment of Bias in Survey Studies Using Location-Based Sampling to Recruit Patrons in Bars

PubMed Central

Morrison, Christopher; Lee, Juliet P.; Gruenewald, Paul J.; Marzell, Miesha

2015-01-01

Location-based sampling is a method to obtain samples of people within ecological contexts relevant to specific public health outcomes. Random selection increases generalizability, however in some circumstances (such as surveying bar patrons) recruitment conditions increase risks of sample bias. We attempted to recruit representative samples of bars and patrons in six California cities, but low response rates precluded meaningful analysis. A systematic review of 24 similar studies revealed that none addressed the key shortcomings of our study. We recommend steps to improve studies that use location-based sampling: (i) purposively sample places of interest, (ii) utilize recruitment strategies appropriate to the environment, and (iii) provide full information on response rates at all levels of sampling. PMID:26574657

A Method for Harmonic Sources Detection based on Harmonic Distortion Power Rate

NASA Astrophysics Data System (ADS)

Lin, Ruixing; Xu, Lin; Zheng, Xian

2018-03-01

Harmonic sources detection at the point of common coupling is an essential step for harmonic contribution determination and harmonic mitigation. The harmonic distortion power rate index is proposed for harmonic source location based on IEEE Std 1459-2010 in the paper. The method only based on harmonic distortion power is not suitable when the background harmonic is large. To solve this problem, a threshold is determined by the prior information, when the harmonic distortion power is larger than the threshold, the customer side is considered as the main harmonic source, otherwise, the utility side is. A simple model of public power system was built in MATLAB/Simulink and field test results of typical harmonic loads verified the effectiveness of proposed method.

Microbial utilization of dissolved organic matter from leaves of the red mangrove, Rhizophora mangle, in the Fresh Creek estuary, Bahamas

NASA Astrophysics Data System (ADS)

Benner, Ronald; Peele, Emily R.; Hodson, Robert E.

1986-11-01

Dissolved organic matter was leached from [ 14C]labeled leaves of the red mangrove, Rhizophora mangle, and used in studies to determine the rates and efficiencies of microbial utilization of the water-soluble components of mangrove leaves in the Fresh Creek estuary, Bahamas. Rates of microbial utilization (assimilation plus mineralization) of mangrove leachate ranged from 0·022 to 4·675 μg ml -1 h -1 depending on the concentration of leachate and the size or diversity of microbial populations. Microflora associated with decaying mangrove leaves utilized mangrove leachate at rates up to 18-fold higher than rates of leachate utilization by planktonic microflora. Chemical analyses indicated that tannins and other potentially inhibitory phenolic compounds made up a major fraction (18%) of the dissolved organic matter in mangrove leachate. Mangrove leachate did not appear to be inhibitory to the microbial uptake of leachate or the microbial degradation of the lignocellulosic component of mangrove leaves except at high concentrations (mg ml -1). The availability of molecular oxygen also was an important parameter affecting rates of leachate utilization; rates of microbial utilization of leachate were up to 8-fold higher under aerobic rather than anaerobic conditions. The overall efficiency of conversion of mangrove leachate into microbial biomass was high and ranged from 64% to 94%. As much as 42% of the added leachate was utilized during 2 to 12 h incubations, indicating that a major fraction of the leachable material from mangrove leaves is incorporated into microbial biomass, and thus available to animals in the estuarine food web.

Is medical perspective on clinical governance practices associated with clinical units' performance and mortality? A cross-sectional study through a record-linkage procedure.

PubMed

Sarchielli, Guido; De Plato, Giovanni; Cavalli, Mario; Albertini, Stefano; Nonni, Ilaria; Bencivenni, Lucia; Montali, Arianna; Ventura, Antonio; Montali, Francesca

2016-01-01

Assessment of the knowledge and application as well as perceived utility by doctors of clinical governance tools in order to explore their impact on clinical units' performance measured through mortality rates and efficiency indicators. This research is a cross-sectional study with a deterministic record-linkage procedure. The sample includes n = 1250 doctors (n = 249 chiefs of clinical units; n = 1001 physicians) working in six public hospitals located in the Emilia-Romagna Region in Italy. Survey instruments include a checklist and a research-made questionnaire which were used for data collection about doctors' knowledge and application as well as perceived utility of clinical governance tools. The analysis was based on clinical units' performance indicators which include patients' mortality, extra-region active mobility rate, average hospital stay, bed occupancy, rotation and turnover rates, and the comparative performance index as efficiency indicators. The clinical governance tools are known and applied differently in all the considered clinical units. Significant differences emerged between roles and organizational levels at which the medical leadership is carried out. The levels of knowledge and application of clinical governance practices are correlated with the clinical units' efficiency indicators (bed occupancy rate, bed turnover interval, and extra-region mobility). These multiple linear regression analyses highlighted that the clinical governance knowledge and application is correlated with clinical units' mortality rates (odds ratio, -8.677; 95% confidence interval, -16.654, -0.700). The knowledge and application, as well as perceived utility by medical professionals of clinical governance tools, are associated with the mortality rates of their units and with some efficiency indicators. However, the medical frontline staff seems to not consider homogeneously useful the clinical governance tools application on its own clinical practice.

Nurse employment contracts in Chinese hospitals: impact of inequitable benefit structures on nurse and patient satisfaction

PubMed Central

2014-01-01

Purpose Ongoing economic and health system reforms in China have transformed nurse employment in Chinese hospitals. Employment of ‘bianzhi’ nurses, a type of position with state-guaranteed lifetime employment that has been customary since 1949, is decreasing while there is an increase in the contract-based nurse employment with limited job security and reduced benefits. The consequences of inequities between the two types of nurses in terms of wages and job-related benefits are unknown. This study examined current rates of contract-based nurse employment and the effects of the new nurse contract employment strategy on nurse and patient outcomes in Chinese hospitals. Methods This cross-sectional study used geographically representative survey data collected from 2008 to 2010 from 181 hospitals in six provinces, two municipalities, and one autonomous region in China. Logistic regression models were used to estimate the association between contract-based nurse utilization, dissatisfaction among contract-based nurses, nurse intentions to leave their positions, and patient satisfaction, controlling for nurse, patient, and hospital characteristics. Principal Results Hospital-level utilization of contract-based nurses varies greatly from 0 to 91%, with an average of 51%. Contract-based nurses were significantly more dissatisfied with their remuneration and benefits than ‘bianzhi’ nurses who have more job security (P <0.01). Contract-based nurses who were dissatisfied with their salary and benefits were more likely to intend to leave their current positions (P <0.01). Hospitals with high levels of dissatisfaction with salary and benefits among contract-based nurses were rated lower and less likely to be recommended by patients (P < 0.05). Conclusions Our results suggest a high utilization of contract-based nurses in Chinese hospitals, and that the inequities in benefits between contract-based nurses and ‘bianzhi’ nurses may adversely affect both nurse and patient satisfaction in hospitals. Our study provides empirical support for the ‘equal pay for equal work’ policy emphasized by the China Ministry of Health’s recent regulations, and calls for efforts in Chinese hospitals to eliminate the disparities between ‘bianzhi’ and contract-based nurses. PMID:24418223

Nurse employment contracts in Chinese hospitals: impact of inequitable benefit structures on nurse and patient satisfaction.

PubMed

Shang, Jingjing; You, Liming; Ma, Chenjuan; Altares, Danielle; Sloane, Douglas M; Aiken, Linda H

2014-01-13

Ongoing economic and health system reforms in China have transformed nurse employment in Chinese hospitals. Employment of 'bianzhi' nurses, a type of position with state-guaranteed lifetime employment that has been customary since 1949, is decreasing while there is an increase in the contract-based nurse employment with limited job security and reduced benefits. The consequences of inequities between the two types of nurses in terms of wages and job-related benefits are unknown. This study examined current rates of contract-based nurse employment and the effects of the new nurse contract employment strategy on nurse and patient outcomes in Chinese hospitals. This cross-sectional study used geographically representative survey data collected from 2008 to 2010 from 181 hospitals in six provinces, two municipalities, and one autonomous region in China. Logistic regression models were used to estimate the association between contract-based nurse utilization, dissatisfaction among contract-based nurses, nurse intentions to leave their positions, and patient satisfaction, controlling for nurse, patient, and hospital characteristics. Hospital-level utilization of contract-based nurses varies greatly from 0 to 91%, with an average of 51%. Contract-based nurses were significantly more dissatisfied with their remuneration and benefits than 'bianzhi' nurses who have more job security (P <0.01). Contract-based nurses who were dissatisfied with their salary and benefits were more likely to intend to leave their current positions (P <0.01). Hospitals with high levels of dissatisfaction with salary and benefits among contract-based nurses were rated lower and less likely to be recommended by patients (P < 0.05). Our results suggest a high utilization of contract-based nurses in Chinese hospitals, and that the inequities in benefits between contract-based nurses and 'bianzhi' nurses may adversely affect both nurse and patient satisfaction in hospitals. Our study provides empirical support for the 'equal pay for equal work' policy emphasized by the China Ministry of Health's recent regulations, and calls for efforts in Chinese hospitals to eliminate the disparities between 'bianzhi' and contract-based nurses.

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

Henry, Michael David; Young, Travis R.; Griffin, Ben

Here, this work reports the utilization of a recently developed film, ScAlN, as a silicon etch mask offering significant improvements in high etch selectivity to silicon. Utilization of ScAlN as a fluorine chemistry based deep reactive ion etch mask demonstrated etch selectivity at 23 550:1, four times better than AlN, 11 times better than Al 2O 3, and 148 times better than silicon dioxide with significantly less resputtering at high bias voltage than either Al 2O 3 or AlN. Ellipsometry film thickness measurements show less than 0.3 nm/min mask erosion rates for ScAlN. Micromasking of resputtered Al for Al 2Omore » 3, AlN, and ScAlN etch masks is also reported here, utilizing cross-sectional scanning electron microscope and confocal microscope roughness measurements. With lower etch bias, the reduced etch rate can be optimized to achieve a trench bottom surface roughness that is comparable to SiO 2 etch masks. Etch mask selectivity enabled by ScAlN is likely to make significant improvements in microelectromechanical systems, wafer level packaging, and plasma dicing of silicon.« less

Racial differences in the mental health needs and service utilization of youth in the juvenile justice system.

PubMed

Rawal, Purva; Romansky, Jill; Jenuwine, Michael; Lyons, John S

2004-01-01

Mental health placement rates by the juvenile justice system differ by race. However, it is unknown whether mental health needs differ by race. This study attempted to investigate potential differences in mental health needs and service utilization among Caucasian, African American, and Hispanic juvenile justice involved youth. A stratified random sample of 473 youth petitioned, adjudicated, and incarcerated from 1995-1996 was examined using a standard chart review protocol and the Childhood Severity of Psychiatric Illness measure for mental health needs. Significant and unique mental health needs were demonstrated for all racial groups. African American youth demonstrated the greatest level of needs. Minority status indicated significantly lower rates of mental health service utilization. Minority youth in the juvenile justice system are most at risk for underserved mental health needs. Based on the current data, it can be inferred that the first contact with the state's child and adolescent serving system, which includes the juvenile justice and mental health sectors, appears to be through the juvenile justice sector for many minority youth with delinquency problems.

Cross-Border Utilization of Health Care: Evidence from a Population-Based Study in South Texas

PubMed Central

Su, Dejun; Richardson, Chad; Wen, Ming; Pagán, José A

2011-01-01

Objective To assess the prevalence of health care utilization in Mexico by Texas border residents and to identify the main contributing factors to their cross-border utilization of health care services. Data and Methods This study used primary data from a population-based telephone survey that was conducted in the whole Texas border area in 2008. The survey included responses from 1,405 adults. Multivariate logistic regression models were estimated to determine predictors of utilizing a wide range of health care services in Mexico. Principal Findings Forty-nine percent of the sample reported having ever purchased medications in Mexico, followed by 41 percent for dentist visits, 37.3 percent for doctor visits, and 6.7 percent for inpatient care. The most significant predictors of health care utilization in Mexico were lack of U.S. health insurance coverage, dissatisfaction with the quality of U.S. health care, and poor self-rated health status. Conclusions The high prevalence of use of health care services in Mexico by Texas border residents is suggestive of unmet needs in health care on the U.S. side of the border. Addressing these unmet needs calls for a binational approach to improve the affordability, accessibility, and quality of health care in the U.S.–Mexico border region. PMID:21158855

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

Shaitelman, Simona F., E-mail: sfshaitelman@mdanderson.org; Lin, Heather Y.; Smith, Benjamin D.

Purpose: To examine utilization trends of accelerated partial breast irradiation (APBI) in the American College of Surgeons' National Cancer Database and changes in APBI use after the 2009 publication of the American Society for Radiation Oncology (ASTRO) guidelines. Methods and Materials: A total of 399,705 women were identified who were diagnosed from 2004 to 2011 with nonmetastatic invasive breast cancer or ductal carcinoma in situ who were treated with breast-conserving surgery and radiation therapy to the breast. Patients were divided by the type of treatment received (whole breast irradiation or APBI) and by suitability to receive APBI as defined bymore » the ASTRO guidelines. Logistic regression was applied to study APBI use overall and within guideline categorization, and a multivariable model was created to determine predictors of treatment with brachytherapy-based APBI based on guideline categorization. Results: For all patients, APBI use increased, from 3.8% in 2004 to 10.6% in 2011 (P<.0001). Overall rates of APBI utilization were higher among “suitable” than “cautionary”/“unsuitable” patients (14.8% vs 7.1%, P<.0001). The majority of APBI treatment was delivered using brachytherapy, for which use peaked in 2008. Starting in 2009, among “suitable” patients, utilization of APBI via brachytherapy plateaued, whereas for “cautionary”/“unsuitable” patients, treatment with brachytherapy-based APBI declined and then plateaued. Conclusion: Use of APBI across all patient groups increased from 2004 through 2008. After publication of the ASTRO APBI guidelines in 2009, rates of brachytherapy-based APBI treatment plateaued among “suitable” patients and declined and then plateaued among “cautionary”/“unsuitable” patients. Our study highlights how large national databases can be used to assess national trends in radiation use in response to the publication of guidelines.« less

McMaster PLUS: a cluster randomized clinical trial of an intervention to accelerate clinical use of evidence-based information from digital libraries.

PubMed

Haynes, R Brian; Holland, Jennifer; Cotoi, Chris; McKinlay, R James; Wilczynski, Nancy L; Walters, Leslie A; Jedras, Dawn; Parrish, Rick; McKibbon, K Ann; Garg, Amit; Walter, Stephen D

2006-01-01

Physicians have difficulty keeping up with new evidence from medical research. We developed the McMaster Premium LiteratUre Service (PLUS), an internet-based addition to an existing digital library, which delivered quality- and relevance-rated medical literature to physicians, matched to their clinical disciplines. We evaluated PLUS in a cluster-randomized trial of 203 participating physicians in Northern Ontario, comparing a Full-Serve version (that included alerts to new articles and a cumulative database of alerts) with a Self-Serve version (that included a passive guide to evidence-based literature). Utilization of the service was the primary trial end-point. Mean logins to the library rose by 0.77 logins/month/user (95% CI 0.43, 1.11) in the Full-Serve group compared with the Self-Serve group. The proportion of Full-Serve participants who utilized the service during each month of the study period showed a sustained increase during the intervention period, with a relative increase of 57% (95% CI 12, 123) compared with the Self-Serve group. There were no differences in these proportions during the baseline period, and following the crossover of the Self-Serve group to Full-Serve, the Self-Serve group's usage became indistinguishable from that of the Full-Serve group (relative difference 4.4 (95% CI -23.7, 43.0). Also during the intervention and crossover periods, measures of self-reported usefulness did not show a difference between the 2 groups. A quality- and relevance-rated online literature service increased the utilization of evidence-based information from a digital library by practicing physicians.

McMaster PLUS: A Cluster Randomized Clinical Trial of an Intervention to Accelerate Clinical Use of Evidence-based Information from Digital Libraries

PubMed Central

Haynes, R. Brian; Holland, Jennifer; Cotoi, Chris; McKinlay, R. James; Wilczynski, Nancy L.; Walters, Leslie A.; Jedras, Dawn; Parrish, Rick; McKibbon, K. Ann; Garg, Amit; Walter, Stephen D.

2006-01-01

Background Physicians have difficulty keeping up with new evidence from medical research. Methods We developed the McMaster Premium LiteratUre Service (PLUS), an internet-based addition to an existing digital library, which delivered quality- and relevance-rated medical literature to physicians, matched to their clinical disciplines. We evaluated PLUS in a cluster-randomized trial of 203 participating physicians in Northern Ontario, comparing a Full-Serve version (that included alerts to new articles and a cumulative database of alerts) with a Self-Serve version (that included a passive guide to evidence-based literature). Utilization of the service was the primary trial end-point. Results Mean logins to the library rose by 0.77 logins/month/user (95% CI 0.43, 1.11) in the Full-Serve group compared with the Self-Serve group. The proportion of Full-Serve participants who utilized the service during each month of the study period showed a sustained increase during the intervention period, with a relative increase of 57% (95% CI 12, 123) compared with the Self-Serve group. There were no differences in these proportions during the baseline period, and following the crossover of the Self-Serve group to Full-Serve, the Self-Serve group’s usage became indistinguishable from that of the Full-Serve group (relative difference 4.4 (95% CI −23.7, 43.0). Also during the intervention and crossover periods, measures of self-reported usefulness did not show a difference between the 2 groups. Conclusion A quality- and relevance-rated online literature service increased the utilization of evidence-based information from a digital library by practicing physicians. PMID:16929034

Verification of Sulfate Attack Penetration Rates for Saltstone Disposal Unit Modeling

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

Flach, G. P.

Recent Special Analysis modeling of Saltstone Disposal Units consider sulfate attack on concrete and utilize degradation rates estimated from Cementitious Barriers Partnership software simulations. This study provides an independent verification of those simulation results using an alternative analysis method and an independent characterization data source. The sulfate penetration depths estimated herein are similar to the best-estimate values in SRNL-STI-2013-00118 Rev. 2 and well below the nominal values subsequently used to define Saltstone Special Analysis base cases.

Anisotropic constitutive model for nickel base single crystal alloys: Development and finite element implementation

NASA Technical Reports Server (NTRS)

Dame, L. T.; Stouffer, D. C.

1986-01-01

A tool for the mechanical analysis of nickel base single crystal superalloys, specifically Rene N4, used in gas turbine engine components is developed. This is achieved by a rate dependent anisotropic constitutive model implemented in a nonlinear three dimensional finite element code. The constitutive model is developed from metallurigical concepts utilizing a crystallographic approach. A non Schmid's law formulation is used to model the tension/compression asymmetry and orientation dependence in octahedral slip. Schmid's law is a good approximation to the inelastic response of the material in cube slip. The constitutive equations model the tensile behavior, creep response, and strain rate sensitivity of these alloys. Methods for deriving the material constants from standard tests are presented. The finite element implementation utilizes an initial strain method and twenty noded isoparametric solid elements. The ability to model piecewise linear load histories is included in the finite element code. The constitutive equations are accurately and economically integrated using a second order Adams-Moulton predictor-corrector method with a dynamic time incrementing procedure. Computed results from the finite element code are compared with experimental data for tensile, creep and cyclic tests at 760 deg C. The strain rate sensitivity and stress relaxation capabilities of the model are evaluated.

Immigrants' utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway.

PubMed

Abebe, Dawit Shawel; Lien, Lars; Elstad, Jon Ivar

2017-06-01

As the immigrant population rises in Norway, it becomes ever more important to consider the responsiveness of health services to the specific needs of these immigrants. It has been questioned whether access to mental healthcare is adequate among all groups of immigrants. This study aims to examine the use of specialist mental healthcare services among ethnic Norwegians and specific immigrants groups. Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (age 0-59) consisted of 3.3 million ethnic Norwegians and 200,000 immigrants from 11 countries. Poisson regression models were applied to examine variations in the use of specialist mental healthcare during 2008-2011 according to country of origin, age group, reason for immigration, and length of stay. Immigrant children and adolescents had overall significantly lower use of specialist mental healthcare than ethnic Norwegians of the same age. A distinct exception was the high utilization rate among children and youth from Iran. Among adult immigrants, utilization rates were generally lower than among ethnic Norwegians, particularly those from Poland, Somalia, Sri Lanka, and Vietnam. Adult immigrants from Iraq and Iran, however, had high utilization rates. Refugees had high utilization rates of specialist mental healthcare, while labour immigrants had low use. Utilization rates of specialist mental healthcare are lower among immigrants than Norwegians. Immigrants from Poland, Somalia, Sri Lanka, and Vietnam, had generally quite low rates, while immigrants from Iran had high utilization rates. The findings suggest that specialist mental healthcare in Norway is underutilized among considerable parts of the immigrant population.

[Cost-utility of the vaccine against the Human Papiloma Virus in Peruvian women].

PubMed

Gutiérrez-Aguado, Alfonso

2011-01-01

To estimate the cost-utility of the vaccine against the Human Papiloma Virus (HPV) in peruvian women after the application of the vaccine at 10 years of age. A cost-utility analysis was performed using the Markov´s hidden model in a hypothetical cohort of peruvian women, based on the information on epidemiological parameters, costs associated to uterine cervical cancer (UCC) and the efficacy and costs of the vaccine against the HPV. The vaccination costs were estimated from the Peruvian Ministry of Health perspective and were compared against the quality-adjusted life years (QALYs), using a discount rate of 5%. The annual cost of the vaccination was USD 16,861,490, for the Papanicoau screening it was USD 3,060,793 and the costs associated to the UCC were USD 15,580,000. The incremental cost utility ratio (ICUR) was 6,775 USD/QALY. Vaccination against HPV can be cost-utility compared to not vaccinating.

[Features of oxygen utilization by the body of patients with arterial hypertension in the days of magnetic storms depending on the psychosomatic status and treatment options].

PubMed

Usenko, G A; Usenko, A G; Vasendin, D V

2015-01-01

During magnetic storms the observed increase in γ-background environment and the reduction of the rate of oxygen utilization by the tissues, but the increase in the number of angina attacks per day to magnetic storms the choleric, in the days of magnetic storms in sanguine, for 3-4 days at a phlegmatic, and 4-5 days in the melancholic especially in groups high anxiety phlegmatic and melancholic. Last-risk group severe arterial hypertension and ischemic heart disease. Antihypertensive therapy based on the blockade of the features of the psychosomatic status, significantly reduced the number of attacks and brought the values of the utilization of oxygen and coefficient of oxygen utilization bu the tissues of all the days to those in healthy individual relevant anxiety and temperament.

Utilization of hospital services for cancer care in Mexico.

PubMed

Hernández-Ávila, Juan Eugenio; Palacio-Mejía, Lina Sofía; González-González, Leonel; Morales-Carmona, Evangelina; Espín-Arellano, Lucino Iván; Fernández-Niño, Julián Alfredo; Mohar-Betancourt, Alejandro; Hernández-Ávila, Mauricio

2016-04-01

To analyze the utilization of hospital services for cancer care by location, sex, age group and care institution in Mexico from 2004-2013. Time series study from 2004-2013, based on administrative records of hospital discharges for cancer in the health sector, including the private sector. The utilization rate increased significantly from 290 to 360 per 100 000 inhabitants. A total of 62% of hospital discharges related to malignant tumors were concentrated in eight types of cancer. Leukemia, breast and colorectal cancers almost doubled in the period. While lung cancer showed a decline among men, it increased among women. A total of 63.1% of cancer patients were women, and 81% of cases occurred in the public sector. From 2011, the Ministry of Health was the main provider of hospital services for cancer care. Increases in utilization were mainly found in the Ministry of Health, quite possibly as a result of the implementation of universal insurance.

A Monte Carlo Approach for Adaptive Testing with Content Constraints

ERIC Educational Resources Information Center

Belov, Dmitry I.; Armstrong, Ronald D.; Weissman, Alexander

2008-01-01

This article presents a new algorithm for computerized adaptive testing (CAT) when content constraints are present. The algorithm is based on shadow CAT methodology to meet content constraints but applies Monte Carlo methods and provides the following advantages over shadow CAT: (a) lower maximum item exposure rates, (b) higher utilization of the…

Cervical Cancer, A Major Killer of Hispanic Women: Implications for Health Education.

ERIC Educational Resources Information Center

Morris, Donna LeBlanc; And Others

1989-01-01

This article outlines the incidence and etiology of cervical cancer among Hispanic women, discusses screening and treatment, and identifies factors that may contribute to high incidence and death rate. Factors include Hispanics' utilization of health services, culturally based attitudes, and the role of Hispanic men. Implications for health…

Utilizing Learners' Negative Ratings in Semantic Content-Based Recommender System for e-Learning Forum

ERIC Educational Resources Information Center

Albatayneh, Naji Ahmad; Ghauth, Khairil Imran; Chua, Fang-Fang

2018-01-01

Nowadays, most of e-learning systems embody online discussion forums as a medium for collaborative learning that supports knowledge sharing and information exchanging between learners. The exponential growth of the available shared information in e-learning online discussion forums has caused a difficulty for learners in discovering interesting…

Optimization of PEDOT films in ionic liquid supercapacitors: demonstration as a power source for polymer electrochromic devices.

PubMed

Österholm, Anna M; Shen, D Eric; Dyer, Aubrey L; Reynolds, John R

2013-12-26

We report on the optimization of the capacitive behavior of poly(3,4-ethylenedioxythiophene) (PEDOT) films as polymeric electrodes in flexible, Type I electrochemical supercapacitors (ESCs) utilizing ionic liquid (IL) and organic gel electrolytes. The device performance was assessed based on figures of merit that are critical to evaluating the practical utility of electroactive polymer ESCs. PEDOT/IL devices were found to be highly stable over hundreds of thousands of cycles and could be reversibly charged/discharged at scan rates between 500 mV/s and 2 V/s depending on the polymer loading. Furthermore, these devices exhibit leakage currents and self-discharge rates that are comparable to state of the art electrochemical double-layer ESCs. Using an IL as device electrolyte allowed an extension of the voltage window of Type I ESCs by 60%, resulting in a 2.5-fold increase in the energy density obtained. The efficacies of tjese PEDOT ESCs were assessed by using them as a power source for a high-contrast and fast-switching electrochromic device, demonstrating their applicability in small organic electronic-based devices.

Creation of a web-based lecture series for psychiatry clerkship students: initial findings.

PubMed

Martin, Vicki L; Bennett, David S

2004-01-01

In recent years, the trend in medical education has been to utilize clerkship settings outside the medical school. Subsequently, students rotate at distant sites from the main campus and have lectures of varying quantity and quality. The objective of the present study was to standardize the core didactic experience for students in the Psychiatry clerkship by using web-based lectures and to assess student satisfaction with such lectures. Students completed a brief satisfaction questionnaire after viewing both web-based and live lectures. Students rated both web-based and live lectures positively, although overall satisfaction ratings were higher for live lectures. Shelf-exam scores improved for the current year, suggesting that learning was not negatively affected by the use of web-based lectures. Web-based lectures appear to be a feasible and satisfactory way to ensure didactic comparability across clinical sites.

A process concept for the production of benzene-ethylene-SNG from coal using flash hydropyrolysis technology

NASA Astrophysics Data System (ADS)

Greene, M. I.; Ladelfa, C. J.; Bivacca, S. J.

1980-05-01

Flash hydropyrolysis (FHP) of coal is an emerging technology for the direct production of methane, ethane and BTX in a single-stage, high throughput reactor. The FHP technique involves the short residence time (1-2 seconds), rapid heatup of coal in a dilute-phase, transport reactor. When integrated into an overall, grass-roots conversion complex, the FHP technique can be utilized to generate a product consisting of SNG, ethylene/propylene, benzene and Fischer-Tropsch-based alcohols. This paper summarizes the process engineering and economics of conceptualized facility based on an FHP reactor operation with a lignitic coal. The plant is hypothetically sited near the extensive lignite fields located in the Texas region of the United States. Utilizing utility-financing methods for the costing of SNG, and selling the chemicals cogenerated at petrochemical market prices, the 20-year average SNG cost has been computed to vary between $3-4/MM Btu, depending upon the coal costs, interest rates, debt/equity ratio, coproduct chemicals prices, etc.

Analytic model comparing the cost utility of TVT versus duloxetine in women with urinary stress incontinence.

PubMed

Jacklin, Paul; Duckett, Jonathan; Renganathan, Arasee

2010-08-01

The purpose of this study was to assess cost utility of duloxetine versus tension-free vaginal tape (TVT) as a second-line treatment for urinary stress incontinence. A Markov model was used to compare the cost utility based on a 2-year follow-up period. Quality-adjusted life year (QALY) estimation was performed by assuming a disutility rate of 0.05. Under base-case assumptions, although duloxetine was a cheaper option, TVT gave a considerably higher QALY gain. When a longer follow-up period was considered, TVT had an incremental cost-effectiveness ratio (ICER) of pound 7,710 ($12,651) at 10 years. If the QALY gain from cure was 0.09, then the ICER for duloxetine and TVT would both fall within the indicative National Institute for Health and Clinical Excellence willingness to pay threshold at 2 years, but TVT would be the cost-effective option having extended dominance over duloxetine. This model suggests that TVT is a cost-effective treatment for stress incontinence.

Solar energy: Technology and applications

NASA Technical Reports Server (NTRS)

Williams, J. R.

1974-01-01

It is pointed out that in 1970 the total energy consumed in the U.S. was equal to the energy of sunlight received by only 0.15% of the land area of the continental U.S. The utilization of solar energy might, therefore, provide an approach for solving the energy crisis produced by the consumption of irreplaceable fossil fuels at a steadily increasing rate. Questions regarding the availability of solar energy are discussed along with the design of solar energy collectors and various approaches for heating houses and buildings by utilizing solar radiation. Other subjects considered are related to the heating of water partly or entirely with solar energy, the design of air conditioning systems based on the use of solar energy, electric power generation by a solar thermal and a photovoltaic approach, solar total energy systems, industrial and agricultural applications of solar energy, solar stills, the utilization of ocean thermal power, power systems based on the use of wind, and solar-energy power systems making use of geosynchronous power plants.

Comprehensive techno-economic analysis of wastewater-based algal biofuel production: A case study.

PubMed

Xin, Chunhua; Addy, Min M; Zhao, Jinyu; Cheng, Yanling; Cheng, Sibo; Mu, Dongyan; Liu, Yuhuan; Ding, Rijia; Chen, Paul; Ruan, Roger

2016-07-01

Combining algae cultivation and wastewater treatment for biofuel production is considered the feasible way for resource utilization. An updated comprehensive techno-economic analysis method that integrates resources availability into techno-economic analysis was employed to evaluate the wastewater-based algal biofuel production with the consideration of wastewater treatment improvement, greenhouse gases emissions, biofuel production costs, and coproduct utilization. An innovative approach consisting of microalgae cultivation on centrate wastewater, microalgae harvest through flocculation, solar drying of biomass, pyrolysis of biomass to bio-oil, and utilization of co-products, was analyzed and shown to yield profound positive results in comparison with others. The estimated break even selling price of biofuel ($2.23/gallon) is very close to the acceptable level. The approach would have better overall benefits and the internal rate of return would increase up to 18.7% if three critical components, namely cultivation, harvest, and downstream conversion could achieve breakthroughs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Mental health symptoms and treatment utilization among trauma-exposed college students.

PubMed

Artime, Tiffany M; Buchholz, Katherine R; Jakupcak, Matthew

2018-05-21

Universities have demonstrated growing awareness of students impacted by interpersonal violence (e.g., sexual and physical assault) and veterans/service-members with combat-related trauma because of their sizable presence on campuses and unique vulnerabilities. This study sought to describe impacts of these two forms of trauma exposure on students' mental health and academic functioning and to compare mental health service utilization among students based on their experiences of trauma exposure. To acquire a large, national sample of college students, we examined archival data from the Fall 2015 American College Health Association National College Health Assessment, a yearly, web-based survey which represented a sample of 19,861 students from 40 institutions. Twenty percent of the students had experienced interpersonal victimization in the last 12 months, combat exposure, or both. Compared with other groups, interpersonal violence survivors reported the most negative impacts on mental health and interference with academic performance. Service utilization rates among trauma-exposed students ranged from 52% to 84%, and students who had experienced recent interpersonal violence were the most likely to have received services. With a national sample, this study confirms that trauma-exposed students report poor mental health. Service utilization is high among this population, but campus-based mental health services appear to remain underutilized. Outreach efforts by student life professionals and campus clinicians targeting demographic subgroups could enhance utilization and accessibility of campus resources. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Demand-side management: Why ratemaking should`nt control tax policy

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

Haney, J.D.

1995-01-01

As utilities spend money on demand-side management (DSM) programs, they usually deduct their costs currently as ordinary and necessary business expenses. However, state regulators may force deferral of DSM costs for ratemaking purposes, with possible consequences on tax returns. When regulators defer DSM costs, the Internal Revenue Service (IRS) has offered several theories to challenge current tax deductions. One theory requires capitilization instead of a current deduction if regulators include the DSM cost in rate base and provide for a rate of return on the balance. The IRS explained this theory two years ago in a White Paper on conservationmore » expenses: The direct relationship between a rate of return allowed by the Regulator for conservation expenditures allowed in rate base and future profits establishes a prima facie case for capitalization under the future benefit standard. The authors believe that IRS policy should not be linked to ratemaking decisions.« less

Hospital-Based Acute Care After Total Hip and Knee Arthroplasty: Implications for Quality Measurement.

PubMed

Trimba, Roman; Laughlin, Richard T; Krishnamurthy, Anil; Ross, Joseph S; Fox, Justin P

2016-03-01

Although hospital readmissions are being adopted as a quality measure after total hip or knee arthroplasty, they may fail accurately capture the patient's postdischarge experience. We studied 272,853 discharges from 517 hospitals to determine hospital emergency department (ED) visit and readmission rates. The hospital-level, 30-day, risk-standardized ED visit (median = 5.6% [2.4%-13.7%]) and hospital readmission (5.0% [2.6%-9.2%]) rates were similar and varied widely. A hospital's risk-standardized ED visit rate did not correlate with its readmission rate (r = -0.03, P = .50). If ED visits were included in a broader "readmission" measure, 246 (47.6%) hospitals would change perceived performance groups. Including ED visits in a broader, hospital-based, acute care measure may be warranted to better describe postdischarge health care utilization. Copyright © 2016 Elsevier Inc. All rights reserved.

Estimation of community-level influenza-associated illness in a low resource rural setting in India.

PubMed

Saha, Siddhartha; Gupta, Vivek; Dawood, Fatimah S; Broor, Shobha; Lafond, Kathryn E; Chadha, Mandeep S; Rai, Sanjay K; Krishnan, Anand

2018-01-01

To estimate rates of community-level influenza-like-illness (ILI) and influenza-associated ILI in rural north India. During 2011, we conducted household-based healthcare utilization surveys (HUS) for any acute medical illness (AMI) in preceding 14days among residents of 28villages of Ballabgarh, in north India. Concurrently, we conducted clinic-based surveillance (CBS) in the area for AMI episodes with illness onset ≤3days and collected nasal and throat swabs for influenza virus testing using real-time polymerase chain reaction. Retrospectively, we applied ILI case definition (measured/reported fever and cough) to HUS and CBS data. We attributed 14days of risk-time per person surveyed in HUS and estimated community ILI rate by dividing the number of ILI cases in HUS by total risk-time. We used CBS data on influenza positivity and applied it to HUS-based community ILI rates by age, month, and clinic type, to estimate the community influenza-associated ILI rates. The HUS of 69,369 residents during the year generated risk-time of 3945 person-years (p-y) and identified 150 (5%, 95%CI: 4-6) ILI episodes (38 ILI episodes/1,000 p-y; 95% CI 32-44). Among 1,372 ILI cases enrolled from clinics, 126 (9%; 95% CI 8-11) had laboratory-confirmed influenza (A (H3N2) = 72; B = 54). After adjusting for age, month, and clinic type, overall influenza-associated ILI rate was 4.8/1,000 p-y; rates were highest among children <5 years (13; 95% CI: 4-29) and persons≥60 years (11; 95%CI: 2-30). We present a novel way to use HUS and CBS data to generate estimates of community burden of influenza. Although the confidence intervals overlapped considerably, higher point estimates for burden among young children and older adults shows the utility for exploring the value of influenza vaccination among target groups.

Comparison of chronic toxicities between brachytherapy-based accelerated partial breast irradiation and whole breast irradiation using intensity modulated radiotherapy.

PubMed

Wobb, Jessica L; Shah, Chirag; Jawad, Maha S; Wallace, Michelle; Dilworth, Joshua T; Grills, Inga S; Ye, Hong; Chen, Peter Y

2015-12-01

Brachytherapy-based APBI (bAPBI) shortens treatment duration and limits dose to normal tissue. While studies have demonstrated similar local control when comparing bAPBI and whole breast irradiation using intensity modulated radiotherapy (WBI-IMRT), comparison of late side effects is limited. Here, we report chronic toxicity profiles associated with these two treatment modalities. 1034 patients with early stage breast cancer were treated at a single institution; 489 received standard-fractionation WBI-IMRT between 2000 and 2013 and 545 received bAPBI (interstitial 40%, applicator-based 60%) between 1993 and 2013. Chronic toxicity was evaluated ≥6 months utilizing CTCAE version 3.0; cosmesis was evaluated using the Harvard scale. Median follow-up was 4.6 years (range 0.1-13.4) for WBI-IMRT versus 6.7 years (range 0.1-20.1) for bAPBI (p < 0.001). Compared to WBI-IMRT, bAPBI was associated with higher rates of ≥grade 2 seroma formation (14.4% vs 2.9%, p < 0.001), telangiectasia (12.3% vs 2.1%, p = 0.002) and symptomatic fat necrosis (10.2% vs 3.6%, p < 0.001). Lower rates of hyperpigmentation were observed (5.8% vs 14.5%; p = 0.001). Infection rates were similar (3.3% vs 1.3%, p = 0.07). There was no difference between rates of fair (6.1% vs. 4.1%, p = 0.30) or poor (0.2% vs. 0.5%, p = NS) cosmesis. Mastectomy rates for local recurrence (3.1% for WBI-IMRT and 1.2% for bAPBI, p = 0.06), or for other reasons (0.8% and 0.6%, p = 0.60) were similar between groups. With 5-year follow-up, WBI-IMRT and bAPBI are associated with similar, acceptable rates of toxicity. These data further support the utilization of bAPBI as a modality to deliver adjuvant radiation in a safe and efficacious manner. Copyright © 2015 Elsevier Ltd. All rights reserved.

A randomized controlled study to evaluate the role of video-based coaching in training laparoscopic skills.

PubMed

Singh, Pritam; Aggarwal, Rajesh; Tahir, Muaaz; Pucher, Philip H; Darzi, Ara

2015-05-01

This study evaluates whether video-based coaching can enhance laparoscopic surgical skills performance. Many professions utilize coaching to improve performance. The sports industry employs video analysis to maximize improvement from every performance. Laparoscopic novices were baseline tested and then trained on a validated virtual reality (VR) laparoscopic cholecystectomy (LC) curriculum. After competence, subjects were randomized on a 1:1 ratio and each performed 5 VRLCs. After each LC, intervention group subjects received video-based coaching by a surgeon, utilizing an adaptation of the GROW (Goals, Reality, Options, Wrap-up) coaching model. Control subjects viewed online surgical lectures. All subjects then performed 2 porcine LCs. Performance was assessed by blinded video review using validated global rating scales. Twenty subjects were recruited. No significant differences were observed between groups in baseline performance and in VRLC1. For each subsequent repetition, intervention subjects significantly outperformed controls on all global rating scales. Interventions outperformed controls in porcine LC1 [Global Operative Assessment of Laparoscopic Skills: (20.5 vs 15.5; P = 0.011), Objective Structured Assessment of Technical Skills: (21.5vs 14.5; P = 0.001), and Operative Performance Rating System: (26 vs 19.5; P = 0.001)] and porcine LC2 [Global Operative Assessment of Laparoscopic Skills: (28 vs 17.5; P = 0.005), Objective Structured Assessment of Technical Skills: (30 vs 16.5; P < 0.001), and Operative Performance Rating System: (36 vs 21; P = 0.004)]. Intervention subjects took significantly longer than controls in porcine LC1 (2920 vs 2004 seconds; P = 0.009) and LC2 (2297 vs 1683; P = 0.003). Despite equivalent exposure to practical laparoscopic skills training, video-based coaching enhanced the quality of laparoscopic surgical performance on both VR and porcine LCs, although at the expense of increased time. Video-based coaching is a feasible method of maximizing performance enhancement from every clinical exposure.

ACA-mandated elimination of cost sharing for preventive screening has had limited early impact.

PubMed

Mehta, Shivan J; Polsky, Daniel; Zhu, Jingsan; Lewis, James D; Kolstad, Jonathan T; Loewenstein, George; Volpp, Kevin G

2015-07-01

The Affordable Care Act eliminated patient cost sharing for evidence-based preventive care, yet the impact of this policy on colonoscopy and mammography rates is unclear. We examined the elimination of cost sharing among small business beneficiaries of Humana, a large national insurer. This was a retrospective interrupted time series analysis of whether the change in cost-sharing policy was associated with a change in screening utilization, using grandfathered plans as a comparison group. We compared beneficiaries in small business nongrandfathered plans that were required to eliminate cost sharing (intervention) with those in grandfathered plans that did not have to change cost sharing (control). There were 63,246 men and women aged 50 to 64 years eligible for colorectal cancer screening, and 30,802 women aged 50 to 64 years eligible for breast cancer screening. The primary outcome variables were rates of colonoscopy and mammography per person-month, with secondary analysis of colonoscopy rates coded as preventive only. There was no significant change in the level or slope of colonoscopy and mammography utilization for intervention plans relative to the control plans. There was also no significant relevant change among those colonoscopies coded as preventive. The results suggest that the implementation of the policy is not having its intended effects, as cost sharing rates for colonoscopy and mammography did not change substantially, and utilization of colonoscopy and mammography changed little, following this new policy approach.

Análisis Costo Efectividad del Stent Farmacológico V/S Stent no Farmacológico en Cardiopatía Isquémica en Chile.

PubMed

De la Puente, Catherine; Vallejos, Carlos; Velásquez, Mónica; Soto, David; Orellana, Juan

2012-12-01

To evaluate and compare the costs and effectiveness of two alternative stent, drug eluting stent (SF) and bare metal stent (SNF). Cost-utility analysis based on a Markov model using data from a cohort study of Hospital Las Higueras of Talcahuano, Chile. The effectiveness measure was the rate of restenosis and the time of restenosis. The effectiveness outcomes are expressed in quality-adjusted life years (QALY) gained. Costs are expressed in national currency 2011. The evaluation perspective was from the public heath budget. We model a cohort from age 63 to 80 years, life expectancy in Chile. Apply discount rate of 0, 3% and 6% for results and costs. Sensitivity analysis is performed according to the ranges of variability in costs, the utility values of the variables and transition between states. No differences in restenosis rates between the two stents, although there were differences in the time of restenosis. The incremental cost effectiveness ratio (ICER) no discount rate was CH$ 235.749 per QALY gained when using drug-eluting stent, the value below the equivalent of 1 Gross Domestic Product (PIB) per capita for 2011 in Chile. The drug-eluting stent (SF) is cost effective compared to bare metal stent (SNF). The ICER is not affected by the sensitivity analysis (variability of cost, utility ranges used, probability of restenosis). Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Impact of disease management on health care utilization: evidence from the "Florida: A Healthy State (FAHS)" Medicaid Program.

PubMed

Afifi, Abdelmonem A; Morisky, Donald E; Kominski, Gerald F; Kotlerman, Jenny B

2007-06-01

To examine the impact of disease management on utilization of selected health care services. Prospective observational population-based study comparing Florida Medicaid patients who elected to participate in disease management (DM, N=15,275) with a usual-care (UC, N=32,034) group who elected not to participate in the program. Patients had at least one of four chronic diseases (diabetes, asthma, congestive heart failure, and hypertension) and all received standard health care. DM participants received supplementary telephone health counseling by a managed care specialist. The data for this paper were collected between October 2001 and October 2004. Annual rates of inpatient hospital stays, inpatient days, emergency room (ER) visits, and outpatient (OP) visits, during and post intervention, were used as outcomes. Age, race, gender, comorbidities, severity indicators, geographic location and pre-intervention utilization were used as covariates. Compared to UC patients, DM patients had lower adjusted post intervention annualized rates of hospitalizations ranging from 0.07 to 0.38 stays, lower rates of hospital days ranging from 0.40 to 2.54 days, and lower rates of ER visits ranging from 0.10 to 0.91 visits per DM enrollee in all four chronic conditions. Most results were statistically significant at the 5% level, except for hypertension patients, where they were suggestive, though not significant. Disease management is effective in reducing potentially avoidable inpatient hospital stays and ER visits among patients with chronic illness.

Predicting SF-6D utility scores from the Neck Disability Index and Numeric Rating Scales for Neck and Arm Pain

PubMed Central

Carreon, Leah Y.; Anderson, Paul A.; McDonough, Christine M.; Djurasovic, Mladen; Glassman, Steven D.

2010-01-01

Study Design Cross-sectional cohort Objective This study aims to provide an algorithm estimate SF-6D utilities using data from the NDI, neck pain and arm pain scores. Summary of Background Data Although cost-utility analysis is increasingly used to provide information about the relative value of alternative interventions, health state values or utilities are rarely available from clinical trial data. The Neck Disability Index (NDI) and numeric rating scales for neck and arm pain, are widely used disease-specific measures of symptoms, function and disability in patients with cervical degenerative disorders. The purpose of this study is to provide an algorithm to allow estimation of SF-6D utilities using data from the NDI, and numeric rating scales for neck and arm pain. Methods SF-36, NDI, neck and arm pain rating scale scores were prospectively collected pre-operatively, at 12 and 24 months post-operatively in 2080 patients undergoing cervical fusion for degenerative disorders. SF-6D utilities were computed and Spearman correlation coefficients were calculated for paired observations from multiple time points between NDI, neck and arm pain scores and SF-6D utility scores. SF-6D scores were estimated from the NDI, neck and arm pain scores using a linear regression model. Using a separate, independent dataset of 396 patients in which and NDI scores were available SF-6D was estimated for each subject and compared to their actual SF-6D. Results The mean age for those in the development sample, was 50.4 ± 11.0 years and 33% were male. In the validation sample the mean age was 53.1 ± 9.9 years and 35% were male. Correlations between the SF-6D and the NDI, neck and arm pain scores were statistically significant (p<0.0001) with correlation coefficients of 0.82, 0.62, and 0.50 respectively. The regression equation using NDI alone to predict SF-6D had an R2 of 0.66 and a root mean square error (RMSE) of 0.056. In the validation analysis, there was no statistically significant difference (p=0.961) between actual mean SF-6D (0.49 ± 0.08) and the estimated mean SF-6D score (0.49 ± 0.08) using the NDI regression model. Conclusion This regression-based algorithm may be a useful tool to predict SF-6D scores in studies of cervical degenerative disease that have collected NDI but not utility scores. PMID:20847713

Prevalence of Invalid Performance on Baseline Testing for Sport-Related Concussion by Age and Validity Indicator.

PubMed

Abeare, Christopher A; Messa, Isabelle; Zuccato, Brandon G; Merker, Bradley; Erdodi, Laszlo

2018-03-12

Estimated base rates of invalid performance on baseline testing (base rates of failure) for the management of sport-related concussion range from 6.1% to 40.0%, depending on the validity indicator used. The instability of this key measure represents a challenge in the clinical interpretation of test results that could undermine the utility of baseline testing. To determine the prevalence of invalid performance on baseline testing and to assess whether the prevalence varies as a function of age and validity indicator. This retrospective, cross-sectional study included data collected between January 1, 2012, and December 31, 2016, from a clinical referral center in the Midwestern United States. Participants included 7897 consecutively tested, equivalently proportioned male and female athletes aged 10 to 21 years, who completed baseline neurocognitive testing for the purpose of concussion management. Baseline assessment was conducted with the Immediate Postconcussion Assessment and Cognitive Testing (ImPACT), a computerized neurocognitive test designed for assessment of concussion. Base rates of failure on published ImPACT validity indicators were compared within and across age groups. Hypotheses were developed after data collection but prior to analyses. Of the 7897 study participants, 4086 (51.7%) were male, mean (SD) age was 14.71 (1.78) years, 7820 (99.0%) were primarily English speaking, and the mean (SD) educational level was 8.79 (1.68) years. The base rate of failure ranged from 6.4% to 47.6% across individual indicators. Most of the sample (55.7%) failed at least 1 of 4 validity indicators. The base rate of failure varied considerably across age groups (117 of 140 [83.6%] for those aged 10 years to 14 of 48 [29.2%] for those aged 21 years), representing a risk ratio of 2.86 (95% CI, 2.60-3.16; P < .001). The results for base rate of failure were surprisingly high overall and varied widely depending on the specific validity indicator and the age of the examinee. The strong age association, with 3 of 4 participants aged 10 to 12 years failing validity indicators, suggests that the clinical interpretation and utility of baseline testing in this age group is questionable. These findings underscore the need for close scrutiny of performance validity indicators on baseline testing across age groups.

18 CFR 35.23 - General provisions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... sale of electric energy in a coordination transaction by a public utility if that sale requires the use... filing must apply consistent treatment to all coordination rate schedules. If the filing does not apply consistent rate treatment, the public utility must explain why it does not do so. (3) If a public utility...

18 CFR 35.23 - General provisions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... sale of electric energy in a coordination transaction by a public utility if that sale requires the use... filing must apply consistent treatment to all coordination rate schedules. If the filing does not apply consistent rate treatment, the public utility must explain why it does not do so. (3) If a public utility...

18 CFR 35.23 - General provisions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... sale of electric energy in a coordination transaction by a public utility if that sale requires the use... filing must apply consistent treatment to all coordination rate schedules. If the filing does not apply consistent rate treatment, the public utility must explain why it does not do so. (3) If a public utility...

Resource utilization after introduction of a standardized clinical assessment and management plan.

PubMed

Friedman, Kevin G; Rathod, Rahul H; Farias, Michael; Graham, Dionne; Powell, Andrew J; Fulton, David R; Newburger, Jane W; Colan, Steven D; Jenkins, Kathy J; Lock, James E

2010-01-01

A Standardized Clinical Assessment and Management Plan (SCAMP) is a novel quality improvement initiative that standardizes the assessment and management of all patients who carry a predefined diagnosis. Based on periodic review of systemically collected data the SCAMP is designed to be modified to improve its own algorithm. One of the objectives of a SCAMP is to identify and reduce resource utilization and patient care costs. We retrospectively reviewed resource utilization in the first 93 arterial switch operation (ASO) SCAMP patients and 186 age-matched control ASO patients. We compared diagnostic and laboratory testing obtained at the initial SCAMP clinic visit and control patient visits. To evaluate the effect of the SCAMP over time, the number of clinic visits per patient year and echocardiograms per patient year in historical control ASO patients were compared to the projected rates for ASO SCAMP participants. Cardiac magnetic resonance imaging (MRI), stress echocardiogram, and lipid profile utilization were higher in the initial SCAMP clinic visit group than in age-matched control patients. Total echocardiogram and lung scan usage were similar. Chest X-ray and exercise stress testing were obtained less in SCAMP patients. ASO SCAMP patients are projected to have 0.5 clinic visits and 0.5 echocardiograms per year. Historical control patients had more clinic visits (1.2 vs. 0.5 visits/patient year, P<.01) and a higher echocardiogram rate (0.92 vs. 0.5 echocardiograms/patient year, P<.01) Implementation of a SCAMP may initially lead to increased resource utilization, but over time resource utilization is projected to decrease.

Inequities in utilization of reproductive and maternal health services in Ethiopia.

PubMed

Bobo, Firew Tekle; Yesuf, Elias Ali; Woldie, Mirkuzie

2017-06-19

Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia. Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used; equity gaps, rate-ratios, concertation curve and concentration index. Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy. Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably.

Theoretical Analysis and Experimental Study on the Coating Removal from Passenger-Vehicle Plastics for Recycling by Using Water Jet Technology

NASA Astrophysics Data System (ADS)

Zhang, Hongshen; Chen, Ming

2015-11-01

The recovery and utilization of automotive plastics are a global concern because of the increasing number of end-of-life vehicles. In-depth studies on technologies for the removal of coatings from automotive plastics can contribute to the high value-added levels of the recycling and utilization of automotive plastic. The liquid waste generated by removing chemical paint by using traditional methods is difficult to handle and readily produces secondary pollution. Therefore, new, clean, and highly efficient techniques of paint removal must be developed. In this article, a method of coating removal from passenger-vehicle plastics was generated based on high-pressure water jet technology to facilitate the recycling of these plastics. The established technology was theoretically analyzed, numerically simulated, and experimentally studied. The high-pressure water jet equipment for the removal of automotive-plastic coatings was constructed through research and testing, and the detailed experiments on coating removal rate were performed by using this equipment. The results showed that high-pressure water jet technology can effectively remove coatings on the surfaces of passenger-vehicle plastics. The research also revealed that the coating removal rate increased as jet pressure ( P) increased and then decreased when jet moving speed ( Vn) increased. The rate decreased as the distance from nozzle to work piece ( S nw ) and the nozzle angle ( Φ) increased. The mathematical model for the rate of removal of coatings from bumper surfaces by water jet was derived based on the experiment data and can effectively predict coating removal rate under different operating conditions.

Radiotherapy utilization in developing countries: An IAEA study.

PubMed

Rosenblatt, Eduardo; Fidarova, Elena; Zubizarreta, Eduardo H; Barton, Michael B; Jones, Glenn W; Mackillop, William J; Cordero, Lisbeth; Yarney, Joel; Lim, Gerard; Gan, John V; Cernea, Valentin; Stojanovic-Rundic, Suzana; Strojan, Primoz; Kochbati, Lotfi; Quarneti, Aldo

2018-05-30

The planning of national radiotherapy (RT) services requires a thorough knowledge of the country's cancer epidemiology profile, the radiotherapy utilization (RTU) rates and a future projection of these data. Previous studies have established RTU rates in high-income countries. Optimal RTU (oRTU) rates were determined for nine middle-income countries, following the epidemiological evidence-based method. The actual RTU (aRTU) rates were calculated dividing the total number of new notifiable cancer patients treated with radiotherapy in 2012 by the total number of cancer patients diagnosed in the same year in each country. An analysis of the characteristics of patients and treatments in a series of 300 consecutive radiotherapy patients shed light on the particular patient and treatments profile in the participating countries. The median oRTU rate for the group of nine countries was 52% (47-56%). The median aRTU rate for the nine countries was 28% (9-46%). These results show that the real proportion of cancer patients receiving RT is lower than the optimal RTU with a rate difference between 10-42.7%. The median percent-unmet need was 47% (18-82.3%). The optimal RTU rate in middle-income countries did not differ significantly from that previously found in high-income countries. The actual RTU rates were consistently lower than the optimal, in particular in countries with limited resources and a large population. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

MIDA boronates are hydrolysed fast and slow by two different mechanisms

NASA Astrophysics Data System (ADS)

Gonzalez, Jorge A.; Ogba, O. Maduka; Morehouse, Gregory F.; Rosson, Nicholas; Houk, Kendall N.; Leach, Andrew G.; Cheong, Paul H.-Y.; Burke, Martin D.; Lloyd-Jones, Guy C.

2016-11-01

MIDA boronates (N-methylimidodiacetic boronic acid esters) serve as an increasingly general platform for small-molecule construction based on building blocks, largely because of the dramatic and general rate differences with which they are hydrolysed under various basic conditions. Yet the mechanistic underpinnings of these rate differences have remained unclear, which has hindered efforts to address the current limitations of this chemistry. Here we show that there are two distinct mechanisms for this hydrolysis: one is base mediated and the other neutral. The former can proceed more than three orders of magnitude faster than the latter, and involves a rate-limiting attack by a hydroxide at a MIDA carbonyl carbon. The alternative ‘neutral’ hydrolysis does not require an exogenous acid or base and involves rate-limiting B-N bond cleavage by a small water cluster, (H2O)n. The two mechanisms can operate in parallel, and their relative rates are readily quantified by 18O incorporation. Whether hydrolysis is ‘fast’ or ‘slow’ is dictated by the pH, the water activity and the mass-transfer rates between phases. These findings stand to enable, in a rational way, an even more effective and widespread utilization of MIDA boronates in synthesis.

Field evaluation and assessment of thermal energy storage for residential space heating

NASA Astrophysics Data System (ADS)

Hersh, H. N.

1982-02-01

A data base was developed based on two heating seasons and 45 test and 30 control homes in Maine and Vermont. Based on first analysis of monitored temperatures and electrical energy used for space heating, fuel bills and reports of users and utilities, the technical performance of TES ceramic and hydronic systems is deemed to be technically satisfactory and there is a high degree of customer acceptance and positive attitudes towards TES. Analysis of house data shows a high degree of variability in electric heat energy demand for a given degree-day. An analysis is underway to investigate relative differences in the efficiency of electricity utilization of storage and direct heating devices. The much higher price of storge systems relative to direct systems is an impediment to market penetration. A changing picture of rate structures may encourage direct systems at the expense of storage systems.

From Information Management to Information Visualization

PubMed Central

Karami, Mahtab

2016-01-01

Summary Objective The development and implementation of a dashboard of medical imaging department (MID) performance indicators. Method Several articles discussing performance measures of imaging departments were searched for this study. All the related measures were extracted. Then, a panel of imaging experts were asked to rate these measures with an open ended question to seek further potential indicators. A second round was performed to confirm the performance rating. The indicators and their ratings were then reviewed by an executive panel. Based on the final panel’s rating, a list of indicators to be used was developed. A team of information technology consultants were asked to determine a set of user interface requirements for the building of the dashboard. In the first round, based on the panel’s rating, a list of main features or requirements to be used was determined. Next, Qlikview was utilized to implement the dashboard to visualize a set of selected KPI metrics. Finally, an evaluation of the dashboard was performed. Results 92 MID indicators were identified. On top of this, 53 main user interface requirements to build of the prototype of dashboard were determined. Then, the project team successfully implemented a prototype of radiology management dashboards into study site. The visual display that was designed was rated highly by users. Conclusion To develop a dashboard, management of information is essential. It is recommended that a quality map be designed for the MID. It can be used to specify the sequence of activities, their related indicators and required data for calculating these indicators. To achieve both an effective dashboard and a comprehensive view of operations, it is necessary to design a data warehouse for gathering data from a variety of systems. Utilizing interoperability standards for exchanging data among different systems can be also effective in this regard. PMID:27437043

Inconsistencies between 14C and short-lived radionuclides-based sediment accumulation rates: Effects of long-term remineralization.

PubMed

Baskaran, M; Bianchi, T S; Filley, T R

2017-08-01

14 C is the most widely utilized geochronometer to investigate geological, geochemical and geophysical problems over the past 5 decades. Establishment of precise sedimentation rates is crucial for the reconstruction of paleo-climate, -ecological and - environmental studies when extrapolation of sedimentation rates is utilized for time scales beyond the dating range. However, agreement between short-term and long-term sedimentation rates in anthropogenically unperturbed sediment cores has not been shown. Here we show that the AMS 14 C-based long-term mass accumulation rate (MAR) of an organic-rich (>70%) sediment core from Mud Lake, Florida to be ∼5 times lower than the short-term MAR obtained using 239,240 Pu, 137 Cs and excess 210 Pb ( 210 Pb xs ). The measured sediment inventories of 210 Pb xs , 137 Cs and 239,240 Pu are comparable to the atmospheric fallout for the sampling site, indicating very little accelerated sediment erosion over the past several decades. Presence of sharp fallout peaks of 239,240 Pu indicates very little sediment mixing. The penetration depths of 137 Cs and 239,240 Pu were found to be much deeper than expected and this is attributed to their post-depositional mobility. MAR calculated using 14 C-ages in successive layers also indicated decreasing MARs with depth, and was reflective of progressive remineralization. Using first-order kinetics, the sediment remineralization rate was found to be 4.4 × 10 -4 y -1 and propose that over the long-term, remineralization of organic-rich sediment affected the long-term MAR, but not the ratio of 14 C/ 12 C. Thus, the MAR and linear sedimentation rate obtained using 14 C (and other isotope-based methods) could be erroneous, although 14 C ages may not be affected by such remineralization. Long-term remineralization rates of organic matter has a direct bearing on the biogeochemical cycling of elements in aqueous systems and mass balance of elements needs to be taken into consideration. Copyright © 2016 Elsevier Ltd. All rights reserved.

Online Prediction of Health Care Utilization in the Next Six Months Based on Electronic Health Record Information: A Cohort and Validation Study.

PubMed

Hu, Zhongkai; Hao, Shiying; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Wang, Yue; Zheng, Le; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng

2015-09-22

The increasing rate of health care expenditures in the United States has placed a significant burden on the nation's economy. Predicting future health care utilization of patients can provide useful information to better understand and manage overall health care deliveries and clinical resource allocation. This study developed an electronic medical record (EMR)-based online risk model predictive of resource utilization for patients in Maine in the next 6 months across all payers, all diseases, and all demographic groups. In the HealthInfoNet, Maine's health information exchange (HIE), a retrospective cohort of 1,273,114 patients was constructed with the preceding 12-month EMR. Each patient's next 6-month (between January 1, 2013 and June 30, 2013) health care resource utilization was retrospectively scored ranging from 0 to 100 and a decision tree-based predictive model was developed. Our model was later integrated in the Maine HIE population exploration system to allow a prospective validation analysis of 1,358,153 patients by forecasting their next 6-month risk of resource utilization between July 1, 2013 and December 31, 2013. Prospectively predicted risks, on either an individual level or a population (per 1000 patients) level, were consistent with the next 6-month resource utilization distributions and the clinical patterns at the population level. Results demonstrated the strong correlation between its care resource utilization and our risk scores, supporting the effectiveness of our model. With the online population risk monitoring enterprise dashboards, the effectiveness of the predictive algorithm has been validated by clinicians and caregivers in the State of Maine. The model and associated online applications were designed for tracking the evolving nature of total population risk, in a longitudinal manner, for health care resource utilization. It will enable more effective care management strategies driving improved patient outcomes.

Online Prediction of Health Care Utilization in the Next Six Months Based on Electronic Health Record Information: A Cohort and Validation Study

PubMed Central

Hu, Zhongkai; Hao, Shiying; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Wang, Yue; Zheng, Le; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank

2015-01-01

Background The increasing rate of health care expenditures in the United States has placed a significant burden on the nation’s economy. Predicting future health care utilization of patients can provide useful information to better understand and manage overall health care deliveries and clinical resource allocation. Objective This study developed an electronic medical record (EMR)-based online risk model predictive of resource utilization for patients in Maine in the next 6 months across all payers, all diseases, and all demographic groups. Methods In the HealthInfoNet, Maine’s health information exchange (HIE), a retrospective cohort of 1,273,114 patients was constructed with the preceding 12-month EMR. Each patient’s next 6-month (between January 1, 2013 and June 30, 2013) health care resource utilization was retrospectively scored ranging from 0 to 100 and a decision tree–based predictive model was developed. Our model was later integrated in the Maine HIE population exploration system to allow a prospective validation analysis of 1,358,153 patients by forecasting their next 6-month risk of resource utilization between July 1, 2013 and December 31, 2013. Results Prospectively predicted risks, on either an individual level or a population (per 1000 patients) level, were consistent with the next 6-month resource utilization distributions and the clinical patterns at the population level. Results demonstrated the strong correlation between its care resource utilization and our risk scores, supporting the effectiveness of our model. With the online population risk monitoring enterprise dashboards, the effectiveness of the predictive algorithm has been validated by clinicians and caregivers in the State of Maine. Conclusions The model and associated online applications were designed for tracking the evolving nature of total population risk, in a longitudinal manner, for health care resource utilization. It will enable more effective care management strategies driving improved patient outcomes. PMID:26395541

Mass spectrometric screening of ligands with lower off-rate from a clicked-based pooled library.

PubMed

Arai, Satoshi; Hirosawa, Shota; Oguchi, Yusuke; Suzuki, Madoka; Murata, Atsushi; Ishiwata, Shin'ichi; Takeoka, Shinji

2012-08-13

This paper describes a convenient screening method using ion trap electrospray ionization mass spectrometry to classify ligands to a target molecule in terms of kinetic parameters. We demonstrate this method in the screening of ligands to a hexahistidine tag from a pooled library synthesized by click chemistry. The ion trap mass spectrometry analysis revealed that higher stabilities of ligand-target complexes in the gas phase were related to lower dissociation rate constants, i.e., off-rates in solution. Finally, we prepared a fluorescent probe utilizing the ligand with lowest off-rate and succeeded in performing single molecule observations of hexahistidine-tagged myosin V walking on actin filaments.

Comparative effectiveness and cost-effectiveness of the implantable miniature telescope.

PubMed

Brown, Gary C; Brown, Melissa M; Lieske, Heidi B; Lieske, Philip A; Brown, Kathryn S; Lane, Stephen S

2011-09-01

To assess the preference-based comparative effectiveness (human value gain) and the cost-utility (cost-effectiveness) of a telescope prosthesis (implantable miniature telescope) for the treatment of end-stage, age-related macular degeneration (AMD). A value-based medicine, second-eye model, cost-utility analysis was performed to quantify the comparative effectiveness and cost-effectiveness of therapy with the telescope prosthesis. Published, evidence-based data from the IMT002 Study Group clinical trial. Ophthalmic utilities were obtained from a validated cohort of >1000 patients with ocular diseases. Comparative effectiveness data were converted from visual acuity to utility (value-based) format. The incremental costs (Medicare) of therapy versus no therapy were integrated with the value gain conferred by the telescope prosthesis to assess its average cost-utility. The incremental value gains and incremental costs of therapy referent to (1) a fellow eye cohort and (2) a fellow eye cohort of those who underwent intra-study cataract surgery were integrated in incremental cost-utility analyses. All value outcomes and costs were discounted at a 3% annual rate, as per the Panel on Cost-Effectiveness in Health and Medicine. Comparative effectiveness was quantified using the (1) quality-adjusted life-year (QALY) gain and (2) percent human value gain (improvement in quality of life). The QALY gain was integrated with incremental costs into the cost-utility ratio ($/QALY, or US dollars expended per QALY gained). The mean, discounted QALY gain associated with use of the telescope prosthesis over 12 years was 0.7577. When the QALY loss of 0.0004 attributable to the adverse events was factored into the model, the final QALY gain was 0.7573. This resulted in a 12.5% quality of life gain for the average patient during the 12 years of the model. The average cost-utility versus no therapy for use of the telescope prosthesis was $14389/QALY. The incremental cost-utility referent to control fellow eyes was $14063/QALY, whereas the incremental cost-utility referent to fellow eyes that underwent intra-study cataract surgery was $11805/QALY. Therapy with the telescope prosthesis considerably improves quality of life and at the same time is cost-effective by conventional standards. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Maximum demand charge rates for commercial and industrial electricity tariffs in the United States

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

McLaren, Joyce; Gagnon, Pieter; Zimny-Schmitt, Daniel

NREL has assembled a list of U.S. retail electricity tariffs and their associated demand charge rates for the Commercial and Industrial sectors. The data was obtained from the Utility Rate Database. Keep the following information in mind when interpreting the data: (1) These data were interpreted and transcribed manually from utility tariff sheets, which are often complex. It is a certainty that these data contain errors, and therefore should only be used as a reference. Actual utility tariff sheets should be consulted if an action requires this type of data. (2) These data only contains tariffs that were entered intomore » the Utility Rate Database. Since not all tariffs are designed in a format that can be entered into the Database, this list is incomplete - it does not contain all tariffs in the United States. (3) These data may have changed since this list was developed (4) Many of the underlying tariffs have additional restrictions or requirements that are not represented here. For example, they may only be available to the agricultural sector or closed to new customers. (5) If there are multiple demand charge elements in a given tariff, the maximum demand charge is the sum of each of the elements at any point in time. Where tiers were present, the highest rate tier was assumed. The value is a maximum for the year, and may be significantly different from demand charge rates at other times in the year. Utility Rate Database: https://openei.org/wiki/Utility_Rate_Database« less

Determination of motion extrema in multi-satellite systems

NASA Astrophysics Data System (ADS)

Allgeier, Shawn E.

Spacecraft, or satellite formation flight has been a topic of interest dating back to the Gemini program of the 1960s. Traditionally space missions have been designed around large monolithic assets. Recent interest in low cost, rapid call up mission architectures structured around fractionated systems, small satellites, and constellations has spurred renewed efforts in spacecraft relative motion problems. While such fractionated, or multi-body systems may provide benefits in terms of risk mitigation and cost savings, they introduce new technical challenges in terms of satellite coordination. Characterization of satellite formations is a vital requirement for them to have utility to industry and government entities. Satellite formations introduce challenges in the form of constellation maintenance, inter-satellite communications, and the demand for more sophisticated guidance, navigation, and control systems. At the core of these challenges is the orbital mechanics which govern the resulting motion. New applications of algebraic techniques are applied to the formation flight problem, specifically Gröbner basis tools, as a means of determining extrema of certain quantities pertaining to formation flight. Specifically, bounds are calculated for the relative position components, relative speed, relative velocity components, and range rate. The position based metrics are relevant for planning formation geometry, particularly in constellation or Earth observation applications. The velocity metrics are relevant in the design of end game interactions for rendezvous and proximity operations. The range rate of one satellite to another is essential in the design of radio frequency hardware for inter-satellite communications so that the doppler shift can be calculated a priori. Range rate may also have utility in space based surveillance and space situational awareness concerns, such as cross tagging. The results presented constitute a geometric perspective and have utility to mission designers, particularly for missions involving rendezvous and proximity operations.

Cost-Effectiveness Analysis of Intensity Modulated Radiation Therapy Versus 3-Dimensional Conformal Radiation Therapy for Preoperative Treatment of Extremity Soft Tissue Sarcomas

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

Richard, Patrick, E-mail: patrjr@uw.edu; Phillips, Mark; Smith, Wade

Purpose: Create a cost-effectiveness model comparing preoperative intensity modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation therapy (3DCRT) for extremity soft tissue sarcomas. Methods and Materials: Input parameters included 5-year local recurrence rates, rates of acute wound adverse events, and chronic toxicities (edema, fracture, joint stiffness, and fibrosis). Health-state utilities were used to calculate quality-adjusted life years (QALYs). Overall treatment costs per QALY or incremental cost-effectiveness ratio (ICER) were calculated. Roll-back analysis was performed using average costs and utilities to determine the baseline preferred radiation technique. One-way, 2-way, and probabilistic sensitivity analyses (PSA) were performed for input parameters with themore » largest impact on the ICER. Results: Overall treatment costs were $17,515.58 for 3DCRT compared with $22,920.51 for IMRT. The effectiveness was higher for IMRT (3.68 QALYs) than for 3DCRT (3.35 QALYs). The baseline ICER for IMRT was $16,842.75/QALY, making it the preferable treatment. The ICER was most sensitive to the probability of local recurrence, upfront radiation costs, local recurrence costs, certain utilities (no toxicity/no recurrence, grade 1 toxicity/no local recurrence, grade 4 toxicity/no local recurrence), and life expectancy. Dominance patterns emerged when the cost of 3DCRT exceeded $15,532.05 (IMRT dominates) or the life expectancy was under 1.68 years (3DCRT dominates). Furthermore, preference patterns changed based on the rate of local recurrence (threshold: 13%). The PSA results demonstrated that IMRT was the preferred cost-effective technique for 64% of trials compared with 36% for 3DCRT. Conclusions: Based on our model, IMRT is the preferred technique by lowering rates of local recurrence, severe toxicities, and improving QALYs. From a third-party payer perspective, IMRT should be a supported approach for extremity soft tissue sarcomas.« less

Impact of socioeconomic position and distance on mental health care utilization: a nationwide Danish follow-up study.

PubMed

Packness, Aake; Waldorff, Frans Boch; Christensen, René dePont; Hastrup, Lene Halling; Simonsen, Erik; Vestergaard, Mogens; Halling, Anders

2017-11-01

To determine the impact of socioeconomic position (SEP) and distance to provider on outpatient mental health care utilization among incident users of antidepressants. A nationwide register-based cohort study of 50,374 person-years. Persons in low SEP were more likely to have outpatient psychiatrist contacts [odds ratio (OR) 1.25; confidence interval (CI) 1.17-1.34], but less likely to consult a co-payed psychologist (OR 0.49; CI 0.46-0.53) and to get mental health service from a GP (MHS-GP) (OR 0.81; CI 0.77-0.86) compared to persons in high SEP after adjusting for socio-demographics, comorbidity and car ownership. Furthermore, persons in low SEP who had contact to any of these therapists tended to have lower rates of visits compared to those in high SEP. When distance to services increased by 5 km, the rate of visits to outpatient psychiatrist tended to decrease by 5% in the lowest income group (IRR 0.95; CI 0.94-0.95) and 1% in the highest (IRR 0.99; CI 0.99-1.00). Likewise, contact to psychologists decreased by 11% in the lowest income group (IRR 0.89; CI 0.85-0.94), whereas rate of visits did not interact. Patients in low SEP have relatively lower utilization of mental health services even when services are free at delivery; co-payment and distance to provider aggravate the disparities in utilization between patients in high SEP and patients in low SEP.

On service differentiation in mobile Ad Hoc networks.

PubMed

Zhang, Shun-liang; Ye, Cheng-qing

2004-09-01

A network model is proposed to support service differentiation for mobile Ad Hoc networks by combining a fully distributed admission control approach and the DIFS based differentiation mechanism of IEEE802.11. It can provide different kinds of QoS (Quality of Service) for various applications. Admission controllers determine a committed bandwidth based on the reserved bandwidth of flows and the source utilization of networks. Packets are marked when entering into networks by markers according to the committed rate. By the mark in the packet header, intermediate nodes handle the received packets in different manners to provide applications with the QoS corresponding to the pre-negotiated profile. Extensive simulation experiments showed that the proposed mechanism can provide QoS guarantee to assured service traffic and increase the channel utilization of networks.

A voting-based star identification algorithm utilizing local and global distribution

NASA Astrophysics Data System (ADS)

Fan, Qiaoyun; Zhong, Xuyang; Sun, Junhua

2018-03-01

A novel star identification algorithm based on voting scheme is presented in this paper. In the proposed algorithm, the global distribution and local distribution of sensor stars are fully utilized, and the stratified voting scheme is adopted to obtain the candidates for sensor stars. The database optimization is employed to reduce its memory requirement and improve the robustness of the proposed algorithm. The simulation shows that the proposed algorithm exhibits 99.81% identification rate with 2-pixel standard deviations of positional noises and 0.322-Mv magnitude noises. Compared with two similar algorithms, the proposed algorithm is more robust towards noise, and the average identification time and required memory is less. Furthermore, the real sky test shows that the proposed algorithm performs well on the real star images.

Simultaneous chromatic dispersion monitoring and optical modulation format identification utilizing four wave mixing

NASA Astrophysics Data System (ADS)

Cui, Sheng; Qiu, Chen; Ke, Changjian; He, Sheng; Liu, Deming

2015-11-01

This paper presents a method which is able to monitor the chromatic dispersion (CD) and identify the modulation format (MF) of optical signals simultaneously. This method utilizes the features of the output curve of the highly sensitive all-optical CD monitor based on four wave mixing (FWM). From the symmetric center of the curve CD can be estimated blindly and independently, while from the profile and convergence region of the curve ten commonly used modulation formats can be recognized with simple algorithm based on maximum correlation classifier. This technique does not need any high speed optoelectronics and has no limitation on signal rate. Furthermore it can tolerate large CD distortions and is robust to polarization mode dispersion (PMD) and amplified spontaneous emission (ASE) noise.

Towards a healthier discount procedure.

PubMed

Klock, Rogier M; Brouwer, Werner Bf; Annemans, Lieven Jp; Bos, Jasper M; Postma, Maarten J

2005-02-01

Most national guidelines for pharmacoeconomic research prescribe discounting, mostly of money and health against the same rate. There is much debate on whether this is adequate. Two theoretical arguments, the consistency argument of Weinstein and Stason, and the paralyzing paradox of Keeler and Cretin, are mostly responsible for the current standards. However, more recently, several authors have indicated that the basis to claim the necessity of using similar discount rates is rather weak, both practically and theoretically. In terms of finding a new theoretical basis on which to base discount rates for money and, in particular, health, Van Hout has made an important suggestion arguing that the discount rate for health could be based on the expected growth in life expectancy and the diminishing marginal utility related to such additional health. Similarly, Gravelle and Smith argue that if the value of health grows over time, discount rates that are used for costs cannot directly be applied to effects, but should be adjusted downwards.

A Golay complementary TS-based symbol synchronization scheme in variable rate LDPC-coded MB-OFDM UWBoF system

NASA Astrophysics Data System (ADS)

He, Jing; Wen, Xuejie; Chen, Ming; Chen, Lin

2015-09-01

In this paper, a Golay complementary training sequence (TS)-based symbol synchronization scheme is proposed and experimentally demonstrated in multiband orthogonal frequency division multiplexing (MB-OFDM) ultra-wideband over fiber (UWBoF) system with a variable rate low-density parity-check (LDPC) code. Meanwhile, the coding gain and spectral efficiency in the variable rate LDPC-coded MB-OFDM UWBoF system are investigated. By utilizing the non-periodic auto-correlation property of the Golay complementary pair, the start point of LDPC-coded MB-OFDM UWB signal can be estimated accurately. After 100 km standard single-mode fiber (SSMF) transmission, at the bit error rate of 1×10-3, the experimental results show that the short block length 64QAM-LDPC coding provides a coding gain of 4.5 dB, 3.8 dB and 2.9 dB for a code rate of 62.5%, 75% and 87.5%, respectively.

A Comparison of a Centralized Versus De-Centralized Recruitment Schema in Two Community-Based Participatory Research Studies for Cancer Prevention

PubMed Central

Adams, Swann Arp; Heiney, Sue P.; Brandt, Heather M.; Wirth, Michael D.; Khan, Samira; Johnson, Hiluv; Davis, Lisa; Wineglass, Cassandra M.; Warren-Jones, Tatiana Y.; Felder, Tisha M.; Drayton, Ruby F.; Davis, Briana; Farr, Deeonna E.; Hébert, James R.

2014-01-01

Use of community-based participatory research (CBPR) approaches is increasing with the goal of making more meaningful and impactful advances in eliminating cancer-related health disparities. While many reports have espoused its advantages, few investigations have focused on comparing CBPR-oriented recruitment and retention. Consequently, the purpose of this analysis was to report and compare two different CBPR approaches in two cancer prevention studies. We utilized frequencies and chi-squared tests to compare and contrast subject recruitment and retention for two studies that incorporated a randomized, controlled intervention design of a dietary and physical activity intervention among African Americans. One study utilized a de-centralized approach to recruitment in which primary responsibility for recruitment was assigned to the general AA community of various church partners whereas the other incorporated a centralized approach to recruitment in which a single lay community individual was hired as research personnel to lead recruitment and intervention delivery. Both studies performed equally well for both recruitment and retention (75 and 88% recruitment rates and 71 and 66% retention rates) far exceeding those rates traditionally cited for cancer clinical trials (~5%). The de-centralized approach to retention appeared to result in statistically greater retention for the control participants compared to the centralized approach (77 vs 51%, P<0.01). Consequently, both CBPR approaches appeared to greatly enhance recruitment and retention rates of AA populations. We further note lessons learned and challenges to consider for future research opportunities. PMID:25086566

A flexible statistical model for alignment of label-free proteomics data – incorporating ion mobility and product ion information

PubMed Central

2013-01-01

Background The goal of many proteomics experiments is to determine the abundance of proteins in biological samples, and the variation thereof in various physiological conditions. High-throughput quantitative proteomics, specifically label-free LC-MS/MS, allows rapid measurement of thousands of proteins, enabling large-scale studies of various biological systems. Prior to analyzing these information-rich datasets, raw data must undergo several computational processing steps. We present a method to address one of the essential steps in proteomics data processing - the matching of peptide measurements across samples. Results We describe a novel method for label-free proteomics data alignment with the ability to incorporate previously unused aspects of the data, particularly ion mobility drift times and product ion information. We compare the results of our alignment method to PEPPeR and OpenMS, and compare alignment accuracy achieved by different versions of our method utilizing various data characteristics. Our method results in increased match recall rates and similar or improved mismatch rates compared to PEPPeR and OpenMS feature-based alignment. We also show that the inclusion of drift time and product ion information results in higher recall rates and more confident matches, without increases in error rates. Conclusions Based on the results presented here, we argue that the incorporation of ion mobility drift time and product ion information are worthy pursuits. Alignment methods should be flexible enough to utilize all available data, particularly with recent advancements in experimental separation methods. PMID:24341404

A flexible statistical model for alignment of label-free proteomics data--incorporating ion mobility and product ion information.

PubMed

Benjamin, Ashlee M; Thompson, J Will; Soderblom, Erik J; Geromanos, Scott J; Henao, Ricardo; Kraus, Virginia B; Moseley, M Arthur; Lucas, Joseph E

2013-12-16

The goal of many proteomics experiments is to determine the abundance of proteins in biological samples, and the variation thereof in various physiological conditions. High-throughput quantitative proteomics, specifically label-free LC-MS/MS, allows rapid measurement of thousands of proteins, enabling large-scale studies of various biological systems. Prior to analyzing these information-rich datasets, raw data must undergo several computational processing steps. We present a method to address one of the essential steps in proteomics data processing--the matching of peptide measurements across samples. We describe a novel method for label-free proteomics data alignment with the ability to incorporate previously unused aspects of the data, particularly ion mobility drift times and product ion information. We compare the results of our alignment method to PEPPeR and OpenMS, and compare alignment accuracy achieved by different versions of our method utilizing various data characteristics. Our method results in increased match recall rates and similar or improved mismatch rates compared to PEPPeR and OpenMS feature-based alignment. We also show that the inclusion of drift time and product ion information results in higher recall rates and more confident matches, without increases in error rates. Based on the results presented here, we argue that the incorporation of ion mobility drift time and product ion information are worthy pursuits. Alignment methods should be flexible enough to utilize all available data, particularly with recent advancements in experimental separation methods.

Optimization of the dressing parameters in cylindrical grinding based on a generalized utility function

NASA Astrophysics Data System (ADS)

Aleksandrova, Irina

2016-01-01

The existing studies, concerning the dressing process, focus on the major influence of the dressing conditions on the grinding response variables. However, the choice of the dressing conditions is often made, based on the experience of the qualified staff or using data from reference books. The optimal dressing parameters, which are only valid for the particular methods and dressing and grinding conditions, are also used. The paper presents a methodology for optimization of the dressing parameters in cylindrical grinding. The generalized utility function has been chosen as an optimization parameter. It is a complex indicator determining the economic, dynamic and manufacturing characteristics of the grinding process. The developed methodology is implemented for the dressing of aluminium oxide grinding wheels by using experimental diamond roller dressers with different grit sizes made of medium- and high-strength synthetic diamonds type ??32 and ??80. To solve the optimization problem, a model of the generalized utility function is created which reflects the complex impact of dressing parameters. The model is built based on the results from the conducted complex study and modeling of the grinding wheel lifetime, cutting ability, production rate and cutting forces during grinding. They are closely related to the dressing conditions (dressing speed ratio, radial in-feed of the diamond roller dresser and dress-out time), the diamond roller dresser grit size/grinding wheel grit size ratio, the type of synthetic diamonds and the direction of dressing. Some dressing parameters are determined for which the generalized utility function has a maximum and which guarantee an optimum combination of the following: the lifetime and cutting ability of the abrasive wheels, the tangential cutting force magnitude and the production rate of the grinding process. The results obtained prove the possibility of control and optimization of grinding by selecting particular dressing parameters.

Quantitative measurements of regional glucose utilization and rate of valine incorporation into proteins by double-tracer autoradiography in the rat brain tumor model

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

Kirikae, M.; Diksic, M.; Yamamoto, Y.L.

1989-02-01

We examined the rate of glucose utilization and the rate of valine incorporation into proteins using 2-(/sup 18/F)fluoro-2-deoxyglucose and L-(1-14C)-valine in a rat brain tumor model by quantitative double-tracer autoradiography. We found that in the implanted tumor the rate of valine incorporation into proteins was about 22 times and the rate of glucose utilization was about 1.5 times that in the contralateral cortex. (In the ipsilateral cortex, the tumor had a profound effect on glucose utilization but no effect on the rate of valine incorporation into proteins.) Our findings suggest that it is more useful to measure protein synthesis thanmore » glucose utilization to assess the effectiveness of antitumor agents and their toxicity to normal brain tissue. We compared two methods to estimate the rate of valine incorporation: kinetic (quantitation done using an operational equation and the average brain rate coefficients) and washed slices (unbound labeled valine removed by washing brain slices in 10% trichloroacetic acid). The results were the same using either method. It would seem that the kinetic method can thus be used for quantitative measurement of protein synthesis in brain tumors and normal brain tissue using (/sup 11/C)-valine with positron emission tomography.« less

Rapid detection of Naegleria fowleri in water distribution pipeline biofilms and drinking water samples.

PubMed

Puzon, Geoffrey J; Lancaster, James A; Wylie, Jason T; Plumb, Iason J

2009-09-01

Rapid detection of pathogenic Naegleria fowler in water distribution networks is critical for water utilities. Current detection methods rely on sampling drinking water followed by culturing and molecular identification of purified strains. This culture-based method takes an extended amount of time (days), detects both nonpathogenic and pathogenic species, and does not account for N. fowleri cells associated with pipe wall biofilms. In this study, a total DNA extraction technique coupled with a real-time PCR method using primers specific for N. fowleri was developed and validated. The method readily detected N. fowleri without preculturing with the lowest detection limit for N. fowleri cells spiked in biofilm being one cell (66% detection rate) and five cells (100% detection rate). For drinking water, the detection limit was five cells (66% detection rate) and 10 cells (100% detection rate). By comparison, culture-based methods were less sensitive for detection of cells spiked into both biofilm (66% detection for <10 cells) and drinking water (0% detection for <10 cells). In mixed cultures of N. fowleri and nonpathogenic Naegleria, the method identified N. fowleri in 100% of all replicates, whereastests with the current consensus primers detected N. fowleri in only 5% of all replicates. Application of the new method to drinking water and pipe wall biofilm samples obtained from a distribution network enabled the detection of N. fowleri in under 6 h, versus 3+ daysforthe culture based method. Further, comparison of the real-time PCR data from the field samples and the standard curves enabled an approximation of N. fowleri cells in the biofilm and drinking water. The use of such a method will further aid water utilities in detecting and managing the persistence of N. fowleri in water distribution networks.

A review of screening mammography participation and utilization in Canada.

PubMed

Doyle, G P; Major, D; Chu, C; Stankiewicz, A; Harrison, M L; Pogany, L; Mai, V M; Onysko, J

2011-09-01

Participation rate is an important indicator for a screening program's effectiveness; however, the current approach to measuring participation rate in Canada is not comparable with other countries. The objective of this study is to review the measurement of screening mammography participation in Canada, make international comparisons, and propose alternative methods. Canadian breast cancer screening program data for women aged 50 to 69 years screened between 2004 and 2006 were extracted from the Canadian Breast Cancer Screening Database (CBCSD). The fee-for-services (FSS) mammography data (opportunistic screening mammography) were obtained from the provincial ministries of health. Both screening mammography program participation and utilization were examined over 24 and 30 months. Canada's screening participation rate increases from 39.4% for a 24-month cut-off to 43.6% for a 30-month cut-off. The 24-month mammography utilization rate is 63.1% in Canada, and the 30-month utilization rate is 70.4%. Due to the differences in health service delivery among Canadian provinces, both programmatic participation and overall utilization of mammography at 24 months and 30 months should be monitored.

The Utility of Thin Slice Ratings for Predicting Language Growth in Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Walton, Katherine M.; Ingersoll, Brooke R.

2016-01-01

Literature on "Thin Slice" ratings indicates that a number of personality characteristics and behaviors can be accurately predicted by ratings of very short segments (<5?min) of behavior. This study examined the utility of Thin Slice ratings of young children with autism spectrum disorder for predicting developmental skills and…

An AWG-based 10 Gbit/s colorless WDM-PON system using a chirp-managed directly modulated laser

NASA Astrophysics Data System (ADS)

Latif, Abdul; Yu, Chong-xiu; Xin, Xiang-jun; Husain, Aftab; Hussain, Ashiq; Munir, Abid; Khan, Yousaf

2012-09-01

We propose an arrayed waveguide grating (AWG)-based 10 Gbit/s per channel full duplex wavelength division multiplexing passive optical network (WDM-PON). A chirp managed directly modulated laser with return-to-zero (RZ) differential phase shift keying (DPSK) modulation technique is utilized for downlink (DL) direction, and then the downlink signal is re-modulated for the uplink (UL) direction using intensity modulation technique with the data rate of 10 Gbit/s per channel. A successful WDM-PON transmission operation with the data rate of 10 Gbit/s per channel over a distance of 25 km without any optical amplification or dispersion compensation is demonstrated with low power penalty.

The resource utilization group system: its effect on nursing home case mix and costs.

PubMed

Thorpe, K E; Gertler, P J; Goldman, P

1991-01-01

Using data from 1985 and 1986, we examine how New York state's prospective payment system affected nursing homes. The system, called Resource Utilization Group (RUG-II), aimed to limit nursing home cost growth and improve access to nursing homes by "heavy-care" patients. As in Medicare's prospective hospital reimbursement system, payments to nursing homes were based on a "price," rather than facility-specific rates. With respect to cost growth, we observed considerable diversity among homes. Specifically, those nursing homes most financially constrained by the RUG-II methodology exhibited the slowest rates of cost growth; we observed higher cost growth among the homes least constrained. This higher rate of cost growth raises a question about the desirability of using a pricing methodology to determine nursing home payment rates. In addition to moderating cost growth, we also observed a significant change in the mix of patients admitted to nursing homes. During the first year of the RUG-II program, nursing homes admitted more heavy-care patients and reduced days of care to lighter-care patients. Thus, through 1986, the RUG-II program appeared to satisfy at least one of its major policy objectives.

Lessons from the Tennessee Valley Authority

NASA Astrophysics Data System (ADS)

Kitchens, Carl Thomas

This dissertation is a program evaluation of the Tennessee Valley Authority (TVA) the largest publicly owned utility in the United States. The first essay in this dissertation examines the TVA's use of eminent domain in order to acquire property for the construction of reservoirs. It develops a new model of asymmetric information and then tests the model predictions using property level data from TVA property purchases in the 1930's. The second essay of this dissertation examines the unintended consequences of reservoir development my examining changes in the malaria rate associated with TVA reservoirs. Using panel data methods, I find that the presence of a TVA reservoir leads to large increases in the malaria mortality and morbidity rate, which cost up to 30 percent of TVA federal appropriations. The final essay in this dissertation examines the impact of TVA electrification programs on economic growth. It combines archival and panel data methods to show that contrary to the historical account, TVA electric rates did not differ substantially from the rates charged by private utilities, and secondly, shows that counties that had electricity contracts with the TVA did not have differential economic growth rates for a variety of economic outcomes. In order to control for selection into contracts, I adopt an instrumental variables strategy based on the cost of electric service.

Multigranular integrated services optical network

NASA Astrophysics Data System (ADS)

Yu, Oliver; Yin, Leping; Xu, Huan; Liao, Ming

2006-12-01

Based on all-optical switches without requiring fiber delay lines and optical-electrical-optical interfaces, the multigranular optical switching (MGOS) network integrates three transport services via unified core control to efficiently support bursty and stream traffic of subwavelength to multiwavelength bandwidth. Adaptive robust optical burst switching (AR-OBS) aggregates subwavelength burst traffic into asynchronous light-rate bursts, transported via slotted-time light paths established by fast two-way reservation with robust blocking recovery control. Multiwavelength optical switching (MW-OS) decomposes multiwavelength stream traffic into a group of timing-related light-rate streams, transported via a light-path group to meet end-to-end delay-variation requirements. Optical circuit switching (OCS) simply converts wavelength stream traffic from an electrical-rate into a light-rate stream. The MGOS network employs decoupled routing, wavelength, and time-slot assignment (RWTA) and novel group routing and wavelength assignment (GRWA) to select slotted-time light paths and light-path groups, respectively. The selected resources are reserved by the unified multigranular robust fast optical reservation protocol (MG-RFORP). Simulation results show that elastic traffic is efficiently supported via AR-OBS in terms of loss rate and wavelength utilization, while connection-oriented wavelength traffic is efficiently supported via wavelength-routed OCS in terms of connection blocking and wavelength utilization. The GRWA-tuning result for MW-OS is also shown.

Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation.

PubMed

Aarons, Gregory A; Ehrhart, Mark G; Farahnak, Lauren R; Hurlburt, Michael S

2015-01-16

Leadership is important in the implementation of innovation in business, health, and allied health care settings. Yet there is a need for empirically validated organizational interventions for coordinated leadership and organizational development strategies to facilitate effective evidence-based practice (EBP) implementation. This paper describes the initial feasibility, acceptability, and perceived utility of the Leadership and Organizational Change for Implementation (LOCI) intervention. A transdisciplinary team of investigators and community stakeholders worked together to develop and test a leadership and organizational strategy to promote effective leadership for implementing EBPs. Participants were 12 mental health service team leaders and their staff (n = 100) from three different agencies that provide mental health services to children and families in California, USA. Supervisors were randomly assigned to the 6-month LOCI intervention or to a two-session leadership webinar control condition provided by a well-known leadership training organization. We utilized mixed methods with quantitative surveys and qualitative data collected via surveys and a focus group with LOCI trainees. Quantitative and qualitative analyses support the LOCI training and organizational strategy intervention in regard to feasibility, acceptability, and perceived utility, as well as impact on leader and supervisee-rated outcomes. The LOCI leadership and organizational change for implementation intervention is a feasible and acceptable strategy that has utility to improve staff-rated leadership for EBP implementation. Further studies are needed to conduct rigorous tests of the proximal and distal impacts of LOCI on leader behaviors, implementation leadership, organizational context, and implementation outcomes. The results of this study suggest that LOCI may be a viable strategy to support organizations in preparing for the implementation and sustainment of EBP.

Flywheel-Based Fast Charging Station - FFCS for Electric Vehicles and Public Transportation

NASA Astrophysics Data System (ADS)

Gabbar, Hossam A.; Othman, Ahmed M.

2017-08-01

This paper demonstrates novel Flywheel-based Fast Charging Station (FFCS) for high performance and profitable charging infrastructures for public electric buses. The design criteria will be provided for fast charging stations. The station would support the private and open charging framework. Flywheel Energy storage system is utilized to offer advanced energy storage for charging stations to achieve clean public transportation, including electric buses with reducing GHG, including CO2 emission reduction. The integrated modelling and management system in the station is performed by a decision-based control platform that coordinates the power streams between the quick chargers, the flywheel storage framework, photovoltaic cells and the network association. There is a tidy exchange up between the capacity rate of flywheel framework and the power rating of the network association.”

77 FR 64977 - Frontier Utilities New York LLC; Supplemental Notice That Initial Market-Based Rate Filing...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-24

... to protest should file with the Federal Energy Regulatory Commission, 888 First Street NE... . To facilitate electronic service, persons with Internet access who will eFile a document and/or be...Registration link. Select the eFiling link to log on and submit the intervention or protests. Persons unable to...

Stimuli Influencing Small Business Owner Adoption of a Software-as-a-Service Solution: A Quantitative Study

ERIC Educational Resources Information Center

Cianciotta, Michael A.

2016-01-01

Cloud computing has moved beyond the early adoption phase and recent trends demonstrate encouraging adoption rates. This utility-based computing model offers significant IT flexibility and potential for cost savings for organizations of all sizes, but may be the most attractive to small businesses because of limited capital to fund required…

Measuring, Rating, Supporting, and Strengthening Open Access Scholarly Publishing in Brazil

ERIC Educational Resources Information Center

Neto, Silvio Carvalho; Willinsky, John; Alperin, Juan Pablo

2016-01-01

This study assesses the extent and nature of open access scholarly publishing in Brazil, one of the world's leaders in providing universal access to its research and scholarship. It utilizes Brazil's Qualis journal evaluation system, along with other relevant data bases to address the association between scholarly quality and open access in the…

Black/White Differences in Adolescent Drug Use: A Test of Six Hypotheses

ERIC Educational Resources Information Center

Rote, Sunshine M.; Taylor, John

2014-01-01

Six specific hypotheses have been developed to account for why Caucasians have higher rates of drug use compared to African-Americans. This article utilizes data from a South Florida-based community study of 893 young adults (1998-2002) to test these hypotheses. Specifically, Caucasians (1) initiate drug use at younger ages than African-Americans…

Relationship between Effective Application of Machine Learning and Malware Detection: A Quantitative Study

ERIC Educational Resources Information Center

Enfinger, Kerry Wayne

2016-01-01

The number of malicious files present in the public domain continues to rise at a substantial rate. Current anti-malware software utilizes a signature-based method to detect the presence of malicious software. Generating these pattern signatures is time consuming due to malicious code complexity and the need for expert analysis, however, by making…

Mindful Leaders in Highly Effective Schools: A Mixed-Method Application of Hoy's M-Scale

ERIC Educational Resources Information Center

Kearney, W. Sean; Kelsey, Cheryl; Herrington, David

2013-01-01

This article presents a mixed-method study utilizing teacher ratings of principal mindfulness from 149 public schools in Texas and follow-up qualitative data analysis through semi-structured interviews conducted with the top 10 percent of princeipals identified as mindful. This research is based on the theoretical framework of mindfulness as…

Observing Classroom Instruction in Schools Implementing the International Baccalaureate Programme

ERIC Educational Resources Information Center

Alford, Beverly L.; Rollins, Kayla Braziel; Stillisano, Jacqueline R.; Waxman, Hersh C.

2013-01-01

The International Baccalaureate (IB) programme utilizes an inquiry-based multi-disciplinary approach and focuses on the teaching of critical-thinking skills. The IB programme is growing at a rapid rate within the United States, with the overall number of IB schools having more than doubled in the last five years. The purpose of the present study…

Micromotor-based energy generation.

PubMed

Singh, Virendra V; Soto, Fernando; Kaufmann, Kevin; Wang, Joseph

2015-06-01

A micromotor-based strategy for energy generation, utilizing the conversion of liquid-phase hydrogen to usable hydrogen gas (H2), is described. The new motion-based H2-generation concept relies on the movement of Pt-black/Ti Janus microparticle motors in a solution of sodium borohydride (NaBH4) fuel. This is the first report of using NaBH4 for powering micromotors. The autonomous motion of these catalytic micromotors, as well as their bubble generation, leads to enhanced mixing and transport of NaBH4 towards the Pt-black catalytic surface (compared to static microparticles or films), and hence to a substantially faster rate of H2 production. The practical utility of these micromotors is illustrated by powering a hydrogen-oxygen fuel cell car by an on-board motion-based hydrogen and oxygen generation. The new micromotor approach paves the way for the development of efficient on-site energy generation for powering external devices or meeting growing demands on the energy grid. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

A Multi Agent-Based Framework for Simulating Household PHEV Distribution and Electric Distribution Network Impact

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

Cui, Xiaohui; Liu, Cheng; Kim, Hoe Kyoung

2011-01-01

The variation of household attributes such as income, travel distance, age, household member, and education for different residential areas may generate different market penetration rates for plug-in hybrid electric vehicle (PHEV). Residential areas with higher PHEV ownership could increase peak electric demand locally and require utilities to upgrade the electric distribution infrastructure even though the capacity of the regional power grid is under-utilized. Estimating the future PHEV ownership distribution at the residential household level can help us understand the impact of PHEV fleet on power line congestion, transformer overload and other unforeseen problems at the local residential distribution network level.more » It can also help utilities manage the timing of recharging demand to maximize load factors and utilization of existing distribution resources. This paper presents a multi agent-based simulation framework for 1) modeling spatial distribution of PHEV ownership at local residential household level, 2) discovering PHEV hot zones where PHEV ownership may quickly increase in the near future, and 3) estimating the impacts of the increasing PHEV ownership on the local electric distribution network with different charging strategies. In this paper, we use Knox County, TN as a case study to show the simulation results of the agent-based model (ABM) framework. However, the framework can be easily applied to other local areas in the US.« less

The role of systematic inpatient cardiac rehabilitation referral in increasing equitable access and utilization.

PubMed

Grace, Sherry L; Leung, Yvonne W; Reid, Robert; Oh, Paul; Wu, Gilbert; Alter, David A; CRCARE Investigators

2012-01-01

While systematic referral strategies have been shown to significantly increase cardiac rehabilitation (CR) enrollment to approximately 70%, whether utilization rates increase among patient groups who are traditionally underrepresented has yet to be established. This study compared CR utilization based on age, marital status, rurality, socioeconomic indicators, clinical risk, and comorbidities following systematic versus nonsystematic CR referral. Coronary artery disease inpatients (N = 2635) from 11 Ontario hospitals, utilizing either systematic (n = 8 wards) or nonsystematic referral strategies (n = 8 wards), completed a survey including sociodemographics and activity status. Clinical data were extracted from charts. At 1 year, 1680 participants completed a mailed survey that assessed CR utilization. The association of patient characteristics and referral strategy on CR utilization was tested using χ. When compared to nonsystematic referral, systematic strategies resulted in significantly greater CR referral and enrollment among obese (32 vs 27% referred, P = .044; 33 vs 26% enrolled, P = .047) patients of lower socioeconomic status (41 vs 34% referred, P = .026; 42 vs 32% enrolled, P = .005); and lower activity status (63 vs 54% referred, P = .005; 62 vs 51% enrolled, P = .002). There was significantly greater enrollment among those of lower education (P = .04) when systematically referred; however, no significant differences in degree of CR participation based on referral strategy. Up to 11% more socioeconomically disadvantaged patients and those with more risk factors utilized CR where systematic processes were in place. They participated in CR to the same high degree as their nonsystematically referred counterparts. These referral strategies should be implemented to promote equitable access.

Trends in Gender-affirming Surgery in Insured Patients in the United States

PubMed Central

Ives, Graham C.; Sluiter, Emily C.; Waljee, Jennifer F.; Yao, Tsung-Hung; Hu, Hsou Mei

2018-01-01

Background: An estimated 0.6% of the U.S. population identifies as transgender and an increasing number of patients are presenting for gender-related medical and surgical services. Utilization of health care services, especially surgical services, by transgender patients is poorly understood beyond survey-based studies. In this article, our aim is 2-fold; first, we intend to demonstrate the utilization of datasets generated by insurance claims data as a means of analyzing gender-related health services, and second, we use this modality to provide basic demographic, utilization, and outcomes data about the insured transgender population. Methods: The Truven MarketScan Database, containing data from 2009 to 2015, was utilized, and a sample set was created using the Gender Identity Disorder diagnosis code. Basic demographic information and utilization of gender-affirming procedures was tabulated. Results: We identified 7,905 transgender patients, 1,047 of which underwent surgical procedures from 2009 to 2015. Our demographic results were consistent with previous survey-based studies, suggesting transgender patients are on average young adults (average age = 29.8), and geographically diverse. The most common procedure from 2009 to 2015 was mastectomy. Complications of all gender-affirming procedures was 5.8%, with the highest rate of complications occurring with phalloplasty. There was a marked year-by-year increase in utilization of surgical services. Conclusion: Transgender care and gender confirming surgery are an increasing component of health care in the United States. The data contained in existing databases can provide demographic, utilization, and outcomes data relevant to providers caring for the transgender patient population. PMID:29876180

Effect of dissolved oxygen tension and agitation rates on sulfur-utilizing autotrophic denitrification: batch tests.

PubMed

Qambrani, Naveed Ahmed; Oh, Sang-Eun

2013-01-01

The effect of dissolved oxygen (DO) and agitation rate in open and closed reactors was examined for sulfur-utilizing autotrophic denitrification. The reaction rate constants were determined based on a half-order kinetic model. Declining denitrification rate constants obtained for open reactors those of 8.46, 8.03, and 2.18 for 50 mg NO(3) (-)-N/L, while 11.12, 9.14, and 0.12 mg(1/2)/L(1/2) h were for 100 mg NO(3) (-)-N/L at agitation speeds of 0, 100, and 200 rpm. In closed reactors, the ever-increasing denitrification rates were 10.13, 22.56, and 37.03, whereas for the same nitrate concentrations and speeds the rates were 13.17, 15.63, and 26.67 mg(1/2)/L(1/2) h. The rate constants correlated well (r ( 2 ) = 0.89-0.99) with a half-order kinetic model. In open reactors, high SO(4) (2-)/N ratios (8.02-75.10) while in closed reactors comparatively low SO(4) (2-)/N ratios (6.10-13.39) were obtained. Sulfur oxidation occurred continuously in the presence of DO, resulting in mixed cultures acclimated to sulfur and nitrate. SO(4) (2-) was produced as an end product, which reduced alkalinity and lowered pH over time. Furthermore, DO inhibited sulfur denitrification in open reactors, while agitation in closed reactors increased the rate of denitrification.

Fatal occupational injuries among electric power company workers.

PubMed

Loomis, D; Dufort, V; Kleckner, R C; Savitz, D A

1999-03-01

Surveillance data suggest high rates of electrocutions and fatal falls among workers in electric utility companies, who may be exposed to electric current, heights, flammable agents, and frequent motor vehicle travel. To characterize the occurrence of fatal injuries among electric utility workers, we studied workers in five electric power companies in the United States. A cohort of 127,129 men hired between 1950 and 1986 was followed through 1988. Injuries at work were identified through manual review of death certificates. The occurrence of occupational injuries was analyzed with directly adjusted rates and Poisson regression. The overall rate of fatal occupational injuries was 13.20 per 100,000 person-years (n = 192), with 76% due to electric current, homicide, and falls from heights. Deaths were concentrated in a few groups with elevated injury rates, notably linemen (rate ratio (RR) 3.33), electricians (RR 2.79), and painters (RR 3.27). Occupations requiring daily work on elevations or frequent, direct contact with energized electrical equipment experienced markedly higher rates of fatal injury from falls and electrocutions with rate ratios of 21.8 (95% confidence interval (CI) 11.4-41.5) and 16.7 (95% CI 6.6-42.6), respectively, independent of worker age and seniority. Although fatal injury rates in this industry have declined in recent decades, significant numbers of deaths still occur. Based on the premise that all injuries are preventable, a need for continued vigilance and efforts at prevention is indicated.

The effect of new and continuing prescription drug use on cost: a longitudinal analysis of chronic and seasonal utilization.

PubMed

Fairman, K A

2000-05-01

To provide basic information about 2 factors contributing to rising prescription drug costs--utilization trends and product selection. Prescription drug costs have risen sharply in recent years, and continued growth is expected. There is little consensus about appropriate cost-management strategies, in part because quantitative data on the causes and implications of increased drug costs are lacking. This study followed 463,820 continuously enrolled adult (> or = 18 years of age on January 1, 1996) utilizers of 15 chronic or seasonal therapeutic classes for 2.5 years (January 1996 through June 1998) using a pharmacy benefit manager's multiple-payer claims database. Outcome measures included (1) change in utilization rate, (2) relationship between new use and utilization growth, (3) stability of the treated population (ie, mostly long-term use vs high rates of turnover), and (4) product mix changes (ie, cost per dispensed day for 1996 vs 1997 and for new vs continuing users, controlling for inflation). Of the 463,820 utilizers, 97% were commercially insured and 3% enrolled in Medicare risk plans; 40% were enrolled in managed care and the remainder covered by indemnity insurance. Rates of growth and turnover varied substantially by class. The highest 2-year utilization rate change was 66.7% for antihyperlipidemic agents; change was < 10% in only 3 classes. Across classes, an average of 38.7% of 1997 users were new (ie, no use in 1996) and an average of 34.0% of 1996 users were dropouts (ie, no use in 1997). Utilization growth depended heavily on treatment continuation; classes with high dropout rates (eg, antirheumatic, antiasthmatic) did not have high growth rates, even with high rates of new use. In most classes, costs were not higher for new than for continuing users. In some classes, however (eg, antipsychotic, antidiabetic), both new and continuing users increased their use of newer, more expensive products. Because factors underlying rising prescription drug costs vary by therapeutic class, cost-containment strategies should address these differences. Further research is needed to assess the clinical and economic costs and benefits of rapid growth in the utilization of certain therapeutic classes.

From clinically relevant outcome measures to quality of life in epilepsy: A time trade-off study.

PubMed

de Kinderen, Reina J A; Wijnen, Ben F M; van Breukelen, Gerard; Postulart, Debby; Majoie, Marian H J M; Aldenkamp, Albert P; Evers, Silvia M A A

2016-09-01

A proposed method for bridging the gap between clinically relevant epilepsy outcome measures and quality-adjusted life years is to derive utility scores for epilepsy health states. The aim of this study is to develop such a utility-function and to investigate the impact of the epilepsy outcome measures on utility. Health states, based on clinically important epilepsy attributes (e.g. seizure frequency, seizure severity, side-effects), were valued by a sample of the Dutch population (N=525) based on the time trade-off method. In addition to standard demographics, every participant was asked to rate 10 or 11 different health state scenarios. A multilevel regression analysis was performed to account for the nested structure of the data. Results show that the best health state (no seizures and no side-effects) is estimated at 0.89 and the worst state (seizures type 5 twice a day plus severe side-effects) at 0.22 (scale: 0-1). An increase in seizure frequency, occurrence of side-effects, and seizure severity were all significantly associated with lower utility values. Furthermore, seizure severity has the largest impact on quality of life compared with seizure frequency and side-effects. This study provides a utility-function for transforming clinically relevant epilepsy outcome measures into utility estimates. We advise using our utility-function in economic evaluations, when quality of life is not directly measured in a study and hence, no health state utilities are available, or when there is convincing empirical evidence of the insensitivity of a generic quality-of-life-instrument within epilepsy. Copyright © 2016 Elsevier B.V. All rights reserved.

Hypothyroidism in Patients with Psoriasis or Rosacea: A Large Population Study.

PubMed

James, Sara M; Hill, Dane E; Feldman, Steven R

2016-10-15

Hypothyroidism is a common disease, and there may be a link between hypothyroidism and inflammatory skin disease. The purpose of this study is to assess whether hypothyroidism is more prevalent in psoriasis or rosacea patients. We utilized a large claims-based database to analyze rates of hypothyroidism in patients with psoriasis and rosacea compared to other patients with skin diseases. Participants were patients between 20-64 years of age with ICD-9 diagnosis codes for psoriasis, rosacea, and hypothyroidism. We found that rates of hypothyroidism in rosacea and psoriasis patients were similar to rates of hypothyroidism in those without rosacea or psoriasis.

Hypothyroidism in Patients with Psoriasis or Rosacea: A Large Population Study.

PubMed

James, Sara M; Hill, Dane E; Feldman, Steven R

2016-09-15

Hypothyroidism is a common disease, and there may be a link between hypothyroidism and inflammatory skin disease. The purpose of this study is to assess whether hypothyroidism is more prevalent in psoriasis or rosacea patients. We utilized a large claims-based database to analyze rates of hypothyroidism in patients with psoriasis and rosacea compared to other patients with skin diseases. Participants were patients between 20-64 years of age with ICD-9 diagnosis codes for psoriasis, rosacea, and hypothyroidism. We found that rates of hypothyroidism in rosacea and psoriasis patients were similar to rates of hypothyroidism in those without rosacea or psoriasis.

Discrimination of Medicine Radix Astragali from Different Geographic Origins Using Multiple Spectroscopies Combined with Data Fusion Methods

NASA Astrophysics Data System (ADS)

Wang, Hai-Yan; Song, Chao; Sha, Min; Liu, Jun; Li, Li-Ping; Zhang, Zheng-Yong

2018-05-01

Raman spectra and ultraviolet-visible absorption spectra of four different geographic origins of Radix Astragali were collected. These data were analyzed using kernel principal component analysis combined with sparse representation classification. The results showed that the recognition rate reached 70.44% using Raman spectra for data input and 90.34% using ultraviolet-visible absorption spectra for data input. A new fusion method based on Raman combined with ultraviolet-visible data was investigated and the recognition rate was increased to 96.43%. The experimental results suggested that the proposed data fusion method effectively improved the utilization rate of the original data.

Sublaminate analysis of interlaminar fracture in composites

NASA Technical Reports Server (NTRS)

Armanios, E. A.; Rehfield, L. W.

1986-01-01

A simple analysis method based upon a transverse shear deformation theory and a sublaminate approach is utilized to analyze a mixed-mode edge delamination specimen. The analysis provides closed form expressions for the interlaminar shear stresses ahead of the crack, the total energy release rate, and the energy release rate components. The parameters controlling the behavior are identified. The effect of specimen stacking sequence and delamination interface on the strain energy release rate components is investigated. Results are compared with a finite element simulation for reference. The simple nature of the method makes it suitable for preliminary design analyses which require a large number of configurations to be evaluated quickly and economically.

The High Value Healthcare Collaborative: Observational Analyses of Care Episodes for Hip and Knee Arthroplasty Surgery.

PubMed

Weeks, William B; Schoellkopf, William J; Sorensen, Lyle S; Masica, Andrew L; Nesse, Robert E; Weinstein, James N

2017-03-01

Broader use of value-based reimbursement models will require providers to transparently demonstrate health care value. We sought to determine and report cost and quality data for episodes of hip and knee arthroplasty surgery among 13 members of the High Value Healthcare Collaborative (HVHC), a consortium of health care systems interested in improving health care value. We conducted a retrospective, cross-sectional observational cohort study of 30-day episodes of care for hip and knee arthroplasty in fee-for-service Medicare beneficiaries aged 65 or older who had hip or knee osteoarthritis and used 1 of 13 HVHC member systems for uncomplicated primary hip arthroplasty (N = 8853) or knee arthroplasty (N = 16,434), respectively, in 2012 or 2013. At the system level, we calculated: per-capita utilization rates; postoperative complication rates; standardized total, acute, and postacute care Medicare expenditures for 30-day episodes of care; and the modeled impact of reducing episode expenditures or per-capita utilization rates. Adjusted per-capita utilization rates varied across HVHC systems and postacute care reimbursements varied more than 3-fold for both types of arthroplasty in both years. Regression analysis confirmed that total episode and postacute care reimbursements significantly differed across HVHC members after considering patient demographic differences. Potential Medicare cost savings were greatest for knee arthroplasty surgery and when lower total reimbursement targets were achieved. The substantial variation that we found offers opportunities for learning and collaboration to collectively improve outcomes, reduce costs, and enhance value. Ceteris paribus, reducing per-episode reimbursements would achieve greater Medicare cost savings than reducing per-capita rates. Copyright © 2016 Elsevier Inc. All rights reserved.

Temperature-Dependent Kinetic Model for Nitrogen-Limited Wine Fermentations▿

PubMed Central

Coleman, Matthew C.; Fish, Russell; Block, David E.

2007-01-01

A physical and mathematical model for wine fermentation kinetics was adapted to include the influence of temperature, perhaps the most critical factor influencing fermentation kinetics. The model was based on flask-scale white wine fermentations at different temperatures (11 to 35°C) and different initial concentrations of sugar (265 to 300 g/liter) and nitrogen (70 to 350 mg N/liter). The results show that fermentation temperature and inadequate levels of nitrogen will cause stuck or sluggish fermentations. Model parameters representing cell growth rate, sugar utilization rate, and the inactivation rate of cells in the presence of ethanol are highly temperature dependent. All other variables (yield coefficient of cell mass to utilized nitrogen, yield coefficient of ethanol to utilized sugar, Monod constant for nitrogen-limited growth, and Michaelis-Menten-type constant for sugar transport) were determined to vary insignificantly with temperature. The resulting mathematical model accurately predicts the observed wine fermentation kinetics with respect to different temperatures and different initial conditions, including data from fermentations not used for model development. This is the first wine fermentation model that accurately predicts a transition from sluggish to normal to stuck fermentations as temperature increases from 11 to 35°C. Furthermore, this comprehensive model provides insight into combined effects of time, temperature, and ethanol concentration on yeast (Saccharomyces cerevisiae) activity and physiology. PMID:17616615

Extracellular glucose can fuel metabolism in red blood cells from high glycemic Atlantic cod (Gadus morhua) but not low glycemic short-horned sculpin (Myoxocephalus scorpius).

PubMed

Driedzic, William R; Clow, Kathy A; Short, Connie E

2014-11-01

Energy metabolism was assessed in red blood cells (RBCs) from Atlantic cod and short-horned sculpin, two species that have markedly different levels of blood glucose. The objective was to determine whether the level of extracellular glucose has an impact on rates of glucose metabolism. The blood glucose level was 2.5 mmol l(-1) in Atlantic cod and 0.2 mmol l(-1) in short-horned sculpin, respectively. Oxygen consumption, lactate production and glucose utilization were measured in whole blood and related to grams of RBCs. Glucose utilization was assessed by measuring both glucose disappearance and the production of (3)H2O from [2-(3)H]-glucose. RBCs from both species have an aerobic-based metabolism. In Atlantic cod, extracellular glucose is sufficient to provide the sum of glucosyl equivalents to support both oxidative metabolism and lactate production. In contrast, extracellular glucose can account for only 10% of the metabolic rate in short-horned sculpin RBCs. In both species, about 70% of glucose enters the RBCs via facilitated transport. The difference in rates of extracellular glucose utilization is related to the extremely low levels of blood glucose in short-horned sculpin. In this species energy metabolism by RBCs must be supported by alternative fuels. © 2014. Published by The Company of Biologists Ltd.

Evaluation of Resource Utilization and Treatment Patterns in Patients with Actinic Keratosis in the United States.

PubMed

Asche, Carl V; Zografos, Panagiotis; Norlin, Jenny M; Urbanek, Bill; Mamay, Carl; Makin, Charles; Erntoft, Sandra; Chen, Chi-Chang; Hines, Dionne M; Mark Siegel, Daniel

2016-01-01

To compare health care resource utilization and treatment patterns between patients with actinic keratosis (AK) treated with ingenol mebutate gel (IngMeb) and those treated with other field-directed AK therapies. A retrospective, propensity-score-matched, cohort study compared refill/repeat and adding-on/switching patterns and outpatient visits and prescriptions (health care resource utilization) over 6 months in patients receiving IngMeb versus those receiving imiquimod, 5-fluorouracil, diclofenac sodium, and methyl aminolevulinate or aminolevulinic acid photodynamic therapy (MAL/ALA-PDT). The final sample analyzed included four matched treatment cohort pairs (IngMeb and comparator; n = 790-971 per treatment arm). Refill rates were similar except for imiquimod (15% vs. 9% for imiquimod and IngMeb, respectively; P < 0.05). MAL/ALA-PDT treatment repetition rates were higher than IngMeb refill rates (20% vs. 10%; P < 0.05). Topical agent add-on/switch rates were comparable. PDT had higher switch rates than did IngMeb (5% vs. 2%; P < 0.05). The IngMeb cohort had a significantly lower proportion of patients with at least one AK-related outpatient visit during the 6-month follow-up than did any other cohort: versus imiquimod (50% vs. 66%; P < 0.0001), versus 5-fluorouracil (50% vs. 69%; P < 0.0001), versus diclofenac sodium (51% vs. 56%; P = 0.034), and versus MAL/ALA-PDT (50% vs. 100%; P < 0.0001). There were significantly fewer AK-related prescriptions among patients receiving IngMeb than among patients in other cohorts. Results based on the first 6 months after treatment initiation suggested that most field-directed AK therapies had clinically comparable treatment patterns except imiquimod, which was associated with higher refill rates, and PDT, which was associated with significantly more frequent treatment sessions and higher switching rates. IngMeb was also associated with significantly fewer outpatient visits than were other field-directed therapies. Copyright © 2016. Published by Elsevier Inc.

Regional differences of maternal health care utilization in China.

PubMed

Tang, Mengsha; Wang, Debin; Hu, Hong; Wang, Guoping; Li, Rongjie

2015-03-01

To describe regional differences in maternal health care (MHC) utilization in China. Cross-sectional comparisons of 4 MHC utilization indicators, namely, early (13 weeks within pregnancy) examinations rate (EER), prenatal examination (>4 times) rate (PER), hospital delivery rate (HDR), and postnatal visit (>1 time) rate (PVR), using index of dissimilarity (ID), linear correlation analysis, and geographical mapping. Significant differences existed across regions in all the indicators (P < .01). All the IDs for rural areas were higher than that for urban areas. The IDs for major regions ranged from 0.01 to 0.27. Linear correlation coefficients between MHC utilization indicators by regions varied from 0.007 to 0.889 (in absolute value, P < .05). Characteristic formats of geographical distribution were found with PER, EER, HDR, and PVR being in "high-plateau," "low-plateau," and "shifting" patterns, respectively. There exist substantial regional discrepancies in MHC utilization in China and future MHC-related policies should take account regional context. © 2013 APJPH.

Study of the Interrelationships between Minimum Flow Release Policies and Hydroelectric Power Development in New England.

DTIC Science & Technology

1981-06-01

available information from Public Utilities comaissions responsible for establishing PURPA rates in each state. 1.4 PRINCIPAL FINDINGS The direct effect all... PURPA rates. However, many of those categorized as private and public developers are private and public utilities. This reflects the interest in hydro...The Public Utility Regulatory Policies Act ( PURPA ) of 1978 empowered FERC to prescribe rules requiring utilities to purchase power from and sell power

Using Medical Claims for Policy Effectiveness Surveillance: Reimbursement and Utilization of Abdomen/Pelvis Computed Tomography Scans.

PubMed

Horný, Michal; Morgan, Jake R; Merker, Vanessa L

2015-12-01

To quantify changes in private insurance payments for and utilization of abdominal/pelvic computed tomography scans (CTs) after 2011 changes in CPT coding and Medicare reimbursement rates, which were designed to reduce costs stemming from misvalued procedures. TruvenHealth Analytics MarketScan Commercial Claims and Encounters database. We used difference-in-differences models to compare combined CTs of the abdomen/pelvis to CTs of the abdomen or pelvis only. Our main outcomes were inflation-adjusted log payments per procedure, daily utilization rates, and total annual payments. Claims data were extracted for all abdominal/pelvic CTs performed in 2009-2011 within noncapitated, employer-sponsored private plans. Adjusted payments per combined CTs of the abdomen/pelvis dropped by 23.8 percent (p < .0001), and their adjusted daily utilization rate accelerated by 0.36 percent (p = .034) per month after January 2011. Utilization rate of abdominal-only or pelvic-only CTs dropped by 5.0 percent (p < .0001). Total annual payments for combined CTs of the abdomen/pelvis decreased in 2011 despite the increased utilization. Private insurance payments for combined CTs of the abdomen/pelvis declined and utilization accelerated significantly after 2011 policy changes. While growth in total annual payments was contained in 2011, it may not be sustained if 2011 utilization trends persist. © Health Research and Educational Trust.

Geographic accessibility and utilization of orthodontic services among Medicaid children and adolescents

PubMed Central

McKernan, Susan C.; Kuthy, Raymond A.; Momany, Elizabeth T.; McQuistan, Michelle R.; Hanley, Paul F.; Jones, Michael P.; Damiano, Peter C.

2014-01-01

Objectives To describe rates of Medicaid-funded services provided by orthodontists in Iowa to children and adolescents, identify factors associated with utilization, and describe geographic barriers to care. Methods We analyzed enrollment and claims data from the Iowa Medicaid program for a 3-year period, January 2008 through December 2010. Descriptive, bivariate, and multivariable logistic regression analyses were performed with utilization of orthodontic services as the main outcome variable. Service areas were identified by small area analysis in order to examine regional variability in utilization. Results The overall rate of orthodontic utilization was 3.1 percent. Medicaid enrollees living in small towns and rural areas were more likely to utilize orthodontic services than those living in urban areas. Children who had an oral evaluation by a primary care provider in the year prior to the study period were more likely to receive orthodontic services. Service areas with lower population density and greater mean travel distance to participating orthodontists had higher utilization rates than smaller, more densely populated areas. Conclusions Rural residency and increased travel distances do not appear to act as barriers to orthodontic care for this population. The wide variability of utilization rates seen across service areas may be related to workforce supply in the form of orthodontists who accept Medicaid-insured patients. Referrals to orthodontists from primary care dentists may improve access to specialty care for Medicaid enrollees. PMID:23289856

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

Code of Federal Regulations, 2012 CFR

2012-04-01

... the energy conservation measures and other direct costs related to the energy project under the... for energy conservation/rate reduction. 990.185 Section 990.185 Housing and Urban Development... Calculating Formula Expenses § 990.185 Utilities expense level: Incentives for energy conservation/rate...

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

Code of Federal Regulations, 2013 CFR

2013-04-01

... the energy conservation measures and other direct costs related to the energy project under the... for energy conservation/rate reduction. 990.185 Section 990.185 Housing and Urban Development... Calculating Formula Expenses § 990.185 Utilities expense level: Incentives for energy conservation/rate...

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

Code of Federal Regulations, 2014 CFR

2014-04-01

... the energy conservation measures and other direct costs related to the energy project under the... for energy conservation/rate reduction. 990.185 Section 990.185 Housing and Urban Development... Calculating Formula Expenses § 990.185 Utilities expense level: Incentives for energy conservation/rate...

Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual.

PubMed

Soares, William E; Wilson, Donna; Rathlev, Niels; Lee, Joshua D; Gordon, Michael; Nunes, Edward V; O'Brien, Charles P; Friedmann, Peter D

2018-02-01

Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12months post-treatment follow up. This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions. Of the 308 participants randomized, 96% had utilization data (76% complete 6months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR=0.88, 95%CI 0.63-1.23, p=0.45), or substance use-related drug detox hospitalizations (IRR=0.83, 95%CI 0.32-2.16, p=0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p=0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR=0.55, 95%CI 0.30-1.00, p=0.05) during the course of the entire study. XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders. Copyright © 2018 Elsevier Inc. All rights reserved.

Cross-Sectional Study of Unmet Mental Health Need in 5- to 7-Year Old Latino Children in the United States: Do Teachers and Parents Make a Difference in Service Utilization?

PubMed

Toppelberg, Claudio O; Hollinshead, Marisa O; Collins, Brian A; Nieto-Castañon, Alfonso

2013-06-01

The aim of the study is to examine the rates of mental health service utilization in young Latino children of immigrants in relation to maternal and teacher reports of child mental health need. Specific knowledge is lacking about gaps in service utilization among young Latino children, the fastest growing and possibly the most underserved segment of the US child population. The associations of mental health service utilization (Service Assessment for Children and Adolescents) and mental health need (clinical levels of internalizing, externalizing, or total problems reported by mothers [Child Behavior Checklist] and teachers [Teacher's Report Form]) were examined in a community sample of young Latino children of immigrants ( n = 228; mean age = 6) and compared across mothers' and teachers' responses. Mother-teacher agreement was also studied. Sixty-five children (28.5 %) had a mental health need; most (76.9 %) of these received no services. For all types of mental health need, service utilization was more likely when need was reported by mothers rather than teachers ( p = .03). Teachers' reports were not associated with service utilization. Mother-teacher agreement was low for externalizing ( r = .23; p ≤ 0.01) and total problems ( r = .21; p ≤ 0.05), and nonsignificant for internalizing problems. This study is the first in the United States to document, in such a young Latino group, high rates of unmet need comparable to those among older Latino youth; low or no mother-teacher agreement on which children had a mental health need; low utilization of school-based services; and a lack of association between service utilization and teacher-reported mental health need-both for externalizing and internalizing problems. These findings suggest that schools are not effectively leveraging mental health services for young Latino children. Potential factors responsible for the findings are discussed.

Regulatory Incentives and Disincentives for Utility Investments in Grid Modernization

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

Kihm, Steve; Beecher, Janice; Lehr, Ronald L.

Electric power is America's most capital-intensive industry, with more than $100 billion invested each year in energy infrastructure. Investment needs are likely to grow as electric utilities make power systems more reliable and resilient, deploy advanced digital technologies, and facilitate new services to meet some consumers' expectations for greater choice and control. But do current regulatory approaches provide the appropriate incentives for grid modernization investments? This report presents three perspectives: -Financial analyst Steve Kihm begins by explaining that any major investor-owned electric utility that wants to raise capital today can do so at a reasonable cost. The question is whethermore » utility managers want to raise capital for grid modernization. Specifically, they look for investments that create the most value for their existing shareholders. In cases where grid modernization investments are not the best choice in terms of shareholder value, Kihm describes shareholder incentive mechanisms that regulators could consider to encourage such investments when they are in the public interest. -From an institutional perspective, Dr. Janice Beecher finds that the traditional rate-base/rate of return regulatory model provides powerful incentives for utilities to pursue investments, cost control, efficiency and even innovation, and it is well suited to the policy objectives of grid modernization. Prudence of grid modernization investments (fair returns) depends on careful evaluation of the specific asset, and any special incentives (bonus returns) should be used only if they promote economic efficiency consistent with the core goals of economic regulation. According to Beecher, realizing the promises of grid modernization depends on effective implementation of the traditional regulatory model and ratemaking tools to serve the public interest. -Conversely, former commissioner and clean energy consultant Ron Lehr says that rapid electric industry changes require a better alignment of utility investment incentives with changes challenging the electricity sector, emerging grid modernization options and benefits, and public policies. For example, investor-owned utilities typically have an incentive to make capital investments, but rarely to employ expense-based solutions, since utilities do not earn profits on expenses. Further, Lehr cites a variety of factors that stand in the way of creating well targeted and well aligned utility incentives, including litigated regulatory processes. These may be a poor choice for finding the right balance among competing interests, establishing rules of prospective application, justifying demonstrations of new technologies and approaches to meeting emerging consumer demands, and keeping pace with rapid change.« less

Modeling the impact behavior of high strength ceramics. Final report

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

Rajendran, A.M.

1993-12-01

An advanced constitutive model is used to describe the shock and high strain rate behaviors of silicon carbide (SC), boron carbide B4C, and titanium diboride (TiB2) under impact loading conditions. The model's governing equations utilize a set of microphysically-based constitutive relationships to model the deformation and damage processes in a ceramic. The total strain is decomposed into elastic, plastic, and microcracking components. The plastic strain component was calculated using conventional viscoplastic equations. The strain components due to microcracking utilized relationships derived for a penny-shaped crack containing elastic solids. The main features of the model include degradation of strength and stiffnessmore » under both compressive and tensile loading conditions. When loaded above the Hugoniot elastic limit (HEL), the strength is limited by the strain rate dependent strength equation. However, below the HEL, the strength variation with respect to strain rate and pressure is modeled through microcracking relationships assuming no plastic flow. The ceramic model parameters were determined using a set of VISAR data from the plate impact experiments.« less

Relations between Municipal Water Use and Selected Meteorological Parameters and Drought Indices, East-Central and Northeast Florida

USGS Publications Warehouse

Murray, Louis C.

2009-01-01

Water-use data collected between 1992 and 2006 at eight municipal water-supply utilities in east-central and northeast Florida were analyzed to identify seasonal trends in use and to quantify monthly variations. Regression analyses were applied to identify significant correlations between water use and selected meteorological parameters and drought indices. Selected parameters and indices include precipitation (P), air temperature (T), potential evapotranspiration (PET), available water (P-PET), monthly changes in these parameters (Delta P, Delta T, Delta PET, Delta(P-PET), the Palmer Drought Severity Index (PDSI), and the Standardized Precipitation Index (SPI). Selected utilities include the City of Daytona Beach (Daytona), the City of Eustis (Eustis), Gainesville Regional Utilities (GRU), Jacksonville Electric Authority (JEA), Orange County Utilities (OCU), Orlando Utilities Commission (OUC), Seminole County Utilities (SCU), and the City of St. Augustine (St. Augustine). Water-use rates at these utilities in 2006 ranged from about 3.2 million gallons per day at Eustis to about 131 million gallons per day at JEA. Total water-use rates increased at all utilities throughout the 15-year period of record, ranging from about 4 percent at Daytona to greater than 200 percent at OCU and SCU. Metered rates, however, decreased at six of the eight utilities, ranging from about 2 percent at OCU and OUC to about 17 percent at Eustis. Decreases in metered rates occurred because the number of metered connections increased at a greater rate than did total water use, suggesting that factors other than just population growth may play important roles in water-use dynamics. Given the absence of a concurrent trend in precipitation, these decreases can likely be attributed to changes in non-climatic factors such as water-use type, usage of reclaimed water, water-use restrictions, demographics, and so forth. When averaged for the eight utilities, metered water-use rates depict a clear seasonal pattern in which rates were lowest in the winter and greatest in the late spring. Averaged water-use rates ranged from about 9 percent below the 15-year daily mean in January to about 11 percent above the daily mean in May. Water-use rates were found to be statistically correlated to meteorological parameters and drought indices, and to be influenced by system memory. Metered rates (in gallons per day per active metered connection) were consistently found to be influenced by P, T, PET, and P-PET and changes in these parameters that occurred in prior months. In the single-variant analyses, best correlations were obtained by fitting polynomial functions to plots of metered rates versus moving-averaged values of selected parameters (R2 values greater than 0.50 at three of eight sites). Overall, metered water-use rates were best correlated with the 3- to 4-month moving average of Delta T or Delta PET (R2 values up to 0.66), whereas the full suite of meteorological parameters was best correlated with metered rates at Daytona and least correlated with rates at St. Augustine. Similarly, metered rates were substantially better correlated with moving-averaged values of precipitation (significant at all eight sites) than with single (current) monthly values (significant at only three sites). Total and metered water-use rates were positively correlated with T, PET, Delta P, Delta T, and Delta PET, and negatively correlated with P, P-PET, Delta (P-PET), PDSI, and SPI. The drought indices were better correlated with total water-use rates than with metered rates, whereas metered rates were better correlated with meteorological parameters. Multivariant analyses produced fits of the data that explained a greater degree of the variance in metered rates than did the single-variant analyses. Adjusted R2 values for the 'best' models ranged from 0.79 at JEA to 0.29 at St. Augustine and exceeded 0.60 at five of eight sites. The amount of available water (P-PET) was the si

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

Mackillop, William J., E-mail: william.mackillop@krcc.on.ca; Kong, Weidong; Brundage, Michael

Purpose: Estimates of the appropriate rate of use of radiation therapy (RT) are required for planning and monitoring access to RT. Our objective was to compare estimates of the appropriate rate of use of RT derived from mathematical models, with the rate observed in a population of patients with optimal access to RT. Methods and Materials: The rate of use of RT within 1 year of diagnosis (RT{sub 1Y}) was measured in the 134,541 cases diagnosed in Ontario between November 2009 and October 2011. The lifetime rate of use of RT (RT{sub LIFETIME}) was estimated by the multicohort utilization tablemore » method. Poisson regression was used to evaluate potential barriers to access to RT and to identify a benchmark subpopulation with unimpeded access to RT. Rates of use of RT were measured in the benchmark subpopulation and compared with published evidence-based estimates of the appropriate rates. Results: The benchmark rate for RT{sub 1Y}, observed under conditions of optimal access, was 33.6% (95% confidence interval [CI], 33.0%-34.1%), and the benchmark for RT{sub LIFETIME} was 41.5% (95% CI, 41.2%-42.0%). Benchmarks for RT{sub LIFETIME} for 4 of 5 selected sites and for all cancers combined were significantly lower than the corresponding evidence-based estimates. Australian and Canadian evidence-based estimates of RT{sub LIFETIME} for 5 selected sites differed widely. RT{sub LIFETIME} in the overall population of Ontario was just 7.9% short of the benchmark but 20.9% short of the Australian evidence-based estimate of the appropriate rate. Conclusions: Evidence-based estimates of the appropriate lifetime rate of use of RT may overestimate the need for RT in Ontario.« less

Utility of an Algorithm to Increase the Accuracy of Medication History in an Obstetrical Setting.

PubMed

Corbel, Aline; Baud, David; Chaouch, Aziz; Beney, Johnny; Csajka, Chantal; Panchaud, Alice

2016-01-01

In an obstetrical setting, inaccurate medication histories at hospital admission may result in failure to identify potentially harmful treatments for patients and/or their fetus(es). This prospective study was conducted to assess average concordance rates between (1) a medication list obtained with a one-page structured medication history algorithm developed for the obstetrical setting and (2) the medication list reported in medical records and obtained by open-ended questions based on standard procedures. Both lists were converted into concordance rate using a best possible medication history approach as the reference (information obtained by patients, prescribers and community pharmacists' interviews). The algorithm-based method obtained a higher average concordance rate than the standard method, with respectively 90.2% [CI95% 85.8-94.3] versus 24.6% [CI95%15.3-34.4] concordance rates (p<0.01). Our algorithm-based method strongly enhanced the accuracy of the medication history in our obstetric population, without using substantial resources. Its implementation is an effective first step to the medication reconciliation process, which has been recognized as a very important component of patients' drug safety.

Brief report: Moving prevention into schools: The impact of a trauma-informed school-based intervention.

PubMed

Mendelson, Tamar; Tandon, S Darius; O'Brennan, Lindsey; Leaf, Philip J; Ialongo, Nicholas S

2015-08-01

Adolescents in disadvantaged communities have high rates of exposure to stress and trauma, which can negatively impact emotion regulation and executive functioning, increasing likelihood of school problems. This pilot study evaluated RAP Club, a 12-session school-based trauma-informed group intervention co-facilitated by a mental health counselor and young adult community member that utilizes evidence-based cognitive-behavioral and mindfulness strategies. Seventh and eighth graders at two urban public schools serving low-income communities were assigned to receive RAP Club (n = 29) or regular school programming (n = 20). RAP Club improved teacher-rated emotion regulation, social and academic competence, classroom behavior, and discipline. Higher program dose predicted improvements in several teacher-rated outcomes. Student self-report outcomes, however, did not vary by study group or dose. Even students with low baseline depression showed improvement in teacher-rated outcomes following program participation, supporting a model of universal program delivery to all students. Findings suggest RAP Club merits further study. Copyright © 2015 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Aircraft noise-induced awakenings are more reasonably predicted from relative than from absolute sound exposure levels.

PubMed

Fidell, Sanford; Tabachnick, Barbara; Mestre, Vincent; Fidell, Linda

2013-11-01

Assessment of aircraft noise-induced sleep disturbance is problematic for several reasons. Current assessment methods are based on sparse evidence and limited understandings; predictions of awakening prevalence rates based on indoor absolute sound exposure levels (SELs) fail to account for appreciable amounts of variance in dosage-response relationships and are not freely generalizable from airport to airport; and predicted awakening rates do not differ significantly from zero over a wide range of SELs. Even in conjunction with additional predictors, such as time of night and assumed individual differences in "sensitivity to awakening," nominally SEL-based predictions of awakening rates remain of limited utility and are easily misapplied and misinterpreted. Probabilities of awakening are more closely related to SELs scaled in units of standard deviates of local distributions of aircraft SELs, than to absolute sound levels. Self-selection of residential populations for tolerance of nighttime noise and habituation to airport noise environments offer more parsimonious and useful explanations for differences in awakening rates at disparate airports than assumed individual differences in sensitivity to awakening.

Home health care and patterns of subsequent VA and medicare health care utilization for veterans.

PubMed

Van Houtven, Courtney Harold; Jeffreys, Amy S; Coffman, Cynthia J

2008-10-01

The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HHC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched controls. We also consider crossover between the VA and Medicare. This is a retrospective study using propensity score and stratified analysis to control for selection bias on observable characteristics. We examined the full cohort of 2002 VA HHC users (n = 24,169) and a 2:1 sample of age- and race-based nonusers (n = 53,356). Utilization measures included VA and Medicare outpatient, inpatient, nursing home, and hospice use, as well as VA home-based primary care, respite care, and adult day health care. VA HHC users had a higher absolute probability of outpatient use by around 3%, of inpatient use by 12%, and nursing home use by 6% than their propensity-score-matched controls. Veterans who used HHC services had a higher rate of VA service use in the subsequent year than controls did, even after we adjusted for differences in observed health status, eligibility advantages, and supplemental insurance status. High utilization for VA home health users spilled over into high Medicare utilization.

Diabetes Care Management Teams Did Not Reduce Utilization When Compared With Traditional Care: A Randomized Cluster Trial.

PubMed

Kearns, Patrick

2017-10-01

PURPOSE: Health services research evaluates redesign models for primary care. Care management is one alternative. Evaluation includes resource utilization as a criterion. Compare the impact of care-manager teams on resource utilization. The comparison includes entire panes of patients and the subset of patients with diabetes. DESIGN: Randomized, prospective, cohort study comparing change in utilization rates between groups, pre- and post-intervention. METHODOLOGY: Ten primary care physician panels in a safety-net setting. Ten physicians were randomized to either a care-management approach (Group 1) or a traditional approach (Group 2). Care managers focused on diabetes and the cardiovascular cluster of diseases. Analysis compared rates of hospitalization, 30-day readmission, emergency room visits, and urgent care visits. Analysis compared baseline rates to annual rates after a yearlong run-in for entire panels and the subset of patients with diabetes. RESULTS: Resource utilization showed no statistically significant change between baseline and Year 3 (P=.79). Emergency room visits and hospital readmission increased for both groups (P=.90), while hospital admissions and urgent care visits decreased (P=.73). Similarly, utilization was not significantly different for patients with diabetes (P=.69). CONCLUSIONS: A care-management team approach failed to improve resource utilization rates by entire panels and the subset of diabetic patients compared to traditional care. This reinforces the need for further evidentiary support for the care-management model's hypothesis in the safety net.

Simulation and evaluation of latent heat thermal energy storage

NASA Technical Reports Server (NTRS)

Sigmon, T. W.

1980-01-01

The relative value of thermal energy storage (TES) for heat pump storage (heating and cooling) as a function of storage temperature, mode of storage (hotside or coldside), geographic locations, and utility time of use rate structures were derived. Computer models used to simulate the performance of a number of TES/heat pump configurations are described. The models are based on existing performance data of heat pump components, available building thermal load computational procedures, and generalized TES subsystem design. Life cycle costs computed for each site, configuration, and rate structure are discussed.

Mechanistic modeling study on process optimization and precursor utilization with atmospheric spatial atomic layer deposition

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

Deng, Zhang; He, Wenjie; Duan, Chenlong

2016-01-15

Spatial atomic layer deposition (SALD) is a promising technology with the aim of combining the advantages of excellent uniformity and conformity of temporal atomic layer deposition (ALD), and an industrial scalable and continuous process. In this manuscript, an experimental and numerical combined model of atmospheric SALD system is presented. To establish the connection between the process parameters and the growth efficiency, a quantitative model on reactant isolation, throughput, and precursor utilization is performed based on the separation gas flow rate, carrier gas flow rate, and precursor mass fraction. The simulation results based on this model show an inverse relation betweenmore » the precursor usage and the carrier gas flow rate. With the constant carrier gas flow, the relationship of precursor usage and precursor mass fraction follows monotonic function. The precursor concentration, regardless of gas velocity, is the determinant factor of the minimal residual time. The narrow gap between precursor injecting heads and the substrate surface in general SALD system leads to a low Péclet number. In this situation, the gas diffusion act as a leading role in the precursor transport in the small gap rather than the convection. Fluid kinetics from the numerical model is independent of the specific structure, which is instructive for the SALD geometry design as well as its process optimization.« less

Self-Coexistence among IEEE 802.22 Networks: Distributed Allocation of Power and Channel

PubMed Central

Sakin, Sayef Azad; Alamri, Atif; Tran, Nguyen H.

2017-01-01

Ensuring self-coexistence among IEEE 802.22 networks is a challenging problem owing to opportunistic access of incumbent-free radio resources by users in co-located networks. In this study, we propose a fully-distributed non-cooperative approach to ensure self-coexistence in downlink channels of IEEE 802.22 networks. We formulate the self-coexistence problem as a mixed-integer non-linear optimization problem for maximizing the network data rate, which is an NP-hard one. This work explores a sub-optimal solution by dividing the optimization problem into downlink channel allocation and power assignment sub-problems. Considering fairness, quality of service and minimum interference for customer-premises-equipment, we also develop a greedy algorithm for channel allocation and a non-cooperative game-theoretic framework for near-optimal power allocation. The base stations of networks are treated as players in a game, where they try to increase spectrum utilization by controlling power and reaching a Nash equilibrium point. We further develop a utility function for the game to increase the data rate by minimizing the transmission power and, subsequently, the interference from neighboring networks. A theoretical proof of the uniqueness and existence of the Nash equilibrium has been presented. Performance improvements in terms of data-rate with a degree of fairness compared to a cooperative branch-and-bound-based algorithm and a non-cooperative greedy approach have been shown through simulation studies. PMID:29215591

Self-Coexistence among IEEE 802.22 Networks: Distributed Allocation of Power and Channel.

PubMed

Sakin, Sayef Azad; Razzaque, Md Abdur; Hassan, Mohammad Mehedi; Alamri, Atif; Tran, Nguyen H; Fortino, Giancarlo

2017-12-07

Ensuring self-coexistence among IEEE 802.22 networks is a challenging problem owing to opportunistic access of incumbent-free radio resources by users in co-located networks. In this study, we propose a fully-distributed non-cooperative approach to ensure self-coexistence in downlink channels of IEEE 802.22 networks. We formulate the self-coexistence problem as a mixed-integer non-linear optimization problem for maximizing the network data rate, which is an NP-hard one. This work explores a sub-optimal solution by dividing the optimization problem into downlink channel allocation and power assignment sub-problems. Considering fairness, quality of service and minimum interference for customer-premises-equipment, we also develop a greedy algorithm for channel allocation and a non-cooperative game-theoretic framework for near-optimal power allocation. The base stations of networks are treated as players in a game, where they try to increase spectrum utilization by controlling power and reaching a Nash equilibrium point. We further develop a utility function for the game to increase the data rate by minimizing the transmission power and, subsequently, the interference from neighboring networks. A theoretical proof of the uniqueness and existence of the Nash equilibrium has been presented. Performance improvements in terms of data-rate with a degree of fairness compared to a cooperative branch-and-bound-based algorithm and a non-cooperative greedy approach have been shown through simulation studies.

Racial Differences in Chronic Conditions and Sociodemographic Characteristics Among High-Utilizing Veterans.

PubMed

Breland, Jessica Y; Chee, Christine Pal; Zulman, Donna M

2015-06-01

African-Americans are disproportionally represented among high-risk, high-utilizing patients. To inform program development for this vulnerable population, the current study describes racial variation in chronic conditions and sociodemographic characteristics among high-utilizing patients in the Veterans Affairs Healthcare System (VA). We identified the 5 % most costly Veterans who used inpatient or outpatient care at the VA during fiscal year 2010 (N = 237,691) based on costs of inpatient and outpatient care, pharmacy services, and VA-sponsored contract care. Patient costs and characteristics were abstracted from VA outpatient and inpatient data files. Racial differences in sociodemographic characteristics (age, sex, marital support, homelessness, and health insurance status) were assessed with chi-square tests. Racial differences in 32 chronic condition diagnoses were calculated as relative risk ratios. African-Americans represented 21 % of high-utilizing Veterans. African-Americans had higher rates of homelessness (26 vs. 10 %, p < 0.001) and lower rates of supplemental health insurance (44 vs. 58 %, p < 0.001). The mean number of chronic conditions was similar across race. However, there were racial differences in the prevalence of specific chronic conditions, including a higher prevalence of HIV/AIDS (95 % confidence interval (CI) 4.86, 5.50) and schizophrenia (95 % CI 1.94, 2.07) and a lower prevalence of ischemic heart disease (95 % CI 0.57, 0.59) and bipolar disorder (95 % CI 0.78, 0.85) among African-American high-utilizing Veterans. Racial disparities among high-utilizing Veterans may differ from those found in the general population. Interventions should devote attention to social, environmental, and mental health issues in order to reduce racial disparities in this vulnerable population.

Standby Rates for Combined Heat and Power Systems

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

Sedano, Richard; Selecky, James; Iverson, Kathryn

2014-02-01

Improvements in technology, low natural gas prices, and more flexible and positive attitudes in government and utilities are making distributed generation more viable. With more distributed generation, notably combined heat and power, comes an increase in the importance of standby rates, the cost of services utilities provide when customer generation is not operating or is insufficient to meet full load. This work looks at existing utility standby tariffs in five states. It uses these existing rates and terms to showcase practices that demonstrate a sound application of regulatory principles and ones that do not. The paper also addresses areas formore » improvement in standby rates.« less

xylA and xylB overexpression as a successful strategy for improving xylose utilization and poly-3-hydroxybutyrate production in Burkholderia sacchari.

PubMed

Guamán, Linda P; Oliveira-Filho, Edmar R; Barba-Ostria, Carlos; Gomez, José G C; Taciro, Marilda K; da Silva, Luiziana Ferreira

2018-03-01

Despite the versatility and many advantages of polyhydroxyalkanoates as petroleum-based plastic substitutes, their higher production cost compared to petroleum-based polymers has historically limited their large-scale production. One appealing approach to reducing production costs is to employ less expensive, renewable feedstocks. Xylose, for example is an abundant and inexpensive carbon source derived from hemicellulosic residues abundant in agro-industrial waste (sugarcane bagasse hemicellulosic hydrolysates). In this work, the production of poly-3-hydroxybutyrate P(3HB) from xylose was studied to develop technologies for conversion of agro-industrial waste into high-value chemicals and biopolymers. Specifically, this work elucidates the organization of the xylose assimilation operon of Burkholderia sacchari, a non-model bacterium with high capacity for P(3HB) accumulation. Overexpression of endogenous xylose isomerase and xylulokinase genes was successfully assessed, improving both specific growth rate and P(3HB) production. Compared to control strain (harboring pBBR1MCS-2), xylose utilization in the engineered strain was substantially improved with 25% increase in specific growth rate, 34% increase in P(3HB) production, and the highest P(3HB) yield from xylose reported to date for B. sacchari (Y P3HB/Xil  = 0.35 g/g). This study highlights that xylA and xylB overexpression is an effective strategy to improve xylose utilization and P(3HB) production in B. sacchari.

Co-Flow Hollow Cathode Technology

NASA Technical Reports Server (NTRS)

Hofer, Richard R.; Goebel, Dan M.

2011-01-01

Hall thrusters utilize identical hollow cathode technology as ion thrusters, yet must operate at much higher mass flow rates in order to efficiently couple to the bulk plasma discharge. Higher flow rates are necessary in order to provide enough neutral collisions to transport electrons across magnetic fields so that they can reach the discharge. This higher flow rate, however, has potential life-limiting implications for the operation of the cathode. A solution to the problem involves splitting the mass flow into the hollow cathode into two streams, the internal and external flows. The internal flow is fixed and set such that the neutral pressure in the cathode allows for a high utilization of the emitter surface area. The external flow is variable depending on the flow rate through the anode of the Hall thruster, but also has a minimum in order to suppress high-energy ion generation. In the co-flow hollow cathode, the cathode assembly is mounted on thruster centerline, inside the inner magnetic core of the thruster. An annular gas plenum is placed at the base of the cathode and propellant is fed throughout to produce an azimuthally symmetric flow of gas that evenly expands around the cathode keeper. This configuration maximizes propellant utilization and is not subject to erosion processes. External gas feeds have been considered in the past for ion thruster applications, but usually in the context of eliminating high energy ion production. This approach is adapted specifically for the Hall thruster and exploits the geometry of a Hall thruster to feed and focus the external flow without introducing significant new complexity to the thruster design.

FPGA-Based Pulse Pile-Up Correction With Energy and Timing Recovery.

PubMed

Haselman, M D; Pasko, J; Hauck, S; Lewellen, T K; Miyaoka, R S

2012-10-01

Modern field programmable gate arrays (FPGAs) are capable of performing complex discrete signal processing algorithms with clock rates well above 100 MHz. This, combined with FPGA's low expense, ease of use, and selected dedicated hardware make them an ideal technology for a data acquisition system for a positron emission tomography (PET) scanner. The University of Washington is producing a high-resolution, small-animal PET scanner that utilizes FPGAs as the core of the front-end electronics. For this scanner, functions that are typically performed in dedicated circuits, or offline, are being migrated to the FPGA. This will not only simplify the electronics, but the features of modern FPGAs can be utilized to add significant signal processing power to produce higher quality images. In this paper we report on an all-digital pulse pile-up correction algorithm that has been developed for the FPGA. The pile-up mitigation algorithm will allow the scanner to run at higher count rates without incurring large data losses due to the overlapping of scintillation signals. This correction technique utilizes a reference pulse to extract timing and energy information for most pile-up events. Using pulses acquired from a Zecotech Photonics MAPD-N with an LFS-3 scintillator, we show that good timing and energy information can be achieved in the presence of pile-up utilizing a moderate amount of FPGA resources.

Prevalence, health care utilization, and costs of fibromyalgia, irritable bowel, and chronic fatigue syndromes in the military health system, 2006-2010.

PubMed

Jeffery, Diana D; Bulathsinhala, Lakmini; Kroc, Michelle; Dorris, Joseph

2014-09-01

We compared prevalence, health care utilization, and costs over time for nonelderly adults diagnosed with fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS) in relation to timing of federal approvals for FMS drugs. We used military health care claims from October 2006 to September 2010. Retrospective, multiple-year comparisons were conducted using trend analyses, and time series regression-based generalized linear models. Over 5 years, FMS prevalence rates increased from 0.307% to 0.522%, whereas IBS and CFS prevalence rates remained stable. The largest increase in FMS prevalence occurred between 2007 and 2008. Health care utilization was higher for FMS cases compared to IBS and CFS cases. Over 5 years, the total cost for FMS-related care increased $163.2 million, whereas IBS costs increased $14.9 million and CFS cost increased $3.7 million. Between 2006 and 2010, total pharmacy cost for FMS cases increased from $55 million ($3,641/person) to $96.3 million ($3,557/person). Although cause and effect cannot be established, the advent of federally approved drugs for FMS in concert with pharmaceutical industry marketing of these drugs coincide with the observed changes in prevalence, health care utilization, and costs of FMS relative to IBS and CFS. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Burdensome and Unnecessary Reporting Requirements of the Public Utility Regulatory Policies Act Need to be Changed.

DTIC Science & Technology

1981-09-14

Commissioners PURPA Public Utility Regulatory Policies Act %GLOSSAk(¥ Aavertising standard As aefineu oy PUijA, no electric utility may recover from any per- son...systems in 4o States, vuerto kico, (uam, and virgin Islanus. Automatic adjustment As detined by PURPA , no electric clause stanuard utility may increase any...Interruptiole rate standard As defined by PURPA , a rate oftereu to eacn industrial and commercial * electric consumer tnat snail retiect the cost of

A Pilot Study to Reduce Computed Tomography Utilization for Pediatric Mild Head Injury in the Emergency Department Using a Clinical Decision Support Tool and a Structured Parent Discussion Tool.

PubMed

Engineer, Rakesh S; Podolsky, Seth R; Fertel, Baruch S; Grover, Purva; Jimenez, Heather; Simon, Erin L; Smalley, Courtney M

2018-05-15

The American College of Emergency Physicians embarked on the "Choosing Wisely" campaign to avoid computed tomographic (CT) scans in patients with minor head injury who are at low risk based on validated decision rules. We hypothesized that a Pediatric Mild Head Injury Care Path could be developed and implemented to reduce inappropriate CT utilization with support of a clinical decision support tool (CDST) and a structured parent discussion tool. A quality improvement project was initiated for 9 weeks to reduce inappropriate CT utilization through 5 interventions: (1) engagement of leadership, (2) provider education, (3) incorporation of a parent discussion tool to guide discussion during the emergency department (ED) visit between the parent and the provider, (4) CDST embedded in the electronic medical record, and (5) importation of data into the note to drive compliance. Patients prospectively were enrolled when providers at a pediatric and a freestanding ED entered data into the CDST for decision making. Rate of care path utilization and head CT reduction was determined for all patients with minor head injury based on International Classification of Diseases, Ninth Revision codes. Targets for care path utilization and head CT reduction were established a priori. Results were compared with baseline data collected from 2013. The CDST was used in 176 (77.5%) of 227 eligible patients. Twelve patients were excluded based on a priori criteria. Adherence to recommendations occurred in 162 (99%) of 164 patients. Head CT utilization was reduced from 62.7% to 22% (odds ratio, 0.17; 95% confidence interval, 0.12-0.24) where CDST was used by the provider. There were no missed traumatic brain injuries in our study group. A Pediatric Mild Head Injury Care Path can be implemented in a pediatric and freestanding ED, resulting in reduced head CT utilization and high levels of adherence to CDST recommendations.

LS-DYNA Implementation of Polymer Matrix Composite Model Under High Strain Rate Impact

NASA Technical Reports Server (NTRS)

Zheng, Xia-Hua; Goldberg, Robert K.; Binienda, Wieslaw K.; Roberts, Gary D.

2003-01-01

A recently developed constitutive model is implemented into LS-DYNA as a user defined material model (UMAT) to characterize the nonlinear strain rate dependent behavior of polymers. By utilizing this model within a micromechanics technique based on a laminate analogy, an algorithm to analyze the strain rate dependent, nonlinear deformation of a fiber reinforced polymer matrix composite is then developed as a UMAT to simulate the response of these composites under high strain rate impact. The models are designed for shell elements in order to ensure computational efficiency. Experimental and numerical stress-strain curves are compared for two representative polymers and a representative polymer matrix composite, with the analytical model predicting the experimental response reasonably well.

A microfluidic fuel cell with flow-through porous electrodes.

PubMed

Kjeang, Erik; Michel, Raphaelle; Harrington, David A; Djilali, Ned; Sinton, David

2008-03-26

A microfluidic fuel cell architecture incorporating flow-through porous electrodes is demonstrated. The design is based on cross-flow of aqueous vanadium redox species through the electrodes into an orthogonally arranged co-laminar exit channel, where the waste solutions provide ionic charge transfer in a membraneless configuration. This flow-through architecture enables improved utilization of the three-dimensional active area inside the porous electrodes and provides enhanced rates of convective/diffusive transport without increasing the parasitic loss required to drive the flow. Prototype fuel cells are fabricated by rapid prototyping with total material cost estimated at 2 USD/unit. Improved performance as compared to previous microfluidic fuel cells is demonstrated, including power densities at room temperature up to 131 mW cm-2. In addition, high overall energy conversion efficiency is obtained through a combination of relatively high levels of fuel utilization and cell voltage. When operated at 1 microL min-1 flow rate, the fuel cell produced 20 mW cm-2 at 0.8 V combined with an active fuel utilization of 94%. Finally, we demonstrate in situ fuel and oxidant regeneration by running the flow-through architecture fuel cell in reverse.

ScAlN etch mask for highly selective silicon etching

DOE PAGES

Henry, Michael David; Young, Travis R.; Griffin, Ben

2017-09-08

Here, this work reports the utilization of a recently developed film, ScAlN, as a silicon etch mask offering significant improvements in high etch selectivity to silicon. Utilization of ScAlN as a fluorine chemistry based deep reactive ion etch mask demonstrated etch selectivity at 23 550:1, four times better than AlN, 11 times better than Al 2O 3, and 148 times better than silicon dioxide with significantly less resputtering at high bias voltage than either Al 2O 3 or AlN. Ellipsometry film thickness measurements show less than 0.3 nm/min mask erosion rates for ScAlN. Micromasking of resputtered Al for Al 2Omore » 3, AlN, and ScAlN etch masks is also reported here, utilizing cross-sectional scanning electron microscope and confocal microscope roughness measurements. With lower etch bias, the reduced etch rate can be optimized to achieve a trench bottom surface roughness that is comparable to SiO 2 etch masks. Etch mask selectivity enabled by ScAlN is likely to make significant improvements in microelectromechanical systems, wafer level packaging, and plasma dicing of silicon.« less

Modelling the cost effectiveness of antidepressant treatment in primary care.

PubMed

Revicki, D A; Brown, R E; Palmer, W; Bakish, D; Rosser, W W; Anton, S F; Feeny, D

1995-12-01

The aim of this study was to estimate the cost effectiveness of nefazodone compared with imipramine or fluoxetine in treating women with major depressive disorder. Clinical decision analysis and a Markov state-transition model were used to estimate the lifetime health outcomes and medical costs of 3 antidepressant treatments. The model, which represents ideal primary care practice, compares treatment with nefazodone to treatment with either imipramine or fluoxetine. The economic analysis was based on the healthcare system of the Canadian province of Ontario, and considered only direct medical costs. Health outcomes were expressed as quality-adjusted life years (QALYs) and costs were in 1993 Canadian dollars ($Can; $Can1 = $US0.75, September 1995). Incremental cost-utility ratios were calculated comparing the relative lifetime discounted medical costs and QALYs associated with nefazodone with those of imipramine or fluoxetine. Data for constructing the model and estimating necessary parameters were derived from the medical literature, clinical trial data, and physician judgement. Data included information on: Ontario primary care physicians' clinical management of major depression; medical resource use and costs; probabilities of recurrence of depression; suicide rates; compliance rates; and health utilities. Estimates of utilities for depression-related hypothetical health states were obtained from patients with major depression (n = 70). Medical costs and QALYs were discounted to present value using a 5% rate. Sensitivity analyses tested the assumptions of the model by varying the discount rate, depression recurrence rates, compliance rates, and the duration of the model. The base case analysis found that nefazodone treatment costs $Can1447 less per patient than imipramine treatment (discounted lifetime medical costs were $Can50,664 vs $Can52,111) and increases the number of QALYs by 0.72 (13.90 vs 13.18). Nefazodone treatment costs $Can14 less than fluoxetine treatment (estimated discounted lifetime medical costs were $Can50,664 vs $Can50,678) and produces slightly more QALYs (13.90 vs 13.79). In the sensitivity analyses, the cost-effectiveness ratios comparing nefazodone with imipramine ranged from cost saving to $Can17,326 per QALY gained. The cost-effectiveness ratios comparing nefazodone with fluoxetine ranged from cost saving to $Can7327 per QALY gained. The model was most sensitive to assumptions about treatment compliance rates and recurrence rates. The findings suggest that nefazodone may be a cost-effective treatment for major depression compared with imipramine or fluoxetine. The basic findings and conclusions do not change even after modifying model parameters within reasonable ranges.

Estimating the relative utility of screening mammography.

PubMed

Abbey, Craig K; Eckstein, Miguel P; Boone, John M

2013-05-01

The concept of diagnostic utility is a fundamental component of signal detection theory, going back to some of its earliest works. Attaching utility values to the various possible outcomes of a diagnostic test should, in principle, lead to meaningful approaches to evaluating and comparing such systems. However, in many areas of medical imaging, utility is not used because it is presumed to be unknown. In this work, we estimate relative utility (the utility benefit of a detection relative to that of a correct rejection) for screening mammography using its known relation to the slope of a receiver operating characteristic (ROC) curve at the optimal operating point. The approach assumes that the clinical operating point is optimal for the goal of maximizing expected utility and therefore the slope at this point implies a value of relative utility for the diagnostic task, for known disease prevalence. We examine utility estimation in the context of screening mammography using the Digital Mammographic Imaging Screening Trials (DMIST) data. We show how various conditions can influence the estimated relative utility, including characteristics of the rating scale, verification time, probability model, and scope of the ROC curve fit. Relative utility estimates range from 66 to 227. We argue for one particular set of conditions that results in a relative utility estimate of 162 (±14%). This is broadly consistent with values in screening mammography determined previously by other means. At the disease prevalence found in the DMIST study (0.59% at 365-day verification), optimal ROC slopes are near unity, suggesting that utility-based assessments of screening mammography will be similar to those found using Youden's index.

Likelihood-Based Random-Effect Meta-Analysis of Binary Events.

PubMed

Amatya, Anup; Bhaumik, Dulal K; Normand, Sharon-Lise; Greenhouse, Joel; Kaizar, Eloise; Neelon, Brian; Gibbons, Robert D

2015-01-01

Meta-analysis has been used extensively for evaluation of efficacy and safety of medical interventions. Its advantages and utilities are well known. However, recent studies have raised questions about the accuracy of the commonly used moment-based meta-analytic methods in general and for rare binary outcomes in particular. The issue is further complicated for studies with heterogeneous effect sizes. Likelihood-based mixed-effects modeling provides an alternative to moment-based methods such as inverse-variance weighted fixed- and random-effects estimators. In this article, we compare and contrast different mixed-effect modeling strategies in the context of meta-analysis. Their performance in estimation and testing of overall effect and heterogeneity are evaluated when combining results from studies with a binary outcome. Models that allow heterogeneity in both baseline rate and treatment effect across studies have low type I and type II error rates, and their estimates are the least biased among the models considered.

Incremental cost-effectiveness of screening and laser treatment for diabetic retinopathy and macular edema in Malawi.

PubMed

Vetrini, Damir; Kiire, Christine A; Burgess, Philip I; Harding, Simon P; Kayange, Petros C; Kalua, Khumbo; Msukwa, Gerald; Beare, Nicholas A V; Madan, Jason

2018-01-01

To investigate the economic impact of introducing targeted screening and laser photocoagulation treatment for sight-threatening diabetic retinopathy and macular edema in a setting with no previous screening or laser treatment for diabetic retinopathy in sub-Saharan Africa. A cohort Markov model was built to compare combined targeted screening and laser treatment for patients with sight-threatening diabetic retinopathy and macular edema against no intervention. Primary outcomes were incremental cost per quality-adjusted life year (QALY) gained and per disability-adjusted life year (DALY) averted. Primary data were collected on 357 participants from the Malawi Diabetic Retinopathy Study, a prospective, observational cohort study. Multiple scenarios were explored and a probabilistic sensitivity analysis was performed. In the base case (age: 50 years, service utilization rate: 80%), the cost of the intervention and the years of severe visual impairment averted per patient screened were $209 and 2.2 years respectively. Applying the World Health Organization threshold of cost-effectiveness for Malawi ($679), the base case was cost-effective when QALYs were used ($400 per QALY gained) but not when DALYs were used ($766 per DALY averted). The intervention was more cost-effective when it targeted younger patients (age: 30 years) and less cost-effective when the utilization rate was lowered to 50%. Annual photographic screening of diabetic patients attending medical diabetes clinics in Malawi, with the provision of laser treatment for those with sight-threatening diabetic retinopathy and macular edema, appears to be cost-effective in terms of QALYs gained, in our base case scenario. Cost-effectiveness improves if services are utilized more intensively and extended to younger patients.

A simple, remote, video based breathing monitor.

PubMed

Regev, Nir; Wulich, Dov

2017-07-01

Breathing monitors have become the all-important cornerstone of a wide variety of commercial and personal safety applications, ranging from elderly care to baby monitoring. Many such monitors exist in the market, some, with vital signs monitoring capabilities, but none remote. This paper presents a simple, yet efficient, real time method of extracting the subject's breathing sinus rhythm. Points of interest are detected on the subject's body, and the corresponding optical flow is estimated and tracked using the well known Lucas-Kanade algorithm on a frame by frame basis. A generalized likelihood ratio test is then utilized on each of the many interest points to detect which is moving in harmonic fashion. Finally, a spectral estimation algorithm based on Pisarenko harmonic decomposition tracks the harmonic frequency in real time, and a fusion maximum likelihood algorithm optimally estimates the breathing rate using all points considered. The results show a maximal error of 1 BPM between the true breathing rate and the algorithm's calculated rate, based on experiments on two babies and three adults.

Exploring Geographic Variation of Mental Health Risk and Service Utilization of Doctors and Hospitals in Toronto: A Shared Component Spatial Modeling Approach

PubMed Central

Perlman, Christopher

2018-01-01

Mental Health has been known to vary geographically. Different rates of utilization of mental health services in local areas reflect geographic variation of mental health and complexity of health care. Variations and inequalities in how the health care system addresses risks are two critical issues for addressing population mental health. This study examines these issues by analyzing the utilization of mental health services in Toronto at the neighbourhood level. We adopted a shared component spatial modeling approach that allows simultaneous analysis of two main health service utilizations: doctor visits and hospitalizations related to mental health conditions. Our results reflect a geographic variation of both types of mental health service utilization across neighbourhoods in Toronto. We identified hot and cold spots of mental health risks that are common to both or specific to only one type of health service utilization. Based on the evidence found, we discuss intervention strategies, focusing on the hotspots and provision of health services about doctors and hospitals, to improve mental health for the neighbourhoods. Limitations of the study and further research directions are also discussed. PMID:29587426

Mission and space vehicle sizing data for a chemical propulsion/aerobraking option

NASA Technical Reports Server (NTRS)

Butler, John; Brothers, Bobby

1986-01-01

Sizing data is presented for various combinations of Mars missions and chemical-propulsion/aerobraking vehicles. Data is compared for vehicles utilizing opposition (2-year mission) and conjunction (3-year mission) trajectories for 1999 and 2001 opportunities, for various sizes of vehicles. Payload capabilities for manned and unmanned missions vehicles and for propulsive-braking and aerobraking cases are shown. The effect of scaling up a reference vehicle is compared to the case of utilizing two identical vehicles, for growth in payload capability. The rate of cumulative build up of weight on the surface of Mars is examined for various mission/vehicle combinations, and is compared to the landed-weight requirements for sortie missions, moving-base missions, and fixed-base missions. Also, the required buildup of weight in low Earth orbit (LEO) for various mission/vehicle combinations is presented and discussed.

Use of Pathogen-Specific Antibody Biomarkers to Estimate Waterborne Infections in Population-Based Settings.

PubMed

Exum, Natalie G; Pisanic, Nora; Granger, Douglas A; Schwab, Kellogg J; Detrick, Barbara; Kosek, Margaret; Egorov, Andrey I; Griffin, Shannon M; Heaney, Christopher D

2016-09-01

This review discusses the utility of pathogen-specific antibody biomarkers for improving estimates of the population burden of waterborne infections, assessing the fraction of infections that can be prevented by specific water treatments, and understanding transmission routes and the natural history and ecology of disease in different populations (including asymptomatic infection rates). We review recent literature on the application of pathogen-specific antibody response data to estimate incidence and prevalence of acute infections and their utility to assess the contributions of waterborne transmission pathways. Advantages and technical challenges associated with the use of serum versus minimally invasive salivary antibody biomarkers in cross-sectional and prospective surveys are discussed. We highlight recent advances and challenges and outline future directions for research, development, and application of antibody-based and other immunological biomarkers of waterborne infections.

The cost-effectiveness of three interventions for providing preventive services to low-income children.

PubMed

Johnson, Ben; Serban, Nicoleta; Griffin, Paul M; Tomar, Scott L

2017-12-01

We evaluated the impact of loan repayment programmes, revising Medicaid fee-for-service rates, and changing dental hygienist supervision requirements on access to preventive dental care for children in Georgia. We estimated cost savings from the three interventions of preventive care for young children after netting out the intervention cost. We used a regression model to evaluate the impact of changing the Medicaid reimbursement rates. The impact of supervision was evaluated by comparing general and direct supervision in school-based dental sealant programmes. Federal loan repayments to dentists and school-based sealant programmes (SBSPs) had lower intervention costs (with higher potential cost savings) than raising the Medicaid reimbursement rate. General supervision had costs 56% lower than direct supervision of dental hygienists for implementing a SBSP. Raising the Medicaid reimbursement rate by 10 percentage points would improve utilization by <1% and cost over $38 million. Given one parameter set, SBSPs could serve over 27 000 children with an intervention cost between $500 000 and $1.3 million with a potential cost saving of $1.1 million. Loan repayment could serve almost 13 000 children for a cost of $400 000 and a potential cost saving of $176 000. The three interventions all improved met need for preventive dental care. Raising the reimbursement rate alone would marginally affect utilization of Medicaid services but would not substantially increase acceptance of Medicaid by providers. Both loan repayment programmes and amending supervision requirements are potentially cost-saving interventions. Loan repayment programmes provide complete care to targeted areas, while amending supervision requirements of dental hygienists could provide preventive care across the state. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Balancing Act: How Utility Rates Are Decided. Teacher/Facilitator's Guide.

ERIC Educational Resources Information Center

American Gas Association, Arlington, VA. Educational Services.

Designed for secondary level students, this guide describes the process of establishing utility rates for gas, electricity, telephone, or water services. Insights are presented into the parties and interests involved in rate changes, along with procedures and issues that influence decision-making. The goals of this teaching guide include: (1)…

BLAST for Behind-the-Meter Applications Lite Tool | Transportation Research

Science.gov Websites

provided by NREL's PV Watts calculator. A generic utility rate structure framework makes it possible to the BLAST documentation for proper CSV formatting. Rate structure values Define demand charges and energy costs to best represent your utility rate structure of interest. Demand charges and energy costs

41 CFR 102-82.20 - What are Executive agencies' rate intervention responsibilities?

Code of Federal Regulations, 2012 CFR

2012-01-01

... 41 Public Contracts and Property Management 3 2012-01-01 2012-01-01 false What are Executive agencies' rate intervention responsibilities? 102-82.20 Section 102-82.20 Public Contracts and Property... PROPERTY 82-UTILITY SERVICES Utility Services § 102-82.20 What are Executive agencies' rate intervention...

41 CFR 102-82.20 - What are Executive agencies' rate intervention responsibilities?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false What are Executive agencies' rate intervention responsibilities? 102-82.20 Section 102-82.20 Public Contracts and Property... PROPERTY 82-UTILITY SERVICES Utility Services § 102-82.20 What are Executive agencies' rate intervention...

41 CFR 102-82.20 - What are Executive agencies' rate intervention responsibilities?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What are Executive agencies' rate intervention responsibilities? 102-82.20 Section 102-82.20 Public Contracts and Property... PROPERTY 82-UTILITY SERVICES Utility Services § 102-82.20 What are Executive agencies' rate intervention...

41 CFR 102-82.20 - What are Executive agencies' rate intervention responsibilities?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 41 Public Contracts and Property Management 3 2014-01-01 2014-01-01 false What are Executive agencies' rate intervention responsibilities? 102-82.20 Section 102-82.20 Public Contracts and Property... PROPERTY 82-UTILITY SERVICES Utility Services § 102-82.20 What are Executive agencies' rate intervention...

41 CFR 102-82.20 - What are Executive agencies' rate intervention responsibilities?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 3 2013-07-01 2013-07-01 false What are Executive agencies' rate intervention responsibilities? 102-82.20 Section 102-82.20 Public Contracts and Property... PROPERTY 82-UTILITY SERVICES Utility Services § 102-82.20 What are Executive agencies' rate intervention...

Screening for Social, Emotional, and Behavioral Problems at Kindergarten Entry: Utility and Incremental Validity of Parent Report

ERIC Educational Resources Information Center

Owens, Julie Sarno; Storer, Jennifer; Holdaway, Alex S.; Serrano, Verenea J.; Watabe, Yuko; Himawan, Lina K.; Krelko, Rebecca E.; Vause, Katherine J.; Girio-Herrera, Erin; Andrews, Nina

2015-01-01

The current study examined the utility and incremental validity of parent ratings on the Strengths and Difficulties Questionnaire and Disruptive Behavior Disorders rating scale completed at kindergarten registration in identifying risk status as defined by important criterion variables (teacher ratings, daily behavioral performance, and quarterly…

FACTORS ASSOCIATED WITH HEALTHCARE UTILIZATION AMONG ARAB IMMIGRANTS AND REFUGEES

PubMed Central

2015-01-01

Background Arab migrants are exposed to pre- and post migration stressors that increase their risk for health problems. However, little is known regarding healthcare utilization rates or factors associated with healthcare utilization among Arab immigrants and refugees. Methods 590 participants were interviewed 1 year post-migration to the United States Factors associated with healthcare utilization including stress coping mechanisms were examined using binary logistic regressions. Results Compared to national healthcare utilization data, immigrants had significantly lower and refugees had significantly higher rates. Being a refugee, married, and having health insurance were significantly associated with medical service utilization. None of the immigrants in this study had utilized psychological services. Among refugees, the use of medications and having strategies for dealing with stress were inversely associated with utilization of psychological services. Discussion (Conclusion) Healthcare utilization was significantly higher among refugees, who also reported a greater need for services than immigrants. PMID:25331684

Increasing Rates of Surgical Management of Multilevel Spinal Curvature in Elderly Patients.

PubMed

Sing, David C; Khanna, Ryan; Shaw, Jeremy D; Metz, Lionel N; Burch, Shane; Berven, Sigurd H

2016-09-01

Retrospective analysis of Nationwide Inpatient Sample (NIS) database. To analyze trends in utilization and hospital charges for multilevel spinal curvature surgery in patients over 60 from 2004 to 2011. Multilevel spinal curvature has been increasingly recognized as a major source of morbidity in patients over sixty years of age. The economic burden of non-operative management for spinal curvature is elusive and likely underestimated. Though patient reported outcomes suggest that surgical treatment of spinal curvature may be superior to non-operative treatment in selected patients, surgical utilization trends remain unclear. Data were obtained from the NIS between 2004 and 2011. The NIS is the largest all-payer inpatient care database with approximately eight million annual patient discharges throughout the United States. Analysis included patients over age 60 with a spinal curvature diagnosis treated with a multi-level spinal fusion (≥3 levels fused) determined by ICD-9-CM diagnosis and procedure codes. Population-based utilization rates were calculated from US census data. A total of 84,302 adult patients underwent multilevel spinal curvature surgery from 2004 to 2011. The annual number of ≥3 level spinal curvature fusions in patients over age 60 increased from 6,571 to 16,526, representing a 107.8% increase from 13.4 cases per 100,000 people in 2004 to 27.9 in 2011 (p < .001). Utilization rates in patients 65-69 years old experienced the greatest growth, increasing by 122% from 15.8 cases per 100,000 people to 35.1. Average hospital charges increased 108% from $90,557 in 2007 to $188,727 in 2011 (p < .001). Rates of surgical management of multilevel spinal curvature increased from 2004 to 2011, exceeding growth of the 60+ age demographic during the same period. Growth was observed in all age demographics, and hospital charges consistently increased from 2004 to 2011 reflecting a per-user increase in expenditure. III. Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

Impact of medical subsidy disqualification on children's healthcare utilization: A difference-in-differences analysis from Japan.

PubMed

Miyawaki, Atsushi; Noguchi, Haruko; Kobayashi, Yasuki

2017-10-01

Financial support for children's medical expenses has been introduced in many countries. Limited work has been done on price elasticity in children's healthcare demand, especially in countries other than the United States. Moreover, it remains unclear how the effects of a change in the cost sharing rate on healthcare demand would differ by medical condition. We investigated the impact of an increase in the cost sharing rate on medical service utilization among school children as a whole and for each of nine common conditions, applying a difference-in-differences approach. The study period ranged from April 1, 2012, to March 30, 2014. Participants were elementary school children in an urban area who were eligible for National Health Insurance (a community-based public insurance) during the study period and who were enrolled in the 2nd, 3rd, or 4th grade in April 2013. We collected observations from 2896 persons and 69,504 (2896 × 24 months) person-months. When elementary school children were promoted to the 4th grade, they became disqualified for a municipal medical subsidy. The control group was the children promoted to the 2nd or the 3rd grade, who remained eligible for the subsidy. All data were obtained from health insurance claims. We identified the nine most common medical conditions among the subject children, and stratified the analyses by the condition diagnosed. We found that an increase in the cost sharing rate reduced outpatient service utilization as a whole. Also, we observed an increase in inpatient service utilization, not because of worsened health conditions, but rather due to substitution of inpatient service for outpatient service. The reductions in outpatient service were heterogeneous across medical conditions; declines were sharper for mild or chronic conditions. These findings may help to characterize how a change in cost sharing rate affects health outcomes in children. Copyright © 2017 Elsevier Ltd. All rights reserved.

Vein grafting your way out of trouble: Examining the utility and efficacy of vein grafts in microsurgery.

PubMed

Nelson, Jonas A; Fischer, John P; Grover, Ritwik; Kovach, Stephen J; Low, David W; Kanchwala, Suhail K; Levin, L Scott; Serletti, Joseph M; Wu, Liza C

2015-06-01

There is limited data on the indications, outcomes, and associated complications with use of interpositional vein grafts (IVG) in microsurgery. This study sought to critically examine and update the utility of this microsurgical technique. All microsurgical cases at a single institution from 2005 to 2011 were examined for use of IVGs in the primary procedure or during take back or salvage attempts. We examined the cohort overall and performed a subgroup analysis by timing of initial IVG. In the study period, 1718 patients underwent 2368 free flaps. 51 IVGs were utilized in 38 patients (2.2%) and 38 flaps (1.6%). Eight (42.1%) of the primary procedure IVGs (n = 19) were planned preoperatively. Nine total flap losses (24%) occurred when IVGs were utilized, 89% of which occurred in the take back cohort (p = 0.02). However, planned IVG had a 100% success rate, and IVG utilized in the primary procedure overall had a 95% success rate. Importantly, A significantly higher rate of thrombotic events was noted in all primary cases where IVGs were utilized (p = 0.005). This study demonstrates that IVGs can be utilized in primary free flap reconstructions with success rates exceeding 95%. However, in salvage procedures, the use of vein grafts does not approach the same rate of success likely due to multiple factors. Yet when utilized appropriately with thrombectomy and resection of the thrombosed vessel to healthy intima, IVGs can provide an important tool for flap salvage. prognostic/risk category, level II. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

The Relationship Between Hospital Value-Based Purchasing Program Scores and Hospital Bond Ratings.

PubMed

Rangnekar, Anooja; Johnson, Tricia; Garman, Andrew; O'Neil, Patricia

2015-01-01

Tax-exempt hospitals and health systems often borrow long-term debt to fund capital investments. Lenders use bond ratings as a standard metric to assess whether to lend funds to a hospital. Credit rating agencies have historically relied on financial performance measures and a hospital's ability to service debt obligations to determine bond ratings. With the growth in pay-for-performance-based reimbursement models, rating agencies are expanding their hospital bond rating criteria to include hospital utilization and value-based purchasing (VBP) measures. In this study, we evaluated the relationship between the Hospital VBP domains--Clinical Process of Care, Patient Experience of Care, Outcome, and Medicare Spending per Beneficiary (MSPB)--and hospital bond ratings. Given the historical focus on financial performance, we hypothesized that hospital bond ratings are not associated with any of the Hospital VBP domains. This was a retrospective, cross-sectional study of all hospitals that were rated by Moody's for fiscal year 2012 and participated in the Centers for Medicare & Medicaid Services' VBP program as of January 2014 (N = 285). Of the 285 hospitals in the study, 15% had been assigned a bond rating of Aa, and 46% had been assigned an A rating. Using a binary logistic regression model, we found an association between MSPB only and bond ratings, after controlling for other VBP and financial performance scores; however, MSPB did not improve the overall predictive accuracy of the model. Inclusion of VBP scores in the methodology used to determine hospital bond ratings is likely to affect hospital bond ratings in the near term.

Cost and Utilization of Retail Clinics vs. Other Providers for Treatment of Pediatric Acute Otitis Media.

PubMed

Duncan, Ian; Clark, Kara; Wang, Stacy

2016-10-01

A common acute condition seen by providers in retails clinics is the evaluation and treatment of acute otitis media (AOM) in children younger than age 20. Annual direct treatment costs for AOM were US $5.3 billion in 1998 dollars. Based on the experience of a large retail pharmacy employer, the authors compared AOM episodes in covered dependents younger than age 20 in retail clinic states to those in states without retail clinic access. Relative costs as well as frequency of visits and antibiotic prescriptions were analyzed for both retail clinic-based, and non-retail clinic-based episodes. Rates of AOM episodes were lower in retail clinic than in non-retail clinic states (62.5 vs. 76.9 per 1000 members per year; P < .0001). The average number of visits per episode was similar between retail clinic and non-retail clinic states (1.417 vs. 1.430, respectively; P = 0.657), suggesting that retail clinics do not result in an increase in overall utilization. On a risk-adjusted basis, retail clinic episodes cost approximately $30-$130 less than community episodes, depending on year. In retail clinic states, the antibiotic prescription fill rate was 95.4% for retail clinic episodes and 82.8% for community episodes, consistent with rates in the literature. This study confirms results of earlier studies that retail clinics are a less costly setting than the community for the treatment of episodes of otitis media There also is little evidence that retail clinics lead to duplication of services (patients receiving follow-up care in other settings).

Allowance for funds in construction: accounting stepchild and regulatory football

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

Coughlan, P.B.

AFC (allowance for funds in construction) is an accounting method of recording the use of additional capital needed to compensate the capital already invested in construction work in progress (CWIP) where CWIP is excluded from the utility's rate base. As a practical matter, the compensation in the form of interest on debt, dividends on preferred and common stocks, and reinvested earnings is paid or recorded currently. Since the CWIP is not included in rate base and current customers are not paying any revenues to support the CWIP capital, the cash to pay the interest comes from a variety of sources,more » including cash revenues covering depreciation and reinvested earnings on rate base capital as well as from sales of additional bonds and stock. Commissions and courts have examined AFC in some depth, but many problems remain. Four unresolved areas are examined in this paper: (1) should AFC be compounded, whether directly or indirectly; (2) who should benefit from the current tax reduction associated with the interest component of AFC; (3) is AFC really a noncash accounting gimmick; (4) what happens when you sell AFC-bearing construction work in progress to a third party. The author presents examples to show why he believes AFC represents valid, good-quality earnings for utilities. It properly represents cash income if certain prerequisite conditions are present and prerequisite procedures followed in its calculation. Among the factors cited in favor of such an allowance by regulators is an avoidance of regulatory lag in much the same way as provided by automatic cost adjustments. (MCW)« less

The Teamwork Mini-Clinical Evaluation Exercise (T-MEX): a workplace-based assessment focusing on collaborative competencies in health care.

PubMed

Olupeliyawa, Asela M; O'Sullivan, Anthony J; Hughes, Chris; Balasooriya, Chinthaka D

2014-02-01

Teamwork is an important and challenging area of learning during the transition from medical graduate to intern. This preliminary investigation examined the psychometric and logistic properties of the Teamwork Mini-Clinical Evaluation Exercise (T-MEX) for the workplace-based assessment of key competencies in working with health care teams. The authors designed the T-MEX for direct observation and assessment of six collaborative behaviors in seven clinical situations important for teamwork, feedback, and reflection. In 2010, they tested it on University of New South Wales senior medical students during their last six-week clinical term to investigate its overall utility, including validity and reliability. Assessors rated students in different situations on the extent to which they met expectations for interns for each collaborative behavior. Both assessors and students rated the tool's usefulness and feasibility. Assessment forms for 88 observed encounters were submitted by 25 students. The T-MEX was suited to a broad range of collaborative clinical practice situations, as evidenced by the encounter types and the behaviors assessed by health care team members. The internal structure of the behavior ratings indicated construct validity. A generalizability study found that eight encounters were adequate for high-stakes measurement purposes. The mean times for observation and feedback and the participants' perceptions suggested usefulness for feedback and feasibility in busy clinical settings. Findings suggest that the T-MEX has good utility for assessing trainee competence in working with health care teams. It fills a gap within the suite of existing tools for workplace-based assessment of professional attributes.

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

Niddrie, D.G.

Oil companies, savings banks, public utilities, and other companies have made use of a new kind of financing technique known as lower floaters. The author describes the lower floater and its particular benefits and potential drawbacks. He concludes that, on balance, variable-rate demand bonds have been good for utilities, which have issued them in great quantity. No one knows how many they will be able to issue at acceptable rates after this year, but the answer may rest with Congress. Because of all the uncertainty, utilities in need of financing should consider issuing variable-rate demand bonds as soon as possible.

Persistent Super-Utilization of Acute Care Services Among Subgroups of Veterans Experiencing Homelessness.

PubMed

Szymkowiak, Dorota; Montgomery, Ann Elizabeth; Johnson, Erin E; Manning, Todd; O'Toole, Thomas P

2017-10-01

Acute health care utilization often occurs among persons experiencing homelessness. However, knowing which individuals will be persistent super-utilizers of acute care is less well understood. The objective of the study was to identify those more likely to be persistent super-utilizers of acute care services. We conducted a latent class analysis of secondary data from the Veterans Health Administration Corporate Data Warehouse, and Homeless Operations Management and Evaluation System. The study sample included 16,912 veterans who experienced homelessness and met super-utilizer criteria in any quarter between July 1, 2014 and December 31, 2015. The latent class analysis included veterans' diagnoses and acute care utilization. Medical, mental health, and substance use morbidity rates were high. More than half of the sample utilized Veterans Health Administration Homeless Programs concurrently with their super-utilization of acute care. There were 7 subgroups of super-utilizers, which varied considerably on the degree to which their super-utilization persisted over time. Approximately a third of the sample met super-utilizer criteria for ≥3 quarters; this group was older and disproportionately male, non-Hispanic white, and unmarried, with lower rates of post-9/11 service and higher rates of rural residence and service-connected disability. They were much more likely to be currently homeless with more medical, mental health, and substance use morbidity. Only a subset of homeless veterans were persistent super-utilizers, suggesting the need for more targeted interventions.

Base Rates, Multiple Indicators, and Comprehensive Forensic Evaluations: Why Sexualized Behavior Still Counts in Assessments of Child Sexual Abuse Allegations

ERIC Educational Resources Information Center

Everson, Mark D.; Faller, Kathleen Coulborn

2012-01-01

Developmentally inappropriate sexual behavior has long been viewed as a possible indicator of child sexual abuse. In recent years, however, the utility of sexualized behavior in forensic assessments of alleged child sexual abuse has been seriously challenged. This article addresses a number of the concerns that have been raised about the…

Utility and Cost-Effectiveness of Motivational Messaging to Increase Survey Response in Physicians: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Chan, Randolph C. H.; Mak, Winnie W. S.; Pang, Ingrid H. Y.; Wong, Samuel Y. S.; Tang, Wai Kwong; Lau, Joseph T. F.; Woo, Jean; Lee, Diana T. F.; Cheung, Fanny M.

2018-01-01

The present study examined whether, when, and how motivational messaging can boost the response rate of postal surveys for physicians based on Higgin's regulatory focus theory, accounting for its cost-effectiveness. A three-arm, blinded, randomized controlled design was used. A total of 3,270 doctors were randomly selected from the registration…

Letting thoughts take wing.

PubMed

Jorgensen, Chuck; Wheeler, Kevin

2002-03-01

Recent developments in neuroelectronics are applied to aviation and airplane flight control instruments. Electromyographic control has been applied to flight simulations using the autopilot interface in order to use gestures to give bank and pitch commands to the autopilot. In other demonstrations, direct rate control was used to perform repeated successful landings and the damage-adaptive capability of inner-loop neural and propulsion-based controls was utilized.

Exploring Enrollment Management for an Independent, Faith-Based, Secondary School: A Case Study

ERIC Educational Resources Information Center

McMaster, Jason Andrew

2017-01-01

This single site case study looked specifically at the foundation and the structure of an independent school in California with respect to how it managed its enrollment and retention rates. For context, the institution being studied utilized a high-tuition strategy combined with a strong financial aid program. In 2012, the school peaked in its…

A Case Study Analysis of Factors that Influence Attrition Rates in Voluntary Online Training Programs

ERIC Educational Resources Information Center

Long, Lori; Dubois, Cathy; Faley, Robert

2009-01-01

This article examines utilization of online training courses in a Midwest-based landscaping company in the United States. The company had implemented online training to facilitate employee development for their 5,000 employees who were in locations throughout the United States. The courses had been in place for about a decade before the…