77 FR 46987 - Utility Allowances Submetering

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-07

... Utility Allowances Submetering AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of... amend the utility allowance regulations concerning the low-income housing tax credit. The proposed regulations update the utility allowance regulations to clarify that utility costs paid by a tenant based on...

The causal structure of utility conditionals.

PubMed

Bonnefon, Jean-François; Sloman, Steven A

2013-01-01

The psychology of reasoning is increasingly considering agents' values and preferences, achieving greater integration with judgment and decision making, social cognition, and moral reasoning. Some of this research investigates utility conditionals, ''if p then q'' statements where the realization of p or q or both is valued by some agents. Various approaches to utility conditionals share the assumption that reasoners make inferences from utility conditionals based on the comparison between the utility of p and the expected utility of q. This article introduces a new parameter in this analysis, the underlying causal structure of the conditional. Four experiments showed that causal structure moderated utility-informed conditional reasoning. These inferences were strongly invited when the underlying structure of the conditional was causal, and significantly less so when the underlying structure of the conditional was diagnostic. This asymmetry was only observed for conditionals in which the utility of q was clear, and disappeared when the utility of q was unclear. Thus, an adequate account of utility-informed inferences conditional reasoning requires three components: utility, probability, and causal structure. Copyright © 2012 Cognitive Science Society, Inc.

Capital Improvement Program Environmental Assessment, Dyess Air Force Base, Texas

DTIC Science & Technology

2010-09-01

utility extension structures would be designed to avoid crossing wetlands to the extent feasible. If a project necessitates a wetlands utility... crossing , horizontal boring techniques would be used to route the utility under the wetlands. Because horizontal boring effectively avoids disturbance...utilized if the utility extension would involve crossing a roadway. • All new utility equipment would be polychlorinated biphenyl (PCB) free

Measuring change in health status of older adults at the population level: the transition probability model.

PubMed

Moineddin, Rahim; Nie, Jason X; Wang, Li; Tracy, C Shawn; Upshur, Ross E G

2010-11-09

The current demographic transition will lead to increasing demands on health services. However, debate exists as to the role age plays relative to co-morbidity in terms of health services utilization. While age has been identified as a critical factor in health services utilization, health services utilization is not simply an outcome of ill health, nor is it an inevitable outcome of aging. Most data on health service utilization studies assess utilization at one point in time, and does not examine transitions in health service utilization. We sought to measure health services utilization and to investigate patterns in the transition of levels of utilization and outcomes associated with different levels of utilization. We conducted a population-based retrospective cohort study of all Ontario residents aged 65+ eligible for public healthcare coverage from January 1998-December 2006. The main outcome measure was total number of utilization events. The total is computed by summing, on a per annum basis, the number of family physician visits, specialist visits, Emergency Department visits, drug claims, lab claims, X-rays, CT scans, MRI scans, and inpatient admissions. Three categories of utilization were created: low, moderate, and high. There is heterogeneity in health services utilization across the late lifespan. Utilization increased consistently in the 9-year study period. The probability of remaining at the high utilization category when the person was in the high category the previous year was more than 0.70 for both males and females and for all age groups. Overall healthcare utilization increases more rapidly among the high users compared to the low users. There was negligible probability for moving from high to low utilization category. Probability of death increased exponentially as age increased. Older adults in the low utilization category had the lowest probability of death. The number of male nonagenarians increased more rapidly than female nonagenarians. There are measurable and identifiable differences in the patterns of health services utilization among older adults. This data will permit clinicians and policy makers to tailor interventions appropriate to the risk class of patients.

Multiple utility constrained multi-objective programs using Bayesian theory

NASA Astrophysics Data System (ADS)

Abbasian, Pooneh; Mahdavi-Amiri, Nezam; Fazlollahtabar, Hamed

2018-03-01

A utility function is an important tool for representing a DM's preference. We adjoin utility functions to multi-objective optimization problems. In current studies, usually one utility function is used for each objective function. Situations may arise for a goal to have multiple utility functions. Here, we consider a constrained multi-objective problem with each objective having multiple utility functions. We induce the probability of the utilities for each objective function using Bayesian theory. Illustrative examples considering dependence and independence of variables are worked through to demonstrate the usefulness of the proposed model.

41 CFR 109-39.301 - Utilization guidelines.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Utilization guidelines... Management System Vehicles § 109-39.301 Utilization guidelines. DOE activities utilizing GSA IFMS motor... meeting DOE utilization guidelines or established local use objectives, as appropriate. Those vehicles not...

Key influences on motivations for utility cycling (cycling for transport to and from places).

PubMed

Heesch, Kristiann C; Sahlqvist, Shannon

2013-12-01

Although increases in cycling in Brisbane are encouraging, bicycle mode share to work (the proportion of people travelling to work by bicycle) in the state of Queensland remains low. The aim of this qualitative study was to draw upon the lived experiences of Queensland cyclists to understand the main motivators for utility cycling (cycling as a means to get to and from places) and compare motivators between utility cyclists (those who cycle for utility as well as for recreation) and non-utility cyclists (those who cycle only for recreation). For an online survey, members of a bicycle group (831 utility cyclists and 931 non-utility cyclists, aged 18-90 years) were asked to describe, unprompted, what would motivate them to engage in utility cycling (more often). Responses were coded into themes within four levels of an ecological model. Within an ecological model, built environment influences on motivation were grouped according to whether they related to appeal (safety), convenience (accessibility) or attractiveness (more amenities) and included adequate infrastructure for short trips, bikeway connectivity, end-of-trip facilities at public locations and easy and safe bicycle access to destinations outside of cities. A key social-cultural influence related to improved interactions among different road users. The built and social-cultural environments need to be more supportive of utility cycling before even current utility and non-utility cyclists will be motivated to engage (more often) in utility cycling. SO WHAT?: Additional government strategies and more and better infrastructure that support utility cycling beyond commuter cycling may encourage a utility cycling culture.

Health State Utility Value in Chronic Obstructive Pulmonary Disease (COPD); The Challenge of Heterogeneity: A Systematic Review and Meta-Analysis.

PubMed

Moayeri, Foruhar; Hsueh, Ya-Seng Arthur; Clarke, Philip; Hua, Xinyang; Dunt, David

2016-06-01

Chronic obstructive pulmonary disease (COPD) has a considerable impact on quality of life and well-being of patients. Health state utility value (HSUV) is a recognized measure for health economic appraisals and is extensively used as an indicator for decision-making studies. This study is a systematic review of literature aimed to estimate mean utility value in COPD using meta-analysis and explore degree of heterogeneity in the utility values across a variety of clinical and study characteristic. The literature review covers studies that used EQ-5D to estimate utility value for patient level research in COPD. Studies that reported utility values elicited by EQ-5D in COPD patients were selected for random-effect meta-analysis addressing inter-study heterogeneity and subgroup analyses. Thirty-two studies were included in the general utility meta-analysis. The estimated general utility value was 0.673 (95% CI 0.653 to 0.693). Meta-analyses of COPD stages utility values showed influence of airway obstruction on utility value. The utility values ranged from 0.820 (95% CI 0.767 to 0.872) for stage I to 0.624 (95% CI 0.571 to 0.677) for stage IV. There was substantial heterogeneity in utility values: I(2) = 97.7%. A more accurate measurement of utility values in COPD is needed to refine valid and generalizable scores of HSUV. Given the limited success of the factors studied to reduce heterogeneity, an approach needs to be developed how best to use mean utility values for COPD in health economic evaluation.

26 CFR 1.42-10 - Utility allowances.

Code of Federal Regulations, 2012 CFR

2012-04-01

... into account, among other things, local utility rates, property type, climate and degree-day variables... which the building containing the units is located. (c) Changes in applicable utility allowance—(1) In...)), the applicable utility allowance for units changes, the new utility allowance must be used to compute...

26 CFR 1.42-10 - Utility allowances.

Code of Federal Regulations, 2014 CFR

2014-04-01

... into account, among other things, local utility rates, property type, climate and degree-day variables... which the building containing the units is located. (c) Changes in applicable utility allowance—(1) In...)), the applicable utility allowance for units changes, the new utility allowance must be used to compute...

26 CFR 1.42-10 - Utility allowances.

Code of Federal Regulations, 2013 CFR

2013-04-01

... into account, among other things, local utility rates, property type, climate and degree-day variables... which the building containing the units is located. (c) Changes in applicable utility allowance—(1) In...)), the applicable utility allowance for units changes, the new utility allowance must be used to compute...

26 CFR 1.42-10 - Utility allowances.

Code of Federal Regulations, 2011 CFR

2011-04-01

... into account, among other things, local utility rates, property type, climate and degree-day variables... which the building containing the units is located. (c) Changes in applicable utility allowance—(1) In...)), the applicable utility allowance for units changes, the new utility allowance must be used to compute...

26 CFR 1.42-10 - Utility allowances.

Code of Federal Regulations, 2010 CFR

2010-04-01

... into account, among other things, local utility rates, property type, climate and degree-day variables... which the building containing the units is located. (c) Changes in applicable utility allowance—(1) In...)), the applicable utility allowance for units changes, the new utility allowance must be used to compute...

42 CFR 456.200 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Utilization Review (ur) Plan... requirements for a written utilization review (UR) plan for each mental hospital providing Medicaid services...

75 FR 37883 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-30

... Planning and Cost Allocation by Transmission Owning and Operating Public Utilities; Proposed Rule #0;#0...] Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities Issued June 17... Transmission Services by Public Utilities; Recovery of Stranded Costs by Public Utilities and Transmitting...

AHP for Risk Management Based on Expected Utility Theory

NASA Astrophysics Data System (ADS)

Azuma, Rumiko; Miyagi, Hayao

This paper presents a model of decision-making considering the risk assessment. The conventional evaluation in AHP is considered to be a kind of utility. When dealing with the risk, however, it is necessary to consider the probability of damage. In order to take risk into decision-making problem, we construct AHP based on expected utility. The risk is considered as a related element of criterion rather than criterion itself. The expected utility is integrated, considering that satisfaction is positive utility and damage by risk is negative utility. Then, evaluation in AHP is executed using the expected utility.

Assessment of distributed photovoltair electric-power systems

NASA Astrophysics Data System (ADS)

Neal, R. W.; Deduck, P. F.; Marshall, R. N.

1982-10-01

The development of a methodology to assess the potential impacts of distributed photovoltaic (PV) systems on electric utility systems, including subtransmission and distribution networks, and to apply that methodology to several illustrative examples was developed. The investigations focused upon five specific utilities. Impacts upon utility system operations and generation mix were assessed using accepted utility planning methods in combination with models that simulate PV system performance and life cycle economics. Impacts on the utility subtransmission and distribution systems were also investigated. The economic potential of distributed PV systems was investigated for ownership by the utility as well as by the individual utility customer.

Electric utility companies and geothermal power

NASA Technical Reports Server (NTRS)

Pivirotto, D. S.

1976-01-01

The requirements of the electric utility industry as the primary potential market for geothermal energy are analyzed, based on a series of structured interviews with utility companies and financial institution executives. The interviews were designed to determine what information and technologies would be required before utilities would make investment decisions in favor of geothermal energy, the time frame in which the information and technologies would have to be available, and the influence of the governmental politics. The paper describes the geothermal resources, electric utility industry, its structure, the forces influencing utility companies, and their relationship to geothermal energy. A strategy for federal stimulation of utility investment in geothermal energy is suggested. Possibilities are discussed for stimulating utility investment through financial incentives, amelioration of institutional barriers, and technological improvements.

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

Team Formation and Communication Restrictions in Collectives

NASA Technical Reports Server (NTRS)

Agogino, Adrian K.; Turner, Kagan

2003-01-01

A collective of agents often needs to maximize a "world utility" function which rates the performance of an entire system, while subject to communication restrictions among the agents. Such communication restrictions make it difficult for agents which try to pursue their own "private" utilities to take actions that also help optimize the world utility. Team formation presents a solution to this problem, where by joining other agents, an agent can significantly increase its knowledge about the environment and improve its chances of both optimizing its own utility and that its doing so will contribute to the world utility. In this article we show how utilities that have been previously shown to be effective in collectives can be modified to be more effective in domains with moderate communication restrictions resulting in performance improvements of up to 75%. Additionally we show that even severe communication constraints can be overcome by forming teams where each agent of a team shares the same utility, increasing performance an additional 25%. We show that utilities and team sizes can be manipulated to form the best compromise between how "aligned" an agent s utility is with the world utility and how easily an agent can learn that utility.

The construction of standard gamble utilities.

PubMed

van Osch, Sylvie M C; Stiggelbout, Anne M

2008-01-01

Health effects for cost-effectiveness analysis are best measured in life years, with quality of life in each life year expressed in terms of utilities. The standard gamble (SG) has been the gold standard for utility measurement. However, the biases of probability weighting, loss aversion, and scale compatibility have an inconclusive effect on SG utilities. We determined their effect on SG utilities using qualitative data to assess the reference point and the focus of attention. While thinking aloud, 45 healthy respondents provided SG utilities for six rheumatoid arthritis health states. Reference points, goals, and focuses of attention were coded. To assess the effect of scale compatibility, correlations were assessed between focus of attention and mean utility. The certain outcome served most frequently as reference point, the SG was perceived as a mixed gamble. Goals were mostly mentioned with respect to this outcome. Scale compatibility led to a significant upward bias in utilities; attention lay relatively more on the low outcome and this was positively correlated with mean utility. SG utilities should be corrected for loss aversion and probability weighting with the mixed correction formula proposed by prospect theory. Scale compatibility will likely still bias SG utilities, calling for research on a correction. Copyright (c) 2007 John Wiley & Sons, Ltd.

Utility Computing: Reality and Beyond

NASA Astrophysics Data System (ADS)

Ivanov, Ivan I.

Utility Computing is not a new concept. It involves organizing and providing a wide range of computing-related services as public utilities. Much like water, gas, electricity and telecommunications, the concept of computing as public utility was announced in 1955. Utility Computing remained a concept for near 50 years. Now some models and forms of Utility Computing are emerging such as storage and server virtualization, grid computing, and automated provisioning. Recent trends in Utility Computing as a complex technology involve business procedures that could profoundly transform the nature of companies' IT services, organizational IT strategies and technology infrastructure, and business models. In the ultimate Utility Computing models, organizations will be able to acquire as much IT services as they need, whenever and wherever they need them. Based on networked businesses and new secure online applications, Utility Computing would facilitate "agility-integration" of IT resources and services within and between virtual companies. With the application of Utility Computing there could be concealment of the complexity of IT, reduction of operational expenses, and converting of IT costs to variable `on-demand' services. How far should technology, business and society go to adopt Utility Computing forms, modes and models?

The discrepancy between risky and riskless utilities: a matter of framing?

PubMed

Stalmeier, P F; Bezembinder, T G

1999-01-01

Utilities differ according to whether they are derived from risky (gamble) and riskless (visual analog scale, time-tradeoff) assessment methods. The discrepancies are usually explained by assuming that the utilities elicited by risky methods incorporate attitudes towards risk, whereas riskless utilities do not. In (cumulative) prospect theory, risk attitude is conceived as consisting of two components: a decision-weight function (attentiveness to changes in, or sensitivity towards, chance) and a utility function (sensitivity towards outcomes). The authors' data suggest that a framing effect is a hitherto unrecognized and important factor in causing discrepancies between risky and riskless utilities. They collected risky evaluations with the gamble method, and riskless evaluations with difference measurement. Risky utilities were derived using expected-utility theory and prospect theory. With the latter approach, sensitivity towards outcomes and sensitivity towards chance are modeled separately. When the hypothesis that risky utilities from prospect theory coincide with riskless utilities was tested, it was rejected (n = 8, F(1,7) = 132, p = 0.000), suggesting that a correction for sensitivity towards chance is not sufficient to resolve the difference between risky and riskless utilities. Next, it was assumed that different gain/loss frames are induced by risky and riskless elicitation methods. Indeed, identical utility functions were obtained when the gain/loss frames were made identical across methods (n = 7), suggesting that framing was operative. The results suggest that risky and riskless utilities are identical after corrections for sensitivity towards chance and framing.

Utility as a rationale for choosing observer performance assessment paradigms for detection tasks in medical imaging.

PubMed

Wunderlich, Adam; Abbey, Craig K

2013-11-01

Studies of lesion detectability are often carried out to evaluate medical imaging technology. For such studies, several approaches have been proposed to measure observer performance, such as the receiver operating characteristic (ROC), the localization ROC (LROC), the free-response ROC (FROC), the alternative free-response ROC (AFROC), and the exponentially transformed FROC (EFROC) paradigms. Therefore, an experimenter seeking to carry out such a study is confronted with an array of choices. Traditionally, arguments for different approaches have been made on the basis of practical considerations (statistical power, etc.) or the gross level of analysis (case-level or lesion-level). This article contends that a careful consideration of utility should form the rationale for matching the assessment paradigm to the clinical task of interest. In utility theory, task performance is commonly evaluated with total expected utility, which integrates the various event utilities against the probability of each event. To formalize the relationship between expected utility and the summary curve associated with each assessment paradigm, the concept of a "natural" utility structure is proposed. A natural utility structure is defined for a summary curve when the variables associated with the summary curve axes are sufficient for computing total expected utility, assuming that the disease prevalence is known. Natural utility structures for ROC, LROC, FROC, AFROC, and EFROC curves are introduced, clarifying how the utilities of correct and incorrect decisions are aggregated by summary curves. Further, conditions are given under which general utility structures for localization-based methodologies reduce to case-based assessment. Overall, the findings reveal how summary curves correspond to natural utility structures of diagnostic tasks, suggesting utility as a motivating principle for choosing an assessment paradigm.

A Healthcare Utilization Analysis Framework for Hot Spotting and Contextual Anomaly Detection

PubMed Central

Hu, Jianying; Wang, Fei; Sun, Jimeng; Sorrentino, Robert; Ebadollahi, Shahram

2012-01-01

Patient medical records today contain vast amount of information regarding patient conditions along with treatment and procedure records. Systematic healthcare resource utilization analysis leveraging such observational data can provide critical insights to guide resource planning and improve the quality of care delivery while reducing cost. Of particular interest to providers are hot spotting: the ability to identify in a timely manner heavy users of the systems and their patterns of utilization so that targeted intervention programs can be instituted, and anomaly detection: the ability to identify anomalous utilization cases where the patients incurred levels of utilization that are unexpected given their clinical characteristics which may require corrective actions. Past work on medical utilization pattern analysis has focused on disease specific studies. We present a framework for utilization analysis that can be easily applied to any patient population. The framework includes two main components: utilization profiling and hot spotting, where we use a vector space model to represent patient utilization profiles, and apply clustering techniques to identify utilization groups within a given population and isolate high utilizers of different types; and contextual anomaly detection for utilization, where models that map patient’s clinical characteristics to the utilization level are built in order to quantify the deviation between the expected and actual utilization levels and identify anomalies. We demonstrate the effectiveness of the framework using claims data collected from a population of 7667 diabetes patients. Our analysis demonstrates the usefulness of the proposed approaches in identifying clinically meaningful instances for both hot spotting and anomaly detection. In future work we plan to incorporate additional sources of observational data including EMRs and disease registries, and develop analytics models to leverage temporal relationships among medical encounters to provide more in-depth insights. PMID:23304306

A healthcare utilization analysis framework for hot spotting and contextual anomaly detection.

PubMed

Hu, Jianying; Wang, Fei; Sun, Jimeng; Sorrentino, Robert; Ebadollahi, Shahram

2012-01-01

Patient medical records today contain vast amount of information regarding patient conditions along with treatment and procedure records. Systematic healthcare resource utilization analysis leveraging such observational data can provide critical insights to guide resource planning and improve the quality of care delivery while reducing cost. Of particular interest to providers are hot spotting: the ability to identify in a timely manner heavy users of the systems and their patterns of utilization so that targeted intervention programs can be instituted, and anomaly detection: the ability to identify anomalous utilization cases where the patients incurred levels of utilization that are unexpected given their clinical characteristics which may require corrective actions. Past work on medical utilization pattern analysis has focused on disease specific studies. We present a framework for utilization analysis that can be easily applied to any patient population. The framework includes two main components: utilization profiling and hot spotting, where we use a vector space model to represent patient utilization profiles, and apply clustering techniques to identify utilization groups within a given population and isolate high utilizers of different types; and contextual anomaly detection for utilization, where models that map patient's clinical characteristics to the utilization level are built in order to quantify the deviation between the expected and actual utilization levels and identify anomalies. We demonstrate the effectiveness of the framework using claims data collected from a population of 7667 diabetes patients. Our analysis demonstrates the usefulness of the proposed approaches in identifying clinically meaningful instances for both hot spotting and anomaly detection. In future work we plan to incorporate additional sources of observational data including EMRs and disease registries, and develop analytics models to leverage temporal relationships among medical encounters to provide more in-depth insights.

Patient Portal Utilization Among Ethnically Diverse Low Income Older Adults: Observational Study

PubMed Central

Quandt, Sara A; Sandberg, Joanne C; Miller Jr, David P; Latulipe, Celine; Leng, Xiaoyan; Talton, Jenifer W; Melius, Kathryn P; Smith, Alden; Bertoni, Alain G

2017-01-01

Background Patient portals can improve patient communication with providers, provide patients with greater health information access, and help improve patient decision making, if they are used. Because research on factors facilitating and limiting patient portal utilization has not been conceptually based, no leverage points have been indicated for improving utilization. Objective The primary objective for this analysis was to use a conceptual framework to determine potentially modifiable factors affecting patient portal utilization by older adults (aged 55 years and older) who receive care at clinics that serve low income and ethnically diverse communities. The secondary objective was to delineate how patient portal utilization is associated with perceived usefulness and usability. Methods Patients from one urban and two rural clinics serving low income patients were recruited and completed interviewer-administered questionnaires on patient portal utilization. Results A total of 200 ethnically diverse patients completed questionnaires, of which 41 (20.5%) patients reported utilizing portals. Education, social support, and frequent Internet utilization improve the odds of patient portal utilization; receiving health care at a rural clinic decreases the odds of portal utilization. Conclusions Leverage points to address disparities in patient portal utilization include providing training for older adults in patient portal utilization, involving spouses or other care partners in this training, and making information technology access available at public places in rural and urban communities. PMID:29138129

Testing the effectiveness of deregulation in the electric utility industry: A market-based approach

NASA Astrophysics Data System (ADS)

Wang, Manfen

In this paper, I investigate one stated purpose of deregulation in the electric utility industry---to make utility operations more responsive to news releases, a proxy for market forces. My premise is that utilities providing electricity to highly deregulated states will be more responsive to market forces than those providing electricity to non-deregulated states. I employ intraday data from April to June 2001, the year after deregulation, and from 1994, the year before deregulation. I also employ the Brown-Forsythe-Modified Levene (BFL) test to determine the volatility differences between days with released news and days without released news. The results of BFL F tests for the year 2001 indicate that utilities headquartered in and serving states that have undergone substantial deregulation respond to news releases more strongly than those utilities headquartered in and serving states that are still regulated. The BFL F tests for utilities in 1994 confirm the premise that regulated utilities are less responsive to news releases. Finally, I conduct regression tests for utilities, the results of which support the findings from BFL tests---that all utilities serving highly deregulated states show pronounced responses to macroeconomic news releases. It appears that deregulation in the electric utility industry does, in fact, make utility operations more responsive to market forces and that deregulation is effective for states that implement a customer-choice model.

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

Code of Federal Regulations, 2011 CFR

2011-04-01

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

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

Code of Federal Regulations, 2010 CFR

2010-04-01

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

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%.

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.

A study on utilization of oral contraceptives in the City of Zagreb (2008-2010).

PubMed

Zelić-Kerep, Ana; Stimac, Danijela; Ozić, Sanja; Zivković, Kresimir; Zivković, Nikica

2014-06-01

Main aim of this study is to quantify and analyze the utilization and utilization trends of oral hormonal contraceptives in the City of Zagreb, 2008-2010, and to propose potential interventions, if necessary. Data gathered from Zagreb pharmacies were assessed by Anatomical Therapeutic Chemical Classification of drugs and Daily Defined Dose methodology. An alarming decrease in total utilization of hormonal contraceptives by 76% from 2008-2009 was found as the main result of this study. A major decrease by 95.5% in utilization of G03AB04 subgroup, sequential combined oral contraceptives, was noted in the year 2009. The subgroup G03AC0, progesterone-only pill group, showed a stable trend, and it became the most utilized subgroup in 2010, due to the decrease in utilization of both fixed and sequential combined oral contraceptives. Utilization of oral contraceptives in Croatia is not regulated adequately, since such dynamics in utilization can occur unnoticed. Measures need to take place in order to improve this situation. Proposed measures include organized farmacovigilance, prescription based on guidelines, and strict screening for risk factors in women seeking oral contraception. More research is required in Croatia to understand the pattern of utilization of hormonal contraceptives and to find the true cause of decrease in utilization of oral contraceptives.

[Utilities: a solution of a decision problem?].

PubMed

Koller, Michael; Ohmann, Christian; Lorenz, Wilfried

2008-01-01

Utility is a concept that originates from utilitarianism, a highly influential philosophical school in the Anglo-American world. The cornerstone of utilitarianism is the principle of maximum happiness or utility. In the medical sciences, this utility approach has been adopted and developed within the field of medical decision making. On an operational level, utility is the evaluation of a health state or an outcome on a one-dimensional scale ranging from 0 (death) to 1 (perfect health). By adding the concept of expectancy, the graphic representation of both concepts in a decision tree results in the specification of expected utilities and helps to resolve complex medical decision problems. Criticism of the utility approach relates to the rational perspective on humans (which is rejected by a considerable fraction of research in psychology) and to the artificial methods used in the evaluation of utility, such as Standard Gamble or Time Trade Off. These may well be the reason why the utility approach has never been accepted in Germany. Nevertheless, innovative concepts for defining goals in health care are urgently required, as the current debate in Germany on "Nutzen" (interestingly translated as 'benefit' instead of as 'utility') and integrated outcome models indicates. It remains to be seen whether this discussion will lead to a re-evaluation of the utility approach.

[Characteristics of dry matter production and nitrogen accumulation in barley genotypes with high nitrogen utilization efficiency].

PubMed

Huang, Yi; Li, Ting-Xuan; Zhang, Xi-Zhou; Ji, Lin

2014-07-01

A pot experiment was conducted under low (125 mg x kg-1) and normal (250 mg x kg(-1)) nitrogen treatments. The nitrogen uptake and utilization efficiency of 22 barley cultivars were investigated, and the characteristics of dry matter production and nitrogen accumulation in barley were analyzed. The results showed that nitrogen uptake and utilization efficiency were different for barley under two nitrogen levels. The maximal values of grain yield, nitrogen utilization efficiency for grain and nitrogen harvest index were 2.87, 2.91 and 2.47 times as those of the lowest under the low nitrogen treatment. Grain yield and nitrogen utilization efficiency for grain and nitrogen harvest index of barley genotype with high nitrogen utilization efficiency were significantly greater than low nitrogen utilization efficiency, and the parameters of high nitrogen utilization efficiency genotype were 82.1%, 61.5% and 50.5% higher than low nitrogen utilization efficiency genotype under the low nitrogen treatment. Dry matter mass and nitrogen utilization of high nitrogen utilization efficiency was significantly higher than those of low nitrogen utilization efficiency. A peak of dry matter mass of high nitrogen utilization efficiency occurred during jointing to heading stage, while that of nitrogen accumulation appeared before jointing. Under the low nitrogen treatment, dry matter mass of DH61 and DH121+ was 34.4% and 38.3%, and nitrogen accumulation was 54. 8% and 58.0% higher than DH80, respectively. Dry matter mass and nitrogen accumulation seriously affected yield before jointing stage, and the contribution rates were 47.9% and 54.7% respectively under the low nitrogen treatment. The effect of dry matter and nitrogen accumulation on nitrogen utilization efficiency for grain was the largest during heading to mature stages, followed by sowing to jointing stages, with the contribution rate being 29.5% and 48.7%, 29.0% and 15.8%, respectively. In conclusion, barley genotype with high nitrogen utilization efficiency had a strong ability of dry matter production and nitrogen accumulation. It could synergistically improve yield and nitrogen utilization efficiency by enhancing the ability of nitrogen uptake and dry matter formation before jointing stage in barley.

18 CFR 35.13 - Filing of changes in rate schedules, tariffs or service agreements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... be reconciled with the utility's most recent FERC Form 1. If the utility has not yet submitted Form 1 for the Test Period, the utility shall submit the relevant Form 1 pages in draft form. (D) The utility.... Balance sheets shall be constructed in accordance with the annual report form for electric utilities...

18 CFR 35.13 - Filing of changes in rate schedules, tariffs or service agreements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... be reconciled with the utility's most recent FERC Form 1. If the utility has not yet submitted Form 1 for the Test Period, the utility shall submit the relevant Form 1 pages in draft form. (D) The utility.... Balance sheets shall be constructed in accordance with the annual report form for electric utilities...

18 CFR 35.13 - Filing of changes in rate schedules, tariffs or service agreements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... be reconciled with the utility's most recent FERC Form 1. If the utility has not yet submitted Form 1 for the Test Period, the utility shall submit the relevant Form 1 pages in draft form. (D) The utility.... Balance sheets shall be constructed in accordance with the annual report form for electric utilities...

18 CFR 35.13 - Filing of changes in rate schedules, tariffs or service agreements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... be reconciled with the utility's most recent FERC Form 1. If the utility has not yet submitted Form 1 for the Test Period, the utility shall submit the relevant Form 1 pages in draft form. (D) The utility.... Balance sheets shall be constructed in accordance with the annual report form for electric utilities...

18 CFR 35.13 - Filing of changes in rate schedules, tariffs or service agreements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... be reconciled with the utility's most recent FERC Form 1. If the utility has not yet submitted Form 1 for the Test Period, the utility shall submit the relevant Form 1 pages in draft form. (D) The utility.... Balance sheets shall be constructed in accordance with the annual report form for electric utilities...

Working memory management and predicted utility

PubMed Central

Chatham, Christopher H.; Badre, David

2013-01-01

Given the limited capacity of working memory (WM), its resources should be allocated strategically. One strategy is filtering, whereby access to WM is granted preferentially to items with the greatest utility. However, reallocation of WM resources might be required if the utility of maintained information subsequently declines. Here, we present behavioral, computational, and neuroimaging evidence that human participants track changes in the predicted utility of information in WM. First, participants demonstrated behavioral costs when the utility of items already maintained in WM declined and resources should be reallocated. An adapted Q-learning model indicated that these costs scaled with the historical utility of individual items. Finally, model-based neuroimaging demonstrated that frontal cortex tracked the utility of items to be maintained in WM, whereas ventral striatum tracked changes in the utility of items maintained in WM to the degree that these items are no longer useful. Our findings suggest that frontostriatal mechanisms track the utility of information in WM, and that these dynamics may predict delays in the removal of information from WM. PMID:23882196

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

PubMed Central

Piantadosi, Steven T.; Hayden, Benjamin Y.

2015-01-01

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

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.

Health-state utilities in a prisoner population: a cross-sectional survey

PubMed Central

Chong, Christopher AKY; Li, Sicong; Nguyen, Geoffrey C; Sutton, Andrew; Levy, Michael H; Butler, Tony; Krahn, Murray D; Thein, Hla-Hla

2009-01-01

Background Health-state utilities for prisoners have not been described. Methods We used data from a 1996 cross-sectional survey of Australian prisoners (n = 734). Respondent-level SF-36 data was transformed into utility scores by both the SF-6D and Nichol's method. Socio-demographic and clinical predictors of SF-6D utility were assessed in univariate analyses and a multivariate general linear model. Results The overall mean SF-6D utility was 0.725 (SD 0.119). When subdivided by various medical conditions, prisoner SF-6D utilities ranged from 0.620 for angina to 0.764 for those with none/mild depressive symptoms. Utilities derived by the Nichol's method were higher than SF-6D scores, often by more than 0.1. In multivariate analysis, significant independent predictors of worse utility included female gender, increasing age, increasing number of comorbidities and more severe depressive symptoms. Conclusion The utilities presented may prove useful for future economic and decision models evaluating prison-based health programs. PMID:19715571

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.

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.

How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

PubMed

Bronkhorst, Babette

2017-08-01

Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

Perceptions of climate-related risk among water sector professionals in Africa-Insights from the 2016 African Water Association Congress.

PubMed

Connolly, Katherine; Mbutu, Mwaura; Bartram, Jamie; Fuente, David

2018-06-01

The ability of water and wastewater utilities to provide safe and reliable water and sanitation services now and in the future will be determined, in part, by their resilience to climate change. Investment in infrastructure, planning, and operational practices that increase resilience are affected, in turn, by how water sector professionals perceive the risks posed to utilities by climate change and its related impacts. We surveyed water sector professionals at the 2016 African Water Association's Congress in Nairobi, Kenya to assess their perceptions of climate-specific and general risks that may disrupt utility service. We find that water sector professionals are most concerned about climate-specific and general risks that affect utility water supplies (quantity), followed by adequacy of utility infrastructure. We also find that professionals tend to rank climate-specific risks as less concerning than general risks facing utilities. Furthermore, non-utility professionals are more concerned about climate-specific risks and climate change in general than utility professionals. These findings highlight the multiple, competing risks utilities face and the need for adaptation strategies that simultaneously address climate-specific and general concerns of utilities. Copyright © 2018 Elsevier GmbH. All rights reserved.

Socio-economic and locational determinants of accessibility and utilization of primary health-care.

PubMed

Field, K S; Briggs, D J

2001-09-01

Differences in levels of utilization vary and are a function of socio-economic and geographical factors. This paper presents the results of a questionnaire study involving twelve GP practices in Northamptonshire, UK, of factors which affect access and utilization in asthmatics and diabetics; these groups were selected to control for differences in utilization behaviour, as a result of different aetiologies. The questionnaire sought data on: residential location of patients, utilization characteristics of primary health-care, personal circumstances and mobility and hindrances to access and utilization. Key themes were identified relating to age, gender, social class, employment, ethnicity and proximity to the GP surgery. The young, elderly and females report higher rates of utilization, as do nonmanual workers and those who are unemployed. However, accessibility and utilization vary greatly in response to mobility and locational characteristics; these variations tend to be masked by data on overall rates of usage. Optimal scaling techniques were used to investigate the interactions between the factors affecting accessibility and utilization, and to characterize patients in terms of their levels of utilization. Results confirmed that current service provision afforded a differential level of service to patients, which does not directly reflect their level of need.

Variability in imaging utilization in U.S. pediatric hospitals.

PubMed

Arnold, Ryan W; Graham, Dionne A; Melvin, Patrice R; Taylor, George A

2011-07-01

Use of medical imaging is under scrutiny because of rising costs and radiation exposure. We compare imaging utilization and costs across pediatric hospitals to determine their variability and potential determinants. Data were extracted from the Pediatric Health Information System (PHIS) database for all inpatient encounters from 40 U.S. children's hospitals. Imaging utilization and costs were compared by insurance type, geographical region, hospital size, severity of illness, length of stay and type of imaging, all among specific diagnoses. The hospital with the highest utilization performed more than twice as many imaging studies per patient as the hospital with the lowest utilization. Similarly, imaging costs ranged from $154 to $671/patient. Median imaging-utilization rate was 1.7 exams/patient on the ward and increased significantly in the PICU (11.8 exams/patient) and in the NICU (17.7 exams per patient, (P < 0.001). Considerable variability in imaging utilization persisted despite adjustment for case mix index (CMI, range in variation 16.6-25%). We found a significant correlation between imaging utilization and both CMI and length of stay, P < 0.0001). However, only 36% of the variation in imaging utilization could be explained by CMI. Diagnostic imaging utilization and costs vary widely in pediatric hospitals.

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.

Identifying and managing inappropriate hospital utilization: a policy synthesis.

PubMed Central

Payne, S M

1987-01-01

Utilization review, the assessment of the appropriateness and efficiency of hospital care through review of the medical record, and utilization management, deliberate action by payers or hospital administrators to influence providers of hospital services to increase the efficiency and effectiveness with which services are provided, are valuable but relatively unfamiliar strategies for containing hospital costs. The purpose of this synthesis is to increase awareness of the scope of and potential for these approaches among health services managers and administrators, third-party payers, policy analysts, and health services researchers. The synthesis will assist the reader to trace the conceptual context and the historical development of utilization review from unstructured methods using individual physicians' professional judgment to structured methods using explicit criteria; to establish the context of utilization review and clarify its uses; to understand the concepts and tools used in assessing the efficiency of hospital use; and to select, design, and evaluate utilization review and utilization management programs. The extent of inappropriate (medical unnecessary) hospital utilization and the factors associated with it are described. Implications for managers, providers, and third-party payers in targeting utilization review and in designing and evaluating utilization management programs are discussed. PMID:3121538

Decision Utility, Incentive Salience, and Cue-Triggered “Wanting”

PubMed Central

Berridge, Kent C.; Aldridge, J. Wayne

2010-01-01

This chapter examines brain mechanisms of reward utility operating at particular decision moments in life—moments such as when one encounters an image, sound, scent, or other cue associated in the past with a particular reward or perhaps just when one vividly imagines that cue. Such a cue can often trigger a sudden motivational urge to pursue its reward and sometimes a decision to do so. Drawing on a utility taxonomy that distinguishes among subtypes of reward utility—predicted utility, decision utility, experienced utility, and remembered utility—it is shown how cue-triggered cravings, such as an addict’s surrender to relapse, can hang on special transformations by brain mesolimbic systems of one utility subtype, namely, decision utility. The chapter focuses on a particular form of decision utility called incentive salience, a type of “wanting” for rewards that is amplified by brain mesolimbic systems. Sudden peaks of intensity of incentive salience, caused by neurobiological mechanisms, can elevate the decision utility of a particular reward at the moment its cue occurs. An understanding of what happens at such moments leads to a better understanding of the mechanisms at work in decision making in general. PMID:25309963

Evaluating Utility Gloves as a Potential Reservoir for Pathogenic Bacteria.

PubMed

Grant, Kathy L; Naber, E Donald; Halteman, William A

2015-08-01

This pilot study sought to determine the rate and degree to which gram-negative Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa and gram-positive Staphylococcus aureus occurred on the inside of utility gloves used at University of Maine at Augusta, Dental Health Programs' dental hygiene clinic. Five steam autoclave utility gloves were randomly selected to serve as control and a convenience sample of 10 used utility gloves were selected from the sterilization area. A sample was collected from a predetermined surface area from the inside of each steam autoclave utility glove and used utility glove. Each sample was used to inoculate a Petri plate containing 2 types of culture media. Samples were incubated at 37° C for 30 to 36 hours in aerobic conditions. Colony forming units (CFU) were counted. Confidence intervals (CI) estimated the rate of contamination with gram-negative K. pneumoniae, E. coli and P. aeruginosa on the inside of steam autoclave utility gloves to be n=33 95% CL [0.000, 0.049], used utility gloves to be n=70, 95% CL [0.000, 0.0303]. Data estimated the rate of contamination with gram-positive S. aureus on the inside of steam autoclave utility gloves to be n=35, 95% CL [0.233, 0.530], used utility gloves to be n=70, 95% CL [0.2730, 0.4975]. Culture media expressed a wide range of CFU from 0 to over 200. The risk of utility glove contamination with gram-negative bacteria is likely low. The expressed growth of S. aureus from steam autoclave utility gloves controls raises questions about the effectiveness and safety of generally accepted sterilization standards for the governmentally mandated use of utility gloves. Copyright © 2015 The American Dental Hygienists’ Association.

Utility Estimation for Pediatric Vesicoureteral Reflux: Methodological Considerations Using an Online Survey Platform.

PubMed

Tejwani, Rohit; Wang, Hsin-Hsiao S; Lloyd, Jessica C; Kokorowski, Paul J; Nelson, Caleb P; Routh, Jonathan C

2017-03-01

The advent of online task distribution has opened a new avenue for efficiently gathering community perspectives needed for utility estimation. Methodological consensus for estimating pediatric utilities is lacking, with disagreement over whom to sample, what perspective to use (patient vs parent) and whether instrument induced anchoring bias is significant. We evaluated what methodological factors potentially impact utility estimates for vesicoureteral reflux. Cross-sectional surveys using a time trade-off instrument were conducted via the Amazon Mechanical Turk® (https://www.mturk.com) online interface. Respondents were randomized to answer questions from child, parent or dyad perspectives on the utility of a vesicoureteral reflux health state and 1 of 3 "warm-up" scenarios (paralysis, common cold, none) before a vesicoureteral reflux scenario. Utility estimates and potential predictors were fitted to a generalized linear model to determine what factors most impacted utilities. A total of 1,627 responses were obtained. Mean respondent age was 34.9 years. Of the respondents 48% were female, 38% were married and 44% had children. Utility values were uninfluenced by child/personal vesicoureteral reflux/urinary tract infection history, income or race. Utilities were affected by perspective and were higher in the child group (34% lower in parent vs child, p <0.001, and 13% lower in dyad vs child, p <0.001). Vesicoureteral reflux utility was not significantly affected by the presence or type of time trade-off warm-up scenario (p = 0.17). Time trade-off perspective affects utilities when estimated via an online interface. However, utilities are unaffected by the presence, type or absence of warm-up scenarios. These findings could have significant methodological implications for future utility elicitations regarding other pediatric conditions. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Disparities between Ophthalmologists and Patients in Estimating Quality of Life Associated with Diabetic Retinopathy

PubMed Central

Zou, Haidong; Xu, Xun; Zhang, Xi

2015-01-01

Background This study aimed to evaluate and compare the utility values associated with diabetic retinopathy (DR) in a sample of Chinese patients and ophthalmologists. Methods Utility values were evaluated by both the time trade-off (TTO) and rating scale (RS) methods for 109 eligible patients with DR and 2 experienced ophthalmologists. Patients were stratified by Snellen best-corrected visual acuity (BCVA) in the better-seeing eye. The correlations between the utility values and general vision-related health status measures were analyzed. These utility values were compared with data from two other studies. Results The mean utility values elicited from the patients themselves with the TTO (0.81; SD 0.10) and RS (0.81; SD 0.11) methods were both statistically lower than the mean utility values assessed by ophthalmologists. Significant predictors of patients’ TTO and RS utility values were both LogMAR BCVA in the affected eye and average weighted LogMAR BCVA. DR grade and duration of visual dysfunction were also variables that significantly predicted patients’ TTO utility values. For ophthalmologists, patients’ LogMAR BCVA in the affected eye and in the better eye were the variables that significantly predicted both the TTO and RS utility values. Patients’ education level was also a variable that significantly predicted RS utility values. Moreover, both diabetic macular edema and employment status were significant predictors of TTO and RS utility values, whether from patients or ophthalmologists. There was no difference in mean TTO utility values compared to our American and Canadian patients. Conclusions DR caused a substantial decrease in Chinese patients’ utility values, and ophthalmologists substantially underestimated its effect on patient quality of life. PMID:26630653

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.

24 CFR 982.517 - Utility allowance schedule.

Code of Federal Regulations, 2013 CFR

2013-04-01

... percent or more in the utility rate since the last time the utility allowance schedule was revised. The... allowance schedule to correct any errors, or as necessary to update the schedule. (d) Use of utility...

24 CFR 982.517 - Utility allowance schedule.

Code of Federal Regulations, 2012 CFR

2012-04-01

... percent or more in the utility rate since the last time the utility allowance schedule was revised. The... allowance schedule to correct any errors, or as necessary to update the schedule. (d) Use of utility...

24 CFR 982.517 - Utility allowance schedule.

Code of Federal Regulations, 2014 CFR

2014-04-01

... percent or more in the utility rate since the last time the utility allowance schedule was revised. The... allowance schedule to correct any errors, or as necessary to update the schedule. (d) Use of utility...

Multiple paths in complex tasks

NASA Technical Reports Server (NTRS)

Galanter, Eugene; Wiegand, Thomas; Mark, Gloria

1987-01-01

The relationship between utility judgments of subtask paths and the utility of the task as a whole was examined. The convergent validation procedure is based on the assumption that measurements of the same quantity done with different methods should covary. The utility measures of the subtasks were obtained during the performance of an aircraft flight controller navigation task. Analyses helped decide among various models of subtask utility combination, whether the utility ratings of subtask paths predict the whole tasks utility rating, and indirectly, whether judgmental models need to include the equivalent of cognitive noise.

Utilization management in anatomic pathology.

PubMed

Lewandrowski, Kent; Black-Schaffer, Steven

2014-01-01

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

DSM and electric utility competitiveness: An Illinois perspective

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

Jackson, P.W.

1994-12-31

A predominant theme in the current electric utility industry literature is that competitive forces have emerged and may become more prominent. The wholesale bulk power market is alreadly competitive, as non-utility energy service providers already have had a significant impact on that market; this trend was accelerated by the Energy Policy Act of 1992. Although competition at the retail level is much less pervasive, electric utility customers increasingly have greater choice in selecting energy services. These choices may include, depending on the customer, the ability to self-generate, switch fuels, move to a new location, or rely more heavily on demand-sidemore » management as a means of controlling electric energy use. This paper explores the subject of how demand-side management (DSM) programs, which are often developed by a utility to satisfy resource requirements as a part of its least-cost planning process, can affect the utility`s ability to compete in the energy services marketplace. In this context, the term `DSM` is used in this paper to refer to those demand-side services and programs which provide resources to the utility`s system. Depending on one`s perspective, DSM programs (so defined) can be viewed either as an enhancement to the competitive position of a utility by enabling it to provide its customers with a broader menu of energy services, simultaneously satisfying the objectives of the utility as well as those of the customers, or as a detractor to a utility`s ability to compete. In the latter case, the concern is with respect to the potential for adverse rate impacts on customers who are not participants in DSM programs. The paper consists of an identification of the pros and cons of DSM as a competitive strategy, the tradeoff which can occur between the cost impacts and rate impacts of DSM, and an examination of alternative strategies for maximizing the utilization of DSM both as a resource and as a competitive strategy.« less

Experience of socioeconomic-related inequality in dental care utilization among Thai elderly under universal coverage.

PubMed

Somkotra, Tewarit

2013-04-01

To assess the socioeconomic-related inequality in dental care utilization among Thai elderly and to determine factors associated with the observed inequality after the country achieved universal coverage. The data were taken from the nationally representative Thailand Health & Welfare Survey 2007. Data of 10,096 Thai elderly (aged over 60 years) were selected. Descriptive analyses of the features of dental care utilization among Thai elderly were carried out, in addition to the concentration index (Cindex ) being used to quantify the extent of socioeconomic-related inequality in dental care utilization. Logistic regression was used to determine factors associated with inequality in dental care. Socioeconomic-related inequality in dental care utilization among Thai elderly was shown. Also, utilization was more concentrated among wealthier older adults, as shown by the positive value of Cindex (equals 0.244). The poor elderly, however, were more likely to utilize dental care at public facilities, particularly primary care facilities. Multivariate analysis showed that certain demographic, socioeconomic and geographic characteristics were particularly associated with poor-rich differences in dental care utilization among Thai elderly. Although socioeconomic-related inequality in dental care utilization among Thai elderly exists, the pro-poor utilization at public facilities, particularly primary care facilities, substantiates the concerted effort to reducing inequality in dental care utilization for Thai elderly. © 2012 Japan Geriatrics Society.

Evaluation of Geographic Indices Describing Health Care Utilization.

PubMed

Kim, Agnus M; Park, Jong Heon; Kang, Sungchan; Kim, Yoon

2017-01-01

The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates. In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index. Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.

Study of the impacts of regulations affecting the acceptance of Integrated Community Energy Systems: public utility, energy facility siting and municipal franchising regulatory programs in Kentucky. Preliminary background report

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

Feurer, D A; Weaver, C L; Gallagher, K C

1980-01-01

Until April 1, 1979, the Public Service Commission had been vested with exclusive jurisdiction over the regulation of rates and service of utilities. As of that date two new agencies, the Energy Regulatory Commission (ERC) and the Utility Regulatory Commission (URC), have replaced the Public Service Commission. The ERC consists of three full-time members appointed by the governor for four year terms and is responsible for enforcing the provisions of the Kentucky statutes relating to electric and gas utilities. The three-member URC is responsible for enforcing the provisions relating to non-energy utilities such as telephone, sewer, and water utilities. Themore » statutes vest all regulatory authority over public utilities in either the ERC or the URC. Local governments retain only the power to grant local franchises. However, it should be noted, that any utility owned or operated by a political subdivision of the state is exempt from regulation. Thus, local government has complete authority over utilities which are self-owned. Public utility regulatory statutes, energy facility siting programs, and municipal franchising authority are examined to identify how they may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES.« less

Perceived utility of emotion: the structure and construct validity of the Perceived Affect Utility Scale in a cross-ethnic sample.

PubMed

Chow, Philip I; Berenbaum, Howard

2012-01-01

This study introduces a new measure of the perceived utility of emotion, which is the degree to which emotions are perceived to be useful in achieving goals. In this study, we administered this new measure, the Perceived Affect Utility Scale (PAUSe), to a sample of 142 European American and 156 East Asian American college students. Confirmatory factor analyses provided support for a new, culturally informed parsing of emotion and for perceived utility of emotion to be distinguishable from ideal affect, a related but separate construct. Next, we explored the potential importance of perceived utility of emotion in cultural research. Through path analyses, we found that: (a) culturally relevant variables (e.g., independence) played a mediating role in the link between ethnic group and perceived utility of emotion; and (b) perceived utility of emotion played a mediating role in the link between culturally relevant variables and ideal affect. In particular, perceived utility of self-centered emotions (e.g., pride) was found to be associated with independence and ideal affect of those same emotions. In contrast, perceived utility of other-centered emotions (e.g., appreciation) was found to be associated with interdependence, dutifulness/self-discipline, and ideal affect of those same emotions. Implications for perceived utility of emotion in understanding cultural factors are discussed.

Expected Utility Distributions for Flexible, Contingent Execution

NASA Technical Reports Server (NTRS)

Bresina, John L.; Washington, Richard

2000-01-01

This paper presents a method for using expected utility distributions in the execution of flexible, contingent plans. A utility distribution maps the possible start times of an action to the expected utility of the plan suffix starting with that action. The contingent plan encodes a tree of possible courses of action and includes flexible temporal constraints and resource constraints. When execution reaches a branch point, the eligible option with the highest expected utility at that point in time is selected. The utility distributions make this selection sensitive to the runtime context, yet still efficient. Our approach uses predictions of action duration uncertainty as well as expectations of resource usage and availability to determine when an action can execute and with what probability. Execution windows and probabilities inevitably change as execution proceeds, but such changes do not invalidate the cached utility distributions, thus, dynamic updating of utility information is minimized.

An absolute scale for measuring the utility of money

NASA Astrophysics Data System (ADS)

Thomas, P. J.

2010-07-01

Measurement of the utility of money is essential in the insurance industry, for prioritising public spending schemes and for the evaluation of decisions on protection systems in high-hazard industries. Up to this time, however, there has been no universally agreed measure for the utility of money, with many utility functions being in common use. In this paper, we shall derive a single family of utility functions, which have risk-aversion as the only free parameter. The fact that they return a utility of zero at their low, reference datum, either the utility of no money or of one unit of money, irrespective of the value of risk-aversion used, qualifies them to be regarded as absolute scales for the utility of money. Evidence of validation for the concept will be offered based on inferential measurements of risk-aversion, using diverse measurement data.

U.S. utilities' experiences with the implementation of energy efficiency programs

NASA Astrophysics Data System (ADS)

Goss, Courtney

In the U.S., many electric utility companies are offering demand-side management (DSM) programs to their customers as ways to save money and energy. However, it is challenging to compare these programs between utility companies throughout the U.S. because of the variability of state energy policies. For example, some states in the U.S. have deregulated electricity markets and others do not. In addition, utility companies within a state differ depending on ownership and size. This study examines 12 utilities' experiences with DSM programs and compares the programs' annual energy savings results that the selected utilities reported to the Energy Information Administration (EIA). The 2009 EIA data suggests that DSM program effectiveness is not significantly affected by electricity market deregulation or utility ownership. However, DSM programs seem to generally be more effective when administered by utilities located in states with energy savings requirements and DSM program mandates.

Diversify your sources of capital through debt offerings

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

Burkhardt, D.A.; Soucy, S.T.

1993-09-01

Despite the trend toward diversification in many areas of the utility industry, most utility executives have yet to realize that many of the benefits derived from diversifying equity ownership can also be gained through a similar approach to their debt securities. Although institutional investors have long been regarded as the exclusive market for utility debt securities, individuals are an increasingly important component of this market. The factors that motivate individuals to purchase utility debt securities are the same as those that influence purchases of utility stocks: safety and dependable income. The benefits of retail ownership of utility debt securities domore » not, however, accrue exclusively to the investor. Utility companies that actively market debt offerings to individual investors also can expect to enjoy a number of tangible benefits. Nowhere are these benefits more obvious than in the area of tax-exempt utility securities.« less

Prospect theory in the health domain: a quantitative assessment.

PubMed

Attema, Arthur E; Brouwer, Werner B F; I'Haridon, Olivier

2013-12-01

It is well-known that expected utility (EU) has empirical deficiencies. Cumulative prospect theory (CPT) has developed as an alternative with more descriptive validity. However, CPT's full function had not yet been quantified in the health domain. This paper is therefore the first to simultaneously measure utility of life duration, probability weighting, and loss aversion in this domain. We observe loss aversion and risk aversion for gains and losses, which for gains can be explained by probabilistic pessimism. Utility for gains is almost linear. For losses, we find less weighting of probability 1/2 and concave utility. This contrasts with the common finding of convex utility for monetary losses. However, CPT was proposed to explain choices among lotteries involving monetary outcomes. Life years are arguably very different from monetary outcomes and need not generate convex utility for losses. Moreover, utility of life duration reflects discounting, causing concave utility. Copyright © 2013 Elsevier B.V. All rights reserved.

Field Trial Results of a 14-channel GPR Integrated with a U.S. Program for 3-D Utility Mapping

NASA Astrophysics Data System (ADS)

Anspach, James H.

2013-04-01

Existing underground utilities continue to be a leading cause of highway construction delay claims in the United States. Although 80-90% of existing utilities can typically be discovered and mapped using a wide range of geophysical tools, there is a recognizable need to improve the process. Existing shortcomings to the utility mapping process include a lack of viable depth attributes, long field occupation times, low experience level of the field technicians, and separate survey / geophysics functions. The U.S. National Academies and its Transportation Research Board recently concluded a project on alleviating the existing utility mapping shortcomings through the development of enhanced GPR. An existing commercial 400MHz 14-channel towed array was enhanced with positioning and interpretation hardware and software over a 3-year US 2M program. Field trials for effectiveness were conducted in a city suburb commercialized environment where the relative permittivity values averaged 9.4. The effectiveness of enhanced GPR was compared to traditional utility mapping techniques (Single Channel GPR, FDEM, Acoustic, Sondes, Gradiometric Magnetometers) during the project. The project area utilities included natural gas, water, electric, telephone, cable, storm, sanitary, traffic control, and several unknown function lines. Depths for these utilities were mostly unknown. 81% of known (from records and field appurtenance visual observation) utilities were detected via traditional geophysical means. These traditional geophysical means also detected 14% additional and previously "unknown" utilities. The enhanced GPR detected approximately 40% of the known and unknown utilities, and found an additional 6% of utilities that were previously undetected. These additional utilities were subsequently determined to be small diameter abandoned water and gas systems in very poor and broken condition. Although it did well with metallic water and gas lines, communication and electric utilities were mostly undetectable. Through a ground-truthing program of test holes to expose utilities, the depth values derived from the enhanced GPR were fairly consistent and within 15 cm of actual depth. The incomplete underground picture determined by the enhanced GPR reinforces previous studies that show that the mapping of existing underground utilities is a multi-tool effort that takes highly trained and skilled field technicians and data interpreters. The addition of a new GPR tool is valuable in determining continuous depth profiles of imaged utilities. A second and significant benefit is the interpretation of other geotechnical data that benefit project designers. This might include showing geometry, location, intensity, and depths of either areas of anomalies, or of known structures, such as paving thickness, substrate thickness, voids, water table, soil lenses, boulders, bedrock, and so forth. The Florida Department of Transportation has decided to take advantage of this new technology and has entered into an experimental contract with Cardno TBE to incorporate several enhanced GPR arrays with traditional utility detection tools. The goal of this contract will be to provide a 3-D model of existing underground utilities for use in automated construction. The GPR 3-D data model will be melded with conventional subsurface utility engineering and mapping practices and will be required to follow the ASCE 38 standard for utility data reliability.

Effects of geodemographic profiles on healthcare service utilization: a case study on cardiac care in Ontario, Canada

PubMed Central

2013-01-01

Background Although literature has associated geodemographic factors with healthcare service utilization, little is known about how these factors — such as population size, age profile, service accessibility, and educational profile — interact to influence service utilization. This study fills this gap in the literature by examining both the direct and the moderating effects of geodemographic profiles on the utilization of cardiac surgery services. Methods We aggregated secondary data obtained from Statistics Canada and Cardiac Care Network of Ontario to derive the geodemographic profiles of Ontario and the corresponding cardiac surgery service utilization in the years between 2004 and 2007. We conducted a two-step test using Partial Least Squares-based structural equation modeling to investigate the relationships between geodemographic profiles and healthcare service utilization. Results Population size and age profile have direct positive effects on service utilization (β=0.737, p<0.01; β=0.284, p<0.01, respectively), whereas service accessibility is negatively associated with service utilization (β=−0.210, p<0.01). Service accessibility decreases the effect of population size on service utilization (β=−0.606, p<0.01), and educational profile weakens the effects of population size and age profile on service utilization (β=−0.595, p<0.01; β=−0.286, p<0.01, respectively). Conclusions In this study, we found that (1) service accessibility has a moderating effect on the relationship between population size and service utilization, and (2) educational profile has moderating effects on both the relationship between population size and service utilization, and the relationship between age profile and service utilization. Our findings suggest that reducing regional disparities in healthcare service utilization should take into account the interaction of geodemographic factors such as service accessibility and education. In addition, the allocation of resources for a particular healthcare service in one area should consider the geographic distribution of the same services in neighboring areas, as patients may be willing to utilize these services in areas not far from where they reside. PMID:23816201

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.

Knowledge, attitudes, practices, and barriers related to research utilization: a survey among pharmacists in Malaysia.

PubMed

Tan, Sin Yee; Hatah, Ernieda

2017-04-01

Background Research utilization is part of evidence-based practice referring to the process of reviewing and critiquing scientific research and applying the findings to one's own clinical practice. Many studies on research utilization have been conducted with doctors and nurses, but to our knowledge, none have been investigated amongst pharmacists. Objective To assess research utilization and its barriers among pharmacists and identify potential influencing factors. Setting Malaysia. Methods This cross-sectional survey was administered online and by mail to a convenient sample of pharmacists working in hospitals, health clinics, and retail pharmacies in rural and urban areas. Main outcome measure Pharmacists' research utilization knowledge, attitudes, and practices. Results Six hundred surveys were mailed to potential respondents, and 466 were returned (77.7% response rate). Twenty-eight respondents completed the survey online. The respondents' research utilization knowledge, attitudes, and practices were found to be moderate. Research utilization was associated with respondents' knowledge and attitude scores (P < 0.001). When factors related to research utilization were modelled, higher educational level was associated with higher level of research utilization (P < 0.001) while less involvement in journal clubs, more years of service (3-7 years and more than 7 years) were associated with low and moderate research utilization, respectively. The main reported barrier to research utilization was lack of sufficient authority to change patient care procedures. Conclusion Pharmacists' research utilization knowledge, attitudes, and practices can be improved by encouraging pharmacists to pursue higher degrees, promoting active participation in institutions' journal clubs, and introducing senior clinical pharmacist specialization.

An elicitation of utility for quality of life under prospect theory.

PubMed

Attema, Arthur E; Brouwer, Werner B F; l'Haridon, Olivier; Pinto, Jose Luis

2016-07-01

This paper performs several tests of decision analysis applied to the health domain. First, we conduct a test of the normative expected utility theory. Second, we investigate the possibility to elicit the more general prospect theory. We observe risk aversion for gains and losses and violations of expected utility. These results imply that mechanisms governing decisions in the health domain are similar to those in the monetary domain. However, we also report one important deviation: utility is universally concave for the health outcomes used in this study, in contrast to the commonly found S-shaped utility for monetary outcomes, with concave utility for gains and convex utility for losses. Copyright © 2016 Elsevier B.V. All rights reserved.

Strategies to encourage and facilitate utility owner participation in transportation projects : guidebook.

DOT National Transportation Integrated Search

2012-11-01

Utility accommodation policies around the country provide minimum requirements for the accommodation, adjustment, and maintenance of utility facilities within the highway right of way. Many state rules and guidelines are based on utility accommodatio...

Moving Toward Sustainability: Sustainable and Effective Practices for Creating Your Own Water Utility Roadmap

EPA Pesticide Factsheets

The document builds on the Effective Utility Management framework. It provides utilities of various sizes with a series of proven and effective practices to help achieve the outcomes in Effective Utility Management.

Utility photovoltaic group: Status report

NASA Astrophysics Data System (ADS)

Serfass, Jeffrey A.; Hester, Stephen L.; Wills, Bethany N.

1996-01-01

The Utility PhotoVoltaic Group (UPVG) was formed in October of 1992 with a mission to accelerate the use of cost-effective small-scale and emerging grid-connected applications of photovoltaics for the benefit of electric utilities and their customers. The UPVG is now implementing a program to install up to 50 megawatts of photovoltaics in small-scale and grid-connected applications. This program, called TEAM-UP, is a partnership of the U.S. electric utility industry and the U.S. Department of Energy to help develop utility PV markets. TEAM-UP is a utility-directed program to significantly increase utility PV experience by promoting installations of utility PV systems. Two primary program areas are proposed for TEAM-UP: (1) Small-Scale Applications (SSA)—an initiative to aggregate utility purchases of small-scale, grid-independent applications; and (2) Grid-Connected Applications (GCA)—an initiative to identify and competitively award cost-sharing contracts for grid-connected PV systems with high market growth potential, or collective purchase programs involving multiple buyers. This paper describes these programs and outlines the schedule, the procurement status, and the results of the TEAM-UP process.

Zymomonas with improved xylose utilization in stress conditions

DOEpatents

Caimi, Perry G; Emptage, Mark; Li, Xu; Viitanen, Paul V; Chou, Yat-Chen; Franden, Mary Ann; Zhang, Min

2013-06-18

Strains of xylose utilizing Zymomonas with improved xylose utilization and ethanol production during fermentation in stress conditions were obtained using an adaptation method. The adaptation involved continuously growing xylose utilizing Zymomonas in media containing high sugars, acetic acid, ammonia, and ethanol.

Determining the Optimal Work Breakdown Structure for Defense Acquisition Contracts

DTIC Science & Technology

2016-03-24

programs. Public utility corresponds with the generally understood concept that having more money is desirable, and having less money is not desirable...From this perspective, program completion on budget provides maximum utility , while being over budget reduces utility as there is less money for other...tree. Utility theory tools were applied using three utility perspectives, and optimal WBSs were identified. Results demonstrated that reporting at WBS

Air Force Third Party Financing Management Guide.

DTIC Science & Technology

1984-05-01

lhe Public Utility Regulatory Policies Act of 1978 ( PURPA ) a l,s qualifying cogenerators to sell their power back to the utilities al the utilities...Conditions favorable to the sale of cogenerated or independrt~y produced power created by the Public Utility Regulatory Policies Act ( PURPA ) of 1978; o...electrical energy. The Public Utility Regulatory Policies Act of 1978 ( PURPA ) allows qualifying cogenerators to sell their powcr back to the

Use of commercial grade item dedication to reduce procurement costs

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

Rosch, F.

1995-09-01

In the mid-1980s, the Nuclear Regulatory Industry (NRC) began inspecting utility practices of procuring and dedicating commercial grade items intended for plant safety-related applications. As a result of the industry efforts to address NRC concerns, nuclear utilities have enhanced existing programs and procedures for dedication of commercial grade items. Though these programs were originally enhanced to meet NRC concerns, utilities have discovered that the dedication of commercial grade items can also reduce overall procurement costs. This paper will discuss the enhancement of utility dedication programs and demonstrates how utilities have utilized them to reduce procurement costs.

Energy essays: a focus on utility communication

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

Selnow, G.W.; Crano, W.D.; Ludwig, S.

The following papers are included: (1) technology, customers, and the feedback loop, (2) utility communications: a need for understanding the American character, (3) utility programs and grass roots communication, (4) reading the tea leaves of public opinion, (5) the need for public opinion surveys in utility communication programs, (6) the role of assessment in effective utility communication programs, (7) utility customer communication; perspectives on current public policy and law, (8) customer communications - a notion in motion, (9) communication when your customer is your owner, (10) radio advertising, (11) television advertising, (12) newspaper advertising, and (13) magazine advertising. (MOW)

National Utility Rate Database: Preprint

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

Ong, S.; McKeel, R.

2012-08-01

When modeling solar energy technologies and other distributed energy systems, using high-quality expansive electricity rates is essential. The National Renewable Energy Laboratory (NREL) developed a utility rate platform for entering, storing, updating, and accessing a large collection of utility rates from around the United States. This utility rate platform lives on the Open Energy Information (OpenEI) website, OpenEI.org, allowing the data to be programmatically accessed from a web browser, using an application programming interface (API). The semantic-based utility rate platform currently has record of 1,885 utility rates and covers over 85% of the electricity consumption in the United States.

Teach It, Don't Preach It: The Differential Effects of Directly-communicated and Self-generated Utility Value Information.

PubMed

Canning, Elizabeth A; Harackiewicz, Judith M

2015-03-01

Social-psychological interventions in education have used a variety of "self-persuasion" or "saying-is-believing" techniques to encourage students to articulate key intervention messages. These techniques are used in combination with more overt strategies, such as the direct communication of messages in order to promote attitude change. However, these different strategies have rarely been systematically compared, particularly in controlled laboratory settings. We focus on one intervention based in expectancy-value theory designed to promote perceptions of utility value in the classroom and test different intervention techniques to promote interest and performance. Across three laboratory studies, we used a mental math learning paradigm in which we varied whether students wrote about utility value for themselves or received different forms of directly-communicated information about the utility value of a novel mental math technique. In Study 1, we examined the difference between directly-communicated and self-generated utility-value information and found that directly-communicated utility-value information undermined performance and interest for individuals who lacked confidence, but that self-generated utility had positive effects. However, Study 2 suggests that these negative effects of directly-communicated utility value can be ameliorated when participants are also given the chance to generate their own examples of utility value, revealing a synergistic effect of directly-communicated and self-generated utility value. In Study 3, we found that individuals who lacked confidence benefited more when everyday examples of utility value were communicated, rather than career and school examples.

Evaluation of Geographic Indices Describing Health Care Utilization

PubMed Central

Park, Jong Heon

2017-01-01

Objectives The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization. Methods We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates. Results In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index. Conclusions Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit. PMID:28173689

Utilization of Ambulatory Mental Health Services.

ERIC Educational Resources Information Center

Williams, Stephen J.; Richardson, Mary

1980-01-01

Studied the use of mental health services by enrolled populations, in order to establish a model or predictor of utilization. Primary focus of utilization data has been patient characteristics; organizational variables, such as plan design and benefit packages, are also shown to affect utilization. (LAB)

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.

The effect of comorbidities upon ocular and systemic health-related quality of life.

PubMed

Real, F J; Brown, G C; Brown, H C; Brown, M M

2008-06-01

The purpose of the study was to assess whether, and to what degree, comorbidities affect patient quality of life. A cross-sectional, quality-of-life study of 170 consecutive vitreoretinal patients compared the utility associated with a participant's primary (most incapacitating) disease and the utility associated with a grouping of all of the participants' diseases. The ocular diseases present included diabetic retinopathy (44%), macular degeneration (30%), lattice degeneration/retinal tear (14%), retinal vascular obstruction (5%), uveitis, macular oedema, macular pucker (5%) and others (2%). Participants underwent interviewer-administered, time trade-off utility questions for each disease, then for a compilation of all diseases. Their primary disease was defined by the lowest utility reported for a single disease, while other health conditions were considered comorbidities. A two-tailed, paired t test was used to compare the means of the primary disease utilities and compilation utilities. The study was powered to have a 90% chance of detecting an 8% difference in mean utility between the two utility groups The mean lowest utility for the most disabling single health condition (primary disease) was 0.82 (SD 0.22; 95% CI 0.79 to 0.85. The mean utility for the grouping together of all diseases was 0.80 (SD 0.24, 95% CI 0.76 to 0.84). No significant difference was found between the mean utilities of the two groups (p = 0.56). The overall health-related quality of life of a patient in an ophthalmic population with serious diseases appears to be primarily determined by the single disease that most adversely affects the individual's quality of life. This conclusion has significant implications in clinical care and when considering the use of comorbidities in cost-utility analyses.

Electric utilities and telecommunications

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

Moeller, J.W.

1995-08-01

Part I of this article will provide some background on the involvement of electric utilities in telecommunications. It will discuss the Power Radio Services, under which the FCC regulates radio communications of electric utilities, the pole attachment statute of the Communications Act, which authorized the FCC to regulate attachments of cable television cables to electric utility poles, and a recent Department of Energy (DOE) report on the need for a demonstration on the use of telecommunications for DSM. Part I will also discuss several recent developments relative to the Power Radio Services and the pole attachment statute. Part II willmore » discuss electric utilities and telecommunications under PUHCA. It will outline the extensive and complex requirements of PUHCA that are applicable to public utility holding companies, as well as the specific requirements of PUHCA for the formation by public utility holding companies of subsidiaries to engage in telecommunications activities. It will also discuss the seven instances in the past decade in which the SEC has approved the formation by public utility holding companies of such subsidiaries. Part III of this article will discuss a principal obstacle to expanded electric utility involvement in telecommunications activities-a series of administrative and judicial decisions that illustrate the potential for dual regulation by the SEC and the FERC to result in confusion and inefficiencies. It will also discuss proposals in Congress to minimize this potential. Part IV will discuss House Bill 3636 and Senate Bill 1822 and their proposals to amend PUHCA to facilitate the formation or acquisition by public utility holding companies of non-utility subsidiaries to engage in telecommunications activities. It will also discuss their proposals to address the potential consequences of dual regulation by the SEC and the FERC of electric utilities involved in telecommunications.« less

Socio-demographic, clinical characteristics and utilization of mental health care services associated with SF-6D utility scores in patients with mental disorders: contributions of the quantile regression.

PubMed

Prigent, Amélie; Kamendje-Tchokobou, Blaise; Chevreul, Karine

2017-11-01

Health-related quality of life (HRQoL) is a widely used concept in the assessment of health care. Some generic HRQoL instruments, based on specific algorithms, can generate utility scores which reflect the preferences of the general population for the different health states described by the instrument. This study aimed to investigate the relationships between utility scores and potentially associated factors in patients with mental disorders followed in inpatient and/or outpatient care settings using two statistical methods. Patients were recruited in four psychiatric sectors in France. Patient responses to the SF-36 generic HRQoL instrument were used to calculate SF-6D utility scores. The relationships between utility scores and patient socio-demographic, clinical characteristics, and mental health care utilization, considered as potentially associated factors, were studied using OLS and quantile regressions. One hundred and seventy six patients were included. Women, severely ill patients and those hospitalized full-time tended to report lower utility scores, whereas psychotic disorders (as opposed to mood disorders) and part-time care were associated with higher scores. The quantile regression highlighted that the size of the associations between the utility scores and some patient characteristics varied along with the utility score distribution, and provided more accurate estimated values than OLS regression. The quantile regression may constitute a relevant complement for the analysis of factors associated with utility scores. For policy decision-making, the association of full-time hospitalization with lower utility scores while part-time care was associated with higher scores supports the further development of alternatives to full-time hospitalizations.

48 CFR 1519.201-72 - Small and disadvantaged business utilization specialists.

Code of Federal Regulations, 2011 CFR

2011-10-01

... prescribed from time to time in furtherance of overall small and small disadvantaged business utilization... business utilization specialists. 1519.201-72 Section 1519.201-72 Federal Acquisition Regulations System... disadvantaged business utilization specialists. (a) Small Business Specialists (SBS) shall be appointed in...

41 CFR 101-42.1102-3 - Controlled substances.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS UTILIZATION AND DISPOSAL 42-UTILIZATION...) Utilization requirements. (1) Excess controlled substances are not required to be reported to GSA, but are subject to the utilization screening requirements of § 101-43.311-2. Holding agencies shall make...

10 CFR 766.101 - Data utilization.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Data utilization. 766.101 Section 766.101 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.101 Data utilization. DOE shall use...

10 CFR 766.101 - Data utilization.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Data utilization. 766.101 Section 766.101 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.101 Data utilization. DOE shall use...

10 CFR 766.101 - Data utilization.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false Data utilization. 766.101 Section 766.101 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.101 Data utilization. DOE shall use...

42 CFR 456.3 - Statewide surveillance and utilization control program.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Statewide surveillance and utilization control... § 456.3 Statewide surveillance and utilization control program. The Medicaid agency must implement a statewide surveillance and utilization control program that— (a) Safeguards against unnecessary or...

42 CFR 456.3 - Statewide surveillance and utilization control program.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Statewide surveillance and utilization control... § 456.3 Statewide surveillance and utilization control program. The Medicaid agency must implement a statewide surveillance and utilization control program that— (a) Safeguards against unnecessary or...

42 CFR 456.3 - Statewide surveillance and utilization control program.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Statewide surveillance and utilization control... § 456.3 Statewide surveillance and utilization control program. The Medicaid agency must implement a statewide surveillance and utilization control program that— (a) Safeguards against unnecessary or...

42 CFR 456.3 - Statewide surveillance and utilization control program.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Statewide surveillance and utilization control... § 456.3 Statewide surveillance and utilization control program. The Medicaid agency must implement a statewide surveillance and utilization control program that— (a) Safeguards against unnecessary or...

42 CFR 456.3 - Statewide surveillance and utilization control program.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Statewide surveillance and utilization control... § 456.3 Statewide surveillance and utilization control program. The Medicaid agency must implement a statewide surveillance and utilization control program that— (a) Safeguards against unnecessary or...

10 CFR 766.101 - Data utilization.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Data utilization. 766.101 Section 766.101 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.101 Data utilization. DOE shall use...

10 CFR 766.101 - Data utilization.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Data utilization. 766.101 Section 766.101 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.101 Data utilization. DOE shall use...

Health Insurance Utilization and Its Impact: Observations from the Middle-Aged and Elderly in China

PubMed Central

Li, Yang; Wang, Xiaojun; Ma, Chi; Ma, Shuangge

2013-01-01

Objective In China, despite a high coverage rate, health insurance is not used for all illness episodes. Our goal is to identify subjects’ characteristics associated with insurance utilization and the association between utilization and medical expenditure. Methods A survey was conducted in January and February of 2012. 2093 middle-aged and elderly subjects (45 years old and above) were surveyed. Results Heath insurance was not utilized for 12.6% (inpatient), 53.3% (outpatient), and 72.6% (self-treatment) of disease episodes. Subjects’ characteristics were associated with insurance utilization. Inpatient and outpatient treatments were expensive. In the multivariate analysis of outpatient treatment expenditure, insurance utilization was significantly associated with higher treatment cost, lost income, and gross total cost. Conclusion Utilization of health insurance may need to be improved. Insurance utilization can reduce out-of-pocket medical expenditure. However, the amount paid by the insured is still high. Policy intervention is needed to further improve the effectiveness of health insurance. PMID:24324654

Scheduling for Parallel Supercomputing: A Historical Perspective of Achievable Utilization

NASA Technical Reports Server (NTRS)

Jones, James Patton; Nitzberg, Bill

1999-01-01

The NAS facility has operated parallel supercomputers for the past 11 years, including the Intel iPSC/860, Intel Paragon, Thinking Machines CM-5, IBM SP-2, and Cray Origin 2000. Across this wide variety of machine architectures, across a span of 10 years, across a large number of different users, and through thousands of minor configuration and policy changes, the utilization of these machines shows three general trends: (1) scheduling using a naive FIFO first-fit policy results in 40-60% utilization, (2) switching to the more sophisticated dynamic backfilling scheduling algorithm improves utilization by about 15 percentage points (yielding about 70% utilization), and (3) reducing the maximum allowable job size further increases utilization. Most surprising is the consistency of these trends. Over the lifetime of the NAS parallel systems, we made hundreds, perhaps thousands, of small changes to hardware, software, and policy, yet, utilization was affected little. In particular these results show that the goal of achieving near 100% utilization while supporting a real parallel supercomputing workload is unrealistic.

Health utility of patients with Crohn's disease and ulcerative colitis: a systematic review and meta-analysis.

PubMed

Malinowski, Krzysztof Piotr; Kawalec, Paweł

2016-08-01

The aim of this systematic review was to collect and summarize the current data on the utilities of patients with Crohn's disease (CD) and ulcerative colitis (UC). A meta-analysis of the obtained utilities was performed using a random-effects model and meta-regression by the disease type and severity. A bootstrap analysis was performed as it does not require assumption on distribution of the data. The highest utility among patients with CD and UC was observed when the diseases were in remission. The meta-regression analysis showed that both disease severity and an instrument/method/questionnaire used to obtain utilities were significant predictors of utility. Utility was the lowest for severe disease and the highest for disease in remission, the association was more notable in patients with CD compared with UC. Expert commentary: The issue of patients' utility is important for healthcare decision makers but it has not been fully investigated and requires further study.

Measuring the equity of inpatient utilization in Chinese rural areas

PubMed Central

2011-01-01

Background As an important outcome of the health system, equity in health service utilization has attracted an increasing amount of attention in the literature on health reform in China in recent years. The poor, who frequently require more services, are often the least able to pay, while the wealthy utilize disproportionately more services although they have less need. Whereas equity in health service utilization between richer and poorer populations has been studied in urban areas, the equity in health service utilization in rural areas has received little attention. With improving levels of economic development, the introduction of health insurance and increasing costs of health services, health service utilization patterns have changed dramatically in rural areas in recent years. However, previous studies have shown neither the extent of utilization inequity, nor which factors are associated with utilization inequity in rural China. Methods This paper uses previously unavailable country-wide data and focuses on income-related inequity of inpatient utilization and its determinants in Chinese rural areas. The data for this study come from the Chinese National Health Services Surveys (NHSS) conducted in 2003 and 2008. To measure the level of inequity in inpatient utilization over time, the concentration index, decomposition of the concentration index, and decomposition of change in the concentration index are employed. Results This study finds that even with the same need for inpatient services, richer individuals utilize more inpatient services than poorer individuals. Income is the principal determinant of this pro-rich inpatient utilization inequity- wealthier individuals are able to pay for more services and therefore use more services regardless of need. However, rising income and increased health insurance coverage have reduced the inequity in inpatient utilization in spite of increasing inpatient prices. Conclusions There remains a strong pro-rich inequity of inpatient utilization in rural China. However, a narrowing income gap between the rich and poor and greater access to health insurance has effectively reduced income inequality, equalizing access to care. This suggests that the most effective way to reduce the inequity is to narrow the gap of income between the rich and poor while adopting social risk protection. PMID:21854641

Assessing equity of healthcare utilization in rural China: results from nationally representative surveys from 1993 to 2008

PubMed Central

2013-01-01

Background The phenomenon of inequitable healthcare utilization in rural China interests policymakers and researchers; however, the inequity has not been actually measured to present the magnitude and trend using nationally representative data. Methods Based on the National Health Service Survey (NHSS) in 1993, 1998, 2003, and 2008, the Probit model with the probability of outpatient visit and the probability of inpatient visit as the dependent variables is applied to estimate need-predicted healthcare utilization. Furthermore, need-standardized healthcare utilization is assessed through indirect standardization method. Concentration index is measured to reflect income-related inequity of healthcare utilization. Results The concentration index of need-standardized outpatient utilization is 0.0486[95% confidence interval (0.0399, 0.0574)], 0.0310[95% confidence interval (0.0229, 0.0390)], 0.0167[95% confidence interval (0.0069, 0.0264)] and −0.0108[95% confidence interval (−0.0213, -0.0004)] in 1993, 1998, 2003 and 2008, respectively. For inpatient service, the concentration index is 0.0529[95% confidence interval (0.0349, 0.0709)], 0.1543[95% confidence interval (0.1356, 0.1730)], 0.2325[95% confidence interval (0.2132, 0.2518)] and 0.1313[95% confidence interval (0.1174, 0.1451)] in 1993, 1998, 2003 and 2008, respectively. Conclusions Utilization of both outpatient and inpatient services was pro-rich in rural China with the exception of outpatient service in 2008. With the same needs for healthcare, rich rural residents utilized more healthcare service than poor rural residents. Compared to utilization of outpatient service, utilization of inpatient service was more inequitable. Inequity of utilization of outpatient service reduced gradually from 1993 to 2008; meanwhile, inequity of inpatient service utilization increased dramatically from 1993 to 2003 and decreased significantly from 2003 to 2008. Recent attempts in China to increase coverage of insurance and primary healthcare could be a contributing factor to counteract the inequity of outpatient utilization, but better benefit packages and delivery strategies still need to be tested and scaled up to reduce future inequity in inpatient utilization in rural China. PMID:23688260

Electric utilities, fiscal illusion and the provision of local public services

NASA Astrophysics Data System (ADS)

Dowell, Paula Elizabeth Kay

2000-10-01

Restructuring activity in the electric utility industry is threatening a once stable and significant source of revenue for local governments. Potentially declining revenues from electric utilities leaves local policymakers with the unpopular decision of raising taxes or reducing the level of public services provided. This has led to pressure on state governments to introduce legislation aimed at mitigating potential revenue loss for local government due to restructuring activity. However, before imposing such legislation, a better understanding of the potential distortionary effects of internal subsidization by electric utilities is needed. Two models of the demand for local public services--a structural model using the Stone-Geary utility framework and a reduced form model--are developed in an attempt to model the behavioral responses of local public expenditures to revenue contributions from electric utilities. Empirical analysis of both models is conducted using a panel data set for 242 municipalities in Tennessee from 1988 to 1998. Aggregate spending and expenditures on four specific service functions are examined. The results provide evidence of a positive flypaper effect. Furthermore, the source of the flypaper effect is attributed to fiscal illusion caused by price distortions. The stimulative effect of electric utility revenue contributions on the level of local public services indicate that a 1.00 change in electric utility subsidies results in a change in local expenditures ranging from 0.22 to 1.32 for the structural model and 1.97 to 2.51 for the reduced form model. The amount of the marginal effect directly attributed to price illusion is estimated to range from 0.04 to $0.85. In addition, the elasticities of electric utility revenue contributions are estimated to range from 0.05 to 0.90. The results raise a number of interesting issues regarding municipal ownership of utilities and legislation regarding tax treatment of utilities after restructuring. The fact that the current study suggests that electric utility subsidies give rise to fiscal illusion raises new questions regarding the justification of safeguarding the exclusive franchise of municipally-owned utilities and revenues from electric utilities in the era of restructuring.

Mean Field Games for Stochastic Growth with Relative Utility

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

Huang, Minyi, E-mail: mhuang@math.carleton.ca; Nguyen, Son Luu, E-mail: sonluu.nguyen@upr.edu

This paper considers continuous time stochastic growth-consumption optimization in a mean field game setting. The individual capital stock evolution is determined by a Cobb–Douglas production function, consumption and stochastic depreciation. The individual utility functional combines an own utility and a relative utility with respect to the population. The use of the relative utility reflects human psychology, leading to a natural pattern of mean field interaction. The fixed point equation of the mean field game is derived with the aid of some ordinary differential equations. Due to the relative utility interaction, our performance analysis depends on some ratio based approximation errormore » estimate.« less

Photovoltaic utility/customer interface study

NASA Astrophysics Data System (ADS)

Eichler, C. H.; Hayes, T. P.; Matthews, M. M.; Wilraker, V. F.

1980-12-01

The technical, economic, and legal and regulatory issues of interconnecting small, privately-owned, on-site photovoltaic generating systems to an electric utility are addressed. Baseline residential, commercial and industrial class photovoltaic systems were developed. Technical issues of concern affecting this interconnection were identified and included fault protection, undervoltage protection, lamp flicker, revenue metering, loss of synchromism, electrical safety, prevention of backfeeding a de-energized utility feeder, effects of on-site generation on utility relaying schemes, effects of power conditioner harmonic distortion on the electric utility, system isolation, electromagnetic interference and site power factor as seen by the utility. Typical interconnection wiring diagrams were developed for interconnecting each class of baseline photovoltaic generating system.

Financial statistics of major US investor-owned electric utilities 1992

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

Not Available

The Financial Statistics of Major US Investor-Owned Electric Utilities publication presents summary and detailed financial accounting data on the investor-owned electric utilities. The objective of the publication is to provide Federal and State governments, industry, and the general public with current and historical data that can be used for policymaking and decisionmaking purposes related to investor-owned electric utility issues. The Financial Statistics of Major US Investor-Owned Electric Utilities publication provides information about the financial results of operations of investor-owned electric utilities for use by government, industry, electric utilities, financial organizations and educational institutions in energy planning. In the private sector,more » the readers of this publication are researchers and analysts associated with the financial markets, the policymaking and decisionmaking members of electric utility companies, and economic development organizations. Other organizations that may be interested in the data presented in this publication include manufacturers of electric power equipment and marketing organizations. In the public sector, the readers of this publication include analysts, researchers, statisticians, and other professionals engaged in regulatory, policy, and program areas. These individuals are generally associated with the Congress, other legislative bodies, State public utility commissions, universities, and national strategic planning organizations.« less

Skill Acquisition and Utilization During Evidence-Based Psychosocial Treatments for Childhood Disruptive Behavior Problems: A Review and Meta-analysis

PubMed Central

Higa, Janelle; Trentacosta, Christopher J.; Herschell, Amy D.; Kolko, David J.

2013-01-01

We review 85 empirical articles published since 2000 that measured the acquisition and/or utilization of parent management skills and/or child cognitive-behavioral skills in the context of an evidence-based treatment (EBT) for childhood behavior problems. Results showed that: (1) there are no standardized measures of skill acquisition or skill utilization that are used across treatments, (2) little is known about predictors, correlates, or outcomes associated with skill acquisition and utilization, and (3) few studies systematically examined techniques to enhance the acquisition and utilization of specific skills. Meta-analytic results from a subset of 68 articles (59 studies) showed an overall treatment–control ES =.31, p < .01 for skill acquisition and ES =.20, p = ns for skill utilization. We recommend that future research focus on the following three areas: (1) development of standardized measures of skill acquisition and utilization from a “common elements” perspective that can used across EBTs; (2) assessment of the predictors, correlates, and outcomes associated with skill acquisition and utilization; and (3) development of innovative interventions to enhance the acquisition and utilization of cognitive-behavioral and parent management skills. PMID:23649324

Decision and cost-utility analyses of surgical versus transcatheter closure of patent ductus arteriosus: should you let a smile be your umbrella?

PubMed

Gray, D T; Weinstein, M C

1998-01-01

Decision and cost-utility analyses considered the tradeoffs of treating patent ductus arteriosus (PDA) using conventional surgery versus transcatheter implantation of the Rashkind occluder. Physicians and informed lay parents assigned utility scores to procedure success/complications combinations seen in prognostically similar pediatric patients with isolated PDA treated from 1982 to 1987. Utility scores multiplied by outcome frequencies from a comparative study generated expected utility values for the two approaches. Cost-utility analyses combined these results with simulated provider cost estimates from 1989. On a 0-100 scale (worst to best observed outcome), the median expected utility for surgery was 99.96, versus 98.88 for the occluder. Results of most sensitivity analyses also slightly favored surgery. Expected utility differences based on 1987 data were minimal. With a mean overall simulated cost of $8,838 vs $12,466 for the occluder, surgery was favored in most cost-utility analyses. Use of the inherently less invasive but less successful, more risky, and more costly occluder approach conferred no apparent net advantage in this study. Analyses of comparable current data would be informative.

Optimal Wonderful Life Utility Functions in Multi-Agent Systems

NASA Technical Reports Server (NTRS)

Wolpert, David H.; Tumer, Kagan; Swanson, Keith (Technical Monitor)

2000-01-01

The mathematics of Collective Intelligence (COINs) is concerned with the design of multi-agent systems so as to optimize an overall global utility function when those systems lack centralized communication and control. Typically in COINs each agent runs a distinct Reinforcement Learning (RL) algorithm, so that much of the design problem reduces to how best to initialize/update each agent's private utility function, as far as the ensuing value of the global utility is concerned. Traditional team game solutions to this problem assign to each agent the global utility as its private utility function. In previous work we used the COIN framework to derive the alternative Wonderful Life Utility (WLU), and experimentally established that having the agents use it induces global utility performance up to orders of magnitude superior to that induced by use of the team game utility. The WLU has a free parameter (the clamping parameter) which we simply set to zero in that previous work. Here we derive the optimal value of the clamping parameter, and demonstrate experimentally that using that optimal value can result in significantly improved performance over that of clamping to zero, over and above the improvement beyond traditional approaches.

Utility measures of health-related quality of life in patients treated for benign paroxysmal positional vertigo.

PubMed

Roberts, Richard A; Abrams, Harvey; Sembach, Melanie K; Lister, Jennifer J; Gans, Richard E; Chisolm, Theresa Hnath

2009-06-01

Comparing the effects of different disorders and interventions on health-related quality of life (HRQoL) is important for healthcare policy and accountability. There are two basic approaches to measure HRQoL: questionnaires derived from psychometrics and preference-based measures or utilities derived from econometrics. While disease-specific HRQoL questionnaires, such as the Dizziness Handicap Inventory (DHI), are important because they focus on the impact of a specific problem and its treatments (i.e., vestibular disorders), economic comparisons of the impacts of diseases/disorders and their treatments are typically based on utility assessment. The utility measures for audiology application (UMAA) were developed to measure utilities for various audiologic conditions using a standard computer. The purpose of this study was to determine if the UMAA provides stable, valid, and sensitive utility measures of the effects of benign paroxysmal positional vertigo (BPPV) and its treatment on HRQoL. It was hypothesized that utilities, as measured by the UMAA, would indicate improvement in HRQoL post-treatment for BPPV comparable to a disease-specific health status measure (DHI). The UMAA incorporates three techniques to measure utility: rating scale, standard gamble, and time tradeoff. A utility is a cardinal measure of strength of preference and is measured on a continuum basis from 0.0 (incapacitating dizziness) to 1.0 (no dizziness). Fifty-two adults with BPPV of the posterior semicircular canal completed the UMAA and DHI before treatment and again post-treatment. A subgroup of 15 participants completed the UMAA on two occasions before treatment to assess test-retest stability and to establish critical difference values. Results from this investigation demonstrate that utilities as measured through the UMAA are stable, valid, and comparable to the DHI. Post-treatment utilities were also significantly higher than pretreatment utilities, indicating that the utilities, as measured through the UMAA, are sensitive to improvement in HRQoL after BPPV treatment. Utilities as measured through the UMAA seem sensitive to changes in HRQoL after treatment of BPPV. Since the UMAA can be used to measure patient preference (i.e., utility), it may be useful for comparison of specific audiologic conditions, such as BPPV, to nonaudiologic conditions, such as cardiovascular disease and kidney disease.

Individual determinants of research utilization by nurses: a systematic review update.

PubMed

Squires, Janet E; Estabrooks, Carole A; Gustavsson, Petter; Wallin, Lars

2011-01-05

Interventions that have a better than random chance of increasing nurses' use of research are important to the delivery of quality patient care. However, few reports exist of successful research utilization in nursing interventions. Systematic identification and evaluation of individual characteristics associated with and predicting research utilization may inform the development of research utilization interventions. To update the evidence published in a previous systematic review on individual characteristics influencing research utilization by nurses. As part of a larger systematic review on research utilization instruments, 12 online bibliographic databases were searched. Hand searching of specialized journals and an ancestry search was also conducted. Randomized controlled trials, clinical trials, and observational study designs examining the association between individual characteristics and nurses' use of research were eligible for inclusion. Studies were limited to those published in the English, Danish, Swedish, and Norwegian languages. A vote counting approach to data synthesis was taken. A total of 42,770 titles were identified, of which 501 were retrieved. Of these 501 articles, 45 satisfied our inclusion criteria. Articles assessed research utilization in general (n = 39) or kinds of research utilization (n = 6) using self-report survey measures. Individual nurse characteristics were classified according to six categories: beliefs and attitudes, involvement in research activities, information seeking, education, professional characteristics, and socio-demographic/socio-economic characteristics. A seventh category, critical thinking, emerged in studies examining kinds of research utilization. Positive relationships, at statistically significant levels, for general research utilization were found in four categories: beliefs and attitudes, information seeking, education, and professional characteristics. The only characteristic assessed in a sufficient number of studies and with consistent findings for the kinds of research utilization was attitude towards research; this characteristic had a positive association with instrumental and overall research utilization. This review reinforced conclusions in the previous review with respect to positive relationships between general research utilization and: beliefs and attitudes, and current role. Furthermore, attending conferences/in-services, having a graduate degree in nursing, working in a specialty area, and job satisfaction were also identified as individual characteristics important to research utilization. While these findings hold promise as potential targets of future research utilization interventions, there were methodological problems inherent in many of the studies that necessitate their findings be replicated in further research using more robust study designs and multivariate assessment methods.

Individual determinants of research utilization by nurses: a systematic review update

PubMed Central

2011-01-01

Background Interventions that have a better than random chance of increasing nurses' use of research are important to the delivery of quality patient care. However, few reports exist of successful research utilization in nursing interventions. Systematic identification and evaluation of individual characteristics associated with and predicting research utilization may inform the development of research utilization interventions. Objective To update the evidence published in a previous systematic review on individual characteristics influencing research utilization by nurses. Methods As part of a larger systematic review on research utilization instruments, 12 online bibliographic databases were searched. Hand searching of specialized journals and an ancestry search was also conducted. Randomized controlled trials, clinical trials, and observational study designs examining the association between individual characteristics and nurses' use of research were eligible for inclusion. Studies were limited to those published in the English, Danish, Swedish, and Norwegian languages. A vote counting approach to data synthesis was taken. Results A total of 42,770 titles were identified, of which 501 were retrieved. Of these 501 articles, 45 satisfied our inclusion criteria. Articles assessed research utilization in general (n = 39) or kinds of research utilization (n = 6) using self-report survey measures. Individual nurse characteristics were classified according to six categories: beliefs and attitudes, involvement in research activities, information seeking, education, professional characteristics, and socio-demographic/socio-economic characteristics. A seventh category, critical thinking, emerged in studies examining kinds of research utilization. Positive relationships, at statistically significant levels, for general research utilization were found in four categories: beliefs and attitudes, information seeking, education, and professional characteristics. The only characteristic assessed in a sufficient number of studies and with consistent findings for the kinds of research utilization was attitude towards research; this characteristic had a positive association with instrumental and overall research utilization. Conclusions This review reinforced conclusions in the previous review with respect to positive relationships between general research utilization and: beliefs and attitudes, and current role. Furthermore, attending conferences/in-services, having a graduate degree in nursing, working in a specialty area, and job satisfaction were also identified as individual characteristics important to research utilization. While these findings hold promise as potential targets of future research utilization interventions, there were methodological problems inherent in many of the studies that necessitate their findings be replicated in further research using more robust study designs and multivariate assessment methods. PMID:21208425

41 CFR 109-38.5103 - Motor vehicle utilization standards.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Motor vehicle... AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 38-MOTOR EQUIPMENT MANAGEMENT 38.51-Utilization of Motor Equipment § 109-38.5103 Motor vehicle utilization standards. (a) The following average utilization standards...

76 FR 3587 - Standards of Performance for Fossil-Fuel-Fired, Electric Utility, Industrial-Commercial...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-20

... Standards of Performance for Fossil-Fuel-Fired, Electric Utility, Industrial-Commercial-Institutional, and... Fossil fuel-fired electric utility steam generating units. Federal Government 22112 Fossil fuel-fired... 22112 Fossil fuel-fired electric utility steam generating units owned by municipalities. 921150 Fossil...

76 FR 3517 - Standards of Performance for Fossil-Fuel-Fired, Electric Utility, Industrial-Commercial...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-20

... Standards of Performance for Fossil-Fuel-Fired, Electric Utility, Industrial-Commercial-Institutional, and... following: Category NAICS \\1\\ Examples of regulated entities Industry 221112 Fossil fuel-fired electric utility steam generating units. Federal Government 22112 Fossil fuel-fired electric utility steam...

An analysis of the direct and indirect costs of utility and right-of-way conflicts on construction roadway projects.

DOT National Transportation Integrated Search

2006-08-01

Utility conflicts are unfortunately a common occurrence on many roadway projects. This report examines the frequency and severity of utility conflicts both within and outside of Kentucky. Understanding which type of utility conflicts most likely occu...

41 CFR 109-38.5104 - Other motor equipment utilization standards.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Other motor equipment... AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 38-MOTOR EQUIPMENT MANAGEMENT 38.51-Utilization of Motor Equipment § 109-38.5104 Other motor equipment utilization standards. No utilization standards are...

41 CFR 109-38.5104 - Other motor equipment utilization standards.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Other motor equipment... AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 38-MOTOR EQUIPMENT MANAGEMENT 38.51-Utilization of Motor Equipment § 109-38.5104 Other motor equipment utilization standards. No utilization standards are...

12 CFR 1320.11 - Consultation with financial market utility.

Code of Federal Regulations, 2014 CFR

2014-01-01

... materials timely submitted by the financial market utility under this section before making a proposed... 12 Banks and Banking 10 2014-01-01 2014-01-01 false Consultation with financial market utility... FINANCIAL MARKET UTILITIES Consultations, Determinations and Hearings § 1320.11 Consultation with financial...

12 CFR 1320.11 - Consultation with financial market utility.

Code of Federal Regulations, 2013 CFR

2013-01-01

... materials timely submitted by the financial market utility under this section before making a proposed... 12 Banks and Banking 9 2013-01-01 2013-01-01 false Consultation with financial market utility... FINANCIAL MARKET UTILITIES Consultations, Determinations and Hearings § 1320.11 Consultation with financial...

12 CFR 1320.11 - Consultation with financial market utility.

Code of Federal Regulations, 2012 CFR

2012-01-01

... materials timely submitted by the financial market utility under this section before making a proposed... 12 Banks and Banking 9 2012-01-01 2012-01-01 false Consultation with financial market utility... FINANCIAL MARKET UTILITIES Consultations, Determinations and Hearings § 1320.11 Consultation with financial...

40 CFR 74.44 - Reduced utilization for combustion sources.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 17 2014-07-01 2014-07-01 false Reduced utilization for combustion....44 Reduced utilization for combustion sources. (a) Calculation of utilization—(1) Annual utilization... reported in accordance with subpart F of this part for combustion sources. “Allowances transferred to all...

40 CFR 74.44 - Reduced utilization for combustion sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 17 2013-07-01 2013-07-01 false Reduced utilization for combustion....44 Reduced utilization for combustion sources. (a) Calculation of utilization—(1) Annual utilization... reported in accordance with subpart F of this part for combustion sources. “Allowances transferred to all...

40 CFR 74.44 - Reduced utilization for combustion sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 17 2012-07-01 2012-07-01 false Reduced utilization for combustion....44 Reduced utilization for combustion sources. (a) Calculation of utilization—(1) Annual utilization... reported in accordance with subpart F of this part for combustion sources. “Allowances transferred to all...

40 CFR 74.44 - Reduced utilization for combustion sources.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 16 2011-07-01 2011-07-01 false Reduced utilization for combustion....44 Reduced utilization for combustion sources. (a) Calculation of utilization—(1) Annual utilization... reported in accordance with subpart F of this part for combustion sources. “Allowances transferred to all...

West Virginia | Solar Research | NREL

Science.gov Websites

Incentive Programs West Virginia currently does not have any statewide financial incentives for midmarket solar. Utility Incentive Programs Check with local utility for utility incentive programs. Resources The utility policies and incentive programs. Net Metering and Interconnection West Virginia Public Service

EQ-5D™-derived utility values for different levels of migraine severity from a UK sample of migraineurs

PubMed Central

2012-01-01

Background To estimate utility values for different levels of migraine pain severity from a United Kingdom (UK) sample of migraineurs. Methods One hundred and six migraineurs completed the EQ-5D to evaluate their health status for mild, moderate and severe levels of migraine pain severity for a recent migraine attack, and for current health defined as health status within seven days post-migraine attack. Statistical tests were used to evaluate differences in mean utility scores by migraine severity. Results Utility scores for each health state were significantly different from 1.0 (no problems on any EQ-5D dimension) (p < 0.0001) and one another (p < 0.0001). The lowest mean utility, − 0.20 (95% confidence interval [CI]: -0.27 – -0.13), was for severe migraine pain. The smallest difference in mean utility was between mild and moderate migraine pain (0.13) and the largest difference in mean utility was between current health (without migraine) and severe migraine pain (1.07). Conclusions Results indicate that all levels of migraine pain are associated with significantly reduced utility values. As severity worsened, utility decreased and severe migraine pain was considered a health state worse than death. Results can be used in cost-utility models examining the relative economic value of therapeutic strategies for migraine in the UK. PMID:22691697

Boosting investor yields through bond insurance

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

Mosbacher, M.L.; Burkhardt, D.A.

The market for utility securities generally tends to be fairly static. Innovative financing techniques are rarely used because of the marketability of utility securities stemming from the companies' generally strong financial credit and the monopoly markets most utilities serve. To many people, utility securities are considered the pillars of the financial world, and innovation is not needed. Further, plain vanilla utility issues are easily understood by investors, as well as by regulators and customers. Over the past several years, however, a new utility bond product has crept into the world of utility securities - insured secondary utility bonds. These insuredmore » bonds may possibly be used as an alternative financing technique for newly issued debt. Individual investors often tend to rely on insurance as a tool for reducing credit risk and are willing to take the lower yields as a tradeoff. Insured utility bonds are created by brokerage firms through the acqusition of a portion of an outstanding utility bond issue and subsequent solicitation of the insurance companies for bids. The insurance company then agrees to insure that portion of the issue until maturity for a fee, and the brokerage firm sells those bonds to their customers as a AAA-insured bond. Issuers are encouraged to explore the retail market as a financing alternative. They may find a most cost-effective means of raising capital.« less

Study of the impacts of regulations affecting the acceptance of Integrated Community Energy Systems: public utility, energy facility siting and municipal franchising regulatory programs in Rhode Island. Preliminary background report

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

Feurer, D A; Weaver, C L; Gallagher, K C

1980-01-01

The Rhode Island statutes vest in the Public Utility Commission and the Division of Public Utilities the exclusive power and authority to regulate public utility companies in that state. Both bodies have been established within the Department of Business Regulation but are independent of the Department's director and are not under his jurisdiction. The jurisdiction to regulate utilities is shared by the Commission and the Division. The Commission serves as a quasi-judicial tribunal with jurisdiction, powers, and duties to hold investigations and hearings involving rates, sufficiency and resonableness of facilities, gas, electric, water, and pipeline public utilities. The administrator, whomore » is chief executive officer of the Division, is responsible for exercising the jurisdiction, supervision, powers, and duties not specifically assigned to the Commission. By virtue of his office, the chairman of the Commission serves also as the administrator and he supervises and directs the execution of all laws relating to public utilities and carriers and all regulations and orders of the Commission governing the conduct and charges of public utilities. Public utility regulatory statutes, energy facility siting programs, and municipal franchising authority are examined to identify how they may impact on the ability of an organization, whether or not it be a regulated utility, to construct and operate an ICES.« less

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

[Spatiotemporal evolvement of soil microbiological characteristics in upland fields with different utilization duration in Cixi, Zhejiang Province].

PubMed

Hu, Jun-Li; Lin, Xian-Gui; Yin, Rui; Chu, Hai-Yan; Zhang, Hua-Yong; Wang, Jun-Hua; Cao, Zhi-Hong

2008-09-01

The microbial number, microbial biomass, and enzymatic activities in five upland soils under agricultural utilization for 50-700 years were determined, with the correlations between soil microbiological characteristics and agricultural utilization duration analyzed. In the meantime, the functional diversity of microbes in soils having been utilized for 50, 100, and 700 years were investigated. The results showed that at the early stage (< 100 years) of agricultural utilization, the number of soil fungi (F) had a slight increase, while the bacterial number (B), B/F ratio, microbial biomass C (C(mic)), microbial biomass N (N(mic)), and the activities of catalase, invertase and urease all decreased markedly. After utilized for more than 100 years, the F decreased significantly, while the B, B/F ratio, C(mic), N(mic), and the activities of test enzymes all tended to increase. During the whole utilization period from 50 to 700 years, the C(mic)/N(mic) ratio had a significant increase with year. The Shannon, Simpson, and McIntosh indices of soil microbial community had the same responses to the agricultural utilization duration as the bacterial number, microbial biomass, and enzymatic activities. All of these indicated that in the upland fields in Cixi of Zhejiang Province, shifts of soil microbial community occurred with increasing agricultural utilization duration, and soil microbiological quality had an overall increase after 100 years agricultural utilization.

Should "standard gamble" and "'time trade off" utility measurement be used more in mental health research?

PubMed

Flood, Chris

2010-06-01

This review and discussion paper demonstrates that utility and preference measurement in mental health research is increasing. However there is still a general reluctance around using the methods due to methodological challenges and concerns around the capacity of users to understand utility methods during the research process. This paper sets out to describe and review some of the previously documented difficulties of using utility measurements in mental health services research and to highlight where they have been used successfully as measures. Additionally the paper aims to discuss a means of improving the methods used to capture service user utility and preference measurement and why decision making would be better informed as a result. International literature on utility measurement is reviewed, specifically examining the use of standard gamble and time trade off methods in mental health. Utility measurement in mental health is increasing though as the review demonstrates, concerns still exist over its application. A number of methods can be used to improve the approach overall and these are discussed as well as specific areas worthy of utility measurement including 'disutility' of admission, medication and medication side effects. Overall this paper argues that it is necessary to persist with efforts to conduct utility measurement calculation albeit with a critical eye on the methods in an attempt to ensure improvements are continually made. Utility and preference scores may be limited in that they only provide a rough score but they are defended as a means of providing some form of strength of preference for health states. The review is limited to English only texts. The debate on whether to use standard gamble and time trade off has implications for health services resource allocations, decision making, health economics research, policy making and health services research generally involving psychiatric service users. The paper argues that the absence of utility measurement in mental health runs the risk of mental health being disadvantaged in decisions around resource allocation. Institutions involved in decision making like the United Kingdom's National Institute for Health and Clinical Excellence, would be better served in their decision making and calculation of Quality Adjusted Life Years if more utility measurement in psychiatric research was carried out. Other arguments for using utility measurement include the desirability of using utility measurement to elicit a patient dimension of risk. Future utility research should aim for better involvement of service users in the design stage, the changing of time frames offered to users in health state scenarios used, a greater need for comparative work of utilities scoring across illness and between standard gamble and time trade off and more staff training in the use of utility methodology with mental health service users.

Economic and environmental optimization of a multi-site utility network for an industrial complex.

PubMed

Kim, Sang Hun; Yoon, Sung-Geun; Chae, Song Hwa; Park, Sunwon

2010-01-01

Most chemical companies consume a lot of steam, water and electrical resources in the production process. Given recent record fuel costs, utility networks must be optimized to reduce the overall cost of production. Environmental concerns must also be considered when preparing modifications to satisfy the requirements for industrial utilities, since wastes discharged from the utility networks are restricted by environmental regulations. Construction of Eco-Industrial Parks (EIPs) has drawn attention as a promising approach for retrofitting existing industrial parks to improve energy efficiency. The optimization of the utility network within an industrial complex is one of the most important undertakings to minimize energy consumption and waste loads in the EIP. In this work, a systematic approach to optimize the utility network of an industrial complex is presented. An important issue in the optimization of a utility network is the desire of the companies to achieve high profits while complying with the environmental regulations. Therefore, the proposed optimization was performed with consideration of both economic and environmental factors. The proposed approach consists of unit modeling using thermodynamic principles, mass and energy balances, development of a multi-period Mixed Integer Linear Programming (MILP) model for the integration of utility systems in an industrial complex, and an economic/environmental analysis of the results. This approach is applied to the Yeosu Industrial Complex, considering seasonal utility demands. The results show that both the total utility cost and waste load are reduced by optimizing the utility network of an industrial complex. 2009 Elsevier Ltd. All rights reserved.

Outpatient utilization of psychopharmaceuticals in the City of Zagreb 2001-2006.

PubMed

Stimac, Danijela; Culig, Josip

2009-03-01

A comprehensive insight into drug utilization as an economic and primarily a public health issue can only be acquired in the context of overall health state of the respective population. The objectives of the study were: 1) to determine the real outpatient utilization of psychopharmaceuticals in Zagreb, 2) to determine the psychopharmaceutical prescribing quality during the study period; and 3) to propose appropriate interventions in Zagreb on the basis of the results obtained. Data on drug utilization were obtained from all Zagreb pharmacies. The number of defined daily doses (DDD) and number of DDD per 1000 inhabitants per day (DDD/1000/day) were calculated from the number of particular drug packages. The Drug Utilization 90% (DU90%) method was used as a criterion of prescribing quality. Outpatient utilization of psychopharmaceuticals showed a declining pattern from 115.40 DDD/1000/day in 2001 to 93.15 DDD/1000/day in 2006. Anxiolytics accounted for the majority of this drug group utilization in the City of Zagreb, although the anxiolytic/antidepressant ratio decreased from 7.19 in 2001 to 3.86 in 2006. The utilization of selective serotonin reuptake inhibitors showed a 2.5-fold increase and accounted for 90% of overall antidepressant utilization. A 2.5-fold decrease was recorded in the utilization of antipsychotics, while the atypical/typical antipsychotic ratio changed from 1:2 in 2001 to 1.1:1 in 2006. Despite some improvement observed in the prescribing quality, the predominance of benzodiazepines in the utilization of psychopharmaceuticals points to the need of additional rationalization in the field.

Horizontal inequity in public health care service utilization for non-communicable diseases in urban Vietnam

PubMed Central

Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Weinehall, Lars; Ng, Nawi

2014-01-01

Background A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI) in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs). Design A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. Results The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. Conclusion Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas. PMID:25095780

[Research on resources chemistry of Chinese medicinal materials and resources recycling utilization ways and goals and tasks].

PubMed

Duan, Jin-ao; Su, Shu-lan; Guo, Sheng; Jiang, Shu; Liu, Pei; Yan, Hui; Qian, Da-wei; Zhu, Hua-xu; Tang, Yu-ping; Wu, Qi-nan

2015-09-01

The objects of research on the resources chemistry of Chinese medicinal materials (RCCMM) are promotion of efficient production, rational utilization and improving quality of CMM and natural products. The development of TCM cause depends on the efficient utilization and sustainable development of CMM, hinges on the technologies and methods for using and discovering medicinal biological resources, stand or fall on the extension of industy chains, detailed utilizaion of resource chemical components by multi-way, multi-level. All of these may help to the recycling utilization and sound development of RCMM. In this article, five respects were discussed to the RCCMM researches and resources recycling utilization ways and goals and tasks. First, based on the principle of resource scarcity, discovering or replacing CMM resources, protecting the rare or endangered species or resources. Second, based on the multifunctionality of CMM, realizing the value-added and value compensation, and promoting the utilization efficiency through systermatic and detailed exploitation and utilization. Third, based on the resource conservation and environment-friendly, reducing raw material consumption, lowering cost, promoting recycling utilization and elevating utilization efficiency. Fourth, based on the stratege of turning harm into good, using the invasive alien biological resources by multi-ways and enriching the medicial resources. Fifth, based on the method of structure modification of chemical components, exploring and enhancing the utility value of resouces chemical substances. These data should provide references and attention for improving the utilization efficiency, promoting the development of recycling economy, and changing the mode of economic growth of agriculture and industry of CMM fundamentally.

Analysis of instruments measuring nurses' attitudes towards research utilization: a systematic review.

PubMed

Frasure, Jamey

2008-01-01

This paper is a report of a systematic review describing instruments used to measure nurses' attitudes towards research utilization. Researchers need to have the tools to measure nurses' attitudes. However, limited literature critically analyses instruments and the concepts that comprise nurses' attitudes towards research utilization. A search of the literature from 1982 to 2007 was performed using the Cumulative Index to Nursing and Allied Health Literature, Health and Psychosocial Instruments, PubMed and MEDLINE data bases. The search terms were nursing research, research utilization, instruments, and nurses' attitudes. A total of 186 sources were identified, of which 25 were reviewed. Fourteen instruments met the criteria for in-depth critical analysis of psychometric properties and concepts, and were included in the final review. Each instrument item was judged to be relevant to direct, indirect, persuasive and overall research utilization as defined by Estabrooks. Instruments were arranged from the strongest to the weakest reliability of the subscales to determine the instrument with the strongest psychometric properties. Indirect and overall research utilization was measured by all of the instruments. Ten instruments measured direct research utilization and nine instruments measured persuasive research utilization. The Research Utilization in Nursing Survey by Estabrooks, as adapted by Kenny, was an instrument with strong psychometric properties measuring all four concepts of nurses' attitudes towards using and participating in research and was clinically feasible. Many published instruments are available for use by nurse researchers to measure nurses' attitude towards research utilization, but only one has been subjected to rigorous testing: the Research Utilization in Nursing Survey by Estabrooks.

The moderation effect of personality on healthcare utilization in Chinese people living with HIV.

PubMed

Yu, Nancy Xiaonan; Mols, Floortje; Stewart, Sunita M; Zhang, Jianxin

2017-06-01

There is evidence that Type D personality can predict impaired quality of life and health status in various chronic conditions. The evidence is conflicting as to whether Type D is associated with increased healthcare services, and no study has reported on the healthcare utilization of people living with HIV (PLWH) who have a Type D personality. This study investigated the impact of Type D personality on healthcare utilization in a sample of Chinese PLWH and examined physical and emotional symptoms as possible mechanisms of healthcare utilization. This was a cross-sectional study of 199 PLWH in rural China. Participants completed a survey on physical symptoms, emotional symptoms, healthcare utilization, and Type D personality. Those PLWH with a Type D personality reported more physical and emotional symptoms and healthcare utilization than patients without this personality. Among PLWH who had a Type D personality, physical symptoms had a direct effect on healthcare utilization, and emotional symptoms did not significantly mediate this association. However, among PLWH without a Type D personality, emotional symptoms significantly mediated the effects of physical symptoms on healthcare utilization. PLWH with a Type D personality reported more healthcare utilization, which was attributed to their high physical symptoms rather than their emotional symptoms. These findings suggest that PLWH with a Type D personality might be bothered by intensified emotional symptoms, which might be too severe to be associated with physical symptoms and healthcare utilization. New prospective studies should focus on the pattern of healthcare utilization among patients with a Type D personality and their intensified physical and emotional symptoms.

Teach It, Don’t Preach It: The Differential Effects of Directly-communicated and Self-generated Utility Value Information

PubMed Central

Canning, Elizabeth A.; Harackiewicz, Judith M.

2015-01-01

Social-psychological interventions in education have used a variety of “self-persuasion” or “saying-is-believing” techniques to encourage students to articulate key intervention messages. These techniques are used in combination with more overt strategies, such as the direct communication of messages in order to promote attitude change. However, these different strategies have rarely been systematically compared, particularly in controlled laboratory settings. We focus on one intervention based in expectancy-value theory designed to promote perceptions of utility value in the classroom and test different intervention techniques to promote interest and performance. Across three laboratory studies, we used a mental math learning paradigm in which we varied whether students wrote about utility value for themselves or received different forms of directly-communicated information about the utility value of a novel mental math technique. In Study 1, we examined the difference between directly-communicated and self-generated utility-value information and found that directly-communicated utility-value information undermined performance and interest for individuals who lacked confidence, but that self-generated utility had positive effects. However, Study 2 suggests that these negative effects of directly-communicated utility value can be ameliorated when participants are also given the chance to generate their own examples of utility value, revealing a synergistic effect of directly-communicated and self-generated utility value. In Study 3, we found that individuals who lacked confidence benefited more when everyday examples of utility value were communicated, rather than career and school examples. PMID:26495326

29 CFR 102.136 - Establishment and utilization of advisory committees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 2 2010-07-01 2010-07-01 false Establishment and utilization of advisory committees. 102... REGULATIONS, SERIES 8 Advisory Committees § 102.136 Establishment and utilization of advisory committees. Advisory committees may from time to time be established or utilized by the agency in the interest of...

41 CFR 109-38.5102 - Utilization controls and practices.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 41 Public Contracts and Property Management 3 2011-01-01 2011-01-01 false Utilization controls and..., TRANSPORTATION, AND MOTOR VEHICLES 38-MOTOR EQUIPMENT MANAGEMENT 38.51-Utilization of Motor Equipment § 109-38.5102 Utilization controls and practices. Controls and practices to be used by DOE organizations and...

41 CFR 101-39.301 - Utilization guidelines.

Code of Federal Regulations, 2011 CFR

2011-07-01

... § 101-39.301 Utilization guidelines. An agency must be able to justify a full-time vehicle assignment... 41 Public Contracts and Property Management 2 2011-07-01 2007-07-01 true Utilization guidelines... System (IFMS) services. Other utilization factors, such as days used, agency mission, and the relative...

29 CFR 102.136 - Establishment and utilization of advisory committees.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 2 2011-07-01 2011-07-01 false Establishment and utilization of advisory committees. 102... REGULATIONS, SERIES 8 Advisory Committees § 102.136 Establishment and utilization of advisory committees. Advisory committees may from time to time be established or utilized by the agency in the interest of...

A Utility Model for Teaching Load Decisions in Academic Departments.

ERIC Educational Resources Information Center

Massey, William F.; Zemsky, Robert

1997-01-01

Presents a utility model for academic department decision making and describes the structural specifications for analyzing it. The model confirms the class-size utility asymmetry predicted by the authors' academic rachet theory, but shows that marginal utility associated with college teaching loads is always negative. Curricular structure and…

Best Practices in School-to-Careers: The Utilities Industry.

ERIC Educational Resources Information Center

National Employer Leadership Council, Washington, DC.

This document highlights the school-to-careers (STC) partnerships connecting workplace experiences to classroom learning to prepare students for successful employment in the utilities industry. First, the current state of the utilities industry and careers in the utilities industry are reviewed. Next, the following organizations and employers are…

77 FR 9303 - National Emission Standards for Hazardous Air Pollutants From Coal- and Oil-Fired Electric...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-16

... Utility Steam Generating Units and Standards of Performance for Fossil-Fuel-Fired Electric Utility... Performance for Fossil-Fuel-Fired Electric Utility, Industrial-Commercial-Institutional, and Small Industrial... electric utility steam generating units (EGUs) and standards of performance for fossil-fuel-fired electric...

Load Management - Methods to Reduce Electric Utilities Peak Loads.

DTIC Science & Technology

1983-08-01

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

24 CFR 599.507 - Tax incentives utilization plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Tax incentives utilization plan....507 Tax incentives utilization plan. (a) Preliminary plan. Within six months of designation, the CoRA must prepare and submit to HUD a preliminary tax incentives utilization plan for achieving the State...

75 FR 51806 - Climate Change Vulnerability Assessment: Four Case Studies of Water Utility Practices

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-23

... case studies describing the approaches currently being taken by four water utilities to assess their... series of case studies describing the approaches currently being taken by four water utilities in the... Vulnerability Assessment: Four Case Studies of Water Utility Practices AGENCY: Environmental Protection Agency...

Marital Distress and Mental Health Care Service Utilization

ERIC Educational Resources Information Center

Schonbrun, Yael Chatav; Whisman, Mark A.

2010-01-01

Objective: This study was designed to evaluate the association between marital distress and mental health service utilization in a population-based sample of men and women (N = 1,601). Method: The association between marital distress and mental health care service utilization was evaluated for overall mental health service utilization and for…

48 CFR 1452.237-71 - Utilization of Woody Biomass.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Biomass. 1452.237-71 Section 1452.237-71 Federal Acquisition Regulations System DEPARTMENT OF THE INTERIOR... Utilization of Woody Biomass. As prescribed in § 1437.7202, insert the following clause: Utilization of Woody Biomass (MAY 2005) (a) The contractor may remove and utilize woody biomass, if: (1) Project work is...

77 FR 30368 - Defense Federal Acquisition Regulation Supplement; Utilization of Domestic Photovoltaic Devices...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-22

... objective of the rule is to promote utilization of domestic photovoltaic devices under energy savings... 0750-AH43 Defense Federal Acquisition Regulation Supplement; Utilization of Domestic Photovoltaic... Authorization Act for Fiscal Year 2011. The section provides that photovoltaic devices to be utilized in...

42 CFR 456.714 - DUR/surveillance and utilization review relationship.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false DUR/surveillance and utilization review.../surveillance and utilization review relationship. (a) The retrospective DUR requirements in this subpart parallel a portion of the surveillance and utilization review (SUR) requirements in subpart A of this part...

42 CFR 456.714 - DUR/surveillance and utilization review relationship.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false DUR/surveillance and utilization review.../surveillance and utilization review relationship. (a) The retrospective DUR requirements in this subpart parallel a portion of the surveillance and utilization review (SUR) requirements in subpart A of this part...

42 CFR 456.714 - DUR/surveillance and utilization review relationship.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false DUR/surveillance and utilization review.../surveillance and utilization review relationship. (a) The retrospective DUR requirements in this subpart parallel a portion of the surveillance and utilization review (SUR) requirements in subpart A of this part...

42 CFR 456.714 - DUR/surveillance and utilization review relationship.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false DUR/surveillance and utilization review.../surveillance and utilization review relationship. (a) The retrospective DUR requirements in this subpart parallel a portion of the surveillance and utilization review (SUR) requirements in subpart A of this part...

42 CFR 456.714 - DUR/surveillance and utilization review relationship.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false DUR/surveillance and utilization review.../surveillance and utilization review relationship. (a) The retrospective DUR requirements in this subpart parallel a portion of the surveillance and utilization review (SUR) requirements in subpart A of this part...

A Framework for Organizing Current and Future Electric Utility Regulatory and Business Models

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

Satchwell, Andrew; Cappers, Peter; Schwartz, Lisa

In this report, we will present a descriptive and organizational framework for incremental and fundamental changes to regulatory and utility business models in the context of clean energy public policy goals. We will also discuss the regulated utility's role in providing value-added services that relate to distributed energy resources, identify the "openness" of customer information and utility networks necessary to facilitate change, and discuss the relative risks, and the shifting of risks, for utilities and customers.

Developing a UAS Program for Electric Utilities

NASA Astrophysics Data System (ADS)

Keltgen, James

New innovations and technologies using unmanned aerial systems (UAS), or drones, have created unique opportunities for commercial applications. Electric utilities, likewise, realize the benefits of using UAS as a tool in electric utility operations. Although the opportunities exist, establishing a UAS program for electric utilities is largely an endeavor of trial and error or research and development with no clear path defined on how to establish a UAS program. By reviewing UAS use case examples and integrating lessons learned with Federal Aviation Administration (FAA) regulations, UAS best practices, unique electric utility values, legal and insurance perspectives, equipment selection, and thoughtful planning and preparation; a solution model is developed to establish a UAS program for electric utilities.

Team Formation in Partially Observable Multi-Agent Systems

NASA Technical Reports Server (NTRS)

Agogino, Adrian K.; Tumer, Kagan

2004-01-01

Sets of multi-agent teams often need to maximize a global utility rating the performance of the entire system where a team cannot fully observe other teams agents. Such limited observability hinders team-members trying to pursue their team utilities to take actions that also help maximize the global utility. In this article, we show how team utilities can be used in partially observable systems. Furthermore, we show how team sizes can be manipulated to provide the best compromise between having easy to learn team utilities and having them aligned with the global utility, The results show that optimally sized teams in a partially observable environments outperform one team in a fully observable environment, by up to 30%.

Deregulation allows new opportunities for utilities

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

Hansen, T.

1996-10-01

The changes electric utilities face today are both scary and exciting. In the past several years utilities have faced uncertainties that have caused major upheaval in their structures and business processes. There has been an increase in the number of mergers and acquisitions as utilities position themselves for competition. many utility employees have faced layoffs, resulting form reengineering and downsizing. Similar events and uncertainties were faced by the airline and telecommunications industries during their transformations form monopolistic to competitive environments. Even though these events have been difficult and unpleasant, there is a bright side. Today`s electric utilities have the opportunitiesmore » to cash in on some innovative new ideas and technologies.« less

Utilities` ``obligation to serve`` under deregulation

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

Alexander, C.B.

The utility no longer has protected status, and the traditional franchise concept is under attack. Exclusive rights once conveyed to the utilities are being denied and not just in the area of gas sales. Exclusive rights once conveyed to utilities will be denied in more areas. State by state, the utilities` franchise is being examined to see which, if any, of its provisions are necessary in a deregulated environment. Can the free market provide everything that`s been provided for many years under monopolistic arrangements? Some of the most critical and difficult of these provisions concern the obligation to serve, whichmore » utilities, in most states, have assumed as part of their franchise agreement. Regulators, courts, utilities, marketers and others are busy sorting through these issues, but resolution could take years. The paper discusses deregulation, universal service fee, representation without taxation, suppliers and marketer restrictions.« less

What Is True Halving in the Payoff Matrix of Game Theory?

PubMed Central

Hasegawa, Eisuke; Yoshimura, Jin

2016-01-01

In game theory, there are two social interpretations of rewards (payoffs) for decision-making strategies: (1) the interpretation based on the utility criterion derived from expected utility theory and (2) the interpretation based on the quantitative criterion (amount of gain) derived from validity in the empirical context. A dynamic decision theory has recently been developed in which dynamic utility is a conditional (state) variable that is a function of the current wealth of a decision maker. We applied dynamic utility to the equal division in dove-dove contests in the hawk-dove game. Our results indicate that under the utility criterion, the half-share of utility becomes proportional to a player’s current wealth. Our results are consistent with studies of the sense of fairness in animals, which indicate that the quantitative criterion has greater validity than the utility criterion. We also find that traditional analyses of repeated games must be reevaluated. PMID:27487194

Design study of wind turbines, 50 kW to 3000 kW for electric utility applications: Executive summary

NASA Technical Reports Server (NTRS)

1977-01-01

Preliminary designs of low power (50 to 500 kW) and high power (500 to 3000 kW) wind generator systems (WGS) for electric utility applications were developed. These designs provide the bases for detail design, fabrication, and experimental demonstration testing of these units at selected utility sites. Several feasible WGS configurations were evaluated, and the concept offering the lowest energy cost potential and minimum technical risk for utility applications was selected. The selected concept was optimized utilizing a parametric computer program prepared for this purpose. The utility requirements evaluation task examined the economic, operational and institutional factors affecting the WGS in a utility environment, and provided additional guidance for the preliminary design effort. Results of the conceptual design task indicated that a rotor operating at constant speed, driving an AC generator through a gear transmission is the most cost effective WGS configuration.

Dishonest Academic Conduct: From the Perspective of the Utility Function.

PubMed

Sun, Ying; Tian, Rui

Dishonest academic conduct has aroused extensive attention in academic circles. To explore how scholars make decisions according to the principle of maximal utility, the author has constructed the general utility function based on the expected utility theory. The concrete utility functions of different types of scholars were deduced. They are as follows: risk neutral, risk averse, and risk preference. Following this, the assignment method was adopted to analyze and compare the scholars' utilities of academic conduct. It was concluded that changing the values of risk costs, internal condemnation costs, academic benefits, and the subjective estimation of penalties following dishonest academic conduct can lead to changes in the utility of academic dishonesty. The results of the current study suggest that within scientific research, measures to prevent and govern dishonest academic conduct should be formulated according to the various effects of the above four variables.

Initiation and Maintenance of Fitness Center Utilization in an Incentive-Based Employer Wellness Program

PubMed Central

Abraham, Jean Marie; Crespin, Daniel; Rothman, Alexander

2015-01-01

Objective Investigate the initiation and maintenance of participation in an employer-based wellness program that provides financial incentives for fitness center utilization. Methods Using multivariate analysis, we investigated how employees’ demographics, health status, exercise-related factors, and lifestyle change preferences affect program participation. Results Forty-two percent of eligible employees participated in the program and 24% earned a $20 incentive at least once by utilizing a gym 8 times or more in a month. On average, participants utilized fitness centers 7.0 months each year and earned credit 4.5 months. Participants’ utilization diminished after their first year in the program. Conclusions Factors associated with initiation and maintenance of fitness center utilization were similar. Declining utilization over time raises concern about the long-run effectiveness of fitness-focused wellness programs. Employers may want to consider additional levers to positively reinforce participation. PMID:26340283

Utilization of High-Temperature Slags From Metallurgy Based on Crystallization Behaviors

NASA Astrophysics Data System (ADS)

Sun, Yongqi; Zhang, Zuotai

2018-05-01

Here, following the principle of modifying crystallization behaviors, including avoidance and optimization, we review recent research on the utilization of hot slags. Because of the high-temperature property (1450-1650°C), the utilization of hot slags are much different from that of other wastes. We approach this issue from two main directions, namely, material recycling and heat utilization. From the respect of material recycling, the utilization of slags mainly follows total utilization and partial utilization, whereas the heat recovery from slags follows two main paths, namely, physical granulation and chemical reaction. The effective disposal of hot slags greatly depends on clarifying the crystallization behaviors, and thus, we discuss some optical techniques and their applicable scientific insights. For the purpose of crystallization avoidance, characterizing the glass-forming ability of slags is of great significance, whereas for crystallization modification, the selection of chemical additives and control of crystallization conditions comprise the central routes.

What Is True Halving in the Payoff Matrix of Game Theory?

PubMed

Ito, Hiromu; Katsumata, Yuki; Hasegawa, Eisuke; Yoshimura, Jin

2016-01-01

In game theory, there are two social interpretations of rewards (payoffs) for decision-making strategies: (1) the interpretation based on the utility criterion derived from expected utility theory and (2) the interpretation based on the quantitative criterion (amount of gain) derived from validity in the empirical context. A dynamic decision theory has recently been developed in which dynamic utility is a conditional (state) variable that is a function of the current wealth of a decision maker. We applied dynamic utility to the equal division in dove-dove contests in the hawk-dove game. Our results indicate that under the utility criterion, the half-share of utility becomes proportional to a player's current wealth. Our results are consistent with studies of the sense of fairness in animals, which indicate that the quantitative criterion has greater validity than the utility criterion. We also find that traditional analyses of repeated games must be reevaluated.

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

Riley, H.W. Jr.

Over the years, utilities have been going through cost cutting measures and efficiency improvements in an effort to be more competitive or stay competitive within their market territory. The next logical step for a utility to take is to promote Creativity. With a creative environment in place, utilities can keep pace with the changes in the industry and maintain or attain their competitive advantage. The goal of the creative electric utility work-force is to keep up with changes in the industry and become more competitive as the market becomes more competitive. Utilities can change the way they do business bymore » utilizing an effectively trained and skilled work-force on the subject of creative thinking. Creativity within a work-force depends on the employees desire to understand difficult aspects of his or her life. This paper will provide the foundation for linking Creativity and the electric utility industry.« less

The laboratory test utilization management toolbox

PubMed Central

Baird, Geoffrey

2014-01-01

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

24 CFR 599.507 - Tax incentives utilization plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

... utilization plan for achieving the State and local commitments made at the time of application as required by... 24 Housing and Urban Development 3 2011-04-01 2010-04-01 true Tax incentives utilization plan. 599....507 Tax incentives utilization plan. (a) Preliminary plan. Within six months of designation, the CoRA...

13 CFR 307.16 - Effective utilization of Revolving Loan Funds.

Code of Federal Regulations, 2011 CFR

2011-01-01

... the capital utilization standard after a reasonable period of time, as determined by EDA, it may be... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Effective utilization of Revolving... Funds and Use of Grant Funds § 307.16 Effective utilization of Revolving Loan Funds. (a) Loan closing...

43 CFR 3272.12 - What environmental protection measures must I include in my utilization plan?

Code of Federal Regulations, 2011 CFR

2011-10-01

... must I include in my utilization plan? 3272.12 Section 3272.12 Public Lands: Interior Regulations... MANAGEMENT (3000) GEOTHERMAL RESOURCE LEASING Utilization Plan and Facility Construction Permit § 3272.12 What environmental protection measures must I include in my utilization plan? (a) Describe, at a...

77 FR 9700 - Utility Scale Wind Towers From China and Vietnam

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-17

...)] Utility Scale Wind Towers From China and Vietnam Determinations On the basis of the record \\1\\ developed... threatened with material injury by reason of imports from China of utility scale wind towers, provided for in... with material injury by reason of imports from Vietnam of utility scale wind towers, provided for in...

78 FR 10210 - Utility Scale Wind Towers From China and Vietnam

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-13

...)] Utility Scale Wind Towers From China and Vietnam Determinations On the basis of the record \\1\\ developed... with material injury by reason of imports of utility scale wind towers from China and Vietnam, provided... of imports of utility scale wind towers from China and Vietnam. Commissioner Dean A. Pinkert...

17 CFR 250.12 - Exemption of certain public utility companies from the definition of subsidiary companies of...

Code of Federal Regulations, 2010 CFR

2010-04-01

... utility companies from the definition of subsidiary companies of holding companies. 250.12 Section 250.12... REGULATIONS, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 Registration and General Exemptions § 250.12 Exemption of certain public utility companies from the definition of subsidiary companies of holding companies...

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

Code of Federal Regulations, 2010 CFR

2010-04-01

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

Quality electric motor repair: A guidebook for electric utilities

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

Schueler, V.; Douglass, J.

This guidebook provides utilities with a resource for better understanding and developing their roles in relation to electric motor repair shops and the industrial and commercial utility customers that use them. The guidebook includes information and tools that utilities can use to raise the quality of electric motor repair practices in their service territories.

18 CFR 366.7 - Procedures for obtaining exempt wholesale generator and foreign utility company status.

Code of Federal Regulations, 2010 CFR

2010-04-01

... obtaining exempt wholesale generator and foreign utility company status. 366.7 Section 366.7 Conservation of... THE PUBLIC UTILITY HOLDING COMPANY ACT OF 2005, FEDERAL POWER ACT AND NATURAL GAS ACT BOOKS AND... Procedures for obtaining exempt wholesale generator and foreign utility company status. (a) Self...

Alternative Fuels Data Center: New Mexico Utility Sparks Change with Fleet

Science.gov Websites

Electrification New Mexico Utility Sparks Change with Fleet Electrification to someone by E -mail Share Alternative Fuels Data Center: New Mexico Utility Sparks Change with Fleet Electrification on Facebook Tweet about Alternative Fuels Data Center: New Mexico Utility Sparks Change with Fleet

Education and Library Services for Community Information Utilities.

ERIC Educational Resources Information Center

Farquhar, John A.

The concept of "computer utility"--the provision of computing and information service by a utility in the form of a national network to which any person desiring information could gain access--has been gaining interest among the public and among the technical community. This report on planning community information utilities discusses the…

Labview utilities

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

Persaud, Arun

2011-09-30

The software package provides several utilities written in LabView. These utilities don't form independent programs, but rather can be used as a library or controls in other labview programs. The utilities include several new controls (xcontrols), VIs for input and output routines, as well as other 'helper'-functions not provided in the standard LabView environment.

75 FR 35458 - National Drinking Water Advisory Council's Climate Ready Water Utilities Working Group Meeting...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-22

... supportive environment in which a utility can take steps to be climate ready. In this meeting, the Working... Ready Water Utilities Working Group Meeting Announcement AGENCY: Environmental Protection Agency (EPA... fourth in-person meeting of the Climate Ready Water Utilities (CRWU) Working Group of the National...

Predictors of Service Utilization among Youth Diagnosed with Mood Disorders

ERIC Educational Resources Information Center

Mendenhall, Amy N.

2012-01-01

In this study, I investigated patterns and predictors of service utilization for children with mood disorders. The Behavioral Model for Health Care Utilization was used as an organizing framework for identifying predictors of the number and quality of services utilized. Hierarchical regression was used in secondary data analyses of the…

Understanding Service Utilization Disparities and Depression in Latinos: The Role of Fatalismo.

PubMed

Anastasia, Elizabeth A; Bridges, Ana J

2015-12-01

Research demonstrates a disparity between need and utilization of mental health services for Latinos. Cultural variations in perceptions of mental illness may be partially responsible for this discrepancy. Past research with Latinos has shown links between fatalismo, a cultural value similar to external locus of control, and both depression and lower service utilization in medical care, while links to psychiatric care have not been investigated. The current study therefore aimed to explore the associations between fatalismo, depression, and past year mental health service utilization by Latinos. A community sample of 83 Latino adults were recruited during local cultural events. Participants completed self-report measures of depression, fatalism, and past year service utilization. Analyses using structural equation modeling showed fatalismo was directly negatively related to past year medical service utilization (β = -.35). In contrast, the link between fatalismo and past year mental health service utilization was mediated by self-reported depressive symptoms (indirect β = .19, p < .001). We conclude that while fatalismo is associated with depression in Latinos, other barriers likely serve as more salient deterrents of service utilization.

Urban Underground Pipelines Mapping Using Ground Penetrating Radar

NASA Astrophysics Data System (ADS)

Jaw, S. W.; M, Hashim

2014-02-01

Underground spaces are now being given attention to exploit for transportation, utilities, and public usage. The underground has become a spider's web of utility networks. Mapping of underground utility pipelines has become a challenging and difficult task. As such, mapping of underground utility pipelines is a "hit-and-miss" affair, and results in many catastrophic damages, particularly in urban areas. Therefore, this study was conducted to extract locational information of the urban underground utility pipeline using trenchless measuring tool, namely ground penetrating radar (GPR). The focus of this study was to conduct underground utility pipeline mapping for retrieval of geometry properties of the pipelines, using GPR. In doing this, a series of tests were first conducted at the preferred test site and real-life experiment, followed by modeling of field-based model using Finite-Difference Time-Domain (FDTD). Results provide the locational information of underground utility pipelines associated with its mapping accuracy. Eventually, this locational information of the underground utility pipelines is beneficial to civil infrastructure management and maintenance which in the long term is time-saving and critically important for the development of metropolitan areas.

Model-based Utility Functions

NASA Astrophysics Data System (ADS)

Hibbard, Bill

2012-05-01

Orseau and Ring, as well as Dewey, have recently described problems, including self-delusion, with the behavior of agents using various definitions of utility functions. An agent's utility function is defined in terms of the agent's history of interactions with its environment. This paper argues, via two examples, that the behavior problems can be avoided by formulating the utility function in two steps: 1) inferring a model of the environment from interactions, and 2) computing utility as a function of the environment model. Basing a utility function on a model that the agent must learn implies that the utility function must initially be expressed in terms of specifications to be matched to structures in the learned model. These specifications constitute prior assumptions about the environment so this approach will not work with arbitrary environments. But the approach should work for agents designed by humans to act in the physical world. The paper also addresses the issue of self-modifying agents and shows that if provided with the possibility to modify their utility functions agents will not choose to do so, under some usual assumptions.

Evaluating gambles using dynamics

NASA Astrophysics Data System (ADS)

Peters, O.; Gell-Mann, M.

2016-02-01

Gambles are random variables that model possible changes in wealth. Classic decision theory transforms money into utility through a utility function and defines the value of a gamble as the expectation value of utility changes. Utility functions aim to capture individual psychological characteristics, but their generality limits predictive power. Expectation value maximizers are defined as rational in economics, but expectation values are only meaningful in the presence of ensembles or in systems with ergodic properties, whereas decision-makers have no access to ensembles, and the variables representing wealth in the usual growth models do not have the relevant ergodic properties. Simultaneously addressing the shortcomings of utility and those of expectations, we propose to evaluate gambles by averaging wealth growth over time. No utility function is needed, but a dynamic must be specified to compute time averages. Linear and logarithmic "utility functions" appear as transformations that generate ergodic observables for purely additive and purely multiplicative dynamics, respectively. We highlight inconsistencies throughout the development of decision theory, whose correction clarifies that our perspective is legitimate. These invalidate a commonly cited argument for bounded utility functions.

Evidence-based practice and research utilization activities among rural nurses.

PubMed

Olade, Rosaline A

2004-01-01

To identify the extent to which rural nurses utilize evidence-based practice guidelines from scientific research in their practice; to describe both previous and current research utilization activities in which they have participated, and to identify the specific barriers they face in their practice settings. Data for this descriptive study were collected through questionnaires with open-ended questions focused on (a) current utilization of nursing research findings, (b) previous involvement in nursing research activities, and (c) participation in medical research activities. The participants were 106 nurses from various practice areas in six rural counties of a southwestern state in the United States. Results revealed that only 20.8% of the participants stated they were currently involved in research utilization, and they were mostly nurses with bachelor's degrees. The two most common areas of current research utilization were pain management and pressure ulcer prevention and management. Barriers to research utilization, such as rural isolation and lack of nursing research consultants, were identified. The types of research utilization activities identified by these nurses indicate how much the facilities in which these nurses work in the rural areas are striving with the utilization of available scientific evidence. Rural nurses face unique barriers related to situational and geographic factors, with implications for nursing administrators, researchers, and educators.

Analysing the primacy of distance in the utilization of health services in the Ahafo-Ano South district, Ghana.

PubMed

Buor, Daniel

2003-01-01

Although the distance factor has been identified as key in the utilization of health services in rural areas of developing countries, it has been analysed without recourse to related factors of travel time and transport cost. Also, the influence of distance on vulnerable groups in utilization has not been an object of survey by researchers. This paper addresses the impact of distance on utilization, and how distance compares with travel time and transport cost that are related to it in the utilization of health services in the Ahafo-Ano South (rural) district in Ghana. The study, a cross-sectional survey, also identifies the position of distance among other important factors of utilization. A sample of 400, drawn through systematic random technique, was used for the survey. Data were analysed using the regression model and some graphic techniques. The main instruments used in data collection were formal (face-by-face) interview and a questionnaire. The survey finds that distance is the most important factor that influences the utilization of health services in the Ahafo-Ano South district. Other key factors are income, service cost and education. The effect of travel time on utilization reflects that of distance and utilization. Recommendations to reduce distance coverage, improve formal education and reduce poverty have been made.

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

PubMed

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

2018-04-01

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

Building brand equity and customer loyalty

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

Pokorny, G.

Customer satisfaction and customer loyalty are two different concepts, not merely two different phrases measuring a single consumer attitude. Utilities having identical customer satisfaction ratings based on performance in areas like power reliability, pricing, and quality of service differ dramatically in their levels of customer loyalty. As competitive markets establish themselves, discrepancies in customer loyalty will have profound impacts on each utility`s prospects for market retention, profitability, and ultimately, shareholder value. Meeting pre-existing consumer needs, wants and preferences is the foundation of any utility strategy for building customer loyalty and market retention. Utilities meet their underlying customer expectations by performingmore » well in three discrete areas: product, customer service programs, and customer service transactions. Brand equity is an intervening variable standing between performance and the loyalty a utility desires. It is the totality of customer perceptions about the unique extra value the utility provides above and beyond its basic product, customer service programs and customer service transactions; it is the tangible, palpable reality of a branded utility that exists in the minds of consumers. By learning to manage their brand equity as well as they manage their brand performance, utilities gain control over all the major elements in the value-creation process that creates customer loyalty. By integrating brand performance and brand equity, electric utility companies can truly become in their customers` eyes a brand - a unique, very special, value-added energy services provider that can ask for and deserve a premium price in the marketplace.« less

Differences in self-monitored, blood glucose test strip utilization by therapy for type 2 diabetes mellitus.

PubMed

Tavares, Ruben; Duclos, Marc; Brabant, Marie-Josée; Checchin, Daniella; Bosnic, Nevzeta; Turvey, Katherine; Terres, Jorge Alfonso Ross

2016-06-01

To determine whether blood glucose test strip (BGTS) utilization in patients with type 2 diabetes (T2D) is associated with the type of diabetes therapy, classified according to hypoglycemic risk. A retrospective, longitudinal (2006-2012) study of Canadian private drug plans (PDP) and Ontario Public Drug Programs (OPDP) prescription claims was conducted. Analyses were restricted to patients with T2D with or without a claim for BGTS. Daily BGTS utilization (TS/patient/day) was evaluated by diabetes therapy classified by hypoglycemic risk. Multivariate analyses were conducted to identify determinants of BGTS utilization. The T2D cohort comprised 5,759,591 observations from 1,949,129 claimants. Mean BGTS utilization was 0.84 TS/patient/day and differed between PDP and OPDP (0.66 vs. 1.00). Daily utilization was greatest in patients receiving therapy associated with a pre-defined high risk of hypoglycemia [insulin: basal + bolus (2.16), premixed (1.65), basal (1.16), other insulin regimens (2.13), and sulfonylureas (0.74)] versus non-sulfonylurea non-insulin-based regimens (0.52). For non-insulin therapy, BGTS utilization was greater for patients on multiple non-insulin therapies versus monotherapy (0.74 vs. 0.53 TS/patient/day). In multivariate analyses, drivers for BGTS utilization included insulin use, previous BGTS use, and female gender. Previous diabetes therapy and duration of therapy were negatively correlated with BGTS utilization. BGTS utilization varies depending on the type of therapy used to treat T2D according to hypoglycemic risk. Decision making regarding BGTS needs to account for robust analyses of current utilization and its value in those settings, including in patients not receiving diabetes therapy and the prevalence of circumstances conducive to more intensive monitoring.

Predisposing characteristics, enabling resources and need as predictors of utilization and clinical outcomes for veterans receiving mental health services.

PubMed

Fasoli, DiJon R; Glickman, Mark E; Eisen, Susan V

2010-04-01

Though demand for mental health services (MHS) among US veterans is increasing, MHS utilization per veteran is decreasing. With health and social service needs competing for limited resources, it is important to understand the association between patient factors, MHS utilization, and clinical outcomes. We use a framework based on Andersen's behavioral model of health service utilization to examine predisposing characteristics, enabling resources, and clinical need as predictors of MHS utilization and clinical outcomes. This was a prospective observational study of veterans receiving inpatient or outpatient MHS through Veterans Administration programs. Clinician ratings (Global Assessment of Functioning [GAF]) and self-report assessments (Behavior and Symptom Identification Scale-24) were completed for 421 veterans at enrollment and 3 months later. Linear and logistic regression analyses were conducted to examine: (1) predisposing characteristics, enabling resources, and need as predictors of MHS inpatient, residential, and outpatient utilization and (2) the association between individual characteristics, utilization, and clinical outcomes. Being older, female, having greater clinical need, lack of enabling resources (employment, stable housing, and social support), and easy access to treatment significantly predicted greater MHS utilization at 3-month follow-up. Less clinical need and no inpatient psychiatric hospitalization predicted better GAF and Behavior and Symptom Identification Scale-24 scores. White race and residential treatment also predicted better GAF scores. Neither enabling resources, nor number of outpatient mental health visits predicted clinical outcomes. This application of Andersen's behavioral model of health service utilization confirmed associations between some predisposing characteristics, need, and enabling resources on MHS utilization but only predisposing characteristics, need, and utilization were associated with clinical outcomes.

Health State Utilities Associated with Glucose Monitoring Devices.

PubMed

Matza, Louis S; Stewart, Katie D; Davies, Evan W; Hellmund, Richard; Polonsky, William H; Kerr, David

2017-03-01

Glucose monitoring is important for patients with diabetes treated with insulin. Conventional glucose monitoring requires a blood sample, typically obtained by pricking the finger. A new sensor-based system called "flash glucose monitoring" monitors glucose levels with a sensor worn on the arm, without requiring blood samples. To estimate the utility difference between these two glucose monitoring approaches for use in cost-utility models. In time trade-off interviews, general population participants in the United Kingdom (London and Edinburgh) valued health states that were drafted and refined on the basis of literature, clinician input, and a pilot study. The health states had identical descriptions of diabetes and insulin treatment, differing only in glucose monitoring approach. A total of 209 participants completed the interviews (51.7% women; mean age = 42.1 years). Mean utilities were 0.851 ± 0.140 for conventional monitoring and 0.882 ± 0.121 for flash monitoring (significant difference between the mean utilities; t = 8.3; P < 0.0001). Of the 209 participants, 78 (37.3%) had a higher utility for flash monitoring, 2 (1.0%) had a higher utility for conventional monitoring, and 129 (61.7%) had the same utility for both health states. The flash glucose monitoring system was associated with a significantly greater utility than the conventional monitoring system. This difference may be useful in cost-utility models comparing the value of glucose monitoring devices for patients with diabetes. This study adds to the literature on treatment process utilities, suggesting that time trade-off methods may be used to quantify preferences among medical devices. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A Practical Guide to Conducting a Systematic Review and Meta-analysis of Health State Utility Values.

PubMed

Petrou, Stavros; Kwon, Joseph; Madan, Jason

2018-05-10

Economic analysts are increasingly likely to rely on systematic reviews and meta-analyses of health state utility values to inform the parameter inputs of decision-analytic modelling-based economic evaluations. Beyond the context of economic evaluation, evidence from systematic reviews and meta-analyses of health state utility values can be used to inform broader health policy decisions. This paper provides practical guidance on how to conduct a systematic review and meta-analysis of health state utility values. The paper outlines a number of stages in conducting a systematic review, including identifying the appropriate evidence, study selection, data extraction and presentation, and quality and relevance assessment. The paper outlines three broad approaches that can be used to synthesise multiple estimates of health utilities for a given health state or condition, namely fixed-effect meta-analysis, random-effects meta-analysis and mixed-effects meta-regression. Each approach is illustrated by a synthesis of utility values for a hypothetical decision problem, and software code is provided. The paper highlights a number of methodological issues pertinent to the conduct of meta-analysis or meta-regression. These include the importance of limiting synthesis to 'comparable' utility estimates, for example those derived using common utility measurement approaches and sources of valuation; the effects of reliance on limited or poorly reported published data from primary utility assessment studies; the use of aggregate outcomes within analyses; approaches to generating measures of uncertainty; handling of median utility values; challenges surrounding the disentanglement of utility estimates collected serially within the context of prospective observational studies or prospective randomised trials; challenges surrounding the disentanglement of intervention effects; and approaches to measuring model validity. Areas of methodological debate and avenues for future research are highlighted.

Reduction of hydrogen peroxide stress derived from fatty acid beta-oxidation improves fatty acid utilization in Escherichia coli.

PubMed

Doi, Hidetaka; Hoshino, Yasushi; Nakase, Kentaro; Usuda, Yoshihiro

2014-01-01

Fatty acids are a promising raw material for substance production because of their highly reduced and anhydrous nature, which can provide higher fermentation yields than sugars. However, they are insoluble in water and are poorly utilized by microbes in industrial fermentation production. We used fatty acids as raw materials for L-lysine fermentation by emulsification and improved the limited fatty acid-utilization ability of Escherichia coli. We obtained a fatty acid-utilizing mutant strain by laboratory evolution and demonstrated that it expressed lower levels of an oxidative-stress marker than wild type. The intracellular hydrogen peroxide (H₂O₂) concentration of a fatty acid-utilizing wild-type E. coli strain was higher than that of a glucose-utilizing wild-type E. coli strain. The novel mutation rpsA(D210Y) identified in our fatty acid-utilizing mutant strain enabled us to promote cell growth, fatty-acid utilization, and L-lysine production from fatty acid. Introduction of this rpsA(D210Y) mutation into a wild-type strain resulted in lower H₂O₂ concentrations. The overexpression of superoxide dismutase (sodA) increased intracellular H₂O₂ concentrations and inhibited E. coli fatty-acid utilization, whereas overexpression of an oxidative-stress regulator (oxyS) decreased intracellular H₂O₂ concentrations and promoted E. coli fatty acid utilization and L-lysine production. Addition of the reactive oxygen species (ROS) scavenger thiourea promoted L-lysine production from fatty acids and decreased intracellular H₂O₂ concentrations. Among the ROS generated by fatty-acid β-oxidation, H₂O₂ critically affected E. coli growth and L-lysine production. This indicates that the regression of ROS stress promotes fatty acid utilization, which is beneficial for fatty acids used as raw materials in industrial production.

Estimation of low-potential heat recuperation efficiency of smoke fumes in a condensation heat utilizer under various operation conditions of a boiler and a heating system

NASA Astrophysics Data System (ADS)

Ionkin, I. L.; Ragutkin, A. V.; Luning, B.; Zaichenko, M. N.

2016-06-01

For enhancement of the natural gas utilization efficiency in boilers, condensation heat utilizers of low-potential heat, which are constructed based on a contact heat exchanger, can be applied. A schematic of the contact heat exchanger with a humidifier for preheating and humidifying of air supplied in the boiler for combustion is given. Additional low-potential heat in this scheme is utilized for heating of the return delivery water supplied from a heating system. Preheating and humidifying of air supplied for combustion make it possible to use the condensation utilizer for heating of a heat-transfer agent to temperature exceeding the dewpoint temperature of water vapors contained in combustion products. The decision to mount the condensation heat utilizer on the boiler was taken based on the preliminary estimation of the additionally obtained heat. The operation efficiency of the condensation heat utilizer is determined by its structure and operation conditions of the boiler and the heating system. The software was developed for the thermal design of the condensation heat utilizer equipped by the humidifier. Computation investigations of its operation are carried out as a function of various operation parameters of the boiler and the heating system (temperature of the return delivery water and smoke fumes, air excess, air temperature at the inlet and outlet of the condensation heat utilizer, heating and humidifying of air in the humidifier, and portion of the circulating water). The heat recuperation efficiency is estimated for various operation conditions of the boiler and the condensation heat utilizer. Recommendations on the most effective application of the condensation heat utilizer are developed.

Cross-bridge blocker BTS permits direct measurement of SR Ca2+ pump ATP utilization in toadfish swimbladder muscle fibers.

PubMed

Young, Iain S; Harwood, Claire L; Rome, Lawrence C

2003-10-01

Because the major processes involved in muscle contraction require rapid utilization of ATP, measurement of ATP utilization can provide important insights into the mechanisms of contraction. It is necessary, however, to differentiate between the contribution made by cross-bridges and that of the sarcoplasmic reticulum (SR) Ca2+ pumps. Specific and potent SR Ca2+ pump blockers have been used in skinned fibers to permit direct measurement of cross-bridge ATP utilization. Up to now, there was no analogous cross-bridge blocker. Recently, N-benzyl-p-toluene sulfonamide (BTS) was found to suppress force generation at micromolar concentrations. We tested whether BTS could be used to block cross-bridge ATP utilization, thereby permitting direct measurement of SR Ca2+ pump ATP utilization in saponin-skinned fibers. At 25 microM, BTS virtually eliminates force and cross-bridge ATP utilization (both <4% of control value). By taking advantage of the toadfish swimbladder muscle's unique right shift in its force-Ca2+ concentration ([Ca2+]) relationship, we measured SR Ca2+ pump ATP utilization in the presence and absence of BTS. At 25 microM, BTS had no effect on SR pump ATP utilization. Hence, we used BTS to make some of the first direct measurements of ATP utilization of intact SR over a physiological range of [Ca2+]at 15 degrees C. Curve fits to SR Ca2+ pump ATP utilization vs. pCa indicate that they have much lower Hill coefficients (1.49) than that describing cross-bridge force generation vs. pCa (approximately 5). Furthermore, we found that BTS also effectively eliminates force generation in bundles of intact swimbladder muscle, suggesting that it will be an important tool for studying integrated SR function during normal motor behavior.

Stratified cost-utility analysis of C-Leg versus mechanical knees: Findings from an Italian sample of transfemoral amputees.

PubMed

Cutti, Andrea Giovanni; Lettieri, Emanuele; Del Maestro, Martina; Radaelli, Giovanni; Luchetti, Martina; Verni, Gennero; Masella, Cristina

2017-06-01

The fitting rate of the C-Leg electronic knee (Otto-Bock, D) has increased steadily over the last 15 years. Current cost-utility studies, however, have not considered the patients' characteristics. To complete a cost-utility analysis involving C-Leg and mechanical knee users; "age at the time of enrollment," "age at the time of first prosthesis," and "experience with the current type of prosthesis" are assumed as non-nested stratification parameters. Cohort retrospective. In all, 70 C-Leg and 57 mechanical knee users were selected. For each stratification criteria, we evaluated the cost-utility of C-Leg versus mechanical knees by computing the incremental cost-utility ratio, that is, the ratio of the "difference in cost" and the "difference in utility" of the two technologies. Cost consisted of acquisition, maintenance, transportation, and lodging expenses. Utility was measured in terms of quality-adjusted life years, computed on the basis of participants' answers to the EQ-5D questionnaire. Patients over 40 years at the time of first prosthesis were the only group featuring an incremental cost-utility ratio (88,779 €/quality-adjusted life year) above the National Institute for Health and Care Excellence practical cost-utility threshold (54,120 €/quality-adjusted live year): C-Leg users experience a significant improvement of "mobility," but limited outcomes on "usual activities," "self-care," "depression/anxiety," and reduction of "pain/discomfort." The stratified cost-utility results have relevant clinical implications and provide useful information for practitioners in tailoring interventions. Clinical relevance A cost-utility analysis that considered patients characteristics provided insights on the "affordability" of C-Leg compared to mechanical knees. In particular, results suggest that C-Leg has a significant impact on "mobility" for first-time prosthetic users over 40 years, but implementation of specific low-cost physical/psychosocial interventions is required to retun within cost-utility thresholds.

Identification of iron and heme utilization genes in Aeromonas and their role in the colonization of the leech digestive tract

PubMed Central

Maltz, Michele; LeVarge, Barbara L.; Graf, Joerg

2015-01-01

It is known that many pathogens produce high-affinity iron uptake systems like siderophores and/or proteins for utilizing iron bound to heme-containing molecules, which facilitate iron-acquisition inside a host. In mutualistic digestive-tract associations, iron uptake systems have not been as well studied. We investigated the importance of two iron utilization systems within the beneficial digestive-tract association Aeromonas veronii and the medicinal leech, Hirudo verbana. Siderophores were detected in A. veronii using chrome azurol S. Using a mini Tn5, a transposon insertion in viuB generated a mutant unable to utilize iron using siderophores. The A. veronii genome was then searched for genes potentially involved in iron utilization bound to heme-containing molecules. A putative outer membrane heme receptor (hgpB) was identified with a transcriptional activator, termed hgpR, downstream. The hgpB gene was interrupted with an antibiotic resistance cassette in both the parent strain and the viuB mutant, yielding an hgpB mutant and a mutant with both iron uptake systems inactivated. In vitro assays indicated that hgpB is involved in utilizing iron bound to heme and that both iron utilization systems are important for A. veronii to grow in blood. In vivo colonization assays revealed that the ability to acquire iron from heme-containing molecules is critical for A. veronii to colonize the leech gut. Since iron and specifically heme utilization is important in this mutualistic relationship and has a potential role in virulence factor of other organisms, genomes from different Aeromonas strains (both clinical and environmental) were queried with iron utilization genes of A. veronii. This analysis revealed that in contrast to the siderophore utilization genes heme utilization genes are widely distributed among aeromonads. The importance of heme utilization in the colonization of the leech further confirms that symbiotic and pathogenic relationships possess similar mechanisms for interacting with animal hosts. PMID:26284048

Comparison of direct and indirect methods of estimating health state utilities for resource allocation: review and empirical analysis.

PubMed

Arnold, David; Girling, Alan; Stevens, Andrew; Lilford, Richard

2009-07-22

Utilities (values representing preferences) for healthcare priority setting are typically obtained indirectly by asking patients to fill in a quality of life questionnaire and then converting the results to a utility using population values. We compared such utilities with those obtained directly from patients or the public. Review of studies providing both a direct and indirect utility estimate. Papers reporting comparisons of utilities obtained directly (standard gamble or time tradeoff) or indirectly (European quality of life 5D [EQ-5D], short form 6D [SF-6D], or health utilities index [HUI]) from the same patient. PubMed and Tufts database of utilities. Sign test for paired comparisons between direct and indirect utilities; least squares regression to describe average relations between the different methods. Mean utility scores (or median if means unavailable) for each method, and differences in mean (median) scores between direct and indirect methods. We found 32 studies yielding 83 instances where direct and indirect methods could be compared for health states experienced by adults. The direct methods used were standard gamble in 57 cases and time trade off in 60(34 used both); the indirect methods were EQ-5D (67 cases), SF-6D (13), HUI-2 (5), and HUI-3 (37). Mean utility values were 0.81 (standard gamble) and 0.77 (time tradeoff) for the direct methods; for the indirect methods: 0.59(EQ-5D), 0.63 (SF-6D), 0.75 (HUI-2) and 0.68 (HUI-3). Direct methods of estimating utilities tend to result in higher health ratings than the more widely used indirect methods, and the difference can be substantial.Use of indirect methods could have important implications for decisions about resource allocation: for example, non-lifesaving treatments are relatively more favoured in comparison with lifesaving interventions than when using direct methods.

The impact of demographic, health-related and social factors on dental services utilization: Systematic review and meta-analysis.

PubMed

Reda, Seif Magdy; Krois, Joachim; Reda, Sophie Franziska; Thomson, William Murray; Schwendicke, Falk

2018-04-16

Regular and/or preventive dental services utilization is an indicator of healthcare access and associated with improved health outcomes. We assessed the proportion of individuals regularly/preventively utilizing dental services, and how this was affected by demographic, health-related and social factors. Three electronic databases (Medline, Embase, Central) were searched (2005-2017). We included observational studies investigating the association between preventive/regular dental service utilization and age, oral and general health, edentulism, family structure and health literacy. The proportion of individuals with regular/preventive utilization overall and in different sub-groups were extracted. Random-effects meta-analyses, with subgroup analyses by region, were performed. Meta-regression was used to assess whether and how associations changed with time and countries' human developmental status (HDI). 103 studies on 7,395,697 participants from 28 countries were included. The global mean (95% CI) proportion of individuals regularly/preventively utilizing dental services was 54% (50-59%). In countries with higher HDI, more individuals regularly/preventively utilized services (p < 0.001). Age did not have a significant impact on utilization in adults (OR = 1.00; 0.89-1.12). Utilization was significantly lower in younger than older children (OR = 0.52; 0.46-0.59), individuals with poorer general health (OR = 0.73; 0.65-0.80) and poorer oral health (OR = 0.64; 0.52-0.75), edentulous individuals (OR = 0.32; 0.23-0.41), and individuals with less supportive family structures (OR = 0.81; 0.73-0.89) or poor health literacy (OR = 0.41; 0.01-0.81). The observed differences within populations did not significantly change with time and were universally present. Regular/preventive utilization varied widely between and within countries. Understanding and tackling the reasons underlying this may help to consistently improve utilization. Higher developmental status of countries is reflected in greater regular/preventive utilization of dental services. However, large demographic, health-related and social differences in utilization remain. These may contribute to dental health inequalities. Copyright © 2018 Elsevier Ltd. All rights reserved.

BpWrapper: BioPerl-based sequence and tree utilities for rapid prototyping of bioinformatics pipelines.

PubMed

Hernández, Yözen; Bernstein, Rocky; Pagan, Pedro; Vargas, Levy; McCaig, William; Ramrattan, Girish; Akther, Saymon; Larracuente, Amanda; Di, Lia; Vieira, Filipe G; Qiu, Wei-Gang

2018-03-02

Automated bioinformatics workflows are more robust, easier to maintain, and results more reproducible when built with command-line utilities than with custom-coded scripts. Command-line utilities further benefit by relieving bioinformatics developers to learn the use of, or to interact directly with, biological software libraries. There is however a lack of command-line utilities that leverage popular Open Source biological software toolkits such as BioPerl ( http://bioperl.org ) to make many of the well-designed, robust, and routinely used biological classes available for a wider base of end users. Designed as standard utilities for UNIX-family operating systems, BpWrapper makes functionality of some of the most popular BioPerl modules readily accessible on the command line to novice as well as to experienced bioinformatics practitioners. The initial release of BpWrapper includes four utilities with concise command-line user interfaces, bioseq, bioaln, biotree, and biopop, specialized for manipulation of molecular sequences, sequence alignments, phylogenetic trees, and DNA polymorphisms, respectively. Over a hundred methods are currently available as command-line options and new methods are easily incorporated. Performance of BpWrapper utilities lags that of precompiled utilities while equivalent to that of other utilities based on BioPerl. BpWrapper has been tested on BioPerl Release 1.6, Perl versions 5.10.1 to 5.25.10, and operating systems including Apple macOS, Microsoft Windows, and GNU/Linux. Release code is available from the Comprehensive Perl Archive Network (CPAN) at https://metacpan.org/pod/Bio::BPWrapper . Source code is available on GitHub at https://github.com/bioperl/p5-bpwrapper . BpWrapper improves on existing sequence utilities by following the design principles of Unix text utilities such including a concise user interface, extensive command-line options, and standard input/output for serialized operations. Further, dozens of novel methods for manipulation of sequences, alignments, and phylogenetic trees, unavailable in existing utilities (e.g., EMBOSS, Newick Utilities, and FAST), are provided. Bioinformaticians should find BpWrapper useful for rapid prototyping of workflows on the command-line without creating custom scripts for comparative genomics and other bioinformatics applications.

Quality of life among obese patients seeking weight loss surgery: the importance of obesity-related social stigma and functional status.

PubMed

Wee, Christina C; Davis, Roger B; Huskey, Karen W; Jones, Daniel B; Hamel, Mary B

2013-02-01

Obesity is a stigmatizing condition associated with adverse psychosocial consequences. The relative importance of weight stigma in reducing health utility or the value a person places on their current health state is unknown. We conducted a telephone survey of patients with obesity. All were seeking weight loss surgery at two bariatric centers (70 % response rate). We assessed patients' health utility (preference-based quality life measure) via a series of standard gamble scenarios assessing patients' willingness to risk death to lose various amounts of weight or achieve perfect health (range 0 to 1; 0 = death and 1 = most valued health/weight state). Multivariable models assessed associations among quality of life domains from the Short-form 36 (SF-36) and Impact of Weight on Quality of Life-lite (IWQOL-lite) and patients' health utility. Our study sample (n = 574) had a mean body mass index of 46.5 kg/m(2) and a mean health utility of 0.87, reflecting the group's average willingness to accept a 13 % risk of death to achieve their most desired health/weight state; utilities were highly variable, however, with 10 % reporting a utility of 1.00 and 27 % reporting a utility lower than 0.90. Among the IWQOL-lite subscales, Public Distress and Work Life were the only two subscales significantly associated with patients' utility after adjustment for sociodemographic factors. Among the SF-36 subscales, Role Physical, Physical Functioning, and Role Emotional were significantly associated with patients' utility. When the leading subscales on both IWQOL-lite and SF-36 were considered together, Role Physical, Public Distress, and to a lesser degree Role Emotional remained independently associated with patients' health utility. Patients seeking weight loss surgery report health utilities similar to those reported for people living with diabetes or with laryngeal cancer; however, utility values varied widely with more than a quarter of patients willing to accept more than a 10 % risk of death to achieve their most valued health/weight state. Interference with role functioning due to physical limitations and obesity-related social stigma were strong determinants of reduced health utility.

A general classification of silicon utilizing organisms

NASA Astrophysics Data System (ADS)

Das, P.; Das, S.

2010-12-01

Silicon utilizing organisms may be defined as organisms with high silicon content (≥ 1% dry weight) and they can metabolize silicon with or without demonstrable silicon transporter genes (SIT) in them(Das,2010). Silicon is the second most abundant element in the lithosphere (27.70%) and it is as important as phosphorus and magnesium (0.03%) in the biota. Hydrated silica represents the second most abundant biogenic mineral after carbonate minerals. Silicon is accumulated and metabolized by some prokaryotes, and Si compounds can stimulate the growth of a range of fungi. It is well known that Si is essential for diatoms. In mammals, Si is considered an essential trace element, required in bone, cartilage and connective tissue formation, enzymatic activities and other metabolic processes. Silicon was suggested to act as a phosphoprotein effector in bone. In mammals, Si is also reported to positively influence the immune system and to be required for lymphocyte proliferation. The aqueous chemistry of Si is dominated by silicic acid at biological pH ranges. Monosilicic acid can form stable complexes with organic hydroxy-containing molecules . Biosilica also has been identified associated with various biomolecules including proteins and carbohydrates. There are main seven groups of silicon utilizing organisms belonging to Gram positive bacteria, algae, protozoa, sponges, fungi, lichens, and monocotyledon plants. In each group again all the members are not silicon utilizing organisms, thus selective members in each group are further classified depending their degree of silicon utilization. Important silicon utilizing bacteria are Mycobacteria, Nocardia, Streptomyces, Staphylococcus, Bacillus, Lactobacillus spp. etc., Important silicon utilizing algae are Centrobacillariophyceae, Pennatibacillariophyceae and Chrysophyceae. Many protozoa belonging to Heterokonta, Choanoflagellida, Actinopoda are well known silicon utilizing microorganisms. Hexactinellida ( glass sponges), Demospongiae and Sclerospongiae are important silicon utilizing sponges. Fungi like Aspergillus, Penicillium, Rhizopus etc. are also silicon utilizing. Candida spp. also belong to silicon utilizing organisms as they are also frequently found in sputum in silicotuberculosis cases. Many monocotyledon plants belonging to Pteridophyta, Magnoliophyta etc. are also well known silicon utilizing organisms. Almost all lichens belong to the group of silicon utilizing organisms.

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.

42 CFR 456.150 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals § 456.150 Scope. This subpart prescribes requirements for control of utilization of inpatient services in mental hospitals, including...

Odyne Plug-In Hybrid Electric Utility Truck Testing | Transportation

Science.gov Websites

Research | NREL Odyne Plug-In Hybrid Electric Utility Truck Evaluation Odyne Plug-In Hybrid data on plug-in hybrid electric utility trucks operated by a variety of companies. Photo courtesy of Odyne, NREL NREL is evaluating the in-service performance of about 120 plug-in hybrid electric utility

Integrating Monetary and Non-monetary Reenlistment Incentives Utilizing the Combinatorial Retention Auction Mechanism (CRAM)

DTIC Science & Technology

2008-12-01

NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS INTEGRATING MONETARY AND NON-MONETARY REENLISTMENT INCENTIVES UTILIZING THE...Monetary and Non- monetary Reenlistment Incentives Utilizing the Combinatorial Retention Auction Mechanism (CRAM) 6. AUTHOR(S) Brooke Zimmerman 5...iii Approved for public release; distribution is unlimited INTEGRATING MONETARY AND NON-MONETARY REENLISTMENT INCENTIVES UTILIZING THE

77 FR 29315 - Utility Scale Wind Towers From the People's Republic of China and the Socialist Republic of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-17

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-981, A-552-814] Utility Scale... duty investigations of utility scale wind towers from the People's Republic of China and the Socialist... investigations are currently due no later than June 6, 2012. \\1\\ See Utility Scale Wind Towers From the People's...

41 CFR 102-79.10 - What basic assignment and utilization of space policy governs an Executive agency?

Code of Federal Regulations, 2011 CFR

2011-01-01

... and utilization of space policy governs an Executive agency? 102-79.10 Section 102-79.10 Public... MANAGEMENT REGULATION REAL PROPERTY 79-ASSIGNMENT AND UTILIZATION OF SPACE General Provisions § 102-79.10 What basic assignment and utilization of space policy governs an Executive agency? Executive agencies...

41 CFR 102-79.10 - What basic assignment and utilization of space policy governs an Executive agency?

Code of Federal Regulations, 2012 CFR

2012-01-01

... and utilization of space policy governs an Executive agency? 102-79.10 Section 102-79.10 Public... MANAGEMENT REGULATION REAL PROPERTY 79-ASSIGNMENT AND UTILIZATION OF SPACE General Provisions § 102-79.10 What basic assignment and utilization of space policy governs an Executive agency? Executive agencies...

41 CFR 102-79.10 - What basic assignment and utilization of space policy governs an Executive agency?

Code of Federal Regulations, 2014 CFR

2014-01-01

... and utilization of space policy governs an Executive agency? 102-79.10 Section 102-79.10 Public... MANAGEMENT REGULATION REAL PROPERTY 79-ASSIGNMENT AND UTILIZATION OF SPACE General Provisions § 102-79.10 What basic assignment and utilization of space policy governs an Executive agency? Executive agencies...

41 CFR 102-79.10 - What basic assignment and utilization of space policy governs an Executive agency?

Code of Federal Regulations, 2013 CFR

2013-07-01

... and utilization of space policy governs an Executive agency? 102-79.10 Section 102-79.10 Public... MANAGEMENT REGULATION REAL PROPERTY 79-ASSIGNMENT AND UTILIZATION OF SPACE General Provisions § 102-79.10 What basic assignment and utilization of space policy governs an Executive agency? Executive agencies...

Montana Logging Utilization, 2002

Treesearch

Todd A. Morgan; Timothy P. Spoelma; Charles E. Keegan; Alfred L. Chase; Michael T. Thompson

2005-01-01

A study of logging utilization in Montana during 2002 provided logging and product utilization data for sawlog and veneer log harvests in Montana. Results of the study indicate a shift toward greater utilization of smaller diameter material, as 78 percent of the harvested volume in Montana during 2002 came from trees less than 17 inches diameter at breast height. The...

Alternative Fuels Data Center: Phoenix Utility Fleet Drives Smarter with

Science.gov Websites

electric car. College Students Engineer Efficient Vehicles in EcoCAR 2 Competition Aug. 2, 2014 Photo of a BiodieselA> Phoenix Utility Fleet Drives Smarter with Biodiesel to someone by E-mail Share ... Aug. 26, 2017 Phoenix Utility Fleet Drives Smarter with Biodiesel Watch how a utility company in

The Utility-Scale Future - Continuum Magazine | NREL

Science.gov Websites

Spring 2011 / Issue 1 Continuum. Clean Energy Innovation at NREL The Utility-Scale Future Continuum facility will lead the way. Wind Innovation Enables Utility-Scale 02 Wind Innovation Enables Utility-Scale Archives 9 Beyond R&D: Market Impact 8 NREL Analysis 7 Partnering: An Engine for Innovation 6 Energy

Would-Be Solar Electric Homeowners Sought For Project

Science.gov Websites

photovoltaic power systems connected to local utility grids. A grid-tied rooftop photovoltaic system consists . Excess electricity may be sold back to the utility. At night, or when additional power is needed, the utilities, will assess the market potential and practicality of home photovoltaic systems. The utilities

Instructional television utilization in the United States

NASA Technical Reports Server (NTRS)

Dumolin, J. R.

1971-01-01

Various aspects of utilizing instructional television (ITV) are summarized and evaluated and basic guidelines for future utilization of television as an instructional medium in education are considered. The role of technology in education, capabilities and limitations of television as an instructional media system and the state of ITV research efforts are discussed. Examples of various ongoing ITV programs are given and summarized. The problems involved in the three stages of the ITV process (production, distribution, and classroom utilization) are presented. A summary analysis outlines probable trends in future utilization.

Physician utilization and expenditures in a Medicaid Population

PubMed Central

Buczko, William

1986-01-01

The determinants of physician visit utilization and expenditures for the full-year Medicaid enrollees in the State Medicaid household survey portion of the National Medical Care Utilization and Expenditure Survey are analyzed in this article. The regression analyses for the probability of a physician visit, for number of physician visits, and for physician visit expenditures underscore the importance of perceived health status as a determinant of both physician utilization and expenditures. Other important determinants of physician utilization and expenditures were regular source of care, State, enrollment group, sex, and family size. PMID:10312009

Lawmakers vie to let utilities onto the info highway

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

Burkhart, L.A.

1994-03-15

Capitol Hill is alive with talk of the information superhighway and the need to amend the antiquated Communications Act of 1936. Electric and gas utilities hope that whatever bill is passed will allow them to provide telecommunications services and take part in the communication revolution. After all, the Clinton Administration's white paper on the issue advocates following a policy that would allow energy utilities to provide telephone services. Rep. Boucher has become a chief advocate of allowing electric utilities to compete in the cable television and telephone industries. Under the Public Utility Holding Company Act (PUHCA), electric utility holding companiesmore » whose operations cross state lines are prohibited from offering telecommunications services. Boucher's measure would amend PUHCA by removing those restrictions.« less

Utilization of information technology in eastern North Carolina physician practices: determining the existence of a digital divide.

PubMed

Rosenthal, David A; Layman, Elizabeth J

2008-02-13

The United States Department of Health and Human Services (DHHS) has emphasized the importance of utilizing health information technologies, thus making the availability of electronic resources critical for physicians across the country. However, few empirical assessments exist regarding the current status of computerization and utilization of electronic resources in physician offices and physicians' perceptions of the advantages and disadvantages of computerization. Through a survey of physicians' utilization and perceptions of health information technology, this study found that a "digital divide" existed for eastern North Carolina physicians in smaller physician practices. The physicians in smaller practices were less likely to utilize or be interested in utilizing electronic health records, word processing applications, and the Internet.

Recovery and Utilization of Extraterrestrial Resources

NASA Technical Reports Server (NTRS)

2004-01-01

This special bibliography includes the extraction, processing, and utilization of lunar, planetary, and asteroid resources; mining and excavation equipment, oxygen and propellant production; and in situ resource utilization.

Quantifying the utility of taking pills for cardiovascular prevention.

PubMed

Hutchins, Robert; Viera, Anthony J; Sheridan, Stacey L; Pignone, Michael P

2015-03-01

The decrease in utility attributed to taking pills for cardiovascular prevention can have major effects on the cost-effectiveness of interventions but has not been well studied. We sought to measure the utility of daily pill-taking for cardiovascular prevention. We conducted a cross-sectional Internet-based survey of 1000 US residents aged ≥30 in March 2014. We calculated utility values, using time trade-off as our primary method and standard gamble and willingness-to-pay techniques as secondary analyses. Mean age of respondents was 50 years. Most were female (59%) and white (63%); 28% had less than a college degree; and 79% took ≥1 pills daily. Mean utility using the time trade-off method was 0.990 (95% confidence interval, 0.988-0.992), including ≈70% not willing to trade any amount of time to avoid taking a preventive pill daily. Using the standard gamble method, mean utility was 0.991 (0.989-0.993), with 62% not willing to risk any chance of death. Respondents were willing to pay an average of $1445 to avoid taking a pill daily, which translated to a mean utility of 0.994 (0.940-0.997), including 41% unwilling to pay any amount. Time trade-off-based utility varied by age (decreasing utility as age increased), sex, race, numeracy, difficulty with obtaining pills, and number of pills taken per day but did not vary by education level, literacy, or income. Mean utility for taking a pill daily for cardiovascular prevention is ≈0.990 to 0.994. © 2015 American Heart Association, Inc.

Theory of Collective Intelligence

NASA Technical Reports Server (NTRS)

Wolpert, David H.

2003-01-01

In this chapter an analysis of the behavior of an arbitrary (perhaps massive) collective of computational processes in terms of an associated "world" utility function is presented We concentrate on the situation where each process in the collective can be viewed as though it were striving to maximize its own private utility function. For such situations the central design issue is how to initialize/update the collective's structure, and in particular the private utility functions, so as to induce the overall collective to behave in a way that has large values of the world utility. Traditional "team game" approaches to this problem simply set each private utility function equal to the world utility function. The "Collective Intelligence" (COIN) framework is a semi-formal set of heuristics that recently have been used to construct private utility. functions that in many experiments have resulted in world utility values up to orders of magnitude superior to that ensuing from use of the team game utility. In this paper we introduce a formal mathematics for analyzing and designing collectives. We also use this mathematics to suggest new private utilities that should outperform the COIN heuristics in certain kinds of domains. In accompanying work we use that mathematics to explain previous experimental results concerning the superiority of COIN heuristics. In that accompanying work we also use the mathematics to make numerical predictions, some of which we then test. In this way these two papers establish the study of collectives as a proper science, involving theory, explanation of old experiments, prediction concerning new experiments, and engineering insights.

Tamoxifen for breast cancer risk reduction: impact of alternative approaches to quality-of-life adjustment on cost-effectiveness analysis.

PubMed

Melnikow, Joy; Birch, Stephen; Slee, Christina; McCarthy, Theodore J; Helms, L Jay; Kuppermann, Miriam

2008-09-01

In cost-effectiveness analysis (CEA), the effects of health-care interventions on multiple health dimensions typically require consideration of both quantity and quality of life. To explore the impact of alternative approaches to quality-of-life adjustment using patient preferences (utilities) on the outcome of a CEA on use of tamoxifen for breast cancer risk reduction. A state transition Markov model tracked hypothetical cohorts of women who did or did not take 5 years of tamoxifen for breast cancer risk reduction. Incremental quality-adjusted effectiveness and cost-effectiveness ratios (ICERs) for models including and excluding a utility adjustment for menopausal symptoms were compared with each other and to a global utility model. Two hundred fifty-five women aged 50 and over with estimated 5-year breast cancer risk >or=1.67% participated in utility assessment interviews. Standard gamble utilities were assessed for specified tamoxifen-related health outcomes, current health, and for a global assessment of possible outcomes of tamoxifen use. Inclusion of a utility for menopausal symptoms in the outcome-specific models substantially increased the ICER; at the threshold 5-year breast cancer risk of 1.67%, tamoxifen was dominated. When a global utility for tamoxifen was used in place of outcome-specific utilities, tamoxifen was dominated under all circumstances. CEAs may be profoundly affected by the types of outcomes considered for quality-of-life adjustment and how these outcomes are grouped for utility assessment. Comparisons of ICERs across analyses must consider effects of different approaches to using utilities for quality-of-life adjustment.

Valuing SF-6D Health States Using a Discrete Choice Experiment.

PubMed

Norman, Richard; Viney, Rosalie; Brazier, John; Burgess, Leonie; Cronin, Paula; King, Madeleine; Ratcliffe, Julie; Street, Deborah

2014-08-01

SF-6D utility weights are conventionally produced using a standard gamble (SG). SG-derived weights consistently demonstrate a floor effect not observed with other elicitation techniques. Recent advances in discrete choice methods have allowed estimation of utility weights. The objective was to produce Australian utility weights for the SF-6D and to explore the application of discrete choice experiment (DCE) methods in this context. We hypothesized that weights derived using this method would reflect the largely monotonic construction of the SF-6D. We designed an online DCE and administered it to an Australia-representative online panel (n = 1017). A range of specifications investigating nonlinear preferences with respect to additional life expectancy were estimated using a random-effects probit model. The preferred model was then used to estimate a preference index such that full health and death were valued at 1 and 0, respectively, to provide an algorithm for Australian cost-utility analyses. Physical functioning, pain, mental health, and vitality were the largest drivers of utility weights. Combining levels to remove illogical orderings did not lead to a poorer model fit. Relative to international SG-derived weights, the range of utility weights was larger with 5% of health states valued below zero. s. DCEs can be used to investigate preferences for health profiles and to estimate utility weights for multi-attribute utility instruments. Australian cost-utility analyses can now use domestic SF-6D weights. The comparability of DCE results to those using other elicitation methods for estimating utility weights for quality-adjusted life-year calculations should be further investigated. © The Author(s) 2013.

Collective Intelligence. Chapter 17

NASA Technical Reports Server (NTRS)

Wolpert, David H.

2003-01-01

Many systems of self-interested agents have an associated performance criterion that rates the dynamic behavior of the overall system. This chapter presents an introduction to the science of such systems. Formally, collectives are defined as any system having the following two characteristics: First, the system must contain one or more agents each of which we view as trying to maximize an associated private utility; second, the system must have an associated world utility function that rates the possible behaviors of that overall system. In practice, collectives are often very large, distributed, and support little, if any, centralized communication and control, although those characteristics are not part of their formal definition. A naturally occurring example of a collective is a human economy. One can identify the agents and their private utilities as the human individuals in the economy and the associated personal rewards they are each trying to maximize. One could then identify the world utility as the time average of the gross domestic product. ("World utility" per se is not a construction internal to a human economy, but rather something defined from the outside.) To achieve high world utility it is necessary to avoid having the agents work at cross-purposes lest phenomena like liquidity traps or the Tragedy of the Commons (TOC) occur, in which agents' individually pursuing their private utilities lowers world utility. The obvious way to avoid such phenomena is by modifying the agents utility functions to be "aligned" with the world utility. This can be done via punitive legislation. A real-world example of an attempt to do this was the creation of antitrust regulations designed to prevent monopolistic practices.

Transformative learning and research utilization in nursing practice: a missing link?

PubMed

Matthew-Maich, Nancy; Ploeg, Jenny; Jack, Susan; Dobbins, Maureen

2010-03-01

Poor or inconsistent research utilization into clinical practice is a recurrent theme across study contexts, rendering leaders disillusioned with how best to foster the uptake of research into nursing practice. This makes it imperative to look to new approaches. Research utilization involves a learning process engaging attitudes, beliefs, and behaviors; yet, this is often overlooked in approaches and models used to facilitate research use. This oversight may offer some explanation to the limited progress in research utilization to date. Transformation Theory offers an explanatory theory and specific strategies (critical reflection and critical discourse) to explore attitudes, beliefs, and behaviors so that they are understood, validated, and can better guide actions. The purpose of this article was to explore what Transformation Theory can contribute to research utilization initiatives in nursing practice. Transformation Theory and transformative learning strategies are discussed and critically analyzed in consideration of their potential roles in fostering research utilization in clinical nursing practice. (1) Research utilization is a learning process that involves knowledge, skills, feelings, attitudes, and beliefs. (2) Transformative learning strategies of critical reflection and discourse can facilitate insight into experiences, finding shared meanings among groups of people, and understanding/validating beliefs, attitudes, and feelings so they can more consciously guide future actions. This dimension is frequently neglected in research utilization efforts. (3) In combination with research utilization theories, Transformation Theory may be a missing link to make research utilization initiatives more effective in rendering and sustaining nursing practice change, thus enhancing client care and well-being. (4) Research and further consideration are both warranted and needed.

Dynamic Resource Management for Parallel Tasks in an Oversubscribed Energy-Constrained Heterogeneous Environment

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

Imam, Neena; Koenig, Gregory A; Machovec, Dylan

2016-01-01

Abstract: The worth of completing parallel tasks is modeled using utility functions, which monotonically-decrease with time and represent the importance and urgency of a task. These functions define the utility earned by a task at the time of its completion. The performance of such a system is measured as the total utility earned by all completed tasks over some interval of time (e.g., 24 hours). To maximize system performance when scheduling dynamically arriving parallel tasks onto a high performance computing (HPC) system that is oversubscribed and energy-constrained, we have designed, analyzed, and compared different heuristic techniques. Four utility-aware heuristics (i.e.,more » Max Utility, Max Utility-per-Time, Max Utility-per-Resource, and Max Utility-per-Energy), three FCFS-based heuristics (Conservative Backfilling, EASY Backfilling, and FCFS with Multiple Queues), and a Random heuristic were examined in this study. A technique that is often used with the FCFS-based heuristics is the concept of a permanent reservation. We compare the performance of permanent reservations with temporary place-holders to demonstrate the advantages that place-holders can provide. We also present a novel energy filtering technique that constrains the maximum energy-per-resource used by each task. We conducted a simulation study to evaluate the performance of these heuristics and techniques in an energy-constrained oversubscribed HPC environment. With place-holders, energy filtering, and dropping tasks with low potential utility, our utility-aware heuristics are able to significantly outperform the existing FCFS-based techniques.« less

Estimation of utility weights for human papilloma virus-related health states according to disease severity.

PubMed

Ock, Minsu; Park, Jeong-Yeol; Son, Woo-Seung; Lee, Hyeon-Jeong; Kim, Seon-Ha; Jo, Min-Woo

2016-11-28

A cost-utility study of a human papilloma virus (HPV) vaccine requires that the utility weights for HPV-related health states (i.e., cervical intraepithelial neoplasia (CIN), cervical cancer, and condyloma) be evaluated. The aim of the present study was to determine the utility weights for HPV-related health states. Hypothetical standardised health states related to HPV were developed based on patient education material and previous publications. To fully reflect disease progression from diagnosis to prognosis, each health state comprised four parts (diagnosis, symptoms, treatment, and progression and prognosis). Nine-hundred members from the Korean general population evaluated the HPV-related health states using a visual analogue scale (VAS) and a standard gamble (SG) approach, which were administered face-to-face via computer-assisted interview. The mean utility values were calculated for each HPV-related health state. According to the VAS, the highest utility (0.73) was HPV-positive status, followed by condyloma (0.66), and CIN grade I (0.61). The lowest utility (0.18) was cervical cancer requiring chemotherapy without surgery, followed by cervical cancer requiring chemoradiation therapy (0.42). SG revealed that the highest utility (0.83) was HPV-positive status, followed by condyloma (0.78), and CIN grade I (0.77). The lowest utility (0.43) was cervical cancer requiring chemotherapy without surgery, followed by cervical cancer requiring chemoradiation therapy (0.60). This study was based on a large sample derived from the general Korean population; therefore, the calculated utility weights might be useful for evaluating the economic benefit of cancer screening and HPV vaccination programs.

Measuring Resource Utilization: A Systematic Review of Validated Self-Reported Questionnaires.

PubMed

Leggett, Laura E; Khadaroo, Rachel G; Holroyd-Leduc, Jayna; Lorenzetti, Diane L; Hanson, Heather; Wagg, Adrian; Padwal, Raj; Clement, Fiona

2016-03-01

A variety of methods may be used to obtain costing data. Although administrative data are most commonly used, the data available in these datasets are often limited. An alternative method of obtaining costing is through self-reported questionnaires. Currently, there are no systematic reviews that summarize self-reported resource utilization instruments from the published literature.The aim of the study was to identify validated self-report healthcare resource use instruments and to map their attributes.A systematic review was conducted. The search identified articles using terms like "healthcare utilization" and "questionnaire." All abstracts and full texts were considered in duplicate. For inclusion, studies had to assess the validity of a self-reported resource use questionnaire, to report original data, include adult populations, and the questionnaire had to be publically available. Data such as type of resource utilization assessed by each questionnaire, and validation findings were extracted from each study.In all, 2343 unique citations were retrieved; 2297 were excluded during abstract review. Forty-six studies were reviewed in full text, and 15 studies were included in this systematic review. Six assessed resource utilization of patients with chronic conditions; 5 assessed mental health service utilization; 3 assessed resource utilization by a general population; and 1 assessed utilization in older populations. The most frequently measured resources included visits to general practitioners and inpatient stays; nonmedical resources were least frequently measured. Self-reported questionnaires on resource utilization had good agreement with administrative data, although, visits to general practitioners, outpatient days, and nurse visits had poorer agreement.Self-reported questionnaires are a valid method of collecting data on healthcare resource utilization.

Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana.

PubMed

Duku, Stephen Kwasi Opoku; Asenso-Boadi, Francis; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

2016-12-01

Utilization of healthcare in Ghana's novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme's financial sustainability. This paper investigates the presence of adverse selection by assessing the effect of healthcare utilization and frequency of use on NHIS renewal. Routine enrolment and utilization data from 2008 to 2013 in two regions in Ghana was analyzed. Pearson Chi-square test was performed to test if the proportion of insured who utilize healthcare in a particular year and renew membership the following year is significantly different from those who utilize healthcare and drop-out. Logistic regressions were estimated to examine the relationship between healthcare utilization and frequency of use in previous year and NHIS renewal in current year. We found evidence suggestive of the presence of adverse selection in the NHIS. Majority of insured who utilized healthcare renewed their membership whiles most of those who did not utilize healthcare dropped out. The likelihood of renewal was significantly higher for those who utilize healthcare than those who did not and also higher for those who make more health facility visits. The NHIS claims bill is high because high risk individuals who self-select into the scheme makes more health facility visits and creates financial sustainability problems. Policy makers should adopt pragmatic ways of enforcing mandatory enrolment so that low risk individuals remain enrolled; and sustainable ways of increasing revenue whiles ensuring that the societal objectives of the scheme are not compromised.

The impact of persistent visually disabling vitreous floaters on health status utility values.

PubMed

Zou, Haidong; Liu, Haiyun; Xu, Xun; Zhang, Xi

2013-08-01

To assess the time trade-off (TTO) utility values in patients with persistent visually disabling vitreous floaters (DVF) and to determine the reliability and validity of TTO methods in DVF patients. Prospective cross-sectional questionnaire survey: Eligible patients with persistent DVF referred to the Shanghai First People's Hospital outpatient service between January 2006 and February 2010, and randomly selected normal vision general population residents, were enrolled. All participants underwent TTO utility value evaluation. After 4-5 weeks, the patients were asked to undergo second TTO utility value evaluation during the follow-up interview. The mean initial utility values of the 107 persistent DVF patients were 0.904 ± 0.054. Regression analyses revealed that length of education, visual acuity in the poorer-vision eye and employment status were associated with utility values (all P < 0.01). All patients took part in the follow-up interview; the intra-class correlation coefficient for TTO utility values at the initial and follow-up interviews was 0.855. In the 91 general population residents, the mean utility value was 0.923 ± 0.032, which was statistically higher than that of active study patients (t = 3.01, P < 0.01). Persistent DVF can substantially diminish the patients' perception of their life, and can be measured by TTO utility values with high reliability and construct validity.

Utility-based early modulation of processing distracting stimulus information.

PubMed

Wendt, Mike; Luna-Rodriguez, Aquiles; Jacobsen, Thomas

2014-12-10

Humans are selective information processors who efficiently prevent goal-inappropriate stimulus information to gain control over their actions. Nonetheless, stimuli, which are both unnecessary for solving a current task and liable to cue an incorrect response (i.e., "distractors"), frequently modulate task performance, even when consistently paired with a physical feature that makes them easily discernible from target stimuli. Current models of cognitive control assume adjustment of the processing of distractor information based on the overall distractor utility (e.g., predictive value regarding the appropriate response, likelihood to elicit conflict with target processing). Although studies on distractor interference have supported the notion of utility-based processing adjustment, previous evidence is inconclusive regarding the specificity of this adjustment for distractor information and the stage(s) of processing affected. To assess the processing of distractors during sensory-perceptual phases we applied EEG recording in a stimulus identification task, involving successive distractor-target presentation, and manipulated the overall distractor utility. Behavioral measures replicated previously found utility modulations of distractor interference. Crucially, distractor-evoked visual potentials (i.e., posterior N1) were more pronounced in high-utility than low-utility conditions. This effect generalized to distractors unrelated to the utility manipulation, providing evidence for item-unspecific adjustment of early distractor processing to the experienced utility of distractor information. Copyright © 2014 the authors 0270-6474/14/3416720-06$15.00/0.

Racial Disparities in Orthodontic Service Utilization for Medicaid-Enrolled Children: An Evaluation of the Washington Medicaid Program

PubMed Central

Merritt, Jantraveus M.; Greenlee, Geoffrey; Bollen, Anne Marie; Scott, JoAnna M.; Chi, Donald L.

2016-01-01

Introduction We assess the relationship between race and orthodontic service utilization for Medicaid-enrolled children. Methods This cross-sectional study focused on 570,364 Washington Medicaid-enrolled children ages 6-19 years. The main predictor variable was self-reported race (White versus non-White). The outcome variable was orthodontic service utilization, defined as children who were pre-authorized for orthodontic treatment by Medicaid in 2012 and subsequently received orthodontic records and initiated treatment. Logistic regression models were used to test the hypothesis that non-Whites would be less likely to utilize orthodontic care than Whites. Results A total of 8,223 children were approved by Medicaid for orthodontic treatment and 7,313 received records and initiated treatment. Non-Whites were significantly more likely to utilize orthodontic care than Whites (Odds Ratio [OR]=1.18; 95% confidence interval [CI]=1.02, 1.36; p=.031). Hispanic non-White children were more likely to utilize orthodontic care than non-Hispanic White children (OR=1.42; 95% CI=1.18, 1.70; p<.001). Conclusion In 2012, non-White children in Washington Medicaid were significantly more likely to utilize orthodontic care than White children. The Washington Medicaid program demonstrates a potential model for addressing racial disparities in orthodontic service utilization. Future research should identify mechanisms underlying these findings and continue to monitor orthodontic service utilization for minority children in Medicaid. PMID:27021456

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.

Methylotroph cloning vehicle

DOEpatents

Hanson, Richard S.; Allen, Larry N.

1989-04-25

A cloning vehicle comprising: a replication determinant effective for replicating the vehicle in a non-C.sub.1 -utilizing host and in a C.sub.1 -utilizing host; DNA effective to allow the vehicle to be mobilized from the non-C.sub.1 -utilizing host to the C.sub.1 -utilizing host; DNA providing resistance to two antibiotics to which the wild-type C.sub.1 -utilizing host is susceptible, each of the antibiotic resistance markers having a recognition site for a restriction endonuclease; a cos site; and a means for preventing replication in the C.sub.1 -utilizing host. The vehicle is used for complementation mapping as follows. DNA comprising a gene from the C.sub.1 -utilizing organism is inserted at the restriction nuclease recognition site, inactivating the antibiotic resistance marker at that site. The vehicle can then be used to form a cosmid structure to infect the non-C.sub.1 -utilizing (e.g., E. coli) host, and then conjugated with a selected C.sub.1 -utilizing mutant. Resistance to the other antibiotic by the mutant is a marker of the conjugation. Other phenotypical changes in the mutant, e.g., loss of an auxotrophic trait, is attributed to the C.sub.1 gene. The vector is also used to inactivate genes whose protein products catalyze side reactions that divert compounds from a biosynthetic pathway to a desired product, thereby producing an organism that makes the desired product in higher yields.

Multiattribute health utility scoring for the computerized adaptive measure CAT-5D-QOL was developed and validated.

PubMed

Kopec, Jacek A; Sayre, Eric C; Rogers, Pamela; Davis, Aileen M; Badley, Elizabeth M; Anis, Aslam H; Abrahamowicz, Michal; Russell, Lara; Rahman, Md Mushfiqur; Esdaile, John M

2015-10-01

The CAT-5D-QOL is a previously reported item response theory (IRT)-based computerized adaptive tool to measure five domains (attributes) of health-related quality of life. The objective of this study was to develop and validate a multiattribute health utility (MAHU) scoring method for this instrument. The MAHU scoring system was developed in two stages. In phase I, we obtained standard gamble (SG) utilities for 75 hypothetical health states in which only one domain varied (15 states per domain). In phase II, we obtained SG utilities for 256 multiattribute states. We fit a multiplicative regression model to predict SG utilities from the five IRT domain scores. The prediction model was constrained using data from phase I. We validated MAHU scores by comparing them with the Health Utilities Index Mark 3 (HUI3) and directly measured utilities and by assessing between-group discrimination. MAHU scores have a theoretical range from -0.842 to 1. In the validation study, the scores were, on average, higher than HUI3 utilities and lower than directly measured SG utilities. MAHU scores correlated strongly with the HUI3 (Spearman ρ = 0.78) and discriminated well between groups expected to differ in health status. Results reported here provide initial evidence supporting the validity of the MAHU scoring system for the CAT-5D-QOL. Copyright © 2015 Elsevier Inc. All rights reserved.

Lessons Learned: Community Solar for Municipal Utilities

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

This report outlines the work that STAT has completed, discusses the range of approaches utilities are taking, and highlights several challenges municipal utilities face in deciding whether and how to pursue community solar. As this report shows, there is no 'silver bullet' in terms of municipal utility community solar design or implementation - programs vary significantly and are highly dependent on localized contexts.

Logging utilization research in the Pacific Northwest: residue prediction and unique research challenges

Treesearch

Erik C. Berg; Todd A. Morgan; Eric A. Simmons; Stanley J. Zarnoch

2015-01-01

Logging utilization research results have informed land managers of changes in utilization of forest growing stock for more than 40 years. The logging utilization residue ratio- growing stock residue volume/mill delivered volume- can be applied to historic or projected timber harvest volumes to predict woody residue volumes at varied spatial scales. Researchers at the...

Earned Income Credit Utilization by Welfare Recipients: A Case Study of Minnesota's Earned Income Credit Program

ERIC Educational Resources Information Center

Hirasuna, Donald P.; Stinson, Thomas F.

2007-01-01

This paper examines utilization of a state earned income credit by AFDC and TANF recipients. Although utilization percentages are increasing, we find that among TANF recipients in 1999, 45.7 percent of all households and 34.8 percent of eligible households did not receive the state earned income credit. Moreover, we find that utilization may…

40 CFR 262.90 - Project XL for Public Utilities in New York State.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Project XL for Public Utilities in New... Utilities § 262.90 Project XL for Public Utilities in New York State. (a) The following definitions apply to..., or any company that provides electric power or telephone service and is regulated by New York State's...

Anion permselective membrane

NASA Technical Reports Server (NTRS)

Hodgdon, R. B.; Waite, W. A.; Alexander, S. S.

1984-01-01

Two polymer ion exchange membranes were synthesized to fulfill the needs of both electrical resistivity and anolyte/catholyte separation for utility load leveling utilizing the DOE/NASA mixed electrolyte REDOX battery. Both membranes were shown to meet mixed electrolyte utility load leveling criteria. Several modifications of an anion exchange membrane failed to meet utility load leveling REDOX battery criteria using the unmixed electrolyte REDOX cell.

Design Considerations for a Water Treatment System Utilizing Ultra-Violet Light Emitting Diodes

DTIC Science & Technology

2014-03-27

DESIGN CONSIDERATIONS FOR A WATER TREATMENT SYSTEM UTILIZING ULTRA-VIOLET LIGHT EMITTING DIODES...the United States. ii AFIT-ENV-14-M-58 DESIGN CONSIDERATIONS FOR A WATER TREATMENT SYSTEM UTILIZING ULTRA-VIOLET LIGHT EMITTING DIODES...DISTRIBUTION UNLIMITED. iii AFIT-ENV-14-M-58 DESIGN CONSIDERATIONS FOR A WATER TREATMENT SYSTEM UTILIZING ULTRA-VIOLET LIGHT EMITTING

The relationship between budget allocated and budget utilized of faculties in an academic institution

NASA Astrophysics Data System (ADS)

Aziz, Wan Noor Hayatie Wan Abdul; Aziz, Rossidah Wan Abdul; Shuib, Adibah; Razi, Nor Faezah Mohamad

2014-06-01

Budget planning enables an organization to set priorities towards achieving certain goals and to identify the highest priorities to be accomplished with the available funds, thus allowing allocation of resources according to the set priorities and constraints. On the other hand, budget execution and monitoring enables allocated funds or resources to be utilized as planned. Our study concerns with investigating the relationship between budget allocation and budget utilization of faculties in a public university in Malaysia. The focus is on the university's operations management financial allocation and utilization based on five categories which are emolument expenditure, academic or services and supplies expenditure, maintenance expenditure, student expenditure and others expenditure. The analysis on financial allocation and utilization is performed based on yearly quarters. Data collected include three years faculties' budget allocation and budget utilization performance involving a sample of ten selected faculties of a public university in Malaysia. Results show that there are positive correlation and significant relationship between quarterly budget allocation and quarterly budget utilization. This study found that emolument give the highest contribution to the total allocation and total utilization for all quarters. This paper presents some findings based on statistical analysis conducted which include descriptive statistics and correlation analysis.

Today's utility business (or, Boy Scouts in the Temple of Mammon)

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

Hyman, L.S.

1993-06-01

In the good old days of monopoly, it didn't matter so much how assets or liabilities were carried on the books. Today it matters very much. But in today's competitive environment it is even more important that utilities have a corporate strategy that takes advantage of their assets and is sensitive to both their customers and their competitors. In the good old days, electric utilities were natural monopolies. Regulators substituted their judgments for those of the marketplace, the utility's engineers managed the production process, its lawyers managed the regulators, and nobody managed the utility as a business. The utility wasmore » not a business. It was a quasi-governmental public service institution that - incidentally - threw off an ever-increasing dividend stream to shareholders who thought that they had purchased the equivalent of a bond that had an attached inflation hedge. The good old days are gone. The business is becoming a real one. Customers have choices. Yet the utility's accounting, managerial, and regulatory policies are rooted in the precepts of the old natural monopoly: the utility will always be the cheapest source of electricity, and customers will always need electricity.« less

(Non-)utilization of pre-hospital emergency care by migrants and non-migrants in Germany.

PubMed

Kietzmann, Diana; Knuth, Daniela; Schmidt, Silke

2017-01-01

This study was designed to explore the utilization and non-utilization of pre-hospital emergency care by migrants and non-migrants, and the factors that influence this behaviour. A cross-sectional representative German survey was conducted in a sample of 2.175 people, 295 of whom had a migration background. An additional sample of 50 people with Turkish migration background was conducted, partially in the Turkish language. Apart from socio-demographics, the utilization of emergency services and the reasons for non-utilization were assessed. Migrants had a higher utilization rate of pre-hospital emergency care (RR = 1.492) than non-migrants. Furthermore, migrants who were not born in Germany had a lower utilization rate (RR = 0.793) than migrants who were born in Germany. Regarding non-utilization, the most frequently stated reasons belonged to the categories initial misjudgment of the emergency situation and acting on one's own behalf, with the latter stated more frequently by migrants than by non-migrants. To prevent over-, under-, and lack of supply, it is necessary to transfer knowledge about the functioning of the medical emergency services, including first aid knowledge.

Tempest in a teapot: utility advertising

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

Ciscel, D.H.

Utility sales programs represent a form of organizational slack. It is an expense that can be traded off in times of administrative stress, providing a satisfactory payment to the consumer while maintaining the integrity of the present institutional arrangement. Because it is a trade-off commodity, regulatory control of utility advertising will remain a ''tempest in a teapot.'' Marketing programs are an integral part of the selling process in the modern corporation, and severe restrictions on advertising must be temporary in nature. Court cases have pointed out that utility companies need to inform the consumer about the use of the productmore » and to promote demand for the product. These actions will be considered legally reasonable no matter what the final disposition of current environmental regulations and energy restrictions. In fact, as acceptable social solutions develop for environmental and energy supply problems, the pressure on utility advertising can be expected to fall proportionately. However, the utility still represents the largest industrial concern in most locales. The utility advertising program makes the company even more visible. When there is public dissatisfaction with the more complex parts of the utility delivery system, the raucous voice of outrage will emerge from this tempestuous teapot.« less

High utilizers of medical care: a crucial subgroup among somatizing patients.

PubMed

Hiller, Wolfgang; Fichter, Manfred M

2004-04-01

Patients with somatoform disorders (SFD) are likely to overutilize healthcare services. This study investigates (a) whether extraordinarily high medical costs can be predicted from patient characteristics or psychopathology, and (b) whether high-utilizing patients respond differently to cognitive-behavioral treatment. We compared 42 SFD high utilizers with 53 SFD average utilizers and 29 patients suffering from other than SFD mental disorders. High utilization was defined by healthcare expenditures of > or = 2500 euros during the past 2 years. Costs were computed from medical and billing records of health insurance companies. Somatization distress, hypochondriasis, depression, dysfunctional cognitions related to bodily symptoms, general psychopathology, personality profiles, and psychosocial disabilities were assessed before treatment. High utilizers had higher levels of self- and observer-rated illness behavior, self-perceived bodily weakness, and psychosocial disabilities. Although they did not report more somatization symptoms, their subjective symptom distress was higher. There were no differences between high and average utilizers concerning general psychopathology, DSM-IV comorbidity, and personality profiles. Treatment improvements were similar. High- and average-utilizing somatizers represent distinguishable subgroups. The results emphasize the importance of mechanisms specifically related to SFD and may enhance the early detection of patients who are likely to develop overutilization. Copyright 2004 Elsevier Inc.

Evaluation utilization research--developing a theory and putting it to use.

PubMed

Neuman, Ari; Shahor, Neria; Shina, Ilan; Sarid, Anat; Saar, Zehava

2013-02-01

This article presents the findings of a two-stage study that had two key objectives: to develop a theory about evaluation utilization in an educational organization and to apply this theory to promote evaluation utilization within the organization. The first stage involved a theoretical conceptualization using a participatory method of concept mapping. This process identified the modes of evaluation utilization within the organization, produced a representation of the relationship between them and led to a theory. The second stage examined the practical implications of this conceptualization in terms of how different stakeholders in the organization perceive the actual and preferable state of evaluation utilization within the organization (i.e. to what extent is evaluation utilized and to what extent should it be utilized). The participatory process of the study promoted the evaluation utilization by involving stakeholders, thus giving them a sense of ownership and improving communication between the evaluation unit and the stakeholders. In addition, understanding the evaluation needs of the stakeholders in the organization helped generate relevant and realizable evaluation processes. On a practical level, the results are currently shaping the evaluation plan and the place of evaluations within the organization. Copyright © 2012 Elsevier Ltd. All rights reserved.

Transitioning to an uncertain and competitive environment

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

Davison, J.C.

1996-08-01

The move to greater competition by natural gas and electric utilities has meant change unparalleled since the 1930s. To adapt to this revolution, utilities will have to, first, understand the nature of the restructuring and, second, answer such fundamental questions as what they are selling and how they can operate profitably. Answering these and related questions will likely result in the utility evaluating its own structure and deciding how it can bring the most value to its customers. Both natural gas and electric utilities ultimately may have to choose what business niche they will most profitably operate in as themore » days of operating as vertically integrated entities in a cost-plus environment are all but gone. This paper analyzes the changing natural gas and electric utility industries and presents a model of the utility industry in the future. It explains why restructure is inevitable, what form it may take and how newly configured utilities might withstand the brutality of competition by using GIS predictive tools, such as business geographies.« less

A theory of utility conditionals: Paralogical reasoning from decision-theoretic leakage.

PubMed

Bonnefon, Jean-François

2009-10-01

Many "if p, then q" conditionals have decision-theoretic features, such as antecedents or consequents that relate to the utility functions of various agents. These decision-theoretic features leak into reasoning processes, resulting in various paralogical conclusions. The theory of utility conditionals offers a unified account of the various forms that this phenomenon can take. The theory is built on 2 main components: (1) a representational tool (the utility grid), which summarizes in compact form the decision-theoretic features of a conditional, and (2) a set of folk axioms of decision, which reflect reasoners' beliefs about the way most agents make their decisions. Applying the folk axioms to the utility grid of a conditional allows for the systematic prediction of the paralogical conclusions invited by the utility grid's decision-theoretic features. The theory of utility conditionals significantly extends the scope of current theories of conditional inference and moves reasoning research toward a greater integration with decision-making research.

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

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

Ruth, Mark; Pratt, Annabelle; Lunacek, Monte

2015-07-17

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

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.

Utilization of medical care following the Three Mile Island crisis.

PubMed

Houts, P S; Hu, T W; Henderson, R A; Cleary, P D; Tokuhata, G

1984-02-01

Four studies are reported on how utilization of primary health care was affected by the Three Mile Island (TMI) crisis and subsequent distress experienced by persons living in the vicinity of the plant. The studies concerned: 1) Blue Cross-Blue Shield records of claims by primary care physicians in the vicinity of TMI; 2) utilization rates in a family practice located near the facility; 3) interviews with persons living within five miles of TMI following the crisis; and 4) responses to a questionnaire by primary care physicians practicing within 25 miles of TMI. All four studies indicated only slight increases in utilization rates during the year following the crisis. One study found that persons who were upset during the crisis tended to be high practice utilizers both before and after the crisis. These results suggest that, while patterns of physician utilization prior to the TMI crisis predicted emotional response during the crisis, the impact of the TMI crisis on subsequent physician utilization was small.

Utilization of medical care following the Three Mile Island crisis.

PubMed Central

Houts, P S; Hu, T W; Henderson, R A; Cleary, P D; Tokuhata, G

1984-01-01

Four studies are reported on how utilization of primary health care was affected by the Three Mile Island (TMI) crisis and subsequent distress experienced by persons living in the vicinity of the plant. The studies concerned: 1) Blue Cross-Blue Shield records of claims by primary care physicians in the vicinity of TMI; 2) utilization rates in a family practice located near the facility; 3) interviews with persons living within five miles of TMI following the crisis; and 4) responses to a questionnaire by primary care physicians practicing within 25 miles of TMI. All four studies indicated only slight increases in utilization rates during the year following the crisis. One study found that persons who were upset during the crisis tended to be high practice utilizers both before and after the crisis. These results suggest that, while patterns of physician utilization prior to the TMI crisis predicted emotional response during the crisis, the impact of the TMI crisis on subsequent physician utilization was small. PMID:6691524

42 CFR 456.614 - Inspections by utilization review committee.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization review...

U.S. Refining Capacity Utilization

EIA Publications

1995-01-01

This article briefly reviews recent trends in domestic refining capacity utilization and examines in detail the differences in reported crude oil distillation capacities and utilization rates among different classes of refineries.

Economics of wind energy for utilities

NASA Technical Reports Server (NTRS)

Mccabe, T. F.; Goldenblatt, M. K.

1982-01-01

Utility acceptance of this technology will be contingent upon the establishment of both its technical and economic feasibility. This paper presents preliminary results from a study currently underway to establish the economic value of central station wind energy to certain utility systems. The results for the various utilities are compared specifically in terms of three parameters which have a major influence on the economic value: (1) wind resource, (2) mix of conventional generation sources, and (3) specific utility financial parameters including projected fuel costs. The wind energy is derived from modeling either MOD-2 or MOD-0A wind turbines in wind resources determined by a year of data obtained from the DOE supported meteorological towers with a two-minute sampling frequency. In this paper, preliminary results for six of the utilities studied are presented and compared.

A Quantitative Assessment of Utility Reporting Practices for Reporting Electric Power Distribution Events

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

Hamachi La Commare, Kristina

Metrics for reliability, such as the frequency and duration of power interruptions, have been reported by electric utilities for many years. This study examines current utility practices for collecting and reporting electricity reliability information and discusses challenges that arise in assessing reliability because of differences among these practices. The study is based on reliability information for year 2006 reported by 123 utilities in 37 states representing over 60percent of total U.S. electricity sales. We quantify the effects that inconsistencies among current utility reporting practices have on comparisons of System Average Interruption Duration Index (SAIDI) and System Average Interruption Frequency Indexmore » (SAIFI) reported by utilities. We recommend immediate adoption of IEEE Std. 1366-2003 as a consistent method for measuring and reporting reliability statistics.« less

Operation of a voltage source converter at increased utility voltage

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

Kaura, V.; Blasko, V.

1997-01-01

The operation of a voltage source converter (VSC) with regeneration capability, controllable power factor, and low distortion of utility currents is analyzed at increased utility voltage. Increase in the utility voltage causes a VSC to saturate and enter a nonlinear mode of operation. To operate under elevated utility, two steps are taken: (1) a pulse width modulation (PWM) algorithm is implemented which extends the linear region of operation by 15% and (2) a PWM saturation regulator is used to control the reactive current at higher utility voltages. The PWM algorithm reduces the switching losses by at least 33% and themore » effect of blanking time by one-third. All analytical results are experimentally verified on a 100 kW three-phase VSC.« less

A systematic review of utility values for chemotherapy-related adverse events.

PubMed

Shabaruddin, Fatiha H; Chen, Li-Chia; Elliott, Rachel A; Payne, Katherine

2013-04-01

Chemotherapy offers cancer patients the potential benefits of improved mortality and morbidity but may cause detrimental outcomes due to adverse drug events (ADEs), some of which requiring time-consuming, resource-intensive and costly clinical management. To appropriately assess chemotherapy agents in an economic evaluation, ADE-related parameters such as the incidence, (dis)utility and cost of ADEs should be reflected within the model parameters. To date, there has been no systematic summary of the existing literature that quantifies the utilities of ADEs due to healthcare interventions in general and chemotherapy treatments in particular. This review aimed to summarize the current evidence base of reported utility values for chemotherapy-related ADEs. A structured electronic search combining terms for utility, utility valuation methods and generic terms for cancer treatment was conducted in MEDLINE and EMBASE in June 2011. Inclusion criteria were: (1) elicitation of utility values for chemotherapy-related ADEs and (2) primary data. Two reviewers identified studies and extracted data independently. Any disagreements were resolved by a third reviewer. Eighteen studies met the inclusion criteria from the 853 abstracts initially identified, collectively reporting 218 utility values for chemotherapy-related ADEs. All 18 studies used short descriptions (vignettes) to obtain the utility values, with nine studies presenting the vignettes used in the valuation exercises. Of the 218 utility values, 178 were elicited using standard gamble (SG) or time trade-off (TTO) approaches, while 40 were elicited using visual analogue scales (VAS). There were 169 utility values of specific chemotherapy-related ADEs (with the top ten being anaemia [34 values], nausea and/or vomiting [32 values], neuropathy [21 values], neutropenia [12 values], diarrhoea [12 values], stomatitis [10 values], fatigue [8 values], alopecia [7 values], hand-foot syndrome [5 values] and skin reaction [5 values]) and 49 of non-specific chemotherapy-related adverse events. In most cases, it was difficult to directly compare the utility values as various definitions and study-specific vignettes were used for the ADEs of interest. This review was designed to provide an overall description of existing literature reporting utility values for chemotherapy-related ADEs. The findings were not exhaustive and were limited to publications that could be identified using the search strategy employed and those reported in the English language. This review identified wide ranges in the utility values reported for broad categories of specific chemotherapy-related ADEs. There were difficulties in comparing the values directly as various study-specific definitions were used for these ADEs and most studies did not make the vignettes used in the valuation exercises available. It is recommended that a basic minimum requirement be developed for the transparent reporting of study designs eliciting utility values, incorporating key criteria such as reporting how the vignettes were developed and presenting the vignettes used in the valuation tasks as well as valuing and reporting the utility values of the ADE-free base states. It is also recommended, in the future, for studies valuing the utilities of chemotherapy-related ADEs to define the ADEs according to the National Cancer Institute (NCI) definitions for chemotherapy-related ADEs as the use of the same definition across studies would ease the comparison and selection of utility values and make the overall inclusion of adverse events within economic models of chemotherapy agents much more straightforward.

Coming to grips with consumerism. [Panel answers on utility operations and problems

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

Not Available

Utility companies, as regulated monopolies, are facing increasing questioning and challenges from consumers. Representatives of the Consumer Federation of America, The Department of Energy, and Edison Electric Institute discuss the kind of information that consumers want and how they can get satisfactory responses from utility companies. The movement, seen as a healthy way for citizens to understand how utilities operate and to learn how to communicate their concerns, is assuming more of a conciliatory than adversary nature. In a panel discussion, the participants outline the issues of communication, rate structure, public relations, utility decision making, and regulation.

Hualapai Tribal Utility Development Project

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

Hualapai Tribal Nation

The first phase of the Hualapai Tribal Utility Development Project (Project) studied the feasibility of establishing a tribally operated utility to provide electric service to tribal customers at Grand Canyon West (see objective 1 below). The project was successful in completing the analysis of the energy production from the solar power systems at Grand Canyon West and developing a financial model, based on rates to be charged to Grand Canyon West customers connected to the solar systems, that would provide sufficient revenue for a Tribal Utility Authority to operate and maintain those systems. The objective to establish a central powermore » grid over which the TUA would have authority and responsibility had to be modified because the construction schedule of GCW facilities, specifically the new air terminal, did not match up with the construction schedule for the solar power system. Therefore, two distributed systems were constructed instead of one central system with a high voltage distribution network. The Hualapai Tribal Council has not taken the action necessary to establish the Tribal Utility Authority that could be responsible for the electric service at GCW. The creation of a Tribal Utility Authority (TUA) was the subject of the second objective of the project. The second phase of the project examined the feasibility and strategy for establishing a tribal utility to serve the remainder of the Hualapai Reservation and the feasibility of including wind energy from a tribal wind generator in the energy resource portfolio of the tribal utility (see objective 2 below). It is currently unknown when the Tribal Council will consider the implementation of the results of the study. Objective 1 - Develop the basic organizational structure and operational strategy for a tribally controlled utility to operate at the Tribe’s tourism enterprise district, Grand Canyon West. Coordinate the development of the Tribal Utility structure with the development of the Grand Canyon West Power Project construction of the power infrastructure at Grand Canyon West. Develop the maintenance and operations capacity necessary to support utility operations. Develop rates for customers on the Grand Canyon West “mini-grid” sufficient for the tribal utility to be self-sustaining. Establish an implementation strategy for tribal utility service at Grand Canyon West Objective 2 - Develop a strategy for tribal utility takeover of electric service on the Reservation. Perform a cost analysis of Reservation electrical service. Develop an implementation strategy for tribal takeover of Reservation electrical service. Examine options and costs associated with integration of the Tribe’s wind resources.« less

[Investigation of health literacy and enterprise provided health service utilization among migrants in construction site].

PubMed

Jiang, Ying; Zeng, Qingqi; Ji, Ying; Wang, Yanling; Zheng, Yunting; Chang, Chun

2015-01-01

To investigate health literacy and enterprise provided health service utilization among migrants in construction sites and explore the influencing factors of enterprise provided health service utilization. All 652 migrants in 10 construction sites in Xi'an and Tongchuan were selected using stratified cluster sampling method, and health literacy level, occupational health awareness and enterprise provided health service utilization of migrants were investigated in 2013 April to June.Score and pass rate was used to describe status of health literacy and occupational health awareness of migrants. Chi-square was used to analyze the difference of occupational health awareness and enterprise provided health service utilization between migrants of different levels of health literacy. And logistic regression was used to analyze the influencing factors of enterprise provided health service utilization. Average score of health literacy among migrants in construction site was (3.75 ± 2.17) (9 score totally). Migrants who knew enterprise should provide health training, physical examination, safety training, occupational protection and pay health insurance for workers accounted for 28.2% (174/616), 43.5% (268/616), 52.8% (325/616), 54.9% (338/616) and 37.7% (230/616) respectively, and the percentage of migrants who thought there were noise and dust in their working environment were 46.4% (201/627) and 44.8% (281/627) respectively.61.1% (373/610) received none of health training, occupational training, physical examination and first-aid kit, and only 0.8% (5/610) had utilized all of the above health service in workplace. And logistic regression showed that migrants whose health literacy score was higher than 5 had 1.819 times probability to utilize enterprise provided health service (OR = 1.82, 95%CI:1.13-2.92) , and migrants who were educated for more than 13 years had 3.812 times probability to utilize enterprise provided health service than those who were educated for less than 6 years (OR = 3.81, 95%CI:1.75-8.31) .However, occupational health awareness had no significant influence to the utility of enterprise provided health service utilization in logistic regression (χ(2) = 3.50, P = 0.061). Occupational health awareness and enterprise provided health service utilization were both low among migrants in construction site, level of health literacy and school years were the main factors that influence enterprise provided health service utilization.

Metabolome analysis-based design and engineering of a metabolic pathway in Corynebacterium glutamicum to match rates of simultaneous utilization of D-glucose and L-arabinose.

PubMed

Kawaguchi, Hideo; Yoshihara, Kumiko; Hara, Kiyotaka Y; Hasunuma, Tomohisa; Ogino, Chiaki; Kondo, Akihiko

2018-05-17

L-Arabinose is the second most abundant component of hemicellulose in lignocellulosic biomass, next to D-xylose. However, few microorganisms are capable of utilizing pentoses, and catabolic genes and operons enabling bacterial utilization of pentoses are typically subject to carbon catabolite repression by more-preferred carbon sources, such as D-glucose, leading to a preferential utilization of D-glucose over pentoses. In order to simultaneously utilize both D-glucose and L-arabinose at the same rate, a modified metabolic pathway was rationally designed based on metabolome analysis. Corynebacterium glutamicum ATCC 31831 utilized D-glucose and L-arabinose simultaneously at a low concentration (3.6 g/L each) but preferentially utilized D-glucose over L-arabinose at a high concentration (15 g/L each), although L-arabinose and D-glucose were consumed at comparable rates in the absence of the second carbon source. Metabolome analysis revealed that phosphofructokinase and pyruvate kinase were major bottlenecks for D-glucose and L-arabinose metabolism, respectively. Based on the results of metabolome analysis, a metabolic pathway was engineered by overexpressing pyruvate kinase in combination with deletion of araR, which encodes a repressor of L-arabinose uptake and catabolism. The recombinant strain utilized high concentrations of D-glucose and L-arabinose (15 g/L each) at the same consumption rate. During simultaneous utilization of both carbon sources at high concentrations, intracellular levels of phosphoenolpyruvate declined and acetyl-CoA levels increased significantly as compared with the wild-type strain that preferentially utilized D-glucose. These results suggest that overexpression of pyruvate kinase in the araR deletion strain increased the specific consumption rate of L-arabinose and that citrate synthase activity becomes a new bottleneck in the engineered pathway during the simultaneous utilization of D-glucose and L-arabinose. Metabolome analysis identified potential bottlenecks in D-glucose and L-arabinose metabolism and was then applied to the following rational metabolic engineering. Manipulation of only two genes enabled simultaneous utilization of D-glucose and L-arabinose at the same rate in metabolically engineered C. glutamicum. This is the first report of rational metabolic design and engineering for simultaneous hexose and pentose utilization without inactivating the phosphotransferase system.

Examination of psychosocial predictors of Virginia pharmacists' intention to utilize a prescription drug monitoring program using the theory of planned behavior.

PubMed

Gavaza, Paul; Fleming, Marc; Barner, Jamie C

2014-01-01

Little is known about the main drivers of pharmacists' intention to utilize prescription drug monitoring programs (PDMPs) when making care decisions and the actual contribution of these factors in explaining intention and behavior. This study examined what theory of planned behavior (TPB) model constructs (i.e., attitude, subjective norm [SN], perceived behavioral control [PBC]), past utilization behavior (PUB) and perceived moral obligation (PMO) were significant predictors of Virginia community pharmacists' intention to utilize a PDMP. A cover letter with a link to a 28-item online survey was e-mailed to 600 members of the Virginia Pharmacists Association. Multiple regression analyses were used to determine the association between pharmacists' intention to utilize the PDMP database and attitude, SN, PBC, PUB and PMO. Ninety-seven usable responses were received, for a response rate of 16.2%. A majority of the respondents were Caucasian (96.4%), female (50.5%), working in independent community pharmacies (60.4%) with an average age of 49.5 ± 13.4 years. Overall, pharmacists intended to utilize a PDMP (mean = 5.3 ± 4.6; possible range: -9 to 9), had a positive attitude toward utilizing PDMP (mean = 6.3 ± 5.3; possible range: -12 to 12), perceived that others wanted them to utilize a PDMP (SN score = 3.7 ± 2.4; range: -6 to 6), and believed that they had control over utilization behavior (PBC score = 4.5 ± 4.0; range: -9 to 9). Attitude (β = 0.723, P < 0.001), SN (β = 0.230, P = 0.014) and PBC (β = -0.215, P = 0.026) significantly predicted pharmacists' intent, accounting for 56.7% of the variance in intention to utilize the PDMP database (P < 0.001). The addition of PMO (P < 0.001) significantly contributed to explaining the variance in intention but PUB did not. Members of the Virginia Pharmacists Association who responded to the survey showed a strong positive intent to utilize PDMP database. Pharmacists' attitudes, subjective norm, perceived behavioral control and perceived moral obligation were significant predictors of intention but past utilization behavior was not. The TPB is a useful theoretical framework when predicting PDMP utilization behavior of community pharmacists, accounting for 56.7% of the variance in intention. Copyright © 2014 Elsevier Inc. All rights reserved.

Vision and quality-of-life.

PubMed Central

Brown, G C

1999-01-01

OBJECTIVE: To determine the relationship of visual acuity loss to quality of life. DESIGN: Three hundred twenty-five patients with visual loss to a minimum of 20/40 or greater in at least 1 eye were interviewed in a standardized fashion using a modified VF-14, questionnaire. Utility values were also obtained using both the time trade-off and standard gamble methods of utility assessment. MAIN OUTCOME MEASURES: Best-corrected visual acuity was correlated with the visual function score on the modified VF-14 questionnaire, as well as with utility values obtained using both the time trade-off and standard gamble methods. RESULTS: Decreasing levels of vision in the eye with better acuity correlated directly with decreasing visual function scores on the modified VF-14 questionnaire, as did decreasing utility values using the time trade-off method of utility evaluation. The standard gamble method of utility evaluation was not as directly correlated with vision as the time trade-off method. Age, level of education, gender, race, length of time of visual loss, and the number of associated systemic comorbidities did not significantly affect the time trade-off utility values associated with visual loss in the better eye. The level of reduced vision in the better eye, rather than the specific disease process causing reduced vision, was related to mean utility values. The average person with 20/40 vision in the better seeing eye was willing to trade 2 of every 10 years of life in return for perfect vision (utility value of 0.8), while the average person with counting fingers vision in the better eye was willing to trade approximately 5 of every 10 remaining years of life (utility value of 0.52) in return for perfect vision. CONCLUSIONS: The time trade-off method of utility evaluation appears to be an effective method for assessing quality of life associated with visual loss. Time trade-off utility values decrease in direct conjunction with decreasing vision in the better-seeing eye. Unlike the modified VF-14 test and its counterparts, utility values allow the quality of life associated with visual loss to be more readily compared to the quality of life associated with other health (disease) states. This information can be employed for cost-effective analyses that objectively compare evidence-based medicine, patient-based preferences and sound econometric principles across all specialties in health care. PMID:10703139

Utility values in the visually impaired: comparing time-trade off and VisQoL.

PubMed

Gothwal, Vijaya K; Bagga, Deepak K

2013-08-01

Visual impairment (VI) negatively affects quality of life (QoL). Utilities represent a way of measuring the QoL impact associated with a particular health state, like VI, and are also useful in economic evaluations of health care interventions. Utilities can be determined either directly or indirectly. Here we determine whether the Vision and Quality of Life Index, VisQoL (indirect approach), is acceptable to use in patients with VI in an urban setting in South India; whether the VisQoL utility values, derived from an Australian sample of both visually impaired and normally sighted participants, demonstrate agreement (if any) with direct utilities, determined by time trade-off (TTO), from visually impaired South Indian patients; and determine the relationship between utilities and self-reported visual disability. Three hundred forty-nine adults with VI were administered the two-item TTO item, six-item VisQoL, and the 16-item Andhra Pradesh Eye Disease-Visual Function Questionnaire (APEDS-VFQ) in a face-to-face interview. The VisQoL utilities were derived from the utility scoring algorithm. Rasch-scaled scores of the APEDS-VFQ were obtained using the conversion scores sheets. Agreement between TTO and utilities VisQoL was assessed using the Bland-Altman method. All participants (response rate, 100%) completed the VisQoL as compared with 72% for the TTO. There was no statistically significant difference in the mean utilities from the two methods (0.65 ± 0.31 by TTO vs. 0.66 ± 0.27 by VisQoL, p = 0.67). However, the 95% limits of agreement on the Bland-Altman plot were wide (-0.65, 0.67), implying a lack of agreement between the methods. The VisQoL relates relatively strongly with APEDS-VFQ as compared with TTO (TTO vs. APEDS-VFQ, r = -0.23, VisQoL vs. APEDS-VFQ, r = -0.66, z = -6.70; p < 0.001 for both). Older participants, female, and those with less than 12 years of education had lower utilities. The direct (TTO) and indirect (VisQoL) methods of utility evaluation tend to disagree in our patients with VI. Given the high completion rates of the VisQoL as compared with the TTO, the VisQoL may be a suitable alternative for utility assessment in an Indian population.

A structured review of health utility measures and elicitation in advanced/metastatic breast cancer.

PubMed

Hao, Yanni; Wolfram, Verena; Cook, Jennifer

2016-01-01

Health utilities are increasingly incorporated in health economic evaluations. Different elicitation methods, direct and indirect, have been established in the past. This study examined the evidence on health utility elicitation previously reported in advanced/metastatic breast cancer and aimed to link these results to requirements of reimbursement bodies. Searches were conducted using a detailed search strategy across several electronic databases (MEDLINE, EMBASE, Cochrane Library, and EconLit databases), online sources (Cost-effectiveness Analysis Registry and the Health Economics Research Center), and web sites of health technology assessment (HTA) bodies. Publications were selected based on the search strategy and the overall study objectives. A total of 768 publications were identified in the searches, and 26 publications, comprising 18 journal articles and eight submissions to HTA bodies, were included in the evidence review. Most journal articles derived utilities from the European Quality of Life Five-Dimensions questionnaire (EQ-5D). Other utility measures, such as the direct methods standard gamble (SG), time trade-off (TTO), and visual analog scale (VAS), were less frequently used. Several studies described mapping algorithms to generate utilities from disease-specific health-related quality of life (HRQOL) instruments such as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Breast Cancer 23 (EORTC QLQ-BR23), Functional Assessment of Cancer Therapy - General questionnaire (FACT-G), and Utility-Based Questionnaire-Cancer (UBQ-C); most used EQ-5D as the reference. Sociodemographic factors that affect health utilities, such as age, sex, income, and education, as well as disease progression, choice of utility elicitation method, and country settings, were identified within the journal articles. Most submissions to HTA bodies obtained utility values from the literature rather than exploring the HRQOL data obtained during clinical development. This was critiqued by the National Institute for Health and Clinical Excellence (NICE). Furthermore, the impact of age on utilities was highlighted by NICE and it was suggested that an age match of the study population should be attempted. Health utilities are recorded across the globe to varying extents and using differing elicitation methods. Manufacturers seeking reimbursement need to be aware of the country-specific requirements for elicitation of health utilities.

A structured review of health utility measures and elicitation in advanced/metastatic breast cancer

PubMed Central

Hao, Yanni; Wolfram, Verena; Cook, Jennifer

2016-01-01

Background Health utilities are increasingly incorporated in health economic evaluations. Different elicitation methods, direct and indirect, have been established in the past. This study examined the evidence on health utility elicitation previously reported in advanced/metastatic breast cancer and aimed to link these results to requirements of reimbursement bodies. Methods Searches were conducted using a detailed search strategy across several electronic databases (MEDLINE, EMBASE, Cochrane Library, and EconLit databases), online sources (Cost-effectiveness Analysis Registry and the Health Economics Research Center), and web sites of health technology assessment (HTA) bodies. Publications were selected based on the search strategy and the overall study objectives. Results A total of 768 publications were identified in the searches, and 26 publications, comprising 18 journal articles and eight submissions to HTA bodies, were included in the evidence review. Most journal articles derived utilities from the European Quality of Life Five-Dimensions questionnaire (EQ-5D). Other utility measures, such as the direct methods standard gamble (SG), time trade-off (TTO), and visual analog scale (VAS), were less frequently used. Several studies described mapping algorithms to generate utilities from disease-specific health-related quality of life (HRQOL) instruments such as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Core 30 (EORTC QLQ-C30), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Breast Cancer 23 (EORTC QLQ-BR23), Functional Assessment of Cancer Therapy – General questionnaire (FACT-G), and Utility-Based Questionnaire-Cancer (UBQ-C); most used EQ-5D as the reference. Sociodemographic factors that affect health utilities, such as age, sex, income, and education, as well as disease progression, choice of utility elicitation method, and country settings, were identified within the journal articles. Most submissions to HTA bodies obtained utility values from the literature rather than exploring the HRQOL data obtained during clinical development. This was critiqued by the National Institute for Health and Clinical Excellence (NICE). Furthermore, the impact of age on utilities was highlighted by NICE and it was suggested that an age match of the study population should be attempted. Conclusion Health utilities are recorded across the globe to varying extents and using differing elicitation methods. Manufacturers seeking reimbursement need to be aware of the country-specific requirements for elicitation of health utilities. PMID:27382319

Utility Energy Services Contracts: Enabling Documents

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

Thomas, Karen; Vasquez, Deb

The Federal Energy Management Program's 'Utility Energy Service Contracts: Enabling Documents' provide legislative information and materials that clarify the authority for federal agencies to enter into utility energy service contracts, or UESCs.

25 CFR 700.105 - Utility charges.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Policies and Instructions Definitions § 700.105 Utility charges. Utility charges means the cost for heat, lighting, hot water, electricity, natural gas, butane, propane, wood, coal or other fuels water, sewer and...

Aligning Utility Incentives with Investment in Energy Efficiency

EPA Pesticide Factsheets

Describes the financial effects on a utility of its spending on energy efficiency programs, how those effects could constitute barriers to more aggressive and sustained utility investment in energy efficiency.

Financial statistics of major US investor-owned electric utilities 1994

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

NONE

1995-12-01

The Financial Statistics of Major U.S. Investor-Owned Electric Utilities publication presents summary and detailed financial accounting data on the investor-owned electric utilities. The objective of the publication is to provide Federal and State Governments, industry, and the general public with current and historical data that can be used for making policy and decisions relating to investor-owned electric utility issues.

Energy Regulation Effects on Critical Infrastructure Protection

DTIC Science & Technology

2008-12-01

Holding Company Act (1935) PURPA Public Utility Regulatory Policies Act (1978) QF Qualifying Facility RTO Regional Transmission Organization SEC...1935 (PUHCA) and the Federal Power Act; the Public Utility Regulatory Policies Act of 1978 ( PURPA ); and the Energy Policy Acts of 1992 (EPAct 1992) and...Congress passed the Public Utility Regulatory Policies Act ( PURPA ) in 1978 which required electric utilities to buy electricity from other generating

Director of Small and Disadvantaged Business Utilization

DTIC Science & Technology

1989-03-17

Small and Disadvantaged Business Utilization References: (a) Title 15, United States Code (b) Title 10, United States Code (c) DoD 5025.1-M, "Department...position of Director of Small and Disadvantaged Business Utilization (Director, SADBU) under the direction, authority, and control of the Under...Defense Agencies, and the DoD Field Activities. C. RESPONSIBILITIES The Director of Small and Disadvantaged Business Utilization shall serve as the

Financial statistics of major U.S. investor-owned electric utilities 1993

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

Not Available

1995-01-01

The Financial Statistics of Major US Investor-Owned Electric Utilities publication presents summary and detailed financial accounting data on the investor-owned electric utilities. The objective of the publication is to provide Federal and State governments, industry, and the general public with current and historical data that can be used for policymaking and decisionmaking purposes related to investor-owned electric utility issues.

41 CFR 102-79.55 - Is there a general hierarchy of consideration that agencies must follow in their utilization of...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Is there a general hierarchy of consideration that agencies must follow in their utilization of space? 102-79.55 Section 102-79... Utilization of Space Utilization of Space § 102-79.55 Is there a general hierarchy of consideration that...

Metabolic Engineering for Substrate Co-utilization

NASA Astrophysics Data System (ADS)

Gawand, Pratish

Production of biofuels and bio-based chemicals is being increasingly pursued by chemical industry to reduce its dependence on petroleum. Lignocellulosic biomass (LCB) is an abundant source of sugars that can be used for producing biofuels and bio-based chemicals using fermentation. Hydrolysis of LCB results in a mixture of sugars mainly composed of glucose and xylose. Fermentation of such a sugar mixture presents multiple technical challenges at industrial scale. Most industrial microorganisms utilize sugars in a sequential manner due to the regulatory phenomenon of carbon catabolite repression (CCR). Due to sequential utilization of sugars, the LCB-based fermentation processes suffer low productivities and complicated operation. Performance of fermentation processes can be improved by metabolic engineering of microorganisms to obtain superior characteristics such as high product yield. With increased computational power and availability of complete genomes of microorganisms, use of model-based metabolic engineering is now a common practice. The problem of sequential sugar utilization, however, is a regulatory problem, and metabolic models have never been used to solve such regulatory problems. The focus of this thesis is to use model-guided metabolic engineering to construct industrial strains capable of co-utilizing sugars. First, we develop a novel bilevel optimization algorithm SimUp, that uses metabolic models to identify reaction deletion strategies to force co-utilization of two sugars. We then use SimUp to identify reaction deletion strategies to force glucose-xylose co-utilization in Escherichia coli. To validate SimUp predictions, we construct three mutants with multiple gene knockouts and test them for glucose-xylose utilization characteristics. Two mutants, designated as LMSE2 and LMSE5, are shown to co-utilize glucose and xylose in agreement with SimUp predictions. To understand the molecular mechanism involved in glucose-xylose co-utilization of the mutant LMSE2, the mutant is subjected to targeted and whole genome sequencing. Finally, we use the mutant LMSE2 to produce D-ribose from a mixture of glucose and xylose by overexpressing an endogenous phosphatase. The methods developed in this thesis are anticipated to provide a novel approach to solve sugar co-utilization problem in industrial microorganisms, and provide insights into microbial response to forced co-utilization of sugars.

EQ-5D-5L and SF-6D Utility Measures in Symptomatic benign Thyroid Nodules: Acceptability and Psychometric Evaluation.

PubMed

Wong, Carlos K H; Lang, Brian H H; Yu, Hill M S; Lam, Cindy L K

2017-08-01

The aim of this study was to examine the acceptability, validity, and reliability of the EuroQoL Five-Dimension Five-Level (EQ-5D-5L) and Short-Form Six-Dimension (SF-6D) health utility measures in patients with symptomatic benign thyroid nodules. Data from a randomized controlled trial (ClinicalTrials.gov identifier: NCT02398721) of 294 patients with symptomatic benign thyroid nodules were utilized for this psychometric evaluation of health-related quality of life (HR-QOL) measurement. Three HR-QOL questionnaires-the generic 12-item Short Form Health Survey (SF-12v2), EQ-5D-5L, and SF-6D-were interviewer-administered at baseline and 2 weeks afterwards. Responses to SF-6D were transformed to SF-6D utility scores using a Hong Kong population scoring algorithm derived by standard gamble, whereas responses to EQ-5D-5L were mapped onto EQ-5D-3L response via interim mapping algorithms and then converted to EQ-5D-5L utility scores using a Chinese-specific value set. Construct validity was determined by evaluating Spearman correlation between SF-12v2 scores and utility scores. Two-week test-retest reliability was assessed using intra-class correlation coefficient. No significant (>15%) floor and ceiling effects were observed for SF-6D utility scores. The SF-6D utility scores had a moderate Spearman rank correlation with the SF-12v2 domain score providing evidence for adequate construct validity. The SF-6D utility scores showed good test-retest reliability (0.794; range 0.696-0.860). Better reliability was observed in SF-6D utility scores than in EQ-5D-5L utility scores. While the EQ-5D-5L instrument was less reproducible, the SF-6D instrument appeared to be an applicable, valid, and reliable measure in assessing the HR-QOL of Chinese patients with symptomatic benign thyroid nodules. The impact of utility score selection on the effectiveness and cost effectiveness of clinical interventions targeted to these patients needs further exploration. NCT02398721, ClinicalTrials.gov.

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.

Vision-Related Quality of Life Associated with Unilateral and Bilateral Ocular Conditions.

PubMed

Brown, Gary C; Brown, Melissa M; Stein, Joshua D; Smiddy, William E

2018-02-21

To present ophthalmic patient time-tradeoff vision utilities for quantifying vision-related quality-of-life when the fellow eye still has good vision. These utilities are important for performing reliable cost-utility analyses. Consecutive time-tradeoff vision utilities were obtained from ophthalmic patients with good vision (20/20-20/25) in one eye and vision ranging from 20/20 to no light perception in the fellow eye over a 15-year period from 2000 through 2014. Five hundred eighty-six ophthalmic participant interviews from Wills Eye Hospital, New York Eye and Ear Hospital, and ophthalmology office practices in Pennsylvania and New Jersey. Participants underwent a full ophthalmic examination, after which time-tradeoff vision utilities were obtained by personal interview by the authors using a standardized, validated instrument. Time-tradeoff vision utilities. Mean time-tradeoff vision utilities were as follows in participants with good vision (20/20-20/25) in at least one eye and the following visions in the fellow eyes: no light perception, 0.79; counting fingers to light perception, 0.87; 20/200 to 20/400, 0.88; 20/60 to 20/100, 0.88; 20/30 to 20/50, 0.87; and 20/20 to 20/25, 0.94. In people with good vision (20/20-20/25) in one eye, the associated mean time-tradeoff vision utility is a remarkably consistent 0.87 to 0.88 when vision in the fellow eye ranges from 20/30 to light perception. Vision of 20/20 to 20/25 in the fellow eye results in a significantly higher associated utility of 0.94 (P < 0.01), whereas vision of no light perception in the fellow eye results in a significantly lower utility of 0.079 (P < 0.01). These utilities are important for calculating reliable patient value (quality-adjusted life-year) gains in ophthalmic cost-utility analysis populations in which there is unilateral and bilateral disease involvement. Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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

Dental Workforce Availability and Dental Services Utilization in Appalachia: A Geospatial Analysis

PubMed Central

Feng, Xue; Sambamoorthi, Usha; Wiener, R. Constance

2016-01-01

Objectives There is considerable variation in dental services utilization across Appalachian counties, and a plausible explanation is that individuals in some geographical areas do not utilize dental care due to dental workforce shortage. We conducted an ecological study on dental workforce availability and dental services utilization in Appalachia. Methods We derived county-level (n = 364) data on demographic, socio-economic characteristics and dental services utilization in Appalachia from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) using person-level data. We obtained county-level dental workforce availability and physician-to-population ratio estimates from Area Health Resource File, and linked them to the county-level BRFSS data. The dependent variable was the proportion using dental services within the last year in each county (ranging from 16.6% to 91.0%). We described the association between dental workforce availability and dental services utilization using ordinary least squares regression and spatial regression techniques. Spatial analyses consisted of bivariate Local Indicators of Spatial Association (LISA) and geographically weighted regression (GWR). Results Bivariate LISA showed that counties in the central and southern Appalachian regions had significant (p < .05) low-low spatial clusters (low dental workforce availability, low percent dental services utilization). GWR revealed considerable local variations in the association between dental utilization and dental workforce availability. In the multivariate GWR models, 8.5% (t-statistics >1.96) and 13.45% (t-statistics >1.96) of counties showed positive and statistically significant relationships between the dental services utilization and workforce availability of dentists and dental hygienists, respectively. Conclusions Dental workforce availability was associated with dental services utilization in the Appalachian region; however, this association was not statistically significant in all counties. The findings suggest that program and policy efforts to improve dental services utilization need to focus on factors other than increasing the dental workforce availability for many counties in Appalachia. PMID:27957773

Health-related utility values of patients with primary Sjögren's syndrome and its predictors.

PubMed

Lendrem, Dennis; Mitchell, Sheryl; McMeekin, Peter; Bowman, Simon; Price, Elizabeth; Pease, Colin T; Emery, Paul; Andrews, Jacqueline; Lanyon, Peter; Hunter, John; Gupta, Monica; Bombardieri, Michele; Sutcliffe, Nurhan; Pitzalis, Costantino; McLaren, John; Cooper, Annie; Regan, Marian; Giles, Ian; Isenberg, David; Vadivelu, Saravanan; Coady, David; Dasgupta, Bhaskar; McHugh, Neil; Young-Min, Steven; Moots, Robert; Gendi, Nagui; Akil, Mohammed; Griffiths, Bridget; Ng, Wan-Fai

2014-07-01

EuroQoL-5 dimension (EQ-5D) is a standardised preference-based tool for measurement of health-related quality of life and EQ-5D utility values can be converted to quality-adjusted life years (QALYs) to aid cost-utility analysis. This study aimed to evaluate the EQ-5D utility values of 639 patients with primary Sjögren's syndrome (PSS) in the UK. Prospective data collected using a standardised pro forma were compared with UK normative data. Relationships between utility values and the clinical and laboratory features of PSS were explored. The proportion of patients with PSS reporting any problem in mobility, self-care, usual activities, pain/discomfort and anxiety/depression were 42.2%, 16.7%, 56.6%, 80.6% and 49.4%, respectively, compared with 5.4%, 1.6%, 7.9%, 30.2% and 15.7% for the UK general population. The median EQ-5D utility value was 0.691 (IQR 0.587-0.796, range -0.239 to 1.000) with a bimodal distribution. Bivariate correlation analysis revealed significant correlations between EQ-5D utility values and many clinical features of PSS, but most strongly with pain, depression and fatigue (R values>0.5). After adjusting for age and sex differences, multiple regression analysis identified pain and depression as the two most important predictors of EQ-5D utility values, accounting for 48% of the variability. Anxiety, fatigue and body mass index were other statistically significant predictors, but they accounted for <5% in variability. This is the first report on the EQ-5D utility values of patients with PSS. These patients have significantly impaired utility values compared with the UK general population. EQ-5D utility values are significantly related to pain and depression scores in PSS. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Health state utility values of high prevalence mental disorders in Australia: results from the National Survey of Mental Health and Wellbeing.

PubMed

Mihalopoulos, Cathrine; Engel, Lidia; Le, Long Khanh-Dao; Magnus, Anne; Harris, Meredith; Chatterton, Mary Lou

2018-07-01

High prevalence mental disorders including depression, anxiety and substance use disorders are associated with high economic and disease burden. However, there is little information regarding the health state utility values of such disorders according to their clinical severity using comparable instruments across all disorders. This study reports utility values for high prevalence mental disorders using data from the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB). Utility values were derived from the AQoL-4D and analysed by disorder classification (affective only (AD), anxiety-related only (ANX), substance use only (SUB) plus four comorbidity groups), severity level (mild, moderate, severe), symptom recency (reported in the past 30 days), and comorbidity (combination of disorders). The adjusted Wald test was applied to detect statistically significant differences of weighted means and the magnitude of difference between groups was presented as a modified Cohen's d. In total, 1526 individuals met criteria for a 12-month mental disorder. The mean utility value was 0.67 (SD = 0.27), with lower utility values associated with higher severity levels and some comorbidities. Utility values for AD, ANX and SUB were 0.64 (SD = 0.25), 0.71 (SD = 0.25) and 0.81 (SD = 0.19), respectively. No differences in utility values were observed between disorders within disorder groups. Utility values were significantly lower among people with recent symptoms (within past 30 days) than those without; when examined by diagnostic group, this pattern held for people with SUB, but not for people with ANX or AD. Health state utility values of people with high prevalence mental disorders differ significantly by severity level, number of mental health comorbidities and the recency of symptoms, which provide new insights on the burden associated with high prevalence mental disorders in Australia. The derived utility values can be used to populate future economic models.

Underestimation of Variance of Predicted Health Utilities Derived from Multiattribute Utility Instruments.

PubMed

Chan, Kelvin K W; Xie, Feng; Willan, Andrew R; Pullenayegum, Eleanor M

2017-04-01

Parameter uncertainty in value sets of multiattribute utility-based instruments (MAUIs) has received little attention previously. This false precision leads to underestimation of the uncertainty of the results of cost-effectiveness analyses. The aim of this study is to examine the use of multiple imputation as a method to account for this uncertainty of MAUI scoring algorithms. We fitted a Bayesian model with random effects for respondents and health states to the data from the original US EQ-5D-3L valuation study, thereby estimating the uncertainty in the EQ-5D-3L scoring algorithm. We applied these results to EQ-5D-3L data from the Commonwealth Fund (CWF) Survey for Sick Adults ( n = 3958), comparing the standard error of the estimated mean utility in the CWF population using the predictive distribution from the Bayesian mixed-effect model (i.e., incorporating parameter uncertainty in the value set) with the standard error of the estimated mean utilities based on multiple imputation and the standard error using the conventional approach of using MAUI (i.e., ignoring uncertainty in the value set). The mean utility in the CWF population based on the predictive distribution of the Bayesian model was 0.827 with a standard error (SE) of 0.011. When utilities were derived using the conventional approach, the estimated mean utility was 0.827 with an SE of 0.003, which is only 25% of the SE based on the full predictive distribution of the mixed-effect model. Using multiple imputation with 20 imputed sets, the mean utility was 0.828 with an SE of 0.011, which is similar to the SE based on the full predictive distribution. Ignoring uncertainty of the predicted health utilities derived from MAUIs could lead to substantial underestimation of the variance of mean utilities. Multiple imputation corrects for this underestimation so that the results of cost-effectiveness analyses using MAUIs can report the correct degree of uncertainty.

Atmospheric waves and their utilization in soaring flight

NASA Technical Reports Server (NTRS)

Baldit, M Albert

1923-01-01

In soaring flight, ascending air currents are utilized and the interesting question is raised whether there are such currents which extend to any considerable distance and which can be utilized practically.

Utilities Expense Report.

ERIC Educational Resources Information Center

Moore, Deborah P.

2001-01-01

Examines how deregulation has affected school district utility costs. Offers ideas that can help school districts save money and energy. Provides several examples of state-wide initiatives intended to help school districts control utility costs. (GR)

A reference set of health utilities for long-term survivors of prostate cancer: population-based data from Ontario, Canada.

PubMed

Krahn, Murray D; Bremner, Karen E; Alibhai, Shabbir M H; Ni, Andy; Tomlinson, George; Laporte, Audrey; Naglie, Gary

2013-12-01

To measure quality of life (QOL) and utilities for prostate cancer (PC) patients and determine their predictors. A population-based, community-dwelling, geographically diverse sample of long-term PC survivors in Ontario, Canada, was identified from the Ontario Cancer Registry and contacted through their referring physician. Consenting patients completed questionnaires by mail: Health Utilities Index (HUI 2/3), Patient Oriented Prostate Utility Scale PORPUS-U (utility), PORPUS-P (health profile), Functional Assessment of Cancer Therapy-Prostate (FACT-P), and Prostate Cancer Index (PCI). Clinical data were obtained from chart reviews. Regression models determined the effects of a series of variables on QOL and utility. We received questionnaires and reviewed charts for 585 patients (mean age 72.6, 2-13 years postdiagnosis). Mean utility scores were as follows: PORPUS-U = 0.92, HUI2 = 0.85, and HUI3 = 0.78. Mean health profile scores were as follows: PORPUS-P = 71.7, PCI sexual, urinary, and bowel function = 23.7, 79.1, and 84.6, respectively (0 = worst, 100 = best), and FACT-P = 125.1 (0 = worst, 156 = best). In multiple regression analyses, comorbidity and PCI urinary, sexual, and bowel function were significant predictors of other QOL measures. With all variables, 32-50 % of the variance in utilities was explained. Many variables affect global QOL of PC survivors; only prostate symptoms and comorbidity have independent effects. Our model allows estimation of the effects of multiple factors on utilities. These utilities for long-term outcomes of PC and its treatment are valuable for decision/cost-effectiveness models of PC treatment.

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.

Sacroiliac joint pain: burden of disease

PubMed Central

Cher, Daniel; Polly, David; Berven, Sigurd

2014-01-01

Objectives The sacroiliac joint (SIJ) is an important and significant cause of low back pain. We sought to quantify the burden of disease attributable to the SIJ. Methods The authors compared EuroQol 5D (EQ-5D) and Short Form (SF)-36-based health state utility values derived from the preoperative evaluation of patients with chronic SIJ pain participating in two prospective clinical trials of minimally invasive SIJ fusion versus patients participating in a nationally representative USA cross-sectional survey (National Health Measurement Study [NHMS]). Comparative analyses controlled for age, sex, and oversampling in NHMS. A utility percentile for each SIJ subject was calculated using NHMS as a reference cohort. Finally, SIJ health state utilities were compared with utilities for common medical conditions that were published in a national utility registry. Results SIJ patients (number [n]=198) had mean SF-6D and EQ-5D utility scores of 0.51 and 0.44, respectively. Values were significantly depressed (0.28 points for the SF-6D utility score and 0.43 points for EQ-5D; both P<0.0001) compared to NHMS controls. SIJ patients were in the lowest deciles for utility compared to the NHMS controls. The SIJ utility values were worse than those of many common, major medical conditions, and similar to those of other common preoperative orthopedic conditions. Conclusion Patients with SIJ pain presenting for minimally invasive surgical care have marked impairment in quality of life that is worse than in many chronic health conditions, and this is similar to other orthopedic conditions that are commonly treated surgically. SIJ utility values are in the lowest two deciles when compared to control populations. PMID:24748825

Does the utilization of dental services associate with masticatory performance in a Japanese urban population?: the Suita study

PubMed Central

Kikui, Miki; Kida, Momoyo; Kosaka, Takayuki; Yamamoto, Masaaki; Yoshimuta, Yoko; Yasui, Sakae; Nokubi, Takashi; Maeda, Yoshinobu; Kokubo, Yoshihiro; Watanabe, Makoto; Miyamoto, Yoshihiro

2015-01-01

Abstract There are numerous reports on the relationship between regular utilization of dental care services and oral health, but most are based on questionnaires and subjective evaluation. Few have objectively evaluated masticatory performance and its relationship to utilization of dental care services. The purpose of this study was to identify the effect of regular utilization of dental services on masticatory performance. The subjects consisted of 1804 general residents of Suita City, Osaka Prefecture (760 men and 1044 women, mean age 66.5 ± 7.9 years). Regular utilization of dental services and oral hygiene habits (frequency of toothbrushing and use of interdental aids) was surveyed, and periodontal status, occlusal support, and masticatory performance were measured. Masticatory performance was evaluated by a chewing test using gummy jelly. The correlation between age, sex, regular dental utilization, oral hygiene habits, periodontal status or occlusal support, and masticatory performance was analyzed using Spearman's correlation test and t‐test. In addition, multiple linear regression analysis was carried out to investigate the relationship of regular dental utilization with masticatory performance after controlling for other factors. Masticatory performance was significantly correlated to age when using Spearman's correlation test, and to regular dental utilization, periodontal status, or occlusal support with t‐test. Multiple linear regression analysis showed that regular utilization of dental services was significantly related to masticatory performance even after adjusting for age, sex, oral hygiene habits, periodontal status, and occlusal support (standardized partial regression coefficient β = 0.055). These findings suggested that the regular utilization of dental care services is an important factor influencing masticatory performance in a Japanese urban population. PMID:29744141

Review of utility values for economic modeling in type 2 diabetes.

PubMed

Beaudet, Amélie; Clegg, John; Thuresson, Per-Olof; Lloyd, Adam; McEwan, Phil

2014-06-01

Economic analysis in type 2 diabetes mellitus (T2DM) requires an assessment of the effect of a wide range of complications. The objective of this article was to identify a set of utility values consistent with the National Institute for Health and Care Excellence (NICE) reference case and to critically discuss and illustrate challenges in creating such a utility set. A systematic literature review was conducted to identify studies reporting utility values for relevant complications. The methodology of each study was assessed for consistency with the NICE reference case. A suggested set of utility values applicable to modeling was derived, giving preference to studies reporting multiple complications and correcting for comorbidity. The review considered 21 relevant diabetes complications. A total of 16,574 articles were identified; after screening, 61 articles were assessed for methodological quality. Nineteen articles met NICE criteria, reporting utility values for 20 of 21 relevant complications. For renal transplant, because no articles meeting NICE criteria were identified, two articles using other methodologies were included. Index value estimates for T2DM without complication ranged from 0.711 to 0.940. Utility decrement associated with complications ranged from 0.014 (minor hypoglycemia) to 0.28 (amputation). Limitations associated with the selection of a utility value for use in economic modeling included variability in patient recruitment, heterogeneity in statistical analysis, large variability around some point estimates, and lack of recent data. A reference set of utility values for T2DM and its complications in line with NICE requirements was identified. This research illustrates the challenges associated with systematically selecting utility data for economic evaluations. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A framework for estimating health state utility values within a discrete choice experiment: modeling risky choices.

PubMed

Robinson, Angela; Spencer, Anne; Moffatt, Peter

2015-04-01

There has been recent interest in using the discrete choice experiment (DCE) method to derive health state utilities for use in quality-adjusted life year (QALY) calculations, but challenges remain. We set out to develop a risk-based DCE approach to derive utility values for health states that allowed 1) utility values to be anchored directly to normal health and death and 2) worse than dead health states to be assessed in the same manner as better than dead states. Furthermore, we set out to estimate alternative models of risky choice within a DCE model. A survey was designed that incorporated a risk-based DCE and a "modified" standard gamble (SG). Health state utility values were elicited for 3 EQ-5D health states assuming "standard" expected utility (EU) preferences. The DCE model was then generalized to allow for rank-dependent expected utility (RDU) preferences, thereby allowing for probability weighting. A convenience sample of 60 students was recruited and data collected in small groups. Under the assumption of "standard" EU preferences, the utility values derived within the DCE corresponded fairly closely to the mean results from the modified SG. Under the assumption of RDU preferences, the utility values estimated are somewhat lower than under the assumption of standard EU, suggesting that the latter may be biased upward. Applying the correct model of risky choice is important whether a modified SG or a risk-based DCE is deployed. It is, however, possible to estimate a probability weighting function within a DCE and estimate "unbiased" utility values directly, which is not possible within a modified SG. We conclude by setting out the relative strengths and weaknesses of the 2 approaches in this context. © The Author(s) 2014.

Strategic Style in Pared-Down Poker

NASA Astrophysics Data System (ADS)

Burns, Kevin

This chapter deals with the manner of making diagnoses and decisions, called strategic style, in a gambling game called Pared-down Poker. The approach treats style as a mental mode in which choices are constrained by expected utilities. The focus is on two classes of utility, i.e., money and effort, and how cognitive styles compare to normative strategies in optimizing these utilities. The insights are applied to real-world concerns like managing the war against terror networks and assessing the risks of system failures. After "Introducing the Interactions" involved in playing poker, the contents are arranged in four sections, as follows. "Underpinnings of Utility" outlines four classes of utility and highlights the differences between them: economic utility (money), ergonomic utility (effort), informatic utility (knowledge), and aesthetic utility (pleasure). "Inference and Investment" dissects the cognitive challenges of playing poker and relates them to real-world situations of business and war, where the key tasks are inference (of cards in poker, or strength in war) and investment (of chips in poker, or force in war) to maximize expected utility. "Strategies and Styles" presents normative (optimal) approaches to inference and investment, and compares them to cognitive heuristics by which people play poker--focusing on Bayesian methods and how they differ from human styles. The normative strategy is then pitted against cognitive styles in head-to-head tournaments, and tournaments are also held between different styles. The results show that style is ergonomically efficient and economically effective, i.e., style is smart. "Applying the Analysis" explores how style spaces, of the sort used to model individual behavior in Pared-down Poker, might also be applied to real-world problems where organizations evolve in terror networks and accidents arise from system failures.

Does the utilization of dental services associate with masticatory performance in a Japanese urban population?: the Suita study.

PubMed

Kikui, Miki; Ono, Takahiro; Kida, Momoyo; Kosaka, Takayuki; Yamamoto, Masaaki; Yoshimuta, Yoko; Yasui, Sakae; Nokubi, Takashi; Maeda, Yoshinobu; Kokubo, Yoshihiro; Watanabe, Makoto; Miyamoto, Yoshihiro

2015-12-01

There are numerous reports on the relationship between regular utilization of dental care services and oral health, but most are based on questionnaires and subjective evaluation. Few have objectively evaluated masticatory performance and its relationship to utilization of dental care services. The purpose of this study was to identify the effect of regular utilization of dental services on masticatory performance. The subjects consisted of 1804 general residents of Suita City, Osaka Prefecture (760 men and 1044 women, mean age 66.5 ± 7.9 years). Regular utilization of dental services and oral hygiene habits (frequency of toothbrushing and use of interdental aids) was surveyed, and periodontal status, occlusal support, and masticatory performance were measured. Masticatory performance was evaluated by a chewing test using gummy jelly. The correlation between age, sex, regular dental utilization, oral hygiene habits, periodontal status or occlusal support, and masticatory performance was analyzed using Spearman's correlation test and t -test. In addition, multiple linear regression analysis was carried out to investigate the relationship of regular dental utilization with masticatory performance after controlling for other factors. Masticatory performance was significantly correlated to age when using Spearman's correlation test, and to regular dental utilization, periodontal status, or occlusal support with t -test. Multiple linear regression analysis showed that regular utilization of dental services was significantly related to masticatory performance even after adjusting for age, sex, oral hygiene habits, periodontal status, and occlusal support (standardized partial regression coefficient β  = 0.055). These findings suggested that the regular utilization of dental care services is an important factor influencing masticatory performance in a Japanese urban population.

The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons.

PubMed

Levy, Adrian R; Kowdley, Kris V; Iloeje, Uchenna; Tafesse, Eskinder; Mukherjee, Jayanti; Gish, Robert; Bzowej, Natalie; Briggs, Andrew H

2008-01-01

Chronic hepatitis B (CHB) is a condition that results in substantial morbidity and mortality worldwide because of progressive liver damage. Investigators undertaking economic evaluations of new therapeutic agents require estimates of health-related quality of life (HRQOL). Recently, evidence has begun to accumulate that differences in cultural backgrounds have a quantifiable impact on perceptions of health. The objective was to elicit utilities for six health states that occur after infection with the hepatitis B virus from infected and uninfected respondents living in jurisdictions with low and with high CHB endemicity. Standard gamble utilities were elicited from hepatitis patients and uninfected respondents using an interviewer-administered survey in the United States, Canada, United Kingdom, Spain, Hong Kong, and mainland China. Generalized linear models were used to the effect on utilities of current health, age and sex, jurisdiction and, for infected respondents, current disease state. The sample included 534 CHB-infected patients and 600 uninfected respondents. CHB and compensated cirrhosis had a moderate impact on HRQOL with utilities ranging from 0.68 to 0.80. Decompensated cirrhosis and hepatocellular carcinoma had a stronger impact with utilities ranging from 0.35 to 0.41. Significant variation was observed between countries, with both types of respondents in mainland China and Hong Kong reporting systematically lower utilities. Health states related to CHB infection have substantial reductions in HRQOL and the utilities reported in this study provide valuable information for comparing new treatment options. The observed intercountry differences suggest that economic evaluations may benefit from country-specific utility estimates. The extent that systematic intercountry differences in utilities hold true for other infectious and chronic diseases remains an open question and has considerable implications for the proper conduct and interpretation of economic evaluations.

The Utility of 5 Hypothetical Health States in Heart Failure Using Time Trade-Off (TTO) and EQ-5D-5L in Korea.

PubMed

Hong, Sung-Hyun; Lee, Jae-Yeon; Park, Sun-Kyeong; Nam, Jin Hyun; Song, Hyun Jin; Park, Sun-Young; Lee, Eui-Kyung

2018-05-26

Utility provides a preference for specific health state in economic evaluation, and they obtained from general population could be useful in respect of societal resource allocation. We aimed to investigate the utilities of health states for heart failure (HF), a major and growing public health problem, related to hospitalization and adverse drug effects by interrogating the general Korean population. Five health states for patients with HF were developed based on literature reviews: stable chronic heart failure (SCHF), hospitalization, SCHF + cough, SCHF + hypotension, and SCHF + hyperkalemia. We selected 100 individuals from the general population through quota sampling by age, sex, and region, and conducted face-to-face interviews. We measured utilities for 5 hypothetical health states of HF using both time trade-off (TTO) and EuroQol-5 dimensions-5 levels (EQ-5D-5L). Repeated-measures analysis of variance compared the utilities between all health states for each instrument. To identify the factors affecting the utility, a linear mixed model (LMM) analysis was performed. The mean utility value for SCHF, SCHF + cough, SCHF + hypotension, SCHF + hyperkalemia, and hospitalization was calculated as 0.815, 0.732, 0.646, 0.548, and 0.360, respectively, by using TTO. The respective values using EQ-5D-5L were 0.871, 0.793, 0.710, 0.589, and 0.215. The utilities for HF significantly differed between all health states in each instrument (p < 0.001). In LMM analysis, hospitalization had a significantly negative effect on the utilities of both instruments. The utilities decreased in order of SCHF, SCHF + cough, SCHF + hypotension, SCHF + hyperkalemia, and hospitalization. These results can be useful for decision making in resource allocation for HF interventions.

Mental health-care utilization in survivors of childhood cancer and siblings: the Swiss childhood cancer survivor study.

PubMed

Gianinazzi, Micol E; Rueegg, Corina S; von der Weid, Nicolas X; Niggli, Felix K; Kuehni, Claudia E; Michel, Gisela

2014-02-01

We aimed to (1) describe the utilization of mental health-care in survivors and siblings, the association with severity of distress, and visits to other professionals in distressed survivors not utilizing mental health-care; and (2) identify factors associated with utilization of mental health-care in distressed survivors. Within the Swiss Childhood Cancer Survivor Study, we sent postal questionnaires to all participants aged <16 years at diagnosis (1976-2003), who survived ≥5 years after diagnosis and were aged ≥16 years at study. Survivors and siblings could indicate if they utilized mental health-care in the past year. Psychological distress was assessed with the Brief Symptom Inventory-18 (BSI-18). Participants with scores T ≥ 57 on two of three scales or the Global Severity Index were considered distressed. We included 1,602 survivors and 703 siblings. Overall, 160 (10 %) and 53 (8 %), utilized mental health-care and 203 (14 %) and 127 (14 %) were considered distressed. Among these, 69 (34 %) survivors and 20 (24 %) siblings had utilized mental health-care. Participants with higher distress were more likely to utilize mental health-care. Distressed survivors not utilizing mental health-care were more likely to see a medical specialist than nondistressed. In the multivariable regression, factors associated with utilizing mental health-care were higher psychological distress and reporting late effects. Our results underline the importance of developing interventional programs and implementing psychological screening in follow-up of survivors. It is also important to systematically address siblings' needs. In follow-up, patients at risk should be informed about existing possibilities or advised to visit mental health professionals.

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

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.

Trading Water Conservation Credits: A Coordinative Approach for Enhanced Urban Water Reliability

NASA Astrophysics Data System (ADS)

Gonzales, P.; Ajami, N. K.

2016-12-01

Water utilities in arid and semi-arid regions are increasingly relying on water use efficiency and conservation to extend the availability of supplies. Despite spatial and institutional inter-dependency of many service providers, these demand-side management initiatives have traditionally been tackled by individual utilities operating in a silo. In this study, we introduce a new approach to water conservation that addresses regional synergies—a novel system of tradable water conservation credits. Under the proposed approach, utilities have the flexibility to invest in water conservation measures that are appropriate for their specific service area. When utilities have insufficient capacity for local cost-effective measures, they may opt to purchase credits, contributing to fund subsidies for utilities that do have that capacity and can provide the credits, while the region as whole benefits from more reliable water supplies. While similar programs have been used to address water quality concerns, to our knowledge this is one of the first studies proposing tradable credits for incentivizing water conservation. Through mathematical optimization, this study estimates the potential benefits of a trading program and demonstrates the institutional and economic characteristics needed for such a policy to be viable, including a proposed web platform to facilitate transparent regional planning, data-driven decision-making, and enhanced coordination of utilities. We explore the impacts of defining conservation targets tailored to local realities of utilities, setting credit prices, and different policy configurations. We apply these models to the case study of water utility members of the Bay Area Water Supply and Conservation Agency. Preliminary work shows that the diverse characteristics of these utilities present opportunities for the region to achieve conservation goals while maximizing the benefits to individual utilities through more flexible coordinative efforts.

Hazard Mitigation Assistance Programs Available to Water and Wastewater Utilities

EPA Pesticide Factsheets

You can prevent damage to your utility before it occurs. Utilities can implement mitigation projects to better withstand a natural disaster, minimize damage and rapidly recover from disruptions to service.

Utility Bill Insert for Wastewater Services

EPA Pesticide Factsheets

Intended for use by wastewater and water supply utilities, one side of the utility bill insert has information for customers that discharge to sanitary sewer systems; the other side is for customers with septic systems.

Utility accommodation and conflict tracker (UACT) : user manual

DOT National Transportation Integrated Search

2009-02-01

Project 0-5475 performed a comprehensive analysis of utility conflict data/information flows between utility : accommodation stakeholders in the Texas Department of Transportation project development process, : developed data models to accommodate wo...

Financial Impacts of Nonutility Power Purchases on Investor-Owned Electric Utilities

EIA Publications

1994-01-01

Provides an overview of the issues surrounding the financial impacts of nonutility generation contracts (since the passage of the Public Utility Regulatory Policies Act of 1978) on investor owned utilities.

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

Bird, L.; Kaiser, M.

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

Commercialization of LLNL Zinc Air Fuel Cell Technology For Stationary And Mobile Applications And Electromechanical Battery For Mobile Applications Final Report CRADA No. TC-1420-97

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

Tokarz, F. J.; Cooper, J. F.; Haley, D.

Utility deregulation is occurring throughout the world. Energy storage, peak demand leveling and power quality are becoming increasingly important. New, innovative costeffective methods are critical to the financial success or failure of utility companies in the new free market environment. The implementation of energy storage gives a utility the ability to better utilize existing generating capacity. Energy is stored in the periods of low overall demand and then the stored energy is connected to the power grid during peak demand periods. Storing energy in this manner will lead to significant economic benefits to utilities as well as their customers. Furthermore,more » because the utility's system is operated more efficiently there is a direct reduction in atmospheric pollutants including greenhouse gases.« less

Analysis of Water Resource Utilization Potential for Jiangsu Coastal Area ' in Nantong City

NASA Astrophysics Data System (ADS)

Ren, Li; Liu, Jin-Tao; Ni, Jian-Jun

2015-04-01

Along with the advance of the growth of population and social economy, requirements for water quality and quantity in coastal areas is getting higher and higher, but due to the uneven distribution of rainfall years and water exploitation, use and management level, the influence of the shortage of water resources is increasingly prominent, seriously restricting the social and economic sustainable development in this region. Accordingly, water resource utilization potential in Jiangsu coastal region is vital for water security in the region. Taking Nantong City as the study area, the regional water resources development and utilization status were evaluated. In this paper, the meaning of water resources, water resources development and utilization, and water resources development and utilization of the three stages of concepts such as system were discussed. Then the development and utilization of regional water resource evaluation were carried out, and the significance of regional society, economy, resources and environment and its development status quo of water resources were exploited. According to conditions and area source, an evaluation index system for development and utilization of water resources of Nantong was built up. The index layer was composed of 16 indicators. In this study, analytic hierarchy process (AHP) was used to determine of weights of indicators at all levels in the index system. Multistage fuzzy comprehensive evaluation model was selected to evaluate the water resources development and utilization status of Nantong, and then water resource utilization potential of Nantong was analyzed.

Cumulative Weighing of Time in Intertemporal Tradeoffs

PubMed Central

2016-01-01

We examine preferences for sequences of delayed monetary gains. In the experimental literature, two prominent models have been advanced as psychological descriptions of preferences for sequences. In one model, the instantaneous utilities of the outcomes in a sequence are discounted as a function of their delays, and assembled into a discounted utility of the sequence. In the other model, the accumulated utility of the outcomes in a sequence is considered along with utility or disutility from improvement in outcome utilities and utility or disutility from the spreading of outcome utilities. Drawing on three threads of evidence concerning preferences for sequences of monetary gains, we propose that the accumulated utility of the outcomes in a sequence is traded off against the duration of utility accumulation. In our first experiment, aggregate choice behavior provides qualitative support for the tradeoff model. In three subsequent experiments, one of which incentivized, disaggregate choice behavior provides quantitative support for the tradeoff model in Bayesian model contests. One thread of evidence motivating the tradeoff model is that, when, in the choice between two single dated outcomes, it is conveyed that receiving less sooner means receiving nothing later, preference for receiving more later increases, but when it is conveyed that receiving more later means receiving nothing sooner, preference is left unchanged. Our results show that this asymmetric hidden-zero effect is indeed driven by those supporting the tradeoff model. The tradeoff model also accommodates all remaining evidence on preferences for sequences of monetary gains. PMID:27560853

Methods for measuring utilization of mental health services in two epidemiologic studies

PubMed Central

NOVINS, DOUGLAS K.; BEALS, JANETTE; CROY, CALVIN; MANSON, SPERO M.

2015-01-01

Objectives of Study Psychiatric epidemiologic studies often include two or more sets of questions regarding service utilization, but the agreement across these different questions and the factors associated with their endorsement have not been examined. The objectives of this study were to describe the agreement of different sets of mental health service utilization questions that were included in the American Indian Service Utilization Psychiatric Epidemiology Risk and Protective Factors Project (AI-SUPERPFP), and compare the results to similar questions included in the baseline National Comorbidity Survey (NCS). Methods Responses to service utilization questions by 2878 AI-SUPERPFP and 5877 NCS participants were examined by calculating estimates of service use and agreement (κ) across the different sets of questions. Logistic regression models were developed to identify factors associated with endorsement of specific sets of questions. Results In both studies, estimates of mental health service utilization varied across the different sets of questions. Agreement across the different question sets was marginal to good (κ = 0.27–0.69). Characteristics of identified service users varied across the question sets. Limitations Neither survey included data to examine the validity of participant responses to service utilization questions. Recommendations for Further Research Question wording and placement appear to impact estimates of service utilization in psychiatric epidemiologic studies. Given the importance of these estimates for policy-making, further research into the validity of survey responses as well as impacts of question wording and context on rates of service utilization is warranted. PMID:18767205

Methylotroph cloning vehicle

DOEpatents

Hanson, R.S.; Allen, L.N.

1989-04-25

A cloning vehicle comprising: a replication determinant effective for replicating the vehicle in a non-C[sub 1]-utilizing host and in a C[sub 1]-utilizing host; DNA effective to allow the vehicle to be mobilized from the non-C[sub 1]-utilizing host to the C[sub 1]-utilizing host; DNA providing resistance to two antibiotics to which the wild-type C[sub 1]-utilizing host is susceptible, each of the antibiotic resistance markers having a recognition site for a restriction endonuclease; a cos site; and a means for preventing replication in the C[sub 1]-utilizing host. The vehicle is used for complementation mapping as follows. DNA comprising a gene from the C[sub 1]-utilizing organism is inserted at the restriction nuclease recognition site, inactivating the antibiotic resistance marker at that site. The vehicle can then be used to form a cosmid structure to infect the non-C[sub 1]-utilizing (e.g., E. coli) host, and then conjugated with a selected C[sub 1]-utilizing mutant. Resistance to the other antibiotic by the mutant is a marker of the conjugation. Other phenotypical changes in the mutant, e.g., loss of an auxotrophic trait, is attributed to the C[sub 1] gene. The vector is also used to inactivate genes whose protein products catalyze side reactions that divert compounds from a biosynthetic pathway to a desired product, thereby producing an organism that makes the desired product in higher yields. 3 figs.

On the Path to SunShot - Utility Regulatory Business Model Reforms forAddressing the Financial Impacts of Distributed Solar on Utilities

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

None, None

Net-energy metering (NEM) with volumetric retail electricity pricing has enabled rapid proliferation of distributed photovoltaics (DPV) in the United States. However, this transformation is raising concerns about the potential for higher electricity rates and cost-shifting to non-solar customers, reduced utility shareholder profitability, reduced utility earnings opportunities, and inefficient resource allocation. Although DPV deployment in most utility territories remains too low to produce significant impacts, these concerns have motivated real and proposed reforms to utility regulatory and business models, with profound implications for future DPV deployment. This report explores the challenges and opportunities associated with such reforms in the context ofmore » the U.S. Department of Energy’s SunShot Initiative. As such, the report focuses on a subset of a broader range of reforms underway in the electric utility sector. Drawing on original analysis and existing literature, we analyze the significance of DPV’s financial impacts on utilities and non-solar ratepayers under current NEM rules and rate designs, the projected effects of proposed NEM and rate reforms on DPV deployment, and alternative reforms that could address utility and ratepayer concerns while supporting continued DPV growth. We categorize reforms into one or more of four conceptual strategies. Understanding how specific reforms map onto these general strategies can help decision makers identify and prioritize options for addressing specific DPV concerns that balance stakeholder interests.« less

Dental health services utilization and associated factors in children 6 to 12 years old in a low-income country.

PubMed

Medina-Solis, Carlo Eduardo; Maupomé, Gerardo; del Socorro, Herrera Miriam; Pérez-Núñez, Ricardo; Avila-Burgos, Leticia; Lamadrid-Figueroa, Hector

2008-01-01

To determine the factors associated with the dental health services utilization among children ages 6 to 12 in León, Nicaragua. A cross-sectional study was carried out in 1,400 schoolchildren. Using a questionnaire, we determined information related to utilization and independent variables in the previous year. Oral health needs were established by means of a dental examination. To identify the independent variables associated with dental health services utilization, two types of multivariate regression models were used, according to the measurement scale of the outcome variable: a) frequency of utilization as (0) none, (1) one, and (2) two or more, analyzed with the ordered logistic regression and b) the type of service utilized as (0) none, (1) preventive services, (2) curative services, and (3) both services, analyzed with the multinomial logistic regression. The proportion of children who received at least one dental service in the 12 months prior to the study was 27.7 percent. The variables associated with utilization in the two models were older age, female sex, more frequent toothbrushing, positive attitude of the mother toward the child's oral health, higher socioeconomic level, and higher oral health needs. Various predisposing, enabling, and oral health needs variables were associated with higher dental health services utilization. As in prior reports elsewhere, these results from Nicaragua confirmed that utilization inequalities exist between socioeconomic groups. The multinomial logistic regression model evidenced the association of different variables depending on the type of service used.

CallWall: tracking resident calls to improve clinical utilization of pathology laboratories.

PubMed

Buck, Thomas P; Connor, Ian M; Horowitz, Gary L; Arnaout, Ramy A

2011-07-01

Clinical pathology (CP) laboratories are used for millions of tests each year. These lead to thousands of calls to CP residents. However, although laboratory utilization is a frequent topic of study, clinical utilization--the content of the interactions between clinicians and CP residents--is not. Because it reflects questions about laboratory utilization, clinical utilization could suggest ways to improve both training and care by reducing diagnostic error. To build and implement a secure, scalable Web-based system to allow CP residents at any hospital to track the calls they receive, the interaction's context, and the action taken as a result, with evidence where applicable, and to use this system to report on clinical utilization at a major academic hospital. Entries were analyzed from a nearly year-long period to describe the clinical utilization of CP at a large academic teaching hospital. Sixteen residents logged 847 calls during 10 months, roughly evenly distributed among transfusion medicine, chemistry, microbiology, and hematopathology. Calls covered 94 different analytes in chemistry and 71 different organisms or tests in microbiology. Analysis revealed areas where CP can improve clinical care through educating the clinical services, for example, about ordering Rh immune globulin, testosterone testing, and diagnosis of tick-borne diseases. Documenting calls also highlighted patterns among residents. Clinical utilization is a potentially rich knowledge base for improving patient care and resident training. Our resident call-tracking system is a useful way for measuring clinical utilization and mining it for actionable information.

Mapping the functional assessment of cancer therapy-breast (FACT-B) to the 5-level EuroQoL Group's 5-dimension questionnaire (EQ-5D-5L) utility index in a multi-ethnic Asian population.

PubMed

Cheung, Yin Bun; Luo, Nan; Ng, Raymond; Lee, Chun Fan

2014-12-12

To develop an algorithm for mapping the Functional Assessment of Cancer Therapy-Breast (FACT-B) to the 5-level EuroQoL Group's 5-dimension questionnaire (EQ-5D-5L) utility index. A survey of 238 breast cancer patients in Singapore was conducted. Models using various regression methods with or without recognizing the upper boundary of utility values at 1 were fitted to predict the EQ-5D-5L utility index based on the five subscale scores of the FACT-B. Data from a follow-up survey of these patients were used to validate the results. A model that maps the physical, emotional, functional well-being and the breast cancer concerns subscales of the FACT-B to the EQ-5D-5L utility index was derived. The social well-being subscale was not associated to the utility index. Although theoretical assumptions may not be valid, ordinary least square outperformed other regression methods. The mean predicted utility index within each performance status level at follow-up deviated from the observed mean less than the minimally important difference of EQ-5D for cancer patients. The mapping algorithm converts the FACT-B to the EQ-5D utility index. This enables oncologists, clinical researchers and policy makers to obtain a quantitative utility summary of a patient's health status when only the FACT-B is assessed.

Substrate utilization profiles of bacterial strains in plankton from the River Warnow, a humic and eutrophic river in north Germany.

PubMed

Freese, Heike M; Eggert, Anja; Garland, Jay L; Schumann, Rhena

2010-01-01

Bacteria are very important degraders of organic substances in aquatic environments. Despite their influential role in the carbon (and many other element) cycle(s), the specific genetic identity of active bacteria is mostly unknown, although contributing phylogenetic groups had been investigated. Moreover, the degree to which phenotypic potential (i. e., utilization of environmentally relevant carbon substrates) is related to the genomic identity of bacteria or bacterial groups is unclear. The present study compared the genomic fingerprints of 27 bacterial isolates from the humic River Warnow with their ability to utilize 14 environmentally relevant substrates. Acetate was the only substrate utilized by all bacterial strains. Only 60% of the strains respired glucose, but this substrate always stimulated the highest bacterial activity (respiration and growth). Two isolates, both closely related to the same Pseudomonas sp., also had very similar substrate utilization patterns. However, similar substrate utilization profiles commonly belonged to genetically different strains (e.g., the substrate profile of Janthinobacterium lividum OW6/RT-3 and Flavobacterium sp. OW3/15-5 differed by only three substrates). Substrate consumption was sometimes totally different for genetically related isolates. Thus, the genomic profiles of bacterial strains were not congruent with their different substrate utilization profiles. Additionally, changes in pre-incubation conditions strongly influenced substrate utilization. Therefore, it is problematic to infer substrate utilization and especially microbial dissolved organic matter transformation in aquatic systems from bacterial molecular taxonomy.

Trends in Preventable Inpatient and Emergency Department Utilization in California Between 2012 and 2015: The Role of Health Insurance Coverage and Primary Care Supply.

PubMed

Cunningham, Peter; Sheng, Yaou

2018-06-01

Expansions of health insurance coverage tend to increase hospital emergency department (ED) utilization and inpatient admissions. However, provisions in the Affordable Care Act that expanded primary care supply were intended in part to offset the potential for increased hospital utilization. To examine the association between health insurance coverage, primary care supply, and ED and inpatient utilization, and to assess how both factors contributed to trends in utilization in California between 2012 and 2015. Population-based measures of ED and inpatient utilization, insurance coverage, and primary care supply were constructed for California counties for the years 2012 through 2015. Fixed effects regression analysis is used to examine the association between health insurance coverage, primary care supply, and rates of preventable ED and inpatient utilization. Higher levels of Medicaid coverage in a county are associated with higher levels of preventable ED and inpatient utilization, although greater numbers of primary care practitioners and Federally Qualified Health Centers reduce this type of utilization. Increases in coverage accelerated a long-term increase in ED visits and prevented an even larger decrease in inpatient admissions, but changes in coverage do not fully explain these underlying trends. Increases in primary care supply offset the effects of coverage changes only modestly. Policymakers should not overstate the impact of the Affordable Care Act on increasing ED visits, and should focus on better understanding the underlying factors that are driving the trends.

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

NASA Astrophysics Data System (ADS)

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

2015-12-01

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

Study on the Potential Development of Rainwater Utilization in the Hilly City of Southern China

NASA Astrophysics Data System (ADS)

Fu, Xiaoran; Liu, Jiahong; Shao, Weiwei; Zhang, Haixing

2017-12-01

Aimed at the current flood problems and the contradiction between supply and demand of water resources in the southern cities of China, the comprehensive utilization of Urban Rainwater Resources (URRs) is a significant solution. At present, the research on the comprehensive utilization system of urban rainwater resources in China is still immature, especially the lack of a comprehensive method for the comprehensive utilization of the rainwater and flood resources in the south. Based on the current mode for utilization of URRs at home and abroad, Fenghuang County in Hunan Province was taken as a case of study, which is a typical mountainous city in the southern China. And the potential development of URRs was simulated and evaluated with a comparison of before and after the exploitation and utilization of URRs in this paper. The reduction effect of flood and waterlogging on the ancient city area is analyzed from SWMM. The simulation results show that the potential of exploitation and utilization of URRs in Fenghuang county is remarkable under the mode of exploitation and utilization which is given priority to flood prevention and control, and the annual development potential is 4.865×105 m3. The rainwater utilization measures of flood control effect is obvious with this mode, and the relevant research results can provide theoretical and technical support for enhancing urban water security capability, water conservation capacity, and disaster mitigation of urban flood.

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

DTIC Science & Technology

2017-06-09

UTILITY OF ARMY DESIGN METHODOLOGY IN U.S. COAST GUARD COUNTER NARCOTIC INTERDICTION STRATEGY A thesis presented to the...Thesis 3. DATES COVERED (From - To) AUG 2016 – JUN 2017 4. TITLE AND SUBTITLE Utility of Army Design Methodology in U.S. Coast Guard Counter...Distribution is Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT This study investigates the utility of using Army Design Methodology (ADM) to

Utility deregulation and AMR technology. [Automated Meter Reading

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

Moore, G.

1991-06-15

This article reviews the effects of deregulation on other utilities and services and examines how the electric utilities can avoid the worst of these effects and capitalize of the best aspects of competition in achieving marketing excellence. The article presents deregulation as a customer service and underscores the need for utilities to learn to compete aggressively and intelligently and provide additional services available through technology such as automated meter reading.

A Roadmap for Recovery/Decontamination Plan for Critical Infrastructure after CBRN Event Involving Drinking Water Utilities: Scoping Study

DTIC Science & Technology

2014-05-01

A Roadmap for Recovery/Decontamination Plan for Critical Infrastructure after CBRN Event Involving Drinking Water Utilities: Scoping Study... Drinking Water Utilities was supported by the Canadian Safety and Security Program (CSSP) which is led by Defence Research and Development Canada’s Centre...after CBRN Event Involving Drinking Water Utilities Scoping Study Prepared by: Vladimir Blinov Konstantin Volchek Emergencies Science and

Utility company views of geothermal development

NASA Technical Reports Server (NTRS)

Hinrichs, T. C.

1974-01-01

The views of geothermal development from a utility company standpoint are presented. The impediments associated with such developments as required reliability and identification of risks are discussed. The utility industry historically is not a risk-taking industry. Support of rapid geothermal development by the utility industry requires identification and elimination of risks or absorption of the risks by other agencies. Suggestions as to the identification and minimization of risks are made.

util_2comp: Planck-based two-component dust model utilities

NASA Astrophysics Data System (ADS)

Meisner, Aaron

2014-11-01

The util_2comp software utilities generate predictions of far-infrared Galactic dust emission and reddening based on a two-component dust emission model fit to Planck HFI, DIRBE and IRAS data from 100 GHz to 3000 GHz. These predictions and the associated dust temperature map have angular resolution of 6.1 arcminutes and are available over the entire sky. Implementations in IDL and Python are included.

Estimating potential stranded commitments for U.S. investor-owned electric utilities

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

Baxter, L.; Hirst, E.

New technologies, low natural gas prices, and federal and state utility regions are restructuring the electricity industry. Yesterday`s vertically integrated utility with a retail monopoly franchise may be a very different organization in a few years. Conferences, regulatory-commission hearings, and other industry fora are dominated by debates over the extent and form of utility deintegration, wholesale competition, and retail wheeling. A key obstacle to restructuring the electricity industry is stranded commitments. Past investments, power-purchase contracts, and public-policy-driven programs that made sense in an era of cost-of-service regulation may not be cost-effective in a competitive power market. Regulators, utilities, and othermore » parties face tough decisions concerning the mitigation and allocation of these stranded commitments. The authors developed and applied a simple method to calculate the amount of stranded commitments facing US investor-owned electric utilities. The results obtained with this method depend strongly on a few key assumptions: (1) the fraction of utility sales that is at risk with respect to competition, (2) the market price of electric generation, and (3) the number of years during which the utility would lose money because of differences between its embedded cost of production and the market price.« less

Single-cell characterization of metabolic switching in the sugar phosphotransferase system of Escherichia coli.

PubMed

Westermayer, Sonja A; Fritz, Georg; Gutiérrez, Joaquín; Megerle, Judith A; Weißl, Mira P S; Schnetz, Karin; Gerland, Ulrich; Rädler, Joachim O

2016-05-01

The utilization of several sugars in Escherichia coli is regulated by the Phosphotransferase System (PTS), in which diverse sugar utilization modules compete for phosphoryl flux from the general PTS proteins. Existing theoretical work predicts a winner-take-all outcome when this flux limits carbon uptake. To date, no experimental work has interrogated competing PTS uptake modules with single-cell resolution. Using time-lapse microscopy in perfused microchannels, we analyzed the competition between N-acetyl-glucosamine and sorbitol, as representative PTS sugars, by measuring both the expression of their utilization systems and the concomitant impact of sugar utilization on growth rates. We find two distinct regimes: hierarchical usage of the carbohydrates, and co-expression of the genes for both systems. Simulations of a mathematical model incorporating asymmetric sugar quality reproduce our metabolic phase diagram, indicating that under conditions of nonlimiting phosphate flux, co-expression is due to uncoupling of both sugar utilization systems. Our model reproduces hierarchical winner-take-all behaviour and stochastic co-expression, and predicts the switching between both strategies as a function of available phosphate flux. Hence, experiments and theory both suggest that PTS sugar utilization involves not only switching between the sugars utilized but also switching of utilization strategies to accommodate prevailing environmental conditions. © 2016 John Wiley & Sons Ltd.

Innovative electricity marketing. Utilities must rethink how they can meet their customers' needs

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

Pierobon, J.R.

1994-04-15

Tradition-bound utility commissioners and electricity providers who believe electric utilities are insulated from competition until retail wheeling arrives should carefully assess just how quickly competition is remaking the electric power marketplace. The widely predicted industry evolution spawned by the Energy Policy Act of 1992 is becoming nothing less than a revolution. Some utilities and their regulators still don't seem to grasp the sea-change taking place. Others are genuinely rethinking how utilities can serve their most valued customers and try to win new ones-even if it means taking customers away from another utility. Electric utilities that respond by understanding, communicating, andmore » meeting needs in the marketplace will likely thrive in the new era. Those that don't are tempting fate. And fate could arrive before a full-fledged retail wheeling proposal becomes law. Regulators fixated on retail wheeling per se or determined to defend the status quo are missing the point. Large users of electricity certainly want retail wheeling. They're applying pressure wherever and however they can to win it. But they're not waiting until they get retail wheeling to flex their purchasing clout. Some state commissioners need to recognize this and empower utilities to respond.« less

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

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.

Does performance evaluation help public managers? A Balanced Scorecard approach in urban waste services.

PubMed

Guimarães, Bernardo; Simões, Pedro; Marques, Rui Cunha

2010-12-01

The urban waste market has evolved significantly in the past decades, which among other changes, has led to the creation of new utilities and new business models. However, very few things have changed for the users. Urban waste collection remains mainly under the responsibility of local authorities and the charges paid by the users in most countries are very low compared to the provision costs. This situation forces the injection of public money into the system, encouraging the 'quiet-life' within the utilities and, therefore, inefficiency. The present study intends to analyze the potential for the application of the Balanced Scorecard (BSc) methodology into the waste utilities. After a comprehensive revision of the urban waste sector in Portugal, the methodology of BSc and its application in local public services is described and discussed. Focusing on implementation rather than on strategy, a set of performance indicators is proposed to be utilized in the different management models of waste utilities in Portugal: the municipalities, semi-autonomous utilities, municipal companies and mixed companies. This implementation is then exemplified through four case studies, one for each type of utility. This paper provides a flexible framework proposal to be applied to waste utilities operating both in Portugal and abroad. Copyright © 2010 Elsevier Ltd. All rights reserved.

Role of catabolite regulatory mechanisms in control of carbohydrate utilization by the rumen anaerobic fungus Neocallimastix frontalis.

PubMed Central

Mountfort, D O; Asher, R A

1983-01-01

Neocallimastix frontalis PN-1 utilized the soluble sugars D-glucose, D-cellobiose, D-fructose, maltose, sucrose, and D-xylose for growth. L-Arabinose, D-galactose, D-mannose, and D-xylitol did not support growth of the fungus. Paired substrate test systems were used to determine whether any two sugars were utilized simultaneously or sequentially. Of the paired monosaccharides tested, glucose was found to be preferentially utilized compared with fructose and xylose. The disaccharides cellobiose and sucrose were preferentially utilized compared with fructose and glucose, respectively, an cellobiose was also the preferred substrate compared with xylose. Xylose was the preferred substrate compared with maltose. In further incubations, the fungus was grown on the substrate utilized last in the two-substrate tests. After moderate growth was attained, the preferred substrate was added to the culture medium. Inhibition of nonpreferred substrate utilization by the addition of the preferred substrate was taken as evidence of catabolite regulation. For the various combinations of substrates tested, fructose and xylose utilization was found to be inhibited in the presence of glucose, indicating that catabolite regulation was involved. No clear-cut inhibition was observed with any of the other substrate combinations tested. The significance of these findings in relation to rumen microbial interactions and competitions is discussed. PMID:6660873

A Decade in Dental Care Utilization among Adults and Children (2001–2010)

PubMed Central

Vujicic, Marko; Nasseh, Kamyar

2014-01-01

Objective To decompose the change in pediatric and adult dental care utilization over the last decade. Data 2001 through 2010 Medical Expenditure Panel Survey. Study Design The Blinder-Oaxaca decomposition was used to explain the change in dental care utilization among adults and children. Changes in dental care utilization were attributed to changes in explained covariates and changes due to movements in estimated coefficients. Controlling for demographics, overall health status, and dental benefits variables, we estimated year-specific logistic regression models. Outputs from these models were used to compute the Blinder-Oaxaca decomposition. Principal Findings Dental care utilization decreased from 40.5 percent in 2001 to 37.0 percent in 2010 for adults and increased from 43.2 percent in 2001 to 46.3 percent in 2010 for children (p < .05). Among adults, changes in insurance status, race, and income contributed to a decline in adult dental care utilization (−0.018, p < .01). Among children, changes in controlled factors did not substantially change dental care utilization, which instead may be explained by changes in policy, oral health status, or preferences. Conclusions Dental care utilization for adults has declined, especially among the poor and uninsured. Without further policy intervention, disadvantaged adults face increasing barriers to dental care. PMID:24299620

How to interpret a healthcare economic analysis.

PubMed

Brown, Melissa M; Brown, Gary C

2005-06-01

The purpose of the review is to present guidelines to help the clinician to interpret healthcare economic analyses and review pertinent recent analysis in the ophthalmic literature. There are four variants of healthcare economic analyses: (1) cost-minimization analysis; (2) cost-benefit analysis; (3) cost-effectiveness analysis and (4) cost-utility analysis. Cost-utility utility analysis has assumed an increasingly important role in healthcare, with increasing number of analyses occurring in the peer-reviewed ophthalmic literature. These include cost-utility analyses of cataract surgery in the first and second eyes, amblyopia treatment, and cost-utility analyses encompassing the vitreoretinal interventions of the following: (1) laser photocoagulation for exudative macular degeneration; (2) laser treatment for diabetic retinopathy; (3) laser photocoagulation for branch retinal vein obstruction; (4) diabetic vitrectomy; (5) treatment of proliferative retinopathy of prematurity and (6) treatment of retinal detachment associated with proliferative vitreoretinopathy. As an increasing number of cost-utility analyses become available they will provide the information system for the practice of value-based medicine, or medicine based upon the patient-perceived value conferred by interventions. Increasing numbers of cost-utility analysis in the ophthalmic literature suggest that ophthalmic interventions, including vitreoretinal interventions, are cost effective. Cost-utility analysis is a major tool in value-based medicine, the practice of medicine based upon the patient-perceived value conferred by healthcare interventions.

[Value-based medicine in ophthalmology].

PubMed

Hirneiss, C; Neubauer, A S; Tribus, C; Kampik, A

2006-06-01

Value-based medicine (VBM) unifies costs and patient-perceived value (improvement in quality of life, length of life, or both) of an intervention. Value-based ophthalmology is of increasing importance for decisions in eye care. The methods of VBM are explained and definitions for a specific terminology in this field are given. The cost-utility analysis as part of health care economic analyses is explained. VBM exceeds evidence-based medicine by incorporating parameters of cost and benefits from an ophthalmological intervention. The benefit of the intervention is defined as an increase or maintenance of visual quality of life and can be determined by utility analysis. The time trade-off method is valid and reliable for utility analysis. The resources expended for the value gained in VBM are measured with cost-utility analysis in terms of cost per quality-adjusted life years gained (euros/QALY). Numerous cost-utility analyses of different ophthalmological interventions have been published. The fundamental instrument of VBM is cost-utility analysis. The results in cost per QALY allow estimation of cost effectiveness of an ophthalmological intervention. Using the time trade-off method for utility analysis allows the comparison of ophthalmological cost-utility analyses with those of other medical interventions. VBM is important for individual medical decision making and for general health care.

Acetate transport and utilization in the rat brain.

PubMed

Deelchand, Dinesh K; Shestov, Alexander A; Koski, Dee M; Uğurbil, Kâmil; Henry, Pierre-Gilles

2009-05-01

Acetate, a glial-specific substrate, is an attractive alternative to glucose for the study of neuronal-glial interactions. The present study investigates the kinetics of acetate uptake and utilization in the rat brain in vivo during infusion of [2-13C]acetate using NMR spectroscopy. When plasma acetate concentration was increased, the rate of brain acetate utilization (CMR(ace)) increased progressively and reached close to saturation for plasma acetate concentration > 2-3 mM, whereas brain acetate concentration continued to increase. The Michaelis-Menten constant for brain acetate utilization (K(M)(util) = 0.01 +/- 0.14 mM) was much smaller than for acetate transport through the blood-brain barrier (BBB) (K(M)(t) = 4.18 +/- 0.83 mM). The maximum transport capacity of acetate through the BBB (V(max)(t) = 0.96 +/- 0.18 micromol/g/min) was nearly twofold higher than the maximum rate of brain acetate utilization (V(max)(util) = 0.50 +/- 0.08 micromol/g/min). We conclude that, under our experimental conditions, brain acetate utilization is saturated when plasma acetate concentrations increase above 2-3 mM. At such high plasma acetate concentration, the rate-limiting step for glial acetate metabolism is not the BBB, but occurs after entry of acetate into the brain.

Dental utilization by active duty Army personnel.

PubMed

Chisick, M C

1993-10-01

In spring 1989, a random, Army-wide sample of 15,364 enlisted and 4,529 officer personnel was surveyed on dental utilization. Results show no difference in annual dental utilization between officer and enlisted personnel when age is controlled. Because annual dental utilization increases with age and enlisted ranks contain a disproportionately large number of younger personnel, a difference in annual dental utilization between enlisted and officer personnel emerges when age is not controlled. Check-ups are the most common reason for dental visits. Nearly all soldiers seek care exclusively in military dental clinics. Non-use is highest among 18- to 19-year-olds (12.2%).

Land mobile spectrum utilization: San Francisco, California and Chicago, Illinois

NASA Astrophysics Data System (ADS)

Reed, L. D.

1980-08-01

Radio frequency utilization by Federal Communication Commission licenses in the San Francisco and Chicago urbanized areas is described. The license include among others: police and fire departments; hospitals; public utilities; marine; and common carrier users. The extent of frequency utilization is described in terms of four occupancy categorizations (zero, low, substantial and very high). The rationale for these categories and their relationship to measured usage data is given. Summary tables enable direct comparison of the use by various individual, radio services, e.g., police, business, taxicab, etc. Separate analyses are given for utilization by each of the land mobile radio services and for each frequency band.

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.

Capacity and Utilization in Health Care: The Effect of Empty Beds on Neonatal Intensive Care Admission

PubMed Central

Freedman, Seth

2016-01-01

Because geographic variation in medical care utilization is jointly determined by both supply and demand, it is difficult to empirically estimate whether capacity itself has a causal impact on utilization in health care. In this paper, I exploit short-term variation in Neonatal Intensive Care Unit (NICU) capacity that is unlikely to be correlated with unobserved demand determinants. I find that available NICU beds have little to no effect on NICU utilization for the sickest infants, but do increase utilization for those in the range of birth weights where admission decisions are likely to be more discretionary. PMID:27942353

Utility pole crash modeling.

DOT National Transportation Integrated Search

2001-02-01

Maine was recently ranked 9th in the nation concerning fatalities caused by collisions with utility poles based on : Miles of Travel. The number of collisions and fatalities can be reduced significantly with an updated Utility Pole : Placement Policy...

Utility installation review system : implementation report.

DOT National Transportation Integrated Search

2009-03-01

Each year, the Texas Department of Transportation (TxDOT) issues thousands of approvals that enable new : utility installations to occupy the state right of way (ROW). The current utility installation review process : relies on the physical delivery ...

Utility accommodation and conflict tracker (UACT) installation and configuration manual.

DOT National Transportation Integrated Search

2009-02-01

Project 0-5475 performed a comprehensive analysis of utility conflict data/information flows between utility : accommodation stakeholders in the Texas Department of Transportation project development process, : developed data models to accommodate wo...

Making It Count: Understanding the Value of Energy Efficiency Financing Programs Funded by Utility Customers

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

Kramer, Chris; Fadrhonc, Emily Martin; Goldman, Charles

Utility customer-supported financing programs are receiving increased attention as a strategy for achieving energy saving goals. Rationales for using utility customer funds to support financing initiatives

Utility Incentives for Combined Heat and Power

EPA Pesticide Factsheets

This report describes the results of EPA's research and analysis into utility incentives for CHP. It provides information about utility-initiated policies, programs, and incentives for CHP systems, and includes case studies and tools and resources.

7 CFR 3560.205 - Rent and utility allowance changes.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., DEPARTMENT OF AGRICULTURE DIRECT MULTI-FAMILY HOUSING LOANS AND GRANTS Rents § 3560.205 Rent and utility... in a visible location frequented by tenants. (e) Approval. If the Agency approves a rent or utility...

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

Bird, L.; Brown, E.

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

Examination of Electric Utility CEO Compensation 2000-2011 and its significance to Company Earnings, Company Revenue, Company Stock and the Dow Jones Utility Average

NASA Astrophysics Data System (ADS)

Labovitch, Andrew

This dissertation examined electric utility CEO compensation during the years 2000 through 2011 for United States owned and operated companies. To determine the extent to which agency theory may apply to electric utility CEO compensation, this examination segmented the industry by four types of company financial metrics: revenue, earnings, stock price and the Dow Jones Utility Average; by five categories of CEO compensation: base salary, bonus, stock grants, all other compensation and total compensation; and by four categories of company size as measured by revenue: large, medium, small and the industry as a whole. Electric utility CEO compensation data was analyzed with the financial metrics to determine correlations. No type of compensation was highly correlated to any of the financial metrics for any size industry segment indicating that there was little agency. CEO compensation in large electric utility companies was higher than compensation in medium and smaller companies even though the CEOs at larger companies earned less per dollar of revenue and per dollar of earnings than their counterparts in smaller companies.

GrDHP: a general utility function representation for dual heuristic dynamic programming.

PubMed

Ni, Zhen; He, Haibo; Zhao, Dongbin; Xu, Xin; Prokhorov, Danil V

2015-03-01

A general utility function representation is proposed to provide the required derivable and adjustable utility function for the dual heuristic dynamic programming (DHP) design. Goal representation DHP (GrDHP) is presented with a goal network being on top of the traditional DHP design. This goal network provides a general mapping between the system states and the derivatives of the utility function. With this proposed architecture, we can obtain the required derivatives of the utility function directly from the goal network. In addition, instead of a fixed predefined utility function in literature, we conduct an online learning process for the goal network so that the derivatives of the utility function can be adaptively tuned over time. We provide the control performance of both the proposed GrDHP and the traditional DHP approaches under the same environment and parameter settings. The statistical simulation results and the snapshot of the system variables are presented to demonstrate the improved learning and controlling performance. We also apply both approaches to a power system example to further demonstrate the control capabilities of the GrDHP approach.

Using Neural Data to Test A Theory of Investor Behavior: An Application to Realization Utility.

PubMed

Frydman, Cary; Barberis, Nicholas; Camerer, Colin; Bossaerts, Peter; Rangel, Antonio

2014-04-01

We use measures of neural activity provided by functional magnetic resonance imaging (fMRI) to test the "realization utility" theory of investor behavior, which posits that people derive utility directly from the act of realizing gains and losses. Subjects traded stocks in an experimental market while we measured their brain activity. We find that all subjects exhibit a strong disposition effect in their trading, even though it is suboptimal. Consistent with the realization utility explanation for this behavior, we find that activity in the ventromedial prefrontal cortex, an area known to encode the value of options during choices, correlates with the capital gains of potential trades; that the neural measures of realization utility correlate across subjects with their individual tendency to exhibit a disposition effect; and that activity in the ventral striatum, an area known to encode information about changes in the present value of experienced utility, exhibits a positive response when subjects realize capital gains. These results provide support for the realization utility model and, more generally, demonstrate how neural data can be helpful in testing models of investor behavior.

Utility functions and resource management in an oversubscribed heterogeneous computing environment

DOE PAGES

Khemka, Bhavesh; Friese, Ryan; Briceno, Luis Diego; ...

2014-09-26

We model an oversubscribed heterogeneous computing system where tasks arrive dynamically and a scheduler maps the tasks to machines for execution. The environment and workloads are based on those being investigated by the Extreme Scale Systems Center at Oak Ridge National Laboratory. Utility functions that are designed based on specifications from the system owner and users are used to create a metric for the performance of resource allocation heuristics. Each task has a time-varying utility (importance) that the enterprise will earn based on when the task successfully completes execution. We design multiple heuristics, which include a technique to drop lowmore » utility-earning tasks, to maximize the total utility that can be earned by completing tasks. The heuristics are evaluated using simulation experiments with two levels of oversubscription. The results show the benefit of having fast heuristics that account for the importance of a task and the heterogeneity of the environment when making allocation decisions in an oversubscribed environment. Furthermore, the ability to drop low utility-earning tasks allow the heuristics to tolerate the high oversubscription as well as earn significant utility.« less

The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons

PubMed Central

Culbert, Gabriel J.; Bazazi, Alexander R.; Waluyo, Agung; Murni, Astia; Muchransyah, Azalia P.; Iriyanti, Mariska; Finnahari; Polonsky, Maxim; Levy, Judith; Altice, Frederick L.

2015-01-01

Negative attitudes toward HIV medications may restrict utilization of antiretroviral therapy (ART) in Indonesian prisons where many people living with HIV (PLH) are diagnosed and first offered ART. This mixed-method study examines the influence of medication attitudes on ART utilization among HIV-infected Indonesian prisoners. Randomly-selected HIV-infected male prisoners (n = 102) completed face-to-face in-depth interviews and structured surveys assessing ART attitudes. Results show that although half of participants utilized ART, a quarter of those meeting ART eligibility guidelines did not. Participants not utilizing ART endorsed greater concerns about ART efficacy, safety, and adverse effects, and more certainty that ART should be deferred in PLH who feel healthy. In multivariate analyses, ART utilization was independently associated with more positive ART attitudes (AOR = 1.09, 95 % CI 1.03–1.16, p = 0.002) and higher internalized HIV stigma (AOR = 1.03, 95 % CI 1.00–1.07, p = 0.016). Social marketing of ART is needed to counteract negative ART attitudes that limit ART utilization among Indonesian prisoners. PMID:26400080

Maximum saliency bias in binocular fusion

NASA Astrophysics Data System (ADS)

Lu, Yuhao; Stafford, Tom; Fox, Charles

2016-07-01

Subjective experience at any instant consists of a single ("unitary"), coherent interpretation of sense data rather than a "Bayesian blur" of alternatives. However, computation of Bayes-optimal actions has no role for unitary perception, instead being required to integrate over every possible action-percept pair to maximise expected utility. So what is the role of unitary coherent percepts, and how are they computed? Recent work provided objective evidence for non-Bayes-optimal, unitary coherent, perception and action in humans; and further suggested that the percept selected is not the maximum a posteriori percept but is instead affected by utility. The present study uses a binocular fusion task first to reproduce the same effect in a new domain, and second, to test multiple hypotheses about exactly how utility may affect the percept. After accounting for high experimental noise, it finds that both Bayes optimality (maximise expected utility) and the previously proposed maximum-utility hypothesis are outperformed in fitting the data by a modified maximum-salience hypothesis, using unsigned utility magnitudes in place of signed utilities in the bias function.

77 FR 45967 - National Emission Standards for Hazardous Air Pollutants From Coal- and Oil-Fired Electric...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-02

... Electric Utility Steam Generating Units and Standards of Performance for Fossil-Fuel-Fired Electric Utility...-fired Electric Utility Steam Generating Units and Standards of Performance for Fossil-Fuel-Fired...

Xylose utilization in recombinant zymomonas

DOEpatents

Caimi, Perry G; McCole, Laura; Tao, Luan; Tomb, Jean-Francois; Viitanen, Paul V

2014-03-25

Xylose-utilizing Zymomonas strains studied were found to accumulate ribulose when grown in xylose-containing media. Engineering these strains to increase ribose-5-phosphate isomerase activity led to reduced ribulose accumulation, improved growth, improved xylose utilization, and increased ethanol production.

Sport Utility Vehicles: Traffic Safety Tips

DOT National Transportation Integrated Search

1996-01-01

This fact sheet, NHTSA Facts: Summer 1996, describe traffic safety tips for driving sport utility vehicles. Because sport utility vehicles have a higher center of gravity, making them more top heavy than cars, they handle and maneuver differently tha...

Utility installation review (UIR) system training materials.

DOT National Transportation Integrated Search

2008-10-01

The Texas Department of Transportation (TxDOT) issues thousands of approvals every year that : enable new utility installations to occupy the state right-of-way (ROW). The utility installation : review process currently in place is manual, tedious, a...

Aligning Utility Incentives with Investment in Energy Efficiency

EPA Pesticide Factsheets

Learn more about the financial effects on a utility of its spending on energy efficiency programs, how those effects could constitute barriers to utility investment in energy efficiency, and how various policies can reduce these barriers.

A Method to Predict Compressor Stall in the TF34-100 Turbofan Engine Utilizing Real-Time Performance Data

DTIC Science & Technology

2015-06-01

A METHOD TO PREDICT COMPRESSOR STALL IN THE TF34-100 TURBOFAN ENGINE UTILIZING REAL-TIME PERFORMANCE...THE TF34-100 TURBOFAN ENGINE UTILIZING REAL-TIME PERFORMANCE DATA THESIS Presented to the Faculty Department of Systems Engineering and...036 A METHOD TO PREDICT COMPRESSOR STALL IN THE TF34-100 TURBOFAN ENGINE UTILIZING REAL-TIME PERFORMANCE DATA Shuxiang ‘Albert’ Li, BS

Aircrew Training Devices: Utility and Utilization of Advanced Instructional Features (Phase II-Air Training Command, Military Airlift Command, and Strategic Air Command [and] Phase III-Electronic Warfare Trainers).

ERIC Educational Resources Information Center

Polzella, Donald J.; Hubbard, David C.

This document consists of an interim report and a final report which describe the second and third phases of a project designed to determine the utility and utilization of sophisticated hardware and software capabilities known as advanced instructional features (AIFs). Used with an aircrew training device (ATD), AIFs permit a simulator instructor…

Research utilization in nursing: the power of one.

PubMed

Jacobson, A F

2000-01-01

Common barriers to research utilization in nursing include characteristics of the setting in which nurses practice, nurses themselves, and nursing's dependence on rituals and traditions in practice. Nurses can overcome these barriers by questioning their practice and adopting attitudes and values that prioritize research utilization. The "Power of One" Model of Research Utilization guides nurses to examine everyday practices, assess their research foundations, and implement and evaluate changes to research-based practice.

Then and now with utility advertising and marketing

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

Netschert, B.C.

Basic business functions, such as advertising and marketing, occupy a valid place in the lives of public utilities, even in an environment where conservation and economy are emphasized. The author describes how a particular group of electric-utility companies has changed emphasis in an exemplary response to new societal pressures and values. He identifies the litmus test of the appropriateness of promotional and information activities and expenditures by utilities in terms of consumer sovereignty.

Utilization of Military Women. (A Report of Increased Utilization of Military Women, FY-1973-1977)

DTIC Science & Technology

The purpose of the study was to examine the utilization of military women and to prepare contingency plans for increasing the use of women to offset...to the utilization of military women : History of women in the Armed Forces; potential supply of women for the Armed Forces; assignment policies...attrition rates; costs of military women versus men; and service plans for increasing use of military women .

Awareness and Utilization of Welders' Personal Protective Eye Devices and Associated Factors: Findings and Lessons From a Nigerian Population.

PubMed

Eze, Boniface I; Okoye, Obiekwe; Aguwa, Emmanuel N

2015-04-01

This study assessed commercial welders' awareness and utilization of personal protective eye devices (PPEDs), and their associations, in Enugu, Nigeria, between January and March, 2011. The participants included 343 males, age 33.9 years±10.0 SD years. The participants reported high awareness of welding-associated ocular hazards (99.4%) and PPEDs (75.2%-98.3%), but low PPED possession and utilization rates. Cost and "presumed lack of utility" were the leading barriers to PPED possession; non-utilization was mainly attributed to "user inconvenience" and "presumed lack of protective benefit." PPED utilization was significantly associated with lower educational status (p=.030) and electric welding (p<.0001). The underlying causes are amenable to preventive occupational eye health education, enhanced ergonomics and affordability of PPEDs, and legislative enforcement of their use. © 2015 The Author(s).

Dental Care Utilization for Examination and Regional Deprivation

PubMed Central

Kim, Cheol-Sin; Han, Sun-Young; Lee, Seung Eun; Kang, Jeong-Hee; Kim, Chul-Woung

2015-01-01

Objectives: Receiving proper dental care plays a significant role in maintaining good oral health. We investigated the relationship between regional deprivation and dental care utilization. Methods: Multilevel logistic regression was used to identify the relationship between the regional deprivation level and dental care utilization purpose, adjusting for individual-level variables, in adults aged 19+ in the 2008 Korean Community Health Survey (n=220 258). Results: Among Korean adults, 12.8% used dental care to undergo examination and 21.0% visited a dentist for other reasons. In the final model, regional deprivation level was associated with significant variations in dental care utilization for examination (p<0.001). However, this relationship was not shown with dental care utilization for other reasons in the final model. Conclusions: This study’s findings suggest that policy interventions should be considered to reduce regional variations in rates of dental care utilization for examination. PMID:26265665

Design Report Final - CUB Inc.

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

Armijo, Kenneth Miguel; Monda, Mark J.; Brunson, Gregory Paul

CUB (Critical Utility Base), Fig. 1.0, are individual portable energy and utility units utilizing renewable energy technologies integrated with high efficient conventional components to provide electricity, battery storage, heat, potable water, waste water treatment, cooling, liquid fuels, to name some of the primary utilities. Typically, these units were designed to provide power / utilities to any remote location or facility like forward operating bases, disaster relief centers, and Native American communities or to energize African villages. Although some CUB models have already been designed to date, the main unit, the CUB-E (electricity), lacks a critical component included in its design.more » It is the integral portion that automates solar electric panel racking deployment and retraction. This racking system will enable the CUB-E to rapidly deploy its utility within minutes, a feature not available in any form currently on the market.« less

Specification of the utility function in discrete choice experiments.

PubMed

van der Pol, Marjon; Currie, Gillian; Kromm, Seija; Ryan, Mandy

2014-03-01

The specification of the utility function has received limited attention within the discrete choice experiment (DCE) literature. This lack of investigation is surprising given that evidence from the contingent valuation literature suggests that welfare estimates are sensitive to different specifications of the utility function. This study investigates the effect of different specifications of the utility function on results within a DCE. The DCE elicited the public's preferences for waiting time for hip and knee replacement and estimated willingness to wait (WTW). The results showed that the WTW for the different patient profiles varied considerably across the three different specifications of the utility function. Assuming a linear utility function led to much higher estimates of marginal rates of substitution (WTWs) than with nonlinear specifications. The goodness-of-fit measures indicated that nonlinear specifications were superior. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Robust Bayesian decision theory applied to optimal dosage.

PubMed

Abraham, Christophe; Daurès, Jean-Pierre

2004-04-15

We give a model for constructing an utility function u(theta,d) in a dose prescription problem. theta and d denote respectively the patient state of health and the dose. The construction of u is based on the conditional probabilities of several variables. These probabilities are described by logistic models. Obviously, u is only an approximation of the true utility function and that is why we investigate the sensitivity of the final decision with respect to the utility function. We construct a class of utility functions from u and approximate the set of all Bayes actions associated to that class. Then, we measure the sensitivity as the greatest difference between the expected utilities of two Bayes actions. Finally, we apply these results to weighing up a chemotherapy treatment of lung cancer. This application emphasizes the importance of measuring robustness through the utility of decisions rather than the decisions themselves. Copyright 2004 John Wiley & Sons, Ltd.

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.

Ban on advertising promoting energy usage violates First Amendment

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

Cohen, J.C.

In reversing the New York Court of Appeals in the Central Hudson Gas suit, the Supreme Court expanded the protection afforded commercial speech. The result could have a major impact on means used to achieve policy objectives of national and state energy conservation. Public utility commissions attempting to limit the growth of energy usage may have to devise stringent economic regulations that directly affect the marketplace and consumer alternatives. This might require an expansion of the statutory powers of public utility commissions. The Court's decision will require public utility commissions to either adopt regulations that restrict the content and formatmore » of utility speech or allocate costs to utility shareholders of impermissible advertising. Otherwise, a utility's unbridled ability to speak, given the economic power of such enterprises and their economic interest, could totally undermine the credibility of national and state energy-conservation policy. 12 references.« less

Wind power for the electric-utility industry: Policy incentives for fuel conservation

NASA Astrophysics Data System (ADS)

March, F.; Dlott, E. H.; Korn, D. H.; Madio, F. R.; McArthur, R. C.; Vachon, W. A.

1982-06-01

A systematic method for evaluating the economics of solar-electric/conservation technologies as fuel-savings investments for electric utilities in the presence of changing federal incentive policies is presented. The focus is on wind energy conversion systems (WECS) as the solar technology closest to near-term large scale implementation. Commercially available large WECS are described, along with computer models to calculate the economic impact of the inclusion of WECS as 10% of the base-load generating capacity on a grid. A guide to legal structures and relationships which impinge on large-scale WECS utilization is developed, together with a quantitative examination of the installation of 1000 MWe of WECS capacity by a utility in the northeast states. Engineering and financial analyses were performed, with results indicating government policy changes necessary to encourage the entrance of utilities into the field of windpower utilization.

Delivery of health services to migrant and seasonal farmworkers.

PubMed

Arcury, Thomas A; Quandt, Sara A

2007-01-01

Farmworkers are low-paid, uninsured employees in an extremely hazardous industry, and they provide an essential service for U.S. society. This review evaluates the delivery of health services to farmworkers. It describes the farmworker population in the United States, noting characteristics (e.g., migratory and immigration status) that limit their access to and utilization of health services. It describes the health services needs of this population, including occupational health, mental health, oral health, and chronic disease treatment. Cultural, structural, legal, financial, and geographic barriers to health services utilization are described. Existing research on health services utilization among farmworkers is discussed. Programs that have been developed to address the barriers to health services utilization among farmworkers are reviewed. Finally, research needed to improve knowledge of farmworker health services utilization is suggested. These research needs include formal evaluations of existing programs and basic research to characterize the health services utilization patterns of farmworkers.

Symbiosis of sea anemones and hermit crabs: different resource utilization patterns in the Aegean Sea

NASA Astrophysics Data System (ADS)

Vafeiadou, Anna-Maria; Antoniadou, Chryssanthi; Chintiroglou, Chariton

2012-09-01

The small-scale distribution and resource utilization patterns of hermit crabs living in symbiosis with sea anemones were investigated in the Aegean Sea. Four hermit crab species, occupying shells of nine gastropod species, were found in symbiosis with the sea anemone Calliactis parasitica. Shell resource utilization patterns varied among hermit crabs, with Dardanus species utilizing a wide variety of shells. The size structure of hermit crab populations also affected shell resource utilization, with small-sized individuals inhabiting a larger variety of shells. Sea anemone utilization patterns varied both among hermit crab species and among residence shells, with larger crabs and shells hosting an increased abundance and biomass of C. parasitica. The examined biometric relationships suggested that small-sized crabs carry, proportionally to their weight, heavier shells and increased anemone biomass than larger ones. Exceptions to the above patterns are related either to local resource availability or to other environmental factors.

Renewable power sparks financial interest

NASA Astrophysics Data System (ADS)

Norman, C.

1981-06-01

A legal and economic assessment is given of section 210 of the Public Utility Regulatory Practices Act (PURPA) of 1978, which guarantees a market for small electrical power producers by requiring utilities to buy from them at premium rates and, in addition, exempts them from regulatory restrictions imposed on utilities. To qualify, small power producers are limited to a capacity of 80 MW at any one site, and they must use such renewable energy sources as wind, hydroelectric, biomass, solar, and waste products. There is no size limit for industrial cogeneration facilities, but those that burn oil or natural gas must meet efficiency standards to qualify. Section 210 has, however, been seriously challenged in the courts by utility companies viewing it as a Federal infringement of the right of States to regulate their utilities; a court ruling favorable to the utilities has already been given in Mississippi, and similar rulings are being sought in New York.

Establishing sustainable strategies in urban underground engineering.

PubMed

Curiel-Esparza, Jorge; Canto-Perello, Julian; Calvo, Maria A

2004-07-01

Growth of urban areas, the corresponding increased demand for utility services and the possibility of new types of utility systems are overcrowding near surface underground space with urban utilities. Available subsurface space will continue to diminish to the point where utilidors (utility tunnels) may become inevitable. Establishing future sustainable strategies in urban underground engineering consists of the ability to lessen the use of traditional trenching. There is an increasing interest in utility tunnels for urban areas as a sustainable technique to avoid congestion of the subsurface. One of the principal advantages of utility tunnels is the substantially lower environmental impact compared with common trenches. Implementing these underground facilities is retarded most by the initial cost and management procedures. The habitual procedure is to meet problems as they arise in current practice. The moral imperative of sustainable strategies fails to confront the economic and political conflicts of interest. Municipal engineers should act as a key enabler in urban underground sustainable development.

Perceived need for care and mental health service utilization among college students with suicidal ideation.

PubMed

Nam, Boyoung; Wilcox, Holly C; Hilimire, Matthew; DeVylder, Jordan E

2018-01-31

This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.

Planning and managing market research: Electric utility market research monograph series: Monograph 1

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

Whitelaw, R.W.

1987-01-01

The market research techniques available now to the electric utility industry have evolved over the last thirty years into a set of sophisticated tools that permit complex behavioral analyses that earlier had been impossible. The marketing questions facing the electric utility industry now are commensurately more complex than ever before. This document was undertaken to present the tools and techniques needed to start or improve the usefulness of market research activities within electric utilities. It describes proven planning and management techniques as well as decision criteria for structuring effective market research functions for each utility's particular needs. The monograph establishesmore » the parameters of sound utility market research given trade-offs between highly centralized or decentralized organizations, research focus, involvement in decision making, and personnel and management skills necessary to maximize the effectiveness of the structure chosen.« less

Risk and utility in portfolio optimization

NASA Astrophysics Data System (ADS)

Cohen, Morrel H.; Natoli, Vincent D.

2003-06-01

Modern portfolio theory (MPT) addresses the problem of determining the optimum allocation of investment resources among a set of candidate assets. In the original mean-variance approach of Markowitz, volatility is taken as a proxy for risk, conflating uncertainty with risk. There have been many subsequent attempts to alleviate that weakness which, typically, combine utility and risk. We present here a modification of MPT based on the inclusion of separate risk and utility criteria. We define risk as the probability of failure to meet a pre-established investment goal. We define utility as the expectation of a utility function with positive and decreasing marginal value as a function of yield. The emphasis throughout is on long investment horizons for which risk-free assets do not exist. Analytic results are presented for a Gaussian probability distribution. Risk-utility relations are explored via empirical stock-price data, and an illustrative portfolio is optimized using the empirical data.

How Accurate are Self-Reports? An Analysis of Self-Reported Healthcare Utilization and Absence When Compared to Administrative Data

PubMed Central

Short, Meghan E.; Pei, Xiaofei; Tabrizi, Maryam J.; Ozminkowski, Ronald J.; Gibson, Teresa B.; DeJoy, Dave M.; Wilson, Mark G.

2009-01-01

Objective To determine the accuracy of self-reported healthcare utilization and absence reported on health risk assessments (HRAs) against administrative claims and human resource records. Methods Self-reported values of healthcare utilization and absenteeism were analyzed for concordance to administrative claims values. Percent agreement, Pearson’s correlations, and multivariate logistic regression models examined the level of agreement and characteristics of participants with concordance. Results Self-report and administrative data showed greater concordance for monthly compared to yearly healthcare utilization metrics. Percent agreement ranged from 30 to 99% with annual doctor visits having the lowest percent agreement. Younger people, males, those with higher education, and healthier individuals more accurately reported their healthcare utilization and absenteeism. Conclusions Self-reported healthcare utilization and absenteeism may be used as a proxy when medical claims and administrative data are unavailable, particularly for shorter recall periods. PMID:19528832

Experimental investigation of a variable speed constant frequency electric generating system from a utility perspective

NASA Technical Reports Server (NTRS)

Herrera, J. I.; Reddoch, T. W.; Lawler, J. S.

1985-01-01

As efforts are accelerated to improve the overall capability and performance of wind electric systems, increased attention to variable speed configurations has developed. A number of potentially viable configurations have emerged. Various attributes of variable speed systems need to be carefully tested to evaluate their performance from the utility points of view. With this purpose, the NASA experimental variable speed constant frequency (VSCF) system has been tested. In order to determine the usefulness of these systems in utility applications, tests are required to resolve issues fundamental to electric utility systems. Legitimate questions exist regarding how variable speed generators will influence the performance of electric utility systems; therefore, tests from a utility perspective, have been performed on the VSCF system and an induction generator at an operating power level of 30 kW on a system rated at 200 kVA and 0.8 power factor.

A study on the quality of outpatient prescription of psychopharmaceuticals in the City of Zagreb 2006-2009.

PubMed

Zivković, Kresimir; Zelić-Kerep, Ana; Stimac, Danijela; Ozić, Sanja; Zivković, Nikica

2014-06-01

The lack of Croatian studies which could determine the justifiability of excessive psychopharmaceutical utilization was an encouragement to conduct this research. Furthermore, regarding the conduction of this study, it would be possible to determine whether the trend of drug utilization has increased, decreased or perhaps stabilized. The data on the outpatient utilization of psycholeptics and psychoanaleptics were collected from all Zagreb pharmacies, 2006-2009. Based on the collected data for all N05 and N06 groups of drugs, the defined daily doses (DDD) and DDD per thousand inhabitants per day (DDD/TID) have been calculated using the Anatomical-Therapeutic-Chemical classification (ATC) for 2006, 2007, 2008 and 2009. To indicate the quality of drug prescription the Drug Utilization 90% (DU 90%) method was used. Moreover, in order to determine a more precise quality of individual drug group prescriptions, the indicators have been calculated by determining the proportion of the total utilization of individual therapeutic and pharmacological therapeutic subgroups in DDD/TID a day. The utilization of anxiolytics (N05B) accounts for most of the psycholeptic utilization in the City of Zagreb throughout the entire study period. In the study period, the utilization of antidepressants has slightly increased, by 10.5%, taking the first and the last years of the period into account. In 2006, 5 benzodiazepines and the hypnotic zolpidem, as well as 5 selective serotonin reuptake inhibitors (SSRIs) and 1 third generation antipsychotic (olanzapin) were found in the DU 90% segment. In 2009, the DU 90% segment also comprised 5 benzodiazepines and the hypnotic zolpidem, as well as 6 SSRIs and 1 third generation antipsychotic (olanzapin). In the City of Zagreb, a general insight into the quality of psychopharmaceutical prescriptions indicates stability in comparison to earlier studies. The ratio index of the first generation antipsychotic utilization, compared to the third generation antipsychotics, shows an increase in the quality of prescription. Also, the ratio index of total tricyclic antidepressants (TCA) and SSRI utilization indicates improvement in quality of prescription. The ratio index of the entire outpatient utilization of anxiolytics and antidepressants expressed in DDD/TID unfortunately shows a very mild increase of prescription quality. Benzodiazepines accounted for more than 50% of the outpatient utilization of psychopharmaceuticals throughout the study period, which proves the need for precise guidelines as the most significant means of drug rationalization and utilization. It is necessary to identify priorities and problems in order to solve them successfully, by monitoring drug utilization and prescription on a national level. Results demonstrate that within the primary health care system, there is a need for constant education on rational prescription of this drug group.

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

A Systematic Review and Meta-Analysis of Utility-Based Quality of Life in Chronic Kidney Disease Treatments

PubMed Central

Wyld, Melanie; Morton, Rachael Lisa; Hayen, Andrew; Howard, Kirsten; Webster, Angela Claire

2012-01-01

Background Chronic kidney disease (CKD) is a common and costly condition to treat. Economic evaluations of health care often incorporate patient preferences for health outcomes using utilities. The objective of this study was to determine pooled utility-based quality of life (the numerical value attached to the strength of an individual's preference for a specific health outcome) by CKD treatment modality. Methods and Findings We conducted a systematic review, meta-analysis, and meta-regression of peer-reviewed published articles and of PhD dissertations published through 1 December 2010 that reported utility-based quality of life (utility) for adults with late-stage CKD. Studies reporting utilities by proxy (e.g., reported by a patient's doctor or family member) were excluded. In total, 190 studies reporting 326 utilities from over 56,000 patients were analysed. There were 25 utilities from pre-treatment CKD patients, 226 from dialysis patients (haemodialysis, n = 163; peritoneal dialysis, n = 44), 66 from kidney transplant patients, and three from patients treated with non-dialytic conservative care. Using time tradeoff as a referent instrument, kidney transplant recipients had a mean utility of 0.82 (95% CI: 0.74, 0.90). The mean utility was comparable in pre-treatment CKD patients (difference = −0.02; 95% CI: −0.09, 0.04), 0.11 lower in dialysis patients (95% CI: −0.15, −0.08), and 0.2 lower in conservative care patients (95% CI: −0.38, −0.01). Patients treated with automated peritoneal dialysis had a significantly higher mean utility (0.80) than those on continuous ambulatory peritoneal dialysis (0.72; p = 0.02). The mean utility of transplant patients increased over time, from 0.66 in the 1980s to 0.85 in the 2000s, an increase of 0.19 (95% CI: 0.11, 0.26). Utility varied by elicitation instrument, with standard gamble producing the highest estimates, and the SF-6D by Brazier et al., University of Sheffield, producing the lowest estimates. The main limitations of this study were that treatment assignments were not random, that only transplant had longitudinal data available, and that we calculated EuroQol Group EQ-5D scores from SF-36 and SF-12 health survey data, and therefore the algorithms may not reflect EQ-5D scores measured directly. Conclusions For patients with late-stage CKD, treatment with dialysis is associated with a significant decrement in quality of life compared to treatment with kidney transplantation. These findings provide evidence-based utility estimates to inform economic evaluations of kidney therapies, useful for policy makers and in individual treatment discussions with CKD patients. PMID:22984353

The goal of value-based medicine analyses: comparability. The case for neovascular macular degeneration.

PubMed

Brown, Gary C; Brown, Melissa M; Brown, Heidi C; Kindermann, Sylvia; Sharma, Sanjay

2007-01-01

To evaluate the comparability of articles in the peer-reviewed literature assessing the (1) patient value and (2) cost-utility (cost-effectiveness) associated with interventions for neovascular age-related macular degeneration (ARMD). A search was performed in the National Library of Medicine database of 16 million peer-reviewed articles using the key words cost-utility, cost-effectiveness, value, verteporfin, pegaptanib, laser photocoagulation, ranibizumab, and therapy. All articles that used an outcome of quality-adjusted life-years (QALYs) were studied in regard to (1) percent improvement in quality of life, (2) utility methodology, (3) utility respondents, (4) types of costs included (eg, direct healthcare, direct nonhealthcare, indirect), (5) cost bases (eg, Medicare, National Health Service in the United Kingdom), and (6) study cost perspective (eg, government, societal, third-party insurer). To qualify as a value-based medicine analysis, the patient value had to be measured using the outcome of the QALYs conferred by respective interventions. As with value-based medicine analyses, patient-based time tradeoff utility analysis had to be utilized, patient utility respondents were necessary, and direct medical costs were used. Among 21 cost-utility analyses performed on interventions for neovascular macular degeneration, 15 (71%) met value-based medicine criteria. The 6 others (29%) were not comparable owing to (1) varying utility methodology, (2) varying utility respondents, (3) differing costs utilized, (4) differing cost bases, and (5) varying study perspectives. Among value-based medicine studies, laser photocoagulation confers a 4.4% value gain (improvement in quality of life) for the treatment of classic subfoveal choroidal neovascularization. Intravitreal pegaptanib confers a 5.9% value gain (improvement in quality of life) for classic, minimally classic, and occult subfoveal choroidal neovascularization, and photodynamic therapy with verteporfin confers a 7.8% to 10.7% value gain for the treatment of classic subfoveal choroidal neovascularization. Intravitreal ranibizumab therapy confers greater than a 15% value gain for the treatment of subfoveal occult and minimally classic subfoveal choroidal neovascularization. The majority of cost-utility studies performed on interventions for neovascular macular degeneration are value-based medicine studies and thus are comparable. Value-based analyses of neovascular ARMD monotherapies demonstrate the power of value-based medicine to improve quality of care and concurrently maximize the efficacy of healthcare resource use in public policy. The comparability of value-based medicine cost-utility analyses has important implications for overall practice standards and public policy. The adoption of value-based medicine standards can greatly facilitate the goal of higher-quality care and maximize the best use of healthcare funds.

THE GOAL OF VALUE-BASED MEDICINE ANALYSES: COMPARABILITY. THE CASE FOR NEOVASCULAR MACULAR DEGENERATION

PubMed Central

Brown, Gary C.; Brown, Melissa M.; Brown, Heidi C.; Kindermann, Sylvia; Sharma, Sanjay

2007-01-01

Purpose To evaluate the comparability of articles in the peer-reviewed literature assessing the (1) patient value and (2) cost-utility (cost-effectiveness) associated with interventions for neovascular age-related macular degeneration (ARMD). Methods A search was performed in the National Library of Medicine database of 16 million peer-reviewed articles using the key words cost-utility, cost-effectiveness, value, verteporfin, pegaptanib, laser photocoagulation, ranibizumab, and therapy. All articles that used an outcome of quality-adjusted life-years (QALYs) were studied in regard to (1) percent improvement in quality of life, (2) utility methodology, (3) utility respondents, (4) types of costs included (eg, direct healthcare, direct nonhealthcare, indirect), (5) cost bases (eg, Medicare, National Health Service in the United Kingdom), and (6) study cost perspective (eg, government, societal, third-party insurer). To qualify as a value-based medicine analysis, the patient value had to be measured using the outcome of the QALYs conferred by respective interventions. As with value-based medicine analyses, patient-based time tradeoff utility analysis had to be utilized, patient utility respondents were necessary, and direct medical costs were used. Results Among 21 cost-utility analyses performed on interventions for neovascular macular degeneration, 15 (71%) met value-based medicine criteria. The 6 others (29%) were not comparable owing to (1) varying utility methodology, (2) varying utility respondents, (3) differing costs utilized, (4) differing cost bases, and (5) varying study perspectives. Among value-based medicine studies, laser photocoagulation confers a 4.4% value gain (improvement in quality of life) for the treatment of classic subfoveal choroidal neovascularization. Intravitreal pegaptanib confers a 5.9% value gain (improvement in quality of life) for classic, minimally classic, and occult subfoveal choroidal neovascularization, and photodynamic therapy with verteporfin confers a 7.8% to 10.7% value gain for the treatment of classic subfoveal choroidal neovascularization. Intravitreal ranibizumab therapy confers greater than a 15% value gain for the treatment of subfoveal occult and minimally classic subfoveal choroidal neovascularization. Conclusions The majority of cost-utility studies performed on interventions for neovascular macular degeneration are value-based medicine studies and thus are comparable. Value-based analyses of neovascular ARMD monotherapies demonstrate the power of value-based medicine to improve quality of care and concurrently maximize the efficacy of healthcare resource use in public policy. The comparability of value-based medicine cost-utility analyses has important implications for overall practice standards and public policy. The adoption of value-based medicine standards can greatly facilitate the goal of higher-quality care and maximize the best use of healthcare funds. PMID:18427606

The Value of Risk Pooling for Mitigating Water Utility Financial Risks Arising From Water Scarcity

NASA Astrophysics Data System (ADS)

Baum, R.; Characklis, G. W.; Hughes, J.; Eskaf, S.

2015-12-01

Water utilities across the United States face growing supply risks as demand growth and extreme weather events make water scarcity more common. As it has become more difficult and expensive to build new supply capacity to accommodate these events, many utility managers respond by either imposing conservation measures, which reduces revenues, or acquiring additional water from other sources, which increases costs. These actions lead to changing financial trends that are difficult to predict and that utilities are currently ill-equipped to manage. As a result, adaptation strategies and tools are being developed to reduce utility vulnerabilities, ensuring both financial stability and continued access to low cost financing, a critical consideration for a capital intensive industry. Previous work in this area has involved the development of utility specific financial hedging tools. However, the time and informational requirements associated with developing these individualized strategies may be a limiting factor for widespread implementation. The objective of this research is to develop more generalized hedging instruments that can be applied simultaneously to multiple utilities across the United States, thereby increasing the potential for widespread implementation. This work first analyzes the financial risks of water scarcity for a large set of water utilities across the country and then proposes a financial hedging solution to mitigate these risks through hydrologic index-based financial insurance. Results provide insights into the most effective indices, the potential for risk pooling to reduce insurance costs, and the performance of these contracts in managing utility financial risk arising from drought.

Utility functions predict variance and skewness risk preferences in monkeys

PubMed Central

Genest, Wilfried; Stauffer, William R.; Schultz, Wolfram

2016-01-01

Utility is the fundamental variable thought to underlie economic choices. In particular, utility functions are believed to reflect preferences toward risk, a key decision variable in many real-life situations. To assess the validity of utility representations, it is therefore important to examine risk preferences. In turn, this approach requires formal definitions of risk. A standard approach is to focus on the variance of reward distributions (variance-risk). In this study, we also examined a form of risk related to the skewness of reward distributions (skewness-risk). Thus, we tested the extent to which empirically derived utility functions predicted preferences for variance-risk and skewness-risk in macaques. The expected utilities calculated for various symmetrical and skewed gambles served to define formally the direction of stochastic dominance between gambles. In direct choices, the animals’ preferences followed both second-order (variance) and third-order (skewness) stochastic dominance. Specifically, for gambles with different variance but identical expected values (EVs), the monkeys preferred high-variance gambles at low EVs and low-variance gambles at high EVs; in gambles with different skewness but identical EVs and variances, the animals preferred positively over symmetrical and negatively skewed gambles in a strongly transitive fashion. Thus, the utility functions predicted the animals’ preferences for variance-risk and skewness-risk. Using these well-defined forms of risk, this study shows that monkeys’ choices conform to the internal reward valuations suggested by their utility functions. This result implies a representation of utility in monkeys that accounts for both variance-risk and skewness-risk preferences. PMID:27402743

Deriving health utilities from the MacNew Heart Disease Quality of Life Questionnaire.

PubMed

Chen, Gang; McKie, John; Khan, Munir A; Richardson, Jeff R

2015-10-01

Quality of life is included in the economic evaluation of health services by measuring the preference for health states, i.e. health state utilities. However, most intervention studies include a disease-specific, not a utility, instrument. Consequently, there has been increasing use of statistical mapping algorithms which permit utilities to be estimated from a disease-specific instrument. The present paper provides such algorithms between the MacNew Heart Disease Quality of Life Questionnaire (MacNew) instrument and six multi-attribute utility (MAU) instruments, the Euroqol (EQ-5D), the Short Form 6D (SF-6D), the Health Utilities Index (HUI) 3, the Quality of Wellbeing (QWB), the 15D (15 Dimension) and the Assessment of Quality of Life (AQoL-8D). Heart disease patients and members of the healthy public were recruited from six countries. Non-parametric rank tests were used to compare subgroup utilities and MacNew scores. Mapping algorithms were estimated using three separate statistical techniques. Mapping algorithms achieved a high degree of precision. Based on the mean absolute error and the intra class correlation the preferred mapping is MacNew into SF-6D or 15D. Using the R squared statistic the preferred mapping is MacNew into AQoL-8D. The algorithms reported in this paper enable MacNew data to be mapped into utilities predicted from any of six instruments. This permits studies which have included the MacNew to be used in cost utility analyses which, in turn, allows the comparison of services with interventions across the health system. © The European Society of Cardiology 2014.

Influence of health-related quality of life on health service utilization in Chinese rural-to-urban female migrant workers.

PubMed

Lu, Chu-Hong; Wang, Pei-Xi; Lei, Yi-Xiong; Luo, Zhong-Cheng

2014-08-15

Rural-to-urban migrant workers have been increasing rapidly in China over recent decades. Health related quality of life (HRQOL) may affect health service utilization. There is a lack of data on HRQOL in relation to health service utilization in Chinese rural-to-urban migrant workers. This study was aimed to explore the influence of HRQOL on health service utilization in Chinese rural-to-urban female migrant workers. This was a cross-sectional survey of 1,438 female rural-to-urban migrant workers in Shenzhen-Dongguan economic zone, China in 2013. HRQOL was assessed by the 36-items Health Survey Short Form (SF-36). Health service utilization was measured by any physician visit over the recent two weeks and any hospitalization over the last 1-year (annual hospitalization). Clustered logistic regression was used to analyze the influence of HRQOL on health service utilization. Lower scores in three HRQOL domains (bodily pain, general health, role physical) were associated with more frequent health service utilization in female rural-to-urban migrant workers. Bodily pain and general health were associated with an independent influence of 15.6% on the risk of recent two-week physician visit, while role physical and general health were associated with an independent influence of 21.2% on the risk of annual hospitalization. The independent influence of HRQOL on health service utilization was smaller than that of socio-demographic and health-related variables. HRQOL may have a modest influence on health service utilization in Chinese rural-to-urban female migrant workers - an underprivileged population in urban China.

[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.

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

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

Barbose, Galen; Wiser, Ryan; Phadke, Amol

2008-02-01

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

The Impact of Hospice Patient Disease Type and Length of Stay on Caregiver Utilization of Grief Counseling: A 10-Year Retrospective Study.

PubMed

Palmer, William W; Yuen, Francis K

2017-11-01

This investigation explored the relationship between hospice patient disease type, length of stay (LOS) in hospice, and caregiver utilization of grief counseling in bereavement. A 10-year retrospective study was conducted utilizing data from caregivers associated with hospice patients who died between 2004 and 2014. A threshold of inclusion for disease type (≥1.00% of hospice admissions) resulted in a sample size of 3704 patients, comprising 19 different disease types and 348 associated caregivers who received counseling. Replicating a previous study, brain cancer, lung cancer, and renal failure were among the top 4 disease types associated with higher-than-average utilization of bereavement services among caregivers, regardless of the patient's LOS. This finding may be related to factors such as the duration of the disease, the deterioration of the patient, the absence of symptom control, and secondary losses. LOS as a predictor of whether counseling will be utilized by hospice caregivers was unsupported by this study, as the percentage of caregivers receiving counseling closely paralleled the patient's LOS across 4 cohorts (1-30 days, 31-60 days, 61-90 days, and 91+ days). However, among the caregivers who utilized counseling, the LOS was a statistically significant predictor of the number of counseling sessions utilized. For caregivers who utilized only 1 counseling session, the associated patient median LOS was 21.5 days. For caregivers who utilized 5 or more counseling sessions, the associated patient median LOS dropped to 12 days, suggesting an inverted relationship between hospice patient LOS and the duration of counseling in bereavement.

Health examination utilization in the visually disabled population in Taiwan: a nationwide population-based study

PubMed Central

2013-01-01

Background People with visual disabilities have increased health needs but face worse inequity to preventive health examinations. To date, only a few nationwide studies have analyzed the utilization of preventive adult health examinations by the visually disabled population. The aim of this study was to investigate the utilization of health examinations by the visually disabled population, and analyze the factors associated with the utilization. Methods Visual disability was certified by ophthalmologists and authenticated by the Ministry of the Interior (MOI), Taiwan. We linked data from three different nationwide datasets (from the MOI, Bureau of Health Promotion, and National Health Research Institutes) between 2006 and 2008 as the data sources. Independent variables included demographic characteristics, income status, health status, and severity of disability; health examination utilization status was the dependent variable. The chi-square test was used to check statistical differences between variables, and a multivariate logistic regression model was used to examine the associated factors with health examination utilization. Results In total, 47,812 visually disabled subjects aged 40 years and over were included in this study, only 16.6% of whom received a health examination. Lower utilization was more likely in male subjects, in those aged 65 years and above, insured dependents and those with a top-ranked premium-based salary, catastrophic illness/injury, chronic diseases of the genitourinary system, and severe or very severe disabilities. Conclusion The overall health examination utilization in the visually disabled population was very low. Lower utilization occurred mainly in males, the elderly, and those with severe disabilities. PMID:24313981

Schizophrenia: multi-attribute utility theory approach to selection of atypical antipsychotics.

PubMed

Bettinger, Tawny L; Shuler, Garyn; Jones, Donnamaria R; Wilson, James P

2007-02-01

Current guidelines/algorithms recommend atypical antipsychotics as first-line agents for the treatment of schizophrenia. Because there are extensive healthcare costs associated with the treatment of schizophrenia, many institutions and health systems are faced with making restrictive formulary decisions regarding the use of atypical antipsychotics. Often, medication acquisition costs are the driving force behind formulary decisions, while other treatment factors are not considered. To apply a multi-attribute utility theory (MAUT) analysis to aid in the selection of a preferred agent among the atypical antipsychotics for the treatment of schizophrenia. Five atypical antipsychotics (risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole) were selected as the alternative agents to be included in the MAUT analysis. The attributes identified for inclusion in the analysis were efficacy, adverse effects, cost, and adherence, with relative weights of 35%, 35%, 20%, and 10%, respectively. For each agent, attribute scores were calculated, weighted, and then summed to generate a total utility score. The agent with the highest total utility score was considered the preferred agent. Aripiprazole, with a total utility score of 75.8, was the alternative agent with the highest total utility score in this model. This was followed by ziprasidone, risperidone, and quetiapine, with total utility scores of 71.8, 69.0, and 65.9, respectively. Olanzapine received the lowest total utility score. A sensitivity analysis was performed and failed to displace aripiprazole as the agent with the highest total utility score. This model suggests that aripiprazole should be considered a preferred agent for the treatment of schizophrenia unless found to be otherwise inappropriate.

Examining the Relationship Between Individual Characteristics, Community-Level Traits, Multidimensional Empowerment, and Maternal Health Care Utilization in the Islamic Republic of Pakistan.

PubMed

Hearld, Kristine R; Anderson, Jami L; Budhwani, Henna

2018-03-06

Introduction The Islamic Republic of Pakistan's maternal mortality ratio is particularly high, and the nation ranks 126 out of 149 countries on the Human Development Report-Gender Inequality Index. This is because Pakistani women have low levels of empowerment, make limited economic contributions, and underutilization of maternal health care. The aim of this study is to create a multidimensional index of women's empowerment and assess the association between this index and maternal health care utilization in Pakistan, controlling for individual characteristics and community-level traits. Methods Data from the 2012-2013 Pakistan Demographic and Health Surveys were employed to investigate the relationship between this index and the latent construct of maternal health care utilization. Results Using exploratory factor analysis, four indicators of maternal health care utilization were loaded onto a single latent factor. Multivariate analyses found support for the association between empowerment and health care utilization, despite adjustments for individual and area level factors. Positive associations between education, wealth, and maternal health care utilization were found. Conclusions Although we find support for the association of educational attainment with maternal health care utilization, the multidimensional women's empowerment index was independently a consistent associate of maternal health care utilization. This illustrates a complex mechanism with both-education and empowerment, being necessary for improved maternal health care utilization. Policy makers seeking to improve outcomes should expand their focus beyond simply improving rates of education to examining effects of cultural norms which constrain the independence of women in making decisions about their own health care.

Implications of workforce and financing changes for primary care practice utilization, revenue, and cost: a generalizable mathematical model for practice management.

PubMed

Basu, Sanjay; Landon, Bruce E; Song, Zirui; Bitton, Asaf; Phillips, Russell S

2015-02-01

Primary care practice transformations require tools for policymakers and practice managers to understand the financial implications of workforce and reimbursement changes. To create a simulation model to understand how practice utilization, revenues, and expenses may change in the context of workforce and financing changes. We created a simulation model estimating clinic-level utilization, revenues, and expenses using user-specified or public input data detailing practice staffing levels, salaries and overhead expenditures, patient characteristics, clinic workload, and reimbursements. We assessed whether the model could accurately estimate clinic utilization, revenues, and expenses across the nation using labor compensation, medical expenditure, and reimbursements databases, as well as cost and revenue data from independent practices of varying size. We demonstrated the model's utility in a simulation of how utilization, revenue, and expenses would change after hiring a nurse practitioner (NP) compared with hiring a part-time physician. Modeled practice utilization and revenue closely matched independent national utilization and reimbursement data, disaggregated by patient age, sex, race/ethnicity, insurance status, and ICD diagnostic group; the model was able to estimate independent revenue and cost estimates, with highest accuracy among larger practices. A demonstration analysis revealed that hiring an NP to work independently with a subset of patients diagnosed with diabetes or hypertension could increase net revenues, if NP visits involve limited MD consultation or if NP reimbursement rates increase. A model of utilization, revenue, and expenses in primary care practices may help policymakers and managers understand the implications of workforce and financing changes.

Assessing corporate restructurings in the electric utility industry: A framework

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

Malko, J.R.

1996-12-31

Corporate restructurings of electric utilities in the United States have become an important and controversial issue during the 1980s. Regulators and electric utility executives have different perspectives concerning corporate restructurings associated with diversification, mergers, and functional separation of generation, transmission, and distribution. Regulators attempt to regulate electric utilities effectively in order to assure that adequate electricity services are provided at reasonable cost and to protect the public interest which includes considering choices and risks to customers. Regulators are considering and developing new regulatory approaches in order to address corporate restructurings and balance regulation and competitive pressures. Electric utility executives typicallymore » view corporate restructurings as a potential partial solution to financial challenges and problems and are analyzing corporate restructuring activities within the framework of the corporate strategic planning process. Executives attempt to find new sources of economic value and consider risks and potential returns to investors in an increasingly competitive environment. The parent holding company is generally used as the basic corporate form for restructuring activities in the electric utility industry. However, the wholly-owned utility subsidiary structure remains in use for some restructurings. The primary purpose of this paper is to propose a framework to assess corporate restructurings in the electric utility industry from a public policy perspective. This paper is organized in the following manner. First, different types of corporate restructurings in the electric utility industry are examined. Second, reasons for corporate restructuring activities are represented. Third, a framework for assessing corporate restructuring activities is proposed. Fourth, the application of the framework is discussed.« less

Facilities Utilization Program Implementation Handbook

NASA Technical Reports Server (NTRS)

1987-01-01

This Facilities Utilization Program Implementation Handbook (FUPIH) prescribes procedures for the review and the reporting on the utilization of NASA facilities. The Directors of NASA Field Installations should designate an Installation Official responsible for coordinating the assignment of buildings space and implementing the facilities utilization reviews and annual report preparation. The individual designated shall be known as the 'Facilities Utilization Officer (FUO).' Functional responsibilities of the FUO are detailed in NASA Management Instruction (NMI) 7234.1. It is recognized that titles used in the implementation of the Facilities Utilization Program may vary between field installations. The Facilities Utilization Program (FUP) is designed to provide a uniform and orderly process for meeting or addressing the following objectives: the establishment of sound facilities requirements to meet NASA's programmatic and institutional needs; the optimum allocation of available facilities and related resources to meet these requirements; and the early identification and request for required additional facilities resources. The detailed review and reporting system enacted by NMI 7234.1 should encourage more comprehensive utilization planning for all NASA facilities and ensure, to the maximum extent practicable, that all such facilities are put to their highest and best use consistent with NASA programmatic and institutional priorities. A principal purpose of the FUP is the early identification of NASA facilities which may be or may become underutilized or excess to NASA needs and to provide a timely reference point from which corrective actions (i.e., consolidation, elimination of duplication, improved utilization of disposal) may be taken. Because the supply of this handbook is limited, distribution should be controlled at the field installation level.

Web-based educational activities developed by the Society for Neuroscience in Anesthesiology and Critical Care (SNACC): the experience of process, utilization, and expert evaluation.

PubMed

Sharma, Deepak; Bilotta, Federico; Moore, Laurel E; Bebawy, John F; Flexman, Alana M; Rochlen, Lauryn; Gorji, Reza; Avitsian, Rafi

2014-01-01

Web-based delivery of educational material by scientific societies appears to have increased recently. However, the utilization of such efforts by the members of professional societies is unknown. We report the experience with delivery of educational resources on the Web site of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC), and utilization of those resources by members. Three web-based educational initiatives were developed over 1 year to be disseminated through the SNACC Web site (http://www.snacc.org) for society members: (1) The SNACC Bibliography; (2) "Chat with the Author"; and (3) Clinical Case Discussions. Content experts and authors of important new research publications were invited to contribute. Member utilization data were abstracted with the help of the webmaster. For the bibliography, there were 1175 page requests during the 6-month period after its launch by 122/664 (19%) distinct SNACC members. The bibliography was utilized by 107/553 (19%) of the active members and 15/91 (16.5%) of the trainee members. The "Chats with the Authors" were viewed by 56 (9%) members and the Clinical Case Discussions by 51 (8%) members. Educational resources can be developed in a timely manner utilizing member contributions without additional financial implications. However, the member utilization of these resources was lower than expected. These are first estimates of utilization of web-based educational resources by members of a scientific society. Further evaluation of such utilization by members of other societies as well as measures of the effectiveness and impact of such activities is needed.

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.

Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network.

PubMed

O'Gorman, Laurel D; Hogenbirk, John C; Warry, Wayne

2016-06-01

Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km(2). The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province. We used OTN medical service utilization data collected through the Ontario Health Insurance Plan and provided by the Ministry of Health and Long Term Care. Using census subdivisions grouped by Northern and Southern Ontario as well as urban and rural areas, we calculated utilization rates per fiscal year and total from 2008/2009 to 2013/2014. We also used billing codes to calculate utilization by therapeutic area of care. There were 652,337 OTN patient visits in Ontario from 2008/2009 to 2013/2014. Median annual utilization rates per 1,000 people were higher in northern areas (rural, 52.0; urban, 32.1) than in southern areas (rural, 6.1; urban, 3.1). The majority of usage in Ontario was in mental health and addictions (61.8%). Utilization in other areas of care such as surgery, oncology, and internal medicine was highest in the rural north, whereas primary care use was highest in the urban south. Utilization was higher and therapeutic areas of care were more diverse in rural Northern Ontario than in other parts of the province. Utilization was also higher in urban Northern Ontario than in Southern Ontario. This suggests that telemedicine is being used to improve access to medical care services, especially in sparsely populated regions of the province.

Impact of depression on health utility value in cancer patients.

PubMed

Fujisawa, Daisuke; Inoguchi, Hironobu; Shimoda, Haruki; Yoshiuchi, Kazuhiro; Inoue, Shinichiro; Ogawa, Asao; Okuyama, Toru; Akechi, Tatsuo; Mimura, Masaru; Shimizu, Ken; Uchitomi, Yosuke

2016-05-01

The quality-adjusted life year, which is usually calculated from the health utility value, is now a standard measurement used in political decision-making in health. Although depression is the leading cause of decrement in health utility in general population, impact of comorbid depression among cancer patients has not been studied sufficiently. Therefore, this study aimed to measure the impact of depression on cancer patients' health utility score, according to the severity of depression. Impact of depression severity (measured by the Patient Health Questionnaire) on health utility score (measured by the EuroQoL-5 scale) was evaluated in a sample of 328 Japanese cancer patients, controlling for performance status, symptom burden, and demographic variables. The patients with depression had significantly lower health utility value than those without depression (mean decrement = 0.14). Decrements in health utility of 0.13, 0.18, and 0.19 were observed for mild, moderate, and moderately severe to severe level of depression, respectively. The difference was significant between groups. Depression severity was a significant predictor for health utility (standardized coefficient beta = -0.25), which was comparable with physical symptom burden and performance status. Participants' age, gender, cancer stage, and comorbid illness were not significant. The model explained 37.9% of the variance. Even mild level of depression caused clinically meaningful decrement in health utility value in cancer patients, which was comparable with decrements due to major physical complications of cancer. Influence of depression should be carefully investigated when interpreting the quality-adjusted life year among cancer patients. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Utility functions predict variance and skewness risk preferences in monkeys.

PubMed

Genest, Wilfried; Stauffer, William R; Schultz, Wolfram

2016-07-26

Utility is the fundamental variable thought to underlie economic choices. In particular, utility functions are believed to reflect preferences toward risk, a key decision variable in many real-life situations. To assess the validity of utility representations, it is therefore important to examine risk preferences. In turn, this approach requires formal definitions of risk. A standard approach is to focus on the variance of reward distributions (variance-risk). In this study, we also examined a form of risk related to the skewness of reward distributions (skewness-risk). Thus, we tested the extent to which empirically derived utility functions predicted preferences for variance-risk and skewness-risk in macaques. The expected utilities calculated for various symmetrical and skewed gambles served to define formally the direction of stochastic dominance between gambles. In direct choices, the animals' preferences followed both second-order (variance) and third-order (skewness) stochastic dominance. Specifically, for gambles with different variance but identical expected values (EVs), the monkeys preferred high-variance gambles at low EVs and low-variance gambles at high EVs; in gambles with different skewness but identical EVs and variances, the animals preferred positively over symmetrical and negatively skewed gambles in a strongly transitive fashion. Thus, the utility functions predicted the animals' preferences for variance-risk and skewness-risk. Using these well-defined forms of risk, this study shows that monkeys' choices conform to the internal reward valuations suggested by their utility functions. This result implies a representation of utility in monkeys that accounts for both variance-risk and skewness-risk preferences.

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

NASA Astrophysics Data System (ADS)

Gonzales, Patricia; Ajami, Newsha; Sun, Yujie

2017-09-01

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

Trade-off decisions in distribution utility management

NASA Astrophysics Data System (ADS)

Slavickas, Rimas Anthony

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

National Information Utility Seeks to Serve Schools Nationwide.

ERIC Educational Resources Information Center

Platzer, Nancy

1985-01-01

Outlines the pros and cons of the National Information Utility Program, which is designed to provide current updatable courseware to schools nationwide. The information is broadcast over FM radio and television signals to facilities subscribing to the utility. (MD)

1977 Nationwide Personal Transportation Study : household vehicle utilization

DOT National Transportation Integrated Search

1981-04-01

This report is part of a series that presents findings from the 1977 Nationwide Personal Transportation Study (NPTS). This report describes patterns of utilization of private vehicles (annual miles driven) in 1977. Utilization is keyed to estimates p...

48 CFR 41.201 - Policy.

Code of Federal Regulations, 2011 CFR

2011-10-01

... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...

48 CFR 41.201 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...

48 CFR 41.201 - Policy.

Code of Federal Regulations, 2012 CFR

2012-10-01

... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...

48 CFR 41.201 - Policy.

Code of Federal Regulations, 2013 CFR

2013-10-01

... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...

48 CFR 41.201 - Policy.

Code of Federal Regulations, 2014 CFR

2014-10-01

... utility franchises or service territories established pursuant to state statute, state regulation, or... having applicable state-approved franchise or other service authorizations are found by the Secretary to... service, including state utility commission rulings and electric utility franchises or service territories...

Distributed Electrical Power Generation: Summary of Alternative Available Technologies

DTIC Science & Technology

2003-09-01

standby charges, among others. Federal law (Public Utilities Regulatory Policy Act [ PURPA ] Section 210) prohibits utilities from assessing...a customer-generator. PURPA . The PURPA of 1978 requires electric utilities to purchase electricity produced from any qualifying power producers

Predictors of Adolescent Health Care Utilization

ERIC Educational Resources Information Center

Vingilis, Evelyn; Wade, Terrance; Seeley, Jane

2007-01-01

This study, using Andersen's health care utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence health care utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process…

Evaluating Utility in Diagnostic Decision Making.

ERIC Educational Resources Information Center

Harber, Jean R.

1981-01-01

The utility of the procedures special educators apply in making decisions about the identification of handicapped individuals has not been thoroughly studied. The paper examines the utility of diagnostic decision making from the perspective of receiver operating curve analysis. (Author)

Use of Cost-Utility Decision Models in Business Education.

ERIC Educational Resources Information Center

Lewis, Darrell R.

1989-01-01

Explains how cost-utility analysis can be applied to the selection of curriculum and instructional methods. Describes the use of multiattribute utility models of decision making as a tool for more informed judgment in educational administration. (SK)

77 FR 35657 - Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-14

... Information Collection Activity; Comment Request AGENCY: Rural Utilities Service, USDA. ACTION: Notice and... 35, as amended), the United States Department of Agriculture (USDA) Rural Development administers rural utilities programs through the Rural Utilities Service. The USDA Rural Development invites...

State Performance-Based Regulation Using Multiyear Rate Plans for U.S. Electric Utilities

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

Lowry, Mark Newton; Makos, Matt; Deason, Jeff

Electric utilities today must contain costs at a time when many need to modernize aging systems and all face major changes in technologies, customer preferences and competitive pressures.Most U.S. electric utility facilities are investor-owned, subject to rate and service regulation by state public utility commissions. Regulatory systems under which these utilities operate affect their performance and ability to meet these challenges. In this business environment, multiyear rate plans have some advantages over traditional rate regulation.The report focuses on key design issues and provides case studies of the multiyear rate plan approach, applicable to both vertically integrated and restructured states. Markmore » Newton Lowry and Matt Makos of Pacific Energy Group Research and Jeff Deason of Berkeley Lab authored the report; Lisa Schwartz, Berkeley Lab, was project manager and technical editor.The report is aimed primarily at state utility regulators and stakeholders in the state regulatory process. The multiyear rate approach also provides ideas on how to streamline oversight of public power utilities and rural electric cooperatives for their governing boards.Two key provisions of multiyear rate plans strengthen cost containment incentives and streamline regulation: 1. Reducing frequency of rate cases, typically to every four or five years 2. Using an attrition relief mechanism to escalate rates or revenue between rate cases to address cost pressures such as inflation and growth in number of customers, independently of the utility’s own cost Better utility performance can be achieved under well-designed multiyear rate plans while achieving lower regulatory costs. Benefits can be shared between utilities and their customers. But plans can be complex and involve significant changes in the regulatory system. Designing plans that stimulate utility performance without undue risk and share benefits fairly can be challenging.This report discusses the rationale for multiyear rate plans and their usefulness under modern business conditions. It then explains critical plan design issues and challenges and presents results from numerical research that considers the extra incentive power achieved under different plan provisions. Next, the report presents several case studies of utilities that have operated under formal multiyear rate plans or, for various reasons, have stayed out of rate cases for more than a decade. These studies consider the effect of multiyear rate plans and rate case frequency on utility cost, reliability and other performance dimensions.« less

Individual Differences in Subjective Utility and Risk Preferences: The Influence of Hedonic Capacity and Trait Anxiety

PubMed Central

Howlett, Jonathon R.; Paulus, Martin P.

2017-01-01

Individual differences in decision-making are important in both normal populations and psychiatric conditions. Variability in decision-making could be mediated by different subjective utilities or by other processes. For example, while traditional economic accounts attribute risk aversion to a concave subjective utility curve, in practice other factors could affect risk behavior. This distinction may have important implications for understanding the biological basis of variability in decision-making and for developing interventions to improve decision-making. Another aspect of decision-making that may vary between individuals is the sensitivity of subjective utility to counterfactual outcomes (outcomes that could have occurred, but did not). We investigated decision-making in relation to hedonic capacity and trait anxiety, two traits that relate to psychiatric conditions but also vary in the general population. Subjects performed a decision-making task, in which they chose between low- and high-risk gambles to win 0, 20, or 40 points on each trial. Subjects then rated satisfaction after each outcome on a visual analog scale, indicating subjective utility. Hedonic capacity was positively associated with the subjective utility of winning 20 points but was not associated with the concavity of the subjective utility curve (constructed using the mean subjective utility of winning 0, 20, or 40 points). Consistent with economic theory, concavity of the subjective utility curve was associated with risk aversion. Hedonic capacity was independently associated with risk seeking (i.e., not mediated by the shape of the subjective utility curve), while trait anxiety was unrelated to risk preferences. Contrary to our expectations, counterfactual sensitivity was unrelated to hedonic capacity and trait anxiety. Nevertheless, trait anxiety was associated with a self-report measure of regret-proneness, suggesting that counterfactual influences may occur via a pathway that is separate from immediate counterfactual processing biases. Taken together, our results show that hedonic capacity but not trait anxiety affects risk-taking through a mechanism that appears independent of the shape of the subjective utility curve, while hedonic capacity and trait anxiety do not affect the influence of counterfactual outcomes on subjective utility. The results have implications for understanding the underlying mechanisms of variable decision-making and for developing interventions to improve decision-making. PMID:28588508

Individual Differences in Subjective Utility and Risk Preferences: The Influence of Hedonic Capacity and Trait Anxiety.

PubMed

Howlett, Jonathon R; Paulus, Martin P

2017-01-01

Individual differences in decision-making are important in both normal populations and psychiatric conditions. Variability in decision-making could be mediated by different subjective utilities or by other processes. For example, while traditional economic accounts attribute risk aversion to a concave subjective utility curve, in practice other factors could affect risk behavior. This distinction may have important implications for understanding the biological basis of variability in decision-making and for developing interventions to improve decision-making. Another aspect of decision-making that may vary between individuals is the sensitivity of subjective utility to counterfactual outcomes (outcomes that could have occurred, but did not). We investigated decision-making in relation to hedonic capacity and trait anxiety, two traits that relate to psychiatric conditions but also vary in the general population. Subjects performed a decision-making task, in which they chose between low- and high-risk gambles to win 0, 20, or 40 points on each trial. Subjects then rated satisfaction after each outcome on a visual analog scale, indicating subjective utility. Hedonic capacity was positively associated with the subjective utility of winning 20 points but was not associated with the concavity of the subjective utility curve (constructed using the mean subjective utility of winning 0, 20, or 40 points). Consistent with economic theory, concavity of the subjective utility curve was associated with risk aversion. Hedonic capacity was independently associated with risk seeking (i.e., not mediated by the shape of the subjective utility curve), while trait anxiety was unrelated to risk preferences. Contrary to our expectations, counterfactual sensitivity was unrelated to hedonic capacity and trait anxiety. Nevertheless, trait anxiety was associated with a self-report measure of regret-proneness, suggesting that counterfactual influences may occur via a pathway that is separate from immediate counterfactual processing biases. Taken together, our results show that hedonic capacity but not trait anxiety affects risk-taking through a mechanism that appears independent of the shape of the subjective utility curve, while hedonic capacity and trait anxiety do not affect the influence of counterfactual outcomes on subjective utility. The results have implications for understanding the underlying mechanisms of variable decision-making and for developing interventions to improve decision-making.

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.

Patient-reported utilities in bilateral visual impairment from amblyopia and age-related macular degeneration.

PubMed

van de Graaf, Elizabeth S; Despriet, Dominiek D G; Klaver, Caroline C W; Simonsz, Huibert J

2016-05-17

Utility of visual impairment caused by amblyopia is important for the cost-effectiveness of screening for amblyopia (lazy eye, prevalence 3-3.5 %). We previously measured decrease of utility in 35-year-old persons with unilateral persistent amblyopia. The current observational case-control study aimed to measure loss of utility in patients with amblyopia with recent decrease of vision in their better eye. As these patients are rare, the sample was supplemented by patients with bilateral age-related macular degeneration with similar decrease of vision. From our out-patient department, two groups of patients with recent deterioration to bilateral visual acuity less than Snellen 0.5 (bilateral visual impairment, BVI) were recruited, with either persistent amblyopia and age-related macular degeneration (AMB + AMD), or with bilateral age-related macular degeneration (BAMD). To measure utility, the time trade-off method and the standard gamble method were applied through interviews. Correlations were sought between utility values and visual acuity, age and Visual Function Questionnaire-25 scores. Seventeen AMB + AMD patients (mean age 72.9 years), and 63 BAMD patients (mean age 79.6 years) were included in the study. Among AMB + AMD, 80 % were willing to trade lifetime in exchange for cure. The overall mean time trade-off utility was 0.925. Among BAMD, 75 % were willing to trade, utility was 0.917. Among AMB + AMD, 38 % accepted risk of death in exchange for cure, overall mean standard gamble utility was 0.999. Among BAMD, 49 % accepted risk of death, utility was 0.998. Utility was not related to visual acuity but it was to age (p = 0.02). Elderly patients with BVI, caused by persistent amblyopia and age-related macular degeneration (AMD) or by bilateral AMD, had an approximately 8 % loss of TTO utility. Notably, the 8 % loss in elderly with BVI differs little from the 3.7 % loss we found previously in 35-year-old persons with unilateral amblyopia with good vision in the other eye. The moderate impact of BVI in senescence could be explained by adaptation, comorbidity, avoidance of risk and a changed percept of cure.

Study of the application of solar chemical dehumidification system to wind tunnel facilities of NASA Lewis Research Center at Cleveland, Ohio

NASA Technical Reports Server (NTRS)

1976-01-01

Energy utilization and cost payback analyses were prepared for proposed modifications. A 50,000 CFM standard compact packaged solid desiccant dehumidifier utilizing high temperature hot water (HTHW) for desiccant regeneration was added. The HTHW is generated by utilizing solar energy and is stored in a storage tank. A steam boiler is provided as a back-up for the solar system. A 50,000 CFM standard compact package solid desiccant dehumidifier utilizing high temperature hot water (HTHW) for desiccant regeneration was added. The HTHW is generated by utilizing a steam boiler and a heat exchanger and is stored in a storage tank.

Communicate or pay the price of silence

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

Derry, F.E.

The electric utility industry's efforts to communicate with its customers through advertising, while highly criticized by consumer interest and other groups, is an important link in providing information that is in the public interest and which the industry has the right and obligation to provide. Advertising represents an efficient and economical way to share information and increase public understanding of the factors affecting utility reliability and cost. Surveys of utility customers show that they want an accounting of what the utility does with its money and consider advertising an appropriate vehicle. By pinpointing cost-related issues, advertising also helps to marketmore » programs that will reduce utility costs, such as off-peak energy use.« less

Energy optimization system

DOEpatents

Zhou, Zhi; de Bedout, Juan Manuel; Kern, John Michael; Biyik, Emrah; Chandra, Ramu Sharat

2013-01-22

A system for optimizing customer utility usage in a utility network of customer sites, each having one or more utility devices, where customer site is communicated between each of the customer sites and an optimization server having software for optimizing customer utility usage over one or more networks, including private and public networks. A customer site model for each of the customer sites is generated based upon the customer site information, and the customer utility usage is optimized based upon the customer site information and the customer site model. The optimization server can be hosted by an external source or within the customer site. In addition, the optimization processing can be partitioned between the customer site and an external source.

Survey of electric utility demand for coal. [1972-1992; by utility and state

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

Asbury, J.G.; Caruso, J.V.; Kouvalis, A.

1979-08-01

This report presents the results of a survey of electric utility demand for coal in the United States. The sources of survey information are: (1) Federal Energy Regulatory Commission Form 423 data on utility coal purchases during the period July 1972 through December 1978 and (2) direct telephone survey data on utility coal-purchase intentions for power plants to be constructed by 1992. Price and quantity data for coal used in existing plants are presented to illustrate price and market-share trends in individual coal-consuming states during recent years. Coal source, quality, quantity, and transportation data are reported for existing and plannedmore » generating plants.« less

Utilization of Substance Abuse Treatment: Gender Differences among Participants in an Aftercare Program.

PubMed

Yeom, Hyong Suk

2015-01-01

This study examined gender differences in the utilization of substance abuse treatment including inpatient, outpatient, and self-help services, using existing data sets from a National Institute on Drug Abuse study that enrolled 78 females and 141 males in a mixed-gender aftercare program in Massachusetts for a 2-year follow-up period. This study found that women came to the study in greater need of treatment than men. Women utilized significantly more outpatient treatment services than men. The characteristic of female per se led to more utilization of outpatient services, whereas the baseline characteristics of employed status and alcohol use led to less utilization of outpatient services.

Consulting report on the NASA technology utilization network system

NASA Technical Reports Server (NTRS)

Hlava, Marjorie M. K.

1992-01-01

The purposes of this consulting effort are: (1) to evaluate the existing management and production procedures and workflow as they each relate to the successful development, utilization, and implementation of the NASA Technology Utilization Network System (TUNS) database; (2) to identify, as requested by the NASA Project Monitor, the strengths, weaknesses, areas of bottlenecking, and previously unaddressed problem areas affecting TUNS; (3) to recommend changes or modifications of existing procedures as necessary in order to effect corrections for the overall benefit of NASA TUNS database production, implementation, and utilization; and (4) to recommend the addition of alternative procedures, routines, and activities that will consolidate and facilitate the production, implementation, and utilization of the NASA TUNS database.

An Update on Ethanol Production and Utilization in Thailand

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

Bloyd, Cary N.

Thailand has continued to promote domestic biofuel utilization. Production and consumption of biofuel in Thailand have continued to increase at a fast rate due to aggressive policies of the Thai government in reducing foreign oil import and increasing domestic renewable energy utilization. This paper focuses on ethanol production and consumption, and the use of gasohol in Thailand. The paper is an update on the previous paper--Biofuel Infrastructure Development and Utilization in Thailand--in August 2008.

Promoting the Utilization of Science in Healthcare (PUSH) Project: A Description of the Perceived Barriers and Facilitators to Research Utilization Among Pediatric Nurses.

PubMed

Cline, Genieveve J; Burger, Kristina J; Amankwah, Ernest K; Goldenberg, Neil A; Ghazarian, Sharon R

The purpose of this descriptive study was to identify the perceived barriers and facilitators to research utilization and evidence-based practice among nurses employed in a tertiary care children's hospital. Results revealed seven facilitator and six barrier themes that contribute to the understanding of the problem. The themes can be utilized by nursing professional development specialists to customize organizational infrastructure and educational programs.

Utilities Power Change: Engaging Commercial Customers in Workplace Charging

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

Lommele, Stephen; Dafoe, Wendy

As stewards of an electric grid that is available almost anywhere people park, utilities that support workplace charging are uniquely positioned to help their commercial customers be a part of the rapidly expanding network of charging infrastructure. Utilities understand the distinctive challenges of their customers, have access to technical information about electrical infrastructure, and have deep experience modeling and managing demand for electricity. This case study highlights the experiences of two utilities with workplace charging programs.

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

Optimal Control Design Advantages Utilizing Two-Degree-of-Freedom Controllers

DTIC Science & Technology

1993-12-01

AFrTIGAE/ENYIV3D-27 AD--A273 839 D"TIC OPTIMAL CONTROL DESIGN ADVANTAGES UTILIZING TWO-DEGREE-OF-FREEDOM CONTROLLERS THESIS Michael J. Stephens...AFIT/GAE/ENY/93D-27 OPTIMAL CONTROL DESIGN ADVANTAGES UTILIZING TWO-DEGREE-OF-FREEDOM CONTROLLERS THESIS Presented to the Faculty of the Graduate...measurement noises compared to the I- DOF model. xvii OPTIMAL CONTROL DESIGN ADVANTAGES UTILIZING TWO-DEGREE-OF-FREEDOM CONTROLLERS I. Introduction L1

Wealth-related Inequality in Utilization of Antihypertensive Medicines in Iran: an Ecological Study on Population Level Data.

PubMed

Hashemi-Meshkini, Amir; Kebriaeezadeh, Abbas; Jamshidi, Hamidreza; Akbari-Sari, Ali; Rezaei-Darzi, Ehsan; Mehdipour, Parinaz; Nikfar, Shekoufeh; Farzadfar, Farshad

2016-02-01

We aim to evaluate the trend of national and sub-national (provincial) utilization pattern of antihypertensive medicines in the Iranian population in the past decade and evaluate whether there is any wealth-related inequality in utilization of these medicines among different provinces. Either fixed effect or random effect linear panel data model was used to check the effect of wealth index on utilization of all antihypertensive medicines and each class, adjusting for other covariates including years of schooling, urbanization, mean age, and food type of provinces. The principal component analysis was applied to make summery measures for covariates using available national datasets. The effect of wealth category on the utilization of all antihypertensive medicines among Iranian provinces was positive and significant (0.84; 95% CI: 0.09, 1.59). Accordingly as subgroup analysis, in BBs and CCBs classes, the effects of wealth category on utilization of medicines were positive and significant (0.36; 95% CI: 0.12, 0.60 and 0.27; 95% CI: 0.07, 0.40, respectively). However in ACEIs and Diuretics classes, the effects of wealth category were positive but not significant. In ARBs class, the effect of wealth on utilization was negative and not significant (-0.04; 95% CI: -0.27, 0.18). According to this study, an inequality could be observed in Iran related to wealth category in utilization of total antihypertensive medicines between provinces.

Determinants of resource needs and utilization among refugees over time.

PubMed

Wright, A Michelle; Aldhalimi, Abir; Lumley, Mark A; Jamil, Hikmet; Pole, Nnamdi; Arnetz, Judith E; Arnetz, Bengt B

2016-04-01

This study examined refugees' resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories. Iraqi refugees to the United States (N = 298) were assessed upon arrival and at 1-year intervals for 2 years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms. Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99 to 71 %), other needs remained high (e.g., 99 % of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview. Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period.

Determinants of U.S. Prescription Drug Utilization using County Level Data.

PubMed

Nianogo, Thierry; Okunade, Albert; Fofana, Demba; Chen, Weiwei

2016-05-01

Prescription drugs are the third largest component of U.S. healthcare expenditures. The 2006 Medicare Part D and the 2010 Affordable Care Act are catalysts for further growths in utilization becuase of insurance expansion effects. This research investigating the determinants of prescription drug utilization is timely, methodologically novel, and policy relevant. Differences in population health status, access to care, socioeconomics, demographics, and variations in per capita number of scripts filled at retail pharmacies across the U.S.A. justify fitting separate econometric models to county data of the states partitioned into low, medium, and high prescription drug users. Given the skewed distribution of per capita number of filled prescriptions (response variable), we fit the variance stabilizing Box-Cox power transformation regression models to 2011 county level data for investigating the correlates of prescription drug utilization separately for low, medium, and high utilization states. Maximum likelihood regression parameter estimates, including the optimal Box-Cox λ power transformations, differ across high (λ = 0.214), medium (λ = 0.942), and low (λ = 0.302) prescription drug utilization models. The estimated income elasticities of -0.634, 0.031, and -0.532 in high, medium, and low utilization models suggest that the economic behavior of prescriptions is not invariant across different utilization levels. Copyright © 2015 John Wiley & Sons, Ltd.

Determinants of Resource Needs and Utilization Among Refugees Over Time

PubMed Central

Wright, A. Michelle; Aldhalimi, Abir; Lumley, Mark A.; Jamil, Hikmet; Pole, Nnamdi; Arnetz, Judith E.; Arnetz, Bengt B.

2015-01-01

Purpose This study examined refugees’ resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories. Methods Iraqi refugees to the United States (N=298) were assessed upon arrival and at 1-year intervals for two years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms. Results Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99% to 71%), other needs remained high (e.g., 99% of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview. Conclusions Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period. PMID:26370213

Suicide Among Veterans in 16 States, 2005 to 2008: Comparisons Between Utilizers and Nonutilizers of Veterans Health Administration (VHA) Services Based on Data From the National Death Index, the National Violent Death Reporting System, and VHA Administrative Records

PubMed Central

Katz, Ira R.; Ignacio, Rosalinda V.; Kemp, Janet

2012-01-01

Objectives. We sought to compare suicide rates among veterans utilizing Veterans Health Administration (VHA) services versus those who did not. Methods. Suicide rates from 2005 to 2008 were estimated for veterans in the 16 states that fully participated in the National Violent Death Reporting System (NVDRS), using data from the National Death Index, NVDRS, and VHA records. Results. Between 2005 and 2008, veteran suicide rates differed by age and VHA utilization status. Among men aged 30 years and older, suicide rates were consistently higher among VHA utilizers. However, among men younger than 30 years, rates declined significantly among VHA utilizers while increasing among nonutilizers. Over these years, an increasing proportion of male veterans younger than 30 years received VHA services, and these individuals had a rising prevalence of diagnosed mental health conditions. Conclusions.The higher rates of suicide for utilizers of VHA among veteran men aged 30 and older were consistent with previous reports about which veterans utilize VHA services. The increasing rates of mental health conditions in utilizers younger than 30 years suggested that the decreasing relative rates in this group were related to the care provided, rather than to selective enrollment of those at lower risk for suicide. PMID:22390582

Optimal Design of Biomass Utilization System for Rural Area Includes Technical and Economic Dimensions

NASA Astrophysics Data System (ADS)

Morioka, Yasuki; Nakata, Toshihiko

In order to design optimal biomass utilization system for rural area, OMNIBUS (The Optimization Model for Neo-Integrated Biomass Utilization System) has been developed. OMNIBUS can derive the optimal system configuration to meet different objective function, such as current account balance, amount of biomass energy supply, and CO2 emission. Most of biomass resources in a focused region e.g. wood biomass, livestock biomass, and crop residues are considered in the model. Conversion technologies considered are energy utilization technologies e.g. direct combustion and methane fermentation, and material utilization technologies e.g. composting and carbonization. Case study in Miyakojima, Okinawa prefecture, has been carried out for several objective functions and constraint conditions. Considering economics of the utilization system as a priority requirement, composting and combustion heat utilization are mainly chosen in the optimal system configuration. However gasification power plant and methane fermentation are included in optimal solutions, only when both biomass energy utilization and CO2 reduction have been set as higher priorities. External benefit of CO2 reduction has large impacts on the system configuration. Provided marginal external benefit of more than 50,000 JPY/t-C, external benefit becomes greater than the revenue from electricity and compost etc. Considering technological learning in the future, expensive technologies such as gasification power plant and methane fermentation will have economic feasibility as well as market competitiveness.

[Assessment of ecological environment benefits of reclaimed water reuse in Beijing].

PubMed

Fan, Yu-Peng; Chen, Wei-Ping

2014-10-01

With the rapid development of the social economy and the sustained growth of population, China is facing increasingly serious water problems, and reclaimed water utilization has become an effective measure to solve water shortage problem and to control further deterioration of the ecological environment. Reclaimed water utilization can not only save a lot of fresh water, but also reduce the environmental impact of wastewater discharge, and thus has great ecological environmental benefits, including resource, environmental and human health benefits and so on. This study used the opportunity cost method to construct an evaluation system for ecological environmental benefits of reclaimed water utilization, and Beijing was taken as an example to conduct an estimation of ecological environmental benefits of reclaimed water utilization. Research results indicated that the reclaimed water utilization in Beijing had considerable environmental benefits for ¥ 1.2 billion in 2010, in which replacement of fresh water accounted for the largest share. The benefits of environmental improvement and groundwater recharge were large, while the other benefits were small or negative. The ecological environment benefits of reclaimed water utilization in Beijing was about 1.8 times that of its direct economic benefits, showing that reclaimed water utilization was in accordance with sustainable development. Related methods and results will provide scientific basis to promote the development of reclaimed water utilization in our country.

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.

The utility of strabismus in adults.

PubMed

Beauchamp, George R; Felius, Joost; Stager, David R; Beauchamp, Cynthia L

2005-01-01

To determine the utility (quality-of-life weight) associated with adult strabismus. Time tradeoff utility values were measured in physician-conducted interviews with 140 adult patients with strabismus in a private practice setting. Patients also completed a questionnaire containing six items that rated the following aspects of disability: specific health problems, problems with tasks of daily living, problems with social interaction, self-image problems, concerns about the future, and job-related problems. Patients were characterized as presurgical or nonsurgical, and their diplopia and asthenopia were rated by the physician on a four-level scale. About 60% of all patients indicated willingness to trade part of their life expectancy in return for being rid of strabismus and its associated effects. The median utility was 0.93 (interquartile range, 0.83 to 1.0). A significantly smaller proportion (44%) of the nonsurgical patients (N = 41) appeared willing to trade time compared with surgical patients (68%; P = .009). Median utility in the presurgical patients was 0.90. Strong relationships were found between utility and the level of diplopia (P < .0001), and between utility and the level of asthenopia (P < .0001). Utility was correlated with all six disability ratings (all P < or = .00062). A majority of the patients interviewed would trade a portion of their life expectancy in return for being rid of strabismus and its associated effects. These results were validated by significant associations with diplopia, asthenopia, and disability.

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

Perspectives on the future of the electric utility industry

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

Tonn, B.; Schaffhauser, A.

1994-04-01

This report offers perspectives on the future of the electric utility industry. These perspectives will be used in further research to assess the prospects for Integrated Resource Planning (IRP). The perspectives are developed first by examining economic, political and regulatory, societal, technological, and environmental trends that are (1) national and global in scope and (2) directly related to the electric utility industry. Major national and global trends include increasing global economic competition, increasing political and ethnic strife, rapidly changing technologies, and increasing worldwide concern about the environment. Major trends in the utility industry include increasing competition in generation; changing patternsmore » of electricity demand; increasing use of information technology to control power systems; and increasing implementation of environmental controls. Ways in which the national and global trends may directly affect the utility industry are also explored. The trends are used to construct three global and national scenarios- ``business as usual,`` ``technotopia future,`` and ``fortress state`` -and three electric utility scenarios- ``frozen in headlights,`` ``megaelectric,`` and ``discomania.`` The scenarios are designed to be thought provoking descriptions of potential futures, not predictions of the future, although three key variables are identified that will have significant impacts on which future evolves-global climate change, utility technologies, and competition. While emphasis needs to be placed on understanding the electric utility scenarios, the interactions between the two sets of scenarios is also of interest.« less

Estimating Health-State Utility for Economic Models in Clinical Studies: An ISPOR Good Research Practices Task Force Report.

PubMed

Wolowacz, Sorrel E; Briggs, Andrew; Belozeroff, Vasily; Clarke, Philip; Doward, Lynda; Goeree, Ron; Lloyd, Andrew; Norman, Richard

Cost-utility models are increasingly used in many countries to establish whether the cost of a new intervention can be justified in terms of health benefits. Health-state utility (HSU) estimates (the preference for a given state of health on a cardinal scale where 0 represents dead and 1 represents full health) are typically among the most important and uncertain data inputs in cost-utility models. Clinical trials represent an important opportunity for the collection of health-utility data. However, trials designed primarily to evaluate efficacy and safety often present challenges to the optimal collection of HSU estimates for economic models. Careful planning is needed to determine which of the HSU estimates may be measured in planned trials; to establish the optimal methodology; and to plan any additional studies needed. This report aimed to provide a framework for researchers to plan the collection of health-utility data in clinical studies to provide high-quality HSU estimates for economic modeling. Recommendations are made for early planning of health-utility data collection within a research and development program; design of health-utility data collection during protocol development for a planned clinical trial; design of prospective and cross-sectional observational studies and alternative study types; and statistical analyses and reporting. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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.

Using Derivative Contracts to Mitigate Water Utility Financial Risks

NASA Astrophysics Data System (ADS)

Characklis, G. W.; Zeff, H.

2012-12-01

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

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

NASA Astrophysics Data System (ADS)

Zeff, Harrison B.; Characklis, Gregory W.

2013-08-01

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

Trends in Alcohol Services Utilization from 1991-1992 to 2001-2002: Ethnic Group Differences in the U.S. Population

PubMed Central

Chartier, Karen G.; Caetano, Raul

2011-01-01

Background During the early 1990s in the U.S., changes to the provision and financing of alcohol treatment services included reductions in inpatient treatment services and in private sector spending for treatment. We investigated trends in alcohol services utilization over the 10-year period from 1991-1992 to 2001-2002 among U.S. Whites, Blacks and Hispanics. Method Data come from two household surveys of the U.S. adult population. The 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES) and the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) conducted face-to-face interviews with a multistage cluster sample of individuals 18 years of age and older in the continental United States. Treatment utilization represented both total utilization and the use of alcohol services. Data analyses were prevalence rates and multivariate logistic regressions for lifetime utilization with drinkers and individuals with alcohol use disorders (AUD). Results From 1991-1992 to 2001-2002, drinking-related emergency room and human services use increased for drinkers, while total utilization and the use of private health professional services and mutual aid decreased for individuals with AUDs. In drinkers and individuals with AUDs, Blacks and Hispanics were less likely than Whites to use private health professional care. Hispanics with AUDs were less likely than Whites with AUDs to use alcohol or drug programs. Ethnicity interacted with alcohol severity to predict alcohol services utilization. At higher levels of alcohol severity, Blacks and Hispanics were less likely than Whites to ever use treatment and to use alcohol services (i.e., human services for Hispanic drinkers, mental health services for Blacks with AUDs, and mutual aid for Hispanics with AUDs). Conclusions Our findings showed increases from 1991-1992 to 2001-2002 in alcohol services utilization for drinkers, but reductions in utilization for individuals with AUDs. Blacks and Hispanics, particularly those at higher levels of alcohol severity, underutilized treatment services compared to Whites. These utilization trends for Blacks and Hispanics may reflect underlying disparities in health care access for minority groups, and language and logistical barriers to utilizing services. PMID:21575015

Factors associated with utilization of long-acting and permanent contraceptive methods among women who have decided not to have more children in Gondar city.

PubMed

Zenebe, Chernet Baye; Adefris, Mulat; Yenit, Melaku Kindie; Gelaw, Yalemzewod Assefa

2017-09-06

Despite the fact that long acting family planning methods reduce population growth and improve maternal health, their utilization remains poor. Therefore, this study assessed the prevalence of long acting and permanent family planning method utilization and associated factors among women in reproductive age groups who have decided not to have more children in Gondar city, northwest Ethiopia. An institution based cross-sectional study was conducted from August to October, 2015. Three hundred seventeen women who have decided not to have more children were selected consecutively into the study. A structured and pretested questionnaire was used to collect data. Both bivariate and multi-variable logistic regressions analyses were used to identify factors associated with utilization of long acting and permanent family planning methods. The multi-variable logistic regression analysis was used to investigate factors associated with the utilization of long acting and permanent family planning methods. The Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was used to show the strength of associations, and variables with a P-value of <0.05 were considered statistically significant. In this study, the overall prevalence of long acting and permanent contraceptive (LAPCM) method utilization was 34.7% (95% CI: 29.5-39.9). According to the multi-variable logistic regression analysis, utilization of long acting and permanent contraceptive methods was significantly associated with women who had secondary school, (AOR: 2279, 95% CI: 1.17, 4.44), college, and above education (AOR: 2.91, 95% CI: 1.36, 6.24), history of previous utilization (AOR: 3.02, 95% CI: 1.69, 5.38), and information about LAPCM (AOR: 8.85, 95% CI: 2.04, 38.41). In this study the prevalence of long acting and permanent family planning method utilization among women who have decided not to have more children was high compared with previous studies conducted elsewhere. Advanced educational status, previous utilization of LAPCM, and information on LAPCM were significantly associated with the utilization of LAPCM. As a result, strengthening behavioral change communication channels to make information accessible is highly recommended.

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.

Regulatory environment and its impact on the market value of investor-owned electric utilities

NASA Astrophysics Data System (ADS)

Vishwanathan, Raman

While other regulated industries have one by one been exposed to competitive reform, electric power, for over eighty years, has remained a great monopoly. For all those years, the vertically integrated suppliers of electricity in the United States have been assigned exclusive territorial (consumer) franchises and have been closely regulated. This environment is in the process change because the electric power industry is currently undergoing some dramatic adjustments. Since 1992, a number of states have initiated regulatory reform and are moving to allow retail customers to choose their energy supplier. There has also been a considerable federal government role in encouraging competition in the generation and transmission of electricity. The objective of this research is to investigate the reaction of investors to the prevailing regulatory environment in the electric utility industry by analyzing the market-to-book value for investor-owned electric utilities in the United States as a gauge of investor concern or support for change. In this study, the variable of interest is the market valuation of utilities, as it captures investor confidence to changes in the regulatory environment. Initially a classic regression model is analyzed on the full sample (of the 96 investor-owned utilities for the years 1992 through 1996), providing a total number of 480 (96 firms over 5 years) observations. Later fixed- and random-effects models are analyzed for the same full-sample model specified in the previous analysis. Also, the analysis is carried forward to examine the impact of the size of the utility and its degree of reliability on nuclear power generation on market values. In the period of this study, 1992--1996, the financial security markets downgraded utilities that were still operating in a regulated environment or had a substantial percentage of their power generation from nuclear power plants. It was also found that the financial market was sensitive to the size of the electric utility. The negative impact of the regulatory environment declined with the increase in the size of the utility, indicating favorable treatment for larger utilities by financial markets. Similarly, for the electric utility industry as a whole, financial markets reacted negatively to nuclear power generation.

Air pollution effects due to deregulation of the electric industry

NASA Astrophysics Data System (ADS)

Davoodi, Khojasteh Riaz

The Energy Policy Act of 1992 introduced the concept of open-access into the electric utility industry which allows privately-owned utilities to transmit power produced by non-utility generators and independent power producers (IPPs). In April 1996, the Federal Energy Regulatory Commission (FERC) laid down the final rules (Orders No. 888 & No. 889), which required utilities to open their transmission lines to any power producer and charge them no more than what they pay for the use of their own lines. These rules set the stage for the retail sale of electricity to industrial, commercial and residential utility customers; non-utility generators (Nugs); and power marketers. These statutory, regulatory and administrative changes create for the electric utility industry two different forces that contradict each other. The first is the concept of competition among utility companies; this places a greater emphasis on electric power generation cost control and affects generation/fuel mix selection and demand side management (DSM) activities. The second force, which is converse to the first, is that utilities are major contributors to the air pollution burden in the United States and environmental concerns are forcing them to reduce emissions of air pollutants by using more environmentally friendly fuels and implementing energy saving programs. This study evaluates the impact of deregulation within the investor owned electric utilities and how this deregulation effects air quality by investigating the trend in demand side management programs and generation/fuel mix. A survey was conducted of investor owned utilities and independent power producers. The results of the survey were analyzed by analysis of variance and regression analysis to determine the impact to Air Pollution. An air Quality Impact model was also developed in this study. This model consists of six modules: (1) demand side management and (2) consumption of coal, (3) gas, (4) renewable, (5) oil and (6) nuclear sources until the year 2005. Each module was analyzed separately and the result from each module was transferred into the Air Quality Impact model. The model assesses the changes in electricity generation within each module due to deregulation and these changes can then be correlated to the emission of air pollutants in the United States.

Are implicit policy assumptions about climate adaptation trying to push drinking water utilities down an impossible path?

NASA Astrophysics Data System (ADS)

Klasic, M. R.; Ekstrom, J.; Bedsworth, L. W.; Baker, Z.

2017-12-01

Extreme events such as wildfires, droughts, and flooding are projected to be more frequent and intense under a changing climate, increasing challenges to water quality management. To protect and improve public health, drinking water utility managers need to understand and plan for climate change and extreme events. This three year study began with the assumption that improved climate projections were key to advancing climate adaptation at the local level. Through a survey (N = 259) and interviews (N = 61) with California drinking water utility managers during the peak of the state's recent drought, we found that scientific information was not a key barrier hindering adaptation. Instead, we found that managers fell into three distinct mental models based on their interaction with, perceptions, and attitudes, towards scientific information and the future of water in their system. One of the mental models, "modeled futures", is a concept most in line with how climate change scientists talk about the use of information. Drinking water utilities falling into the "modeled future" category tend to be larger systems that have adequate capacity to both receive and use scientific information. Medium and smaller utilities in California, that more often serve rural low income communities, tend to fall into the other two mental models, "whose future" and "no future". We show evidence that there is an implicit presumption that all drinking water utility managers should strive to align with "modeled future" mental models. This presentation questions this assumption as it leaves behind many utilities that need to adapt to climate change (several thousand in California alone), but may not have the technical, financial, managerial, or other capacity to do so. It is clear that no single solution or pathway to drought resilience exists for water utilities, but we argue that a more explicit understanding and definition of what it means to be a resilient drinking water utility is necessary. By highlighting, then questioning, the assumption that all utility managers should strive to have "modeled future" mentalities, this presentation seeks to foster an open dialogue around which pathway or pathways are most feasible for supporting drinking water utility managers planning for climate change.

Institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Region, Central Ethiopia: A Community-based cross sectional study.

PubMed

Darega, Birhanu; Dida, Nagasa; Tafese, Fikru; Ololo, Shimeles

2016-07-07

Delivery at health institutions under the care of trained health-care providers and utilization of postnatal cares services plays vital roles in promoting child survival and reducing the risk of maternal mortality. More than 80 % of maternal deaths can be prevented if pregnant women access to essential maternity cares like antenatal care, institutional delivery and postnatal care services. Thus, this study aimed to assess institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Regional State, Ethiopia. A community-based cross-sectional study design was employed among 703 randomly identified mothers of Abuna Gindeberet district in March, 2013. Data were collected through interviewer-administered questionnaires and analyzed using SPSS version 16.0. Descriptive, bivariate and multivariate analyses were used to determine prevalence and to identify associated factors with institutional delivery and postnatal care, considering p-value of less than 0.05 as significant. The results were presented in a narrative forms, tables and graphs. One hundred one (14.4 %) of mothers gave birth to their last baby in health institutions. From 556 (79.1 %) of respondents who heard about postnatal care services, only 223 (31.7 %) of them utilized postnatal care services for their recent childbirth. From the total postnatal care users, 204 (91.5 %) of them took the services from health extension workers. Decision-making styles, household distances from health institutions, household being model family and ANC services utilizations were found to be statistically significant with both institutional delivery and postnatal care services utilizations. But educational status of husbands was statistically significant with only postnatal care services utilizations. Both institutional delivery and postnatal care services utilizations from health institutions were low. Decision-making styles, household distances from health institutions, household being model family and ANC services utilizations were the common factors that affect institutional delivery and postnatal care services utilizations from health institutions. Therefore, giving attention to the identified factors could improve and sustain institutional delivery and postnatal care services utilizations from health institutions.

42 CFR 456.181 - Reports of evaluations and plans of care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals... and plan of care must be entered in the applicant's or recipient's record— (a) At the time of... evaluation or plan. Utilization Review (UR) Plan: General Requirements ...

42 CFR 456.381 - Reports of evaluations and plans of care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care... evaluation and plan of care must be entered in the applicant's or recipient's record— (a) At the time of... plan. Utilization Review (UR) Plan: General Requirement ...

42 CFR 456.381 - Reports of evaluations and plans of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care... evaluation and plan of care must be entered in the applicant's or recipient's record— (a) At the time of... plan. Utilization Review (UR) Plan: General Requirement ...

Combined Utility/Transportation Tunnel Systems - Economic, Technical and Institutional Feasibility

DOT National Transportation Integrated Search

1976-07-01

Although utility tunnels are common in Europe and Asia, United States use is largely confined to institutions where all utilities are under single ownership. Cut-and-cover transportation projects appear to display nearly ideal conditions for the use ...

Utilities on the info highway: Part two

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

Burkhart, L.A.

1994-05-15

This article describes federal government legislation to allow electric and gas utilities to provide telecommunications services. The final law will probably allow all utilities to provide telecommunication services, even those regulated by PUHCA. Details of House and Senate bills are described.

Evaluation of overweight load routing on buried utility facilities

DOT National Transportation Integrated Search

2011-02-01

Overweight traffic movements can negatively affect pavement integrity and quality. However, it is less : known to what degree buried utility plant along and across the right of way is affected by these overweight : loads, especially if the utility fa...

Inventory of Electric Utility Power Plants in the United States

EIA Publications

2002-01-01

Final issue of this report. Provides detailed statistics on existing generating units operated by electric utilities as of December 31, 2000, and certain summary statistics about new generators planned for operation by electric utilities during the next 5 years.

77 FR 26735 - Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-07

... AGENCY: Rural Utilities Service, USDA. ACTION: Notice and request for comments. SUMMARY: In accordance... Department of Agriculture (USDA) Rural Development administers rural utilities programs through the Rural Utilities Service (RUS). The USDA Rural Development invites comments on the following information...

The utilization of the seven principles for good practices of full-time and adjunct faculty in teaching health & science in community colleges

NASA Astrophysics Data System (ADS)

Musaitif, Linda M.

Purpose. The purpose of this study was to determine the degree to which undergraduate full-time and adjunct faculty members in the health and science programs at community colleges in Southern California utilize the seven principles of good practice as measured by the Faculty Inventory of the Seven Principles for Good Practice in Undergraduate Education. A second purpose was to compare degree of utilization for gender and class size. Methodology. This is a quantitative study wherein there exists a systematic and mathematical assessment of data gathered through the use of a Likert scale survey to process and determine the mathematical model of the use of the principles by the target population of both full-time and adjunct faculty of health/science programs of community colleges in Southern California. Findings. Examination of the data revealed that both full-time and adjunct faculty members of Southern California community colleges perceive themselves a high degree of utilization of the seven principles of good practice. There was no statistically significant data to suggest a discrepancy between full-time and adjunct professors' perceptions among the utilization of the seven principles. Overall, male faculty members perceived themselves as utilizing the principles to a greater degree than female faculty. Data suggest that faculty with class size 60 or larger showed to utilize the seven principles more frequently than the professors with smaller class sizes. Conclusions. Full-time and adjunct professors of the health and sciences in Southern California community colleges perceive themselves as utilizing the seven principles of good practice to a high degree. Recommendations. This study suggests many recommendations for future research, including the degree to which negative economic factors such as budget cuts and demands affect the utilization of the seven principles. Also recommended is a study comparing students' perceptions of faculty's utilization of the seven principles of good practice in the classroom with faculty's self-perception.

3D Buried Utility Location Using A Marching-Cross-Section Algorithm for Multi-Sensor Data Fusion

PubMed Central

Dou, Qingxu; Wei, Lijun; Magee, Derek R.; Atkins, Phil R.; Chapman, David N.; Curioni, Giulio; Goddard, Kevin F.; Hayati, Farzad; Jenks, Hugo; Metje, Nicole; Muggleton, Jennifer; Pennock, Steve R.; Rustighi, Emiliano; Swingler, Steven G.; Rogers, Christopher D. F.; Cohn, Anthony G.

2016-01-01

We address the problem of accurately locating buried utility segments by fusing data from multiple sensors using a novel Marching-Cross-Section (MCS) algorithm. Five types of sensors are used in this work: Ground Penetrating Radar (GPR), Passive Magnetic Fields (PMF), Magnetic Gradiometer (MG), Low Frequency Electromagnetic Fields (LFEM) and Vibro-Acoustics (VA). As part of the MCS algorithm, a novel formulation of the extended Kalman Filter (EKF) is proposed for marching existing utility tracks from a scan cross-section (scs) to the next one; novel rules for initializing utilities based on hypothesized detections on the first scs and for associating predicted utility tracks with hypothesized detections in the following scss are introduced. Algorithms are proposed for generating virtual scan lines based on given hypothesized detections when different sensors do not share common scan lines, or when only the coordinates of the hypothesized detections are provided without any information of the actual survey scan lines. The performance of the proposed system is evaluated with both synthetic data and real data. The experimental results in this work demonstrate that the proposed MCS algorithm can locate multiple buried utility segments simultaneously, including both straight and curved utilities, and can separate intersecting segments. By using the probabilities of a hypothesized detection being a pipe or a cable together with its 3D coordinates, the MCS algorithm is able to discriminate a pipe and a cable close to each other. The MCS algorithm can be used for both post- and on-site processing. When it is used on site, the detected tracks on the current scs can help to determine the location and direction of the next scan line. The proposed “multi-utility multi-sensor” system has no limit to the number of buried utilities or the number of sensors, and the more sensor data used, the more buried utility segments can be detected with more accurate location and orientation. PMID:27827836

Health State Utilities for Patients with Brain Metastases.

PubMed

Lester-Coll, Nataniel H; Dosoretz, Arie P; Hayman, James A; Yu, James B

2016-07-04

 Estimating the cost-effectiveness of whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS), including Gamma Knife radiosurgery (GKRS), requires the quantitative measurement of patients' health states after treatment. We sought to quantify individuals' preferences for the relevant health states after WBRT or GKRS for brain metastases on a 0 to 1 scale, where 1 is perfect health and 0 is death.  We prospectively measured utilities in patients with brain metastases evaluated at Yale for consideration of WBRT and/or GKRS, as well as oncology nurses who had cared for patients with brain metastases before and after WBRT or GKRS, using the Standard Gamble (SG) technique. Demographic information was also collected. Nonparametric tests were used to compare potential differences in utility values and for subgroups based on demographic characteristics.  There were 24 patients and 31 nurses who completed the study between December 2013 and May 2015. Median utilities ranged from 0.85 for the status-post (S/P) GKRS state to 0.25 (for neurologic dying). The median utility of being S/P WBRT was 0.70 compared to 0.85 S/P GKRS (p < 0.001). The cognitive decline from WBRT was associated with a notably low utility score of 0.30. There were no statistically significant differences between patients' and nurses' median utility scores.  These SG utilities provide unique insights into brain metastases-related health states from the patient and provider perspective. As perceived by individuals with direct knowledge of the health states in question, WBRT has a significantly lower utility compared to GKRS. Cognitive decline following WBRT is associated with significant perceived reduction in quality of life. Differences in the relative importance of overall survival and quality of life with treatment existed between patients with different stages of disease. These utilities can be used to calculate quality-adjusted life expectancy in cost-effectiveness evaluations of SRS and WBRT.

3D Buried Utility Location Using A Marching-Cross-Section Algorithm for Multi-Sensor Data Fusion.

PubMed

Dou, Qingxu; Wei, Lijun; Magee, Derek R; Atkins, Phil R; Chapman, David N; Curioni, Giulio; Goddard, Kevin F; Hayati, Farzad; Jenks, Hugo; Metje, Nicole; Muggleton, Jennifer; Pennock, Steve R; Rustighi, Emiliano; Swingler, Steven G; Rogers, Christopher D F; Cohn, Anthony G

2016-11-02

We address the problem of accurately locating buried utility segments by fusing data from multiple sensors using a novel Marching-Cross-Section (MCS) algorithm. Five types of sensors are used in this work: Ground Penetrating Radar (GPR), Passive Magnetic Fields (PMF), Magnetic Gradiometer (MG), Low Frequency Electromagnetic Fields (LFEM) and Vibro-Acoustics (VA). As part of the MCS algorithm, a novel formulation of the extended Kalman Filter (EKF) is proposed for marching existing utility tracks from a scan cross-section (scs) to the next one; novel rules for initializing utilities based on hypothesized detections on the first scs and for associating predicted utility tracks with hypothesized detections in the following scss are introduced. Algorithms are proposed for generating virtual scan lines based on given hypothesized detections when different sensors do not share common scan lines, or when only the coordinates of the hypothesized detections are provided without any information of the actual survey scan lines. The performance of the proposed system is evaluated with both synthetic data and real data. The experimental results in this work demonstrate that the proposed MCS algorithm can locate multiple buried utility segments simultaneously, including both straight and curved utilities, and can separate intersecting segments. By using the probabilities of a hypothesized detection being a pipe or a cable together with its 3D coordinates, the MCS algorithm is able to discriminate a pipe and a cable close to each other. The MCS algorithm can be used for both post- and on-site processing. When it is used on site, the detected tracks on the current scs can help to determine the location and direction of the next scan line. The proposed "multi-utility multi-sensor" system has no limit to the number of buried utilities or the number of sensors, and the more sensor data used, the more buried utility segments can be detected with more accurate location and orientation.