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

NASA Astrophysics Data System (ADS)

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

2018-04-01

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

Successful rehabilitation program rests on service utilization.

PubMed

Lane, L

1993-07-01

An effective rehabilitation strategy is built upon three fundamentals: translating resident needs into delivered services, managing occupancy and marketing programs, and utilizing existing reimbursement mechanisms to ensure profitability of the venture.

Community energy management in Sitka, Alaska: What strategies can help increase energy independence?

Treesearch

David Nicholls; Trista Patterson

2013-01-01

This report summarizes practical energy management strategies that could help communities in southeast Alaska move closer to energy independence while utilizing local resources more effectively. Our analysis focuses primarily on Sitka, Alaska, yet could be relevant to other communities having similar energy structures that rely primarily on hydroelectric power...

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

Utilizing the PPET Mnemonic to Guide Classroom-Level PBIS for Students with or At Risk for EBD across Classroom Settings

ERIC Educational Resources Information Center

Hunter, William C.; Barton-Arwood, Sally; Jasper, Andrea; Murley, Renee; Clements, Tarol

2017-01-01

In this article, the authors discuss how the emphasis on classroom-level Positive Behavior Interventions and Supports strategies can establish a foundation for an efficient classroom management program and be utilized as a resource. The strategies described are physical classroom, procedures and rules, explicit timing, and transition (PETT…

Implementation Strategies for Educational Intranet Resources.

ERIC Educational Resources Information Center

Herson, Katie; Sosabowski, Michael; Lloyd, Andrew; Flowers, Stephen; Paine, Cameron; Newton, Becci

2000-01-01

Describes two alternative strategies for intranet implementation based on experiences at the University of Brighton (United Kingdom). Highlights include differing degrees of staff and student utilization; barriers to success; a unified strategy for effective intranet implementation; and how to manage organizational resistance to change.…

Planning and Implementing Social Service Information Systems: A Guide for Management and Users. Human Services Monograph Series Number 25. Project Share.

ERIC Educational Resources Information Center

Cotter, Barbara

Intended to aid administrators and users of social services in establishing information systems, this comprehensive guide to the design of such systems identifies the elements, effective strategies, and potential pitfalls involved in their planning, implementation, and utilization. Detailed discussions of management strategies for system…

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

NASA Astrophysics Data System (ADS)

Groves, D. G.; Lempert, R.

2008-12-01

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

Long-term consequences of selected competitive strategies during deregulation of the United States electric utility industry: System dynamics modeling and simulation

NASA Astrophysics Data System (ADS)

Khalil, Yehia Fahim

Currently, U.S. investor-owned utilities (IOUs) are facing major reforms in their business environment similar to the airlines, telecommunications, banking, and insurance industries. As a result, IOUs are gearing up for fierce price competition in the power generation sector, and are vying for electricity customers outside their franchised service territories. Energy experts predict that some IOUs may suffer fatal financial setbacks (especially those with nuclear plants), while others may thrive under competition. Both federal and state energy regulators anticipate that it may take from five to ten years to complete the transition of America's electric utility industry from a regulated monopoly to a market-driven business. During this transition, utility executives are pursuing aggressive business strategies to confront the upcoming price wars. The most compelling strategies focus on cutting operation and maintenance (O&M) costs of power production, downsizing the work force, and signing bilateral energy agreements with large price-sensitive customers to retain their business. This research assesses the impact of the three pivotal strategies on financial performance of utilities during transition to open market competition. A system-dynamics-based management flight simulator has been developed to predict the dynamic performance of a hypothetical IOU organization preparing for market competition. The simulation results show that while the three business strategies lead to short-lived gains, they also produce unanticipated long-term consequences that adversely impact the organization's operating revenues. Generally, the designed flight simulator serves as a learning laboratory which allows management to test new strategies before implementation.

77 FR 39554 - Self-Regulatory Organizations; NYSE Arca, Inc.; Order Granting Approval of Proposed Rule Change...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-03

... investment objective by implementing a ``top-down'' portfolio management style. This management style begins...'' portfolio management style utilizes a tactical and globally diversified allocation strategy in an attempt to... open-end management investment company.\\4\\ The [[Page 39555

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

PubMed

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

2017-03-01

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

State Network Utilization Study: Mississippi Educational Television.

ERIC Educational Resources Information Center

Wilson, Savan; And Others

This document is the result of a utilization study of Mississippi Educational Television where 27 target audiences were identified and surveyed. The following information is included: a draft of and updated state network utilization studies; planning and management strategies; a profile of the survey populations; a distance learning survey report;…

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.

Management strategies for fibromyalgia

PubMed Central

Le Marshall, Kim Francis; Littlejohn, Geoffrey Owen

2011-01-01

Clinical question What are the effective, evidence-based strategies available for the management of fibromyalgia? Conclusion There are a number of management strategies available with robust evidence to support their use in clinical practice. Definition Fibromyalgia is a complex pain syndrome characterized by widespread, chronic muscular pain and tenderness, disordered sleep, emotional distress, cognitive disturbance, and fatigue. Its prevalence is estimated to be 3%–5% in the population and higher yet in patients with comorbid rheumatic diseases. Level of evidence Systematic reviews, meta-analyses, randomized controlled trials (RCTs). Search sources PubMed, Cochrane Library, manual search Consumer summary Key messages for patients and clinicians are: There are many effective pharmacological management strategies available for fibromyalgia.A nonpharmacological, multicomponent approach utilizing education, aerobic exercise, psychological therapy, and other strategies is also effective for fibromyalgia.Despite the significant and, at times, disabling physical and psychological symptoms, fibromyalgia can be a manageable condition with a potentially good outcome. PMID:27790003

Exertional heat stroke management strategies in United States high school football.

PubMed

Kerr, Zachary Y; Marshall, Stephen W; Comstock, R Dawn; Casa, Douglas J

2014-01-01

The 5-year period of 2005-2009 saw more exertional heat stroke-related deaths in organized sports than any other 5-year period in the past 35 years. The risk of exertional heat stroke appears highest in football, particularly during the preseason. To estimate the incidence of exertional heat stroke events and assess the utilization of exertional heat stroke management strategies during the 2011 preseason in United States high school football programs. Cross-sectional study; Level of evidence, 3. A self-administered online questionnaire addressing the incidence of exertional heat stroke events and utilization of exertional heat stroke management strategies (eg, removing athlete's football equipment, calling Emergency Medical Services [EMS]) was completed in May to June 2012 by 1142 (18.0%) athletic trainers providing care to high school football athletes during the 2011 preseason. Among all respondents, 20.3% reported treating at least 1 exertional heat stroke event. An average of 0.50 ± 1.37 preseason exertional heat stroke events were treated per program. Athletic trainers responding to exertional heat stroke reported using an average of 6.6 ± 1.8 management strategies. The most common management strategies were low-level therapeutic interventions such as removing the athlete's football equipment (98.2%) and clothing (77.8%) and moving the athlete to a shaded area (91.6%). Few athletic trainers reported active management strategies such as calling EMS (29.3%) or using a rectal thermometer to check core body temperature (0.9%). Athletic trainers in states with mandated preseason heat acclimatization guidelines reported a higher utilization of management strategies such as cooling the athlete through air conditioning (90.1% vs 65.0%, respectively; P < .001), immersion in ice water (63.0% vs 45.4%, respectively; P = .01), or fans (54.3% vs 42.0%, respectively; P = .06) and monitoring the athlete's temperature (60.5% vs 46.2%, respectively; P = .04). Preseason exertional heat stroke events, which are likely to be fatal if untreated, were reported by one fifth of all athletic trainers in high school football programs. The standard of care is (and should be) to treat proactively; therefore, treatment is not a perfect proxy for incidence. Nevertheless, there is an urgent need for improved education and awareness of exertional heat stroke in high school football. Areas of improvement include the greatly increased use of rectal thermometers and immersion in ice water.

Experiences addressing health-related financial challenges with disease management among African American women with asthma.

PubMed

Patel, Minal R; Caldwell, Cleopatra H; Id-Deen, Effat; Clark, Noreen M

2014-06-01

Despite economic hardship, compliance with self-management regimens is still evident among individuals and families managing chronic disease. The purpose of this study was to describe how women with asthma address cost-related challenges to management of their condition. In 2012 and 2013, four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding means to reduce the impact of the cost of asthma management. Major themes identified were acceptance of the status quo; stockpiling and sharing medicines; utilizing community assistance programs; reaching out to healthcare providers and social networks for help; foregoing self-management; and utilizing urgent care. Awareness of strategies that are helpful to patients in reducing out-of-pocket costs may better equip service providers and others to develop interventions to make useful strategies more widely available.

Experiences addressing health-related financial challenges with disease management among African American women with asthma

PubMed Central

Patel, Minal R.; Caldwell, Cleopatra H.; Id-Deen, Effat; Clark, Noreen M.

2018-01-01

Objective Despite economic hardship, compliance with self-management regimens is still evident among individuals and families managing chronic disease. The purpose of this study was to describe how women with asthma address cost-related challenges to management of their condition. Methods In 2012 and 2013, four focus groups were conducted in Southeast Michigan with 26 African American women with asthma, recruited based on maximum variation sampling procedures. A semi-structured interview protocol was employed by trained facilitators. Coded transcripts were analyzed for themes regarding means to reduce the impact of the cost of asthma management. Results Major themes identified were acceptance of the status quo; stockpiling and sharing medicines; utilizing community assistance programs; reaching out to healthcare providers and social networks for help; foregoing self-management; and utilizing urgent care. Conclusions Awareness of strategies that are helpful to patients in reducing out-of-pocket costs may better equip service providers and others to develop interventions to make useful strategies more widely available. PMID:24471517

A Decision Support System For The Real-Time Allocation Of The Water Resource Of The Tarim River Basin, China

NASA Astrophysics Data System (ADS)

Wei, J.; Wang, G.; Liu, R.

2008-12-01

The Tarim River Basin is the longest inland river in China. Due to water scarcity, ecologically-fragile is becoming a significant constraint to sustainable development in this region. To effectively manage the limited water resources for ecological purposes and for conventional water utilization purposes, a real-time water resources allocation Decision Support System (DSS) has been developed. Based on workflows of the water resources regulations and comprehensive analysis of the efficiency and feasibility of water management strategies, the DSS includes information systems that perform data acquisition, management and visualization, and model systems that perform hydrological forecast, water demand prediction, flow routing simulation and water resources optimization of the hydrological and water utilization process. An optimization and process control strategy is employed to dynamically allocate the water resources among the different stakeholders. The competitive targets and constraints are taken into considered by multi-objective optimization and with different priorities. The DSS of the Tarim River Basin has been developed and been successfully utilized to support the water resources management of the Tarim River Basin since 2005.

Evaluation of pre-emption and transition strategies for Northern Virginia Smart Traffic Signal Systems (NVSTSS).

DOT National Transportation Integrated Search

2008-01-01

Modern traffic signal control systems provide emergency vehicle preemption (EVP) capabilities by utilizing advanced sensors and communication technologies. EVP strategies are widely implemented by urban transportation management agencies. One of the ...

Teaching Tip: Utilizing Classroom Simulation to Convey Key Concepts in IT Portfolio Management

ERIC Educational Resources Information Center

Larson, Eric C.

2013-01-01

Managing a portfolio of IT projects is an important capability for firms and their managers. The classroom simulation described here provides students in an MBA information systems management/strategy course with the opportunity to deepen their understanding of the key concepts that should be considered in managing an IT portfolio and helps…

77 FR 29429 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing of Proposed Rule Change Relating...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-17

... investment objective by implementing a ``top-down'' portfolio management style. This management style begins...'' portfolio management style utilizes a tactical and globally diversified allocation strategy in an attempt to... open-end management investment company.\\5\\ The investment adviser to the Fund is AdvisorShares...

From Physician to Consumer: The Effectiveness of Strategies to Manage Health Care Utilization

PubMed Central

Flynn, Kathryn E.; Smith, Maureen A.; Davis, Margaret K.

2006-01-01

Many strategies are commonly used to influence physician behavior in managed care organizations. This review examines the effectiveness of three mechanisms to influence physician behavior: financial incentives directed at providers or patients, policies/procedures for managing care, and the selection/education of both providers and patients. We reach three conclusions. First, all health care systems use financial incentives, but these mechanisms are shifting away from financial incentives directed at the physician to those directed at the consumer. Second, heavily procedural strategies such as utilization review and gatekeeping show some evidence of effectiveness but are highly unpopular due to their restrictions on physician and patient choice. Third, a future system built on consumer choice is contradicted by mechanisms that rely solely on narrow networks of providers or the education of physicians. If patients become the new locus of decision-making in health care, provider-focused mechanisms to influence physician behavior will not disappear but are likely to decline in importance. PMID:12508705

Scope of symptoms and self-management strategies for chemotherapy-induced peripheral neuropathy in breast cancer patients.

PubMed

Speck, Rebecca M; DeMichele, Angela; Farrar, John T; Hennessy, Sean; Mao, Jun J; Stineman, Margaret G; Barg, Frances K

2012-10-01

This study explored the self-management strategies utilized by female breast cancer patients to cope with the impact of chemotherapy-induced peripheral neuropathy (CIPN) symptoms. We also examined the variety of taxane-related side effects in women with and without CIPN in order to discriminate the CIPN symptom experience. A purposive sample of 25 patients treated with docetaxel or paclitaxel were recruited, half with and half without CIPN. Semistructured interviews and patient level data were utilized for this exploratory, descriptive study. Interview data were analyzed with the constant comparative method; patient level data were abstracted from the electronic medical record. Participants were aged 24-60 years, were currently receiving chemotherapy or within 6 months of having completed treatment, and 14 had CIPN. CIPN impacted routine activities, functions, and behaviors in the areas of domestic, work, and social/leisure life. Multiple self-management and coping strategies to minimize the impact of CIPN symptoms were reported; the focus was on movement to reduce symptoms, attitude awareness, logistics to simplify demands, and environmental change. Women with and without CIPN were similar in the quantity and type of other reported side effects. CIPN affects breast cancer patients' routine activities, functions, and behaviors, but they develop management strategies to reduce the impact. The management strategies reported in this study suggest breast cancer patients may adopt interventions that focus on exercise, mindfulness, occupational therapy, and environmental planning toward the goal of reducing the impact of CIPN symptoms on their lives.

Navigating financial and supply reliability tradeoffs in regional drought management portfolios

NASA Astrophysics Data System (ADS)

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

2014-06-01

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

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

NASA Astrophysics Data System (ADS)

Alp, E.; Aksoy, M. N.; Koçer, B.

2013-12-01

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

Ecology and management of pinyon-juniper ecosystems in the Bureau of Indian Affairs Southwestern Region

Treesearch

John Waconda

2008-01-01

The large acreages of the woodland forest cover type on tribal lands continues to post challenges to this agency's overall management strategies. The development of management plans, evaluation of growth study plots, and anticipated biomass utilization can help resolve some of the challenges.

Application of dynamic traffic assignment to advanced managed lane modeling.

DOT National Transportation Integrated Search

2013-11-01

In this study, a demand estimation framework is developed for assessing the managed lane (ML) : strategies by utilizing dynamic traffic assignment (DTA) modeling, instead of the traditional : approaches that are based on the static traffic assignment...

Investigation of Cost and Energy Optimization of Drinking Water Distribution Systems.

PubMed

Cherchi, Carla; Badruzzaman, Mohammad; Gordon, Matthew; Bunn, Simon; Jacangelo, Joseph G

2015-11-17

Holistic management of water and energy resources through energy and water quality management systems (EWQMSs) have traditionally aimed at energy cost reduction with limited or no emphasis on energy efficiency or greenhouse gas minimization. This study expanded the existing EWQMS framework and determined the impact of different management strategies for energy cost and energy consumption (e.g., carbon footprint) reduction on system performance at two drinking water utilities in California (United States). The results showed that optimizing for cost led to cost reductions of 4% (Utility B, summer) to 48% (Utility A, winter). The energy optimization strategy was successfully able to find the lowest energy use operation and achieved energy usage reductions of 3% (Utility B, summer) to 10% (Utility A, winter). The findings of this study revealed that there may be a trade-off between cost optimization (dollars) and energy use (kilowatt-hours), particularly in the summer, when optimizing the system for the reduction of energy use to a minimum incurred cost increases of 64% and 184% compared with the cost optimization scenario. Water age simulations through hydraulic modeling did not reveal any adverse effects on the water quality in the distribution system or in tanks from pump schedule optimization targeting either cost or energy minimization.

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.

Quality of life in patients with various Barrett's esophagus associated health states.

PubMed

Hur, Chin; Wittenberg, Eve; Nishioka, Norman S; Gazelle, G Scott

2006-08-02

The management of Barrett's esophagus (BE), particularly high grade dysplasia (HGD), is an area of much debate and controversy. Surgical esophagectomy, intensive endoscopic surveillance and mucosal ablative techniques, especially photodynamic therapy (PDT), have been proposed as possible management strategies. The purpose of this study was to determine the health related quality of life associated with Barrett's esophagus and many of the pivotal health states associated with Barrett's HGD management. 20 patients with Barrett's esophagus were enrolled in a pilot survey study at a large urban hospital. The utility of Barrett's esophagus without dysplasia (current health state) as well as various health states associated with HGD management (hypothetical states as the subject did not have HGD) were measured using a validated health utility instrument (Paper Standard Gamble). These specific health states were chosen for the study because they are considered pivotal in Barrett's HGD decision making. Information regarding Barrett's HGD was presented to the subject in a standardized format that was designed to be easily comprehendible. The average utility scores (0-1 with 0 = death and 1 = perfect health) for the various Barrett's esophagus associated states were: BE without dysplasia-0.95; Post-esophagectomy for HGD with dysphagia-0.92; Post-PDT for HGD with recurrence uncertainty-0.93; Post-PDT for HGD with recurrence uncertainty and dysphagia-0.91; Intensive endoscopic surveillance for HGD-0.90. We present the scores for utilities associated with Barrett's esophagus as well as various states associated with the management of HGD. The results of our study may be useful in advising patients and providers regarding expected outcomes of the various HGD management strategies as well as providing utility scores for future cost-effectiveness analyses.

Roadmap to risk evaluation and mitigation strategies (REMS) success

PubMed Central

Balian, John D.; Malhotra, Rachpal; Perentesis, Valerie

2010-01-01

Medical safety-related risk management is a rapidly evolving and increasingly important aspect of drug approval and market longevity. To effectively meet the challenges of this new era, we describe a risk management roadmap that proactively yet practically anticipates risk-management requirements, provides the foundation for enduring yet appropriately flexible risk-management practices, and leverages these techniques to efficiently and effectively utilize risk evaluation and mitigation strategies (REMS)/risk minimization programs as market access enablers. This fully integrated risk-management paradigm creates exciting opportunities for newer tools, techniques, and approaches to more successfully optimize product development, approval, and commercialization, with patients as the ultimate beneficiaries. PMID:25083193

Compromise-based Robust Prioritization of Climate Change Adaptation Strategies for Watershed Management

NASA Astrophysics Data System (ADS)

Kim, Y.; Chung, E. S.

2014-12-01

This study suggests a robust prioritization framework for climate change adaptation strategies under multiple climate change scenarios with a case study of selecting sites for reusing treated wastewater (TWW) in a Korean urban watershed. The framework utilizes various multi-criteria decision making techniques, including the VIKOR method and the Shannon entropy-based weights. In this case study, the sustainability of TWW use is quantified with indicator-based approaches with the DPSIR framework, which considers both hydro-environmental and socio-economic aspects of the watershed management. Under the various climate change scenarios, the hydro-environmental responses to reusing TWW in potential alternative sub-watersheds are determined using the Hydrologic Simulation Program in Fortran (HSPF). The socio-economic indicators are obtained from the statistical databases. Sustainability scores for multiple scenarios are estimated individually and then integrated with the proposed approach. At last, the suggested framework allows us to prioritize adaptation strategies in a robust manner with varying levels of compromise between utility-based and regret-based strategies.

Reducing regional vulnerabilities and multi-city robustness conflicts using many-objective optimization under deep uncertainty

NASA Astrophysics Data System (ADS)

Reed, Patrick; Trindade, Bernardo; Jonathan, Herman; Harrison, Zeff; Gregory, Characklis

2016-04-01

Emerging water scarcity concerns in southeastern US are associated with several deeply uncertain factors, including rapid population growth, limited coordination across adjacent municipalities and the increasing risks for sustained regional droughts. Managing these uncertainties will require that regional water utilities identify regionally coordinated, scarcity-mitigating strategies that trigger the appropriate actions needed to avoid water shortages and financial instabilities. This research focuses on the Research Triangle area of North Carolina, seeking to engage the water utilities within Raleigh, Durham, Cary and Chapel Hill in cooperative and robust regional water portfolio planning. Prior analysis of this region through the year 2025 has identified significant regional vulnerabilities to volumetric shortfalls and financial losses. Moreover, efforts to maximize the individual robustness of any of the mentioned utilities also have the potential to strongly degrade the robustness of the others. This research advances a multi-stakeholder Many-Objective Robust Decision Making (MORDM) framework to better account for deeply uncertain factors when identifying cooperative management strategies. Results show that the sampling of deeply uncertain factors in the computational search phase of MORDM can aid in the discovery of management actions that substantially improve the robustness of individual utilities as well as the overall region to water scarcity. Cooperative water transfers, financial risk mitigation tools, and coordinated regional demand management must be explored jointly to decrease robustness conflicts between the utilities. The insights from this work have general merit for regions where adjacent municipalities can benefit from cooperative regional water portfolio planning.

Reducing regional vulnerabilities and multi-city robustness conflicts using many-objective optimization under deep uncertainty

NASA Astrophysics Data System (ADS)

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

2015-12-01

Emerging water scarcity concerns in southeastern US are associated with several deeply uncertain factors, including rapid population growth, limited coordination across adjacent municipalities and the increasing risks for sustained regional droughts. Managing these uncertainties will require that regional water utilities identify regionally coordinated, scarcity-mitigating strategies that trigger the appropriate actions needed to avoid water shortages and financial instabilities. This research focuses on the Research Triangle area of North Carolina, seeking to engage the water utilities within Raleigh, Durham, Cary and Chapel Hill in cooperative and robust regional water portfolio planning. Prior analysis of this region through the year 2025 has identified significant regional vulnerabilities to volumetric shortfalls and financial losses. Moreover, efforts to maximize the individual robustness of any of the mentioned utilities also have the potential to strongly degrade the robustness of the others. This research advances a multi-stakeholder Many-Objective Robust Decision Making (MORDM) framework to better account for deeply uncertain factors when identifying cooperative management strategies. Results show that the sampling of deeply uncertain factors in the computational search phase of MORDM can aid in the discovery of management actions that substantially improve the robustness of individual utilities as well as of the overall region to water scarcity. Cooperative water transfers, financial risk mitigation tools, and coordinated regional demand management should be explored jointly to decrease robustness conflicts between the utilities. The insights from this work have general merit for regions where adjacent municipalities can benefit from cooperative regional water portfolio planning.

Improving productivity through more effective time management.

PubMed

Arnold, Edwin; Pulich, Marcia

2004-01-01

Effective time management has become increasingly important for managers as they seek to accomplish objectives in today's organizations, which have been restructured for efficiency while employing fewer people. Managers can improve their ability to manage time effectively by examining their attitudes toward time, analyzing time-wasting behaviors, and developing better time management skills. Managers can improve their performance and promotion potential with more effective time utilization. Strategies for improving time management skills are presented.

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

Development and Application of Climate Services for Water Resources Planning and Management within the Department of Interior Bureau of Reclamation

NASA Astrophysics Data System (ADS)

Raff, D. A.; Morgan, A.; Brekke, L. D.

2014-12-01

The Bureau of Reclamation is the nation's largest wholesale water supplier and the second largest producer of hydropower. Reclamation operates 337 reservoirs with a total storage capacity of 245 million acre-feet and operates 53 hydroelectric powerplants that annually produce, on average for the past 10 years, 40 billion kilowatt-hours. Reclamation is adapting to the impacts and future challenges posed by the changing climate through the development of new climate services as well as through cooperation with Federal, state, local, tribal, academic, and non-governmental partners in the use of climate and water resource information that may be available. Reclamation is utilizing this information within a strategy that has four goals: 1) Increase Water Management Flexibility, 2) Enhance Climate Adaptation Planning, 3) Improve Infrastructure Resiliency, and 4) Expand Information Sharing. Within this presentation we will focus on the utilization of climate services within each of these key goals of Reclamation's strategy. This includes the utilization of climate information to track and potentially improve reservoir management to increase water management flexibility, the development of climate informed hydrology that supports climate adaptation planning, use of climate information to inform decisions of infrastructure resilience, and climate services use for jointly informed water management decisions through education and web based services.

Reducing Gridlock on the Grid: Utility Trends in Managing Peak Electric Load through Residential Demand Response

NASA Astrophysics Data System (ADS)

McDonald, Betsy

Utilities across the United States are piloting residential demand response programs to help manage peak electric demand. Using publicly available program evaluations, this thesis analyzes nine such programs to uncover and synthesize the range of program offerings, goals, enrollment strategies, and customer experiences. This review reveals that program participation, components, and results differ based on a variety of factors, including geographic characteristics, program goals, and implementation strategies. The diversity of program designs and evaluation findings suggests an underlying tension between the need to generate cost-effective program impacts and the desire to increase accessibility so that program benefits are not exclusive to certain segments of the population. For more significant and impactful engagement, program goals may need to shift. State level policy support could help shift program goals toward increasing program accessibility. Future research should explore creative strategies that target existing barriers and allow for more inclusive deployment.

Construction in Occupied Spaces

NASA Astrophysics Data System (ADS)

Ward, Andrew E.; Azhar, Salman; Khalfan, Malik

2017-06-01

Conducting construction activities in occupied environments presents a great challenge due to the additional logistical requirements and the presence of the building occupants. The aim of this research is to gather and evaluate the means and methods to successfully plan, manage, and execute construction activities in occupied spaces in an effort to provide consolidated industry tools and strategies for maintaining a schedule and minimizing the impact on the occupants. The methodology of the research utilizes an exploratory approach to gather qualitative data. The data was collected through interviews with industry professionals to identify industry best practices. The semi-structured interviews provided a platform for the documents, lessons learned, and the techniques and strategies used for occupied construction by the construction industry. The information obtained in the interview process identified six themes that are critical to achieving and maintaining quality in occupied construction. These themes of the schedule, cost, customer satisfaction, planning, fire/life safety and utilities, and contractor management are reviewed in detail, and the paper discusses how to manage each element. The analysis and extracted management techniques, procedures and strategies can be used by the construction industry for future projects by focusing on the critical aspects of occupied construction and the manner in which to succeed with it.

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

PubMed

Kim, Yeonjoo; Chung, Eun-Sung

2014-03-01

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

Developing Supply Chain Management Program: A Competency Model

ERIC Educational Resources Information Center

Sauber, Matthew H.; McSurely, Hugh B.; Tummala, V. M. Rao

2008-01-01

Purpose: This paper aims to show the process of designing and measuring learning competencies in program development. Design/methodology/approach: The paper includes cross-sectoral comparisons to draw on programmatic and pedagogical strategies, more commonly utilized in vocational education, and transfer the application of these strategies into…

Optimal urban water conservation strategies considering embedded energy: coupling end-use and utility water-energy models.

NASA Astrophysics Data System (ADS)

Escriva-Bou, A.; Lund, J. R.; Pulido-Velazquez, M.; Spang, E. S.; Loge, F. J.

2014-12-01

Although most freshwater resources are used in agriculture, a greater amount of energy is consumed per unit of water supply for urban areas. Therefore, efforts to reduce the carbon footprint of water in cities, including the energy embedded within household uses, can be an order of magnitude larger than for other water uses. This characteristic of urban water systems creates a promising opportunity to reduce global greenhouse gas emissions, particularly given rapidly growing urbanization worldwide. Based on a previous Water-Energy-CO2 emissions model for household water end uses, this research introduces a probabilistic two-stage optimization model considering technical and behavioral decision variables to obtain the most economical strategies to minimize household water and water-related energy bills given both water and energy price shocks. Results show that adoption rates to reduce energy intensive appliances increase significantly, resulting in an overall 20% growth in indoor water conservation if household dwellers include the energy cost of their water use. To analyze the consequences on a utility-scale, we develop an hourly water-energy model based on data from East Bay Municipal Utility District in California, including the residential consumption, obtaining that water end uses accounts for roughly 90% of total water-related energy, but the 10% that is managed by the utility is worth over 12 million annually. Once the entire end-use + utility model is completed, several demand-side management conservation strategies were simulated for the city of San Ramon. In this smaller water district, roughly 5% of total EBMUD water use, we found that the optimal household strategies can reduce total GHG emissions by 4% and utility's energy cost over 70,000/yr. Especially interesting from the utility perspective could be the "smoothing" of water use peaks by avoiding daytime irrigation that among other benefits might reduce utility energy costs by 0.5% according to our assessment.

Controlling inpatient psychiatric utilization through managed care.

PubMed

Wickizer, T M; Lessler, D; Travis, K M

1996-03-01

There is little current understanding of how managed care strategies affect hospital inpatient psychiatric care for mentally ill patients. This study examined one prominent form of managed care, utilization management, which reviews requests for psychiatric care and authorizes provision of care deemed appropriate and clinically necessary. The authors analyzed data on 2,265 utilization management reviews conducted during 1989-1992 for patients insured by a single large commercial insurance company. Three utilization management procedures were examined: preadmission review, continued-stay review, and case management. The performance indicators analyzed included percent of admission requests granted, number of days requested and approved, and number of treatment extensions granted. Utilization management initially approved inpatient psychiatric treatment for nearly all (98.8%) of the patients but authorized, on average, only one-third of the days requested (6.9 versus 19.0). On average, 23.5 (total) days of care were requested and 16.8 days were approved. Care for patients with alcohol or drug dependence diagnoses was more restricted than was care for other patients. These data suggest that managed care does restrict inpatient psychiatric care, primarily by managing length of stay. The fact that almost all patients were approved for the same initial length of stay implies adherence to strict treatment protocols that do not distinguish among different clinical or patient factors. There is a need for careful study of the effects of managed care on outcomes and quality of psychiatric care.

Coastal management strategy for small island: ecotourism potency development in Karimata Island, West Kalimantan

NASA Astrophysics Data System (ADS)

Rudiastuti, A. W.; Munawaroh; Setyawan, I. E.; Pramono, G. H.

2018-04-01

Sustainable coastal management is playing an important role in coastal resources conservation, particularly on small islands. Karimata archipelago has unique characteristics and great potential to be developed as a tourism object, one of which is Karimata Island as the largest island and also reserve area. The concept of ecotourism focuses on the ecology conservation, economic benefits, and social life. Ecotourism aims to build sustainable tourism that provides economically viable and social benefits to the community. This study aims to develop coastal management strategy based on ecotourism at Karimata Island. Spatial approaching through coastal type was done. Qualitative descriptive analysis and SWOT are used to develop sustainable management strategies for the coast of Karimata Island, where the opportunities and challenges to the development of coastal ecotourism Karimata Island also included. If this potential is optimally utilized, it can be relied as an economic opportunity for local communities. Structurally shaped coast, marine depositional coast and coast build by organism are several of coastal types found at Karimata Island. Coastal ecosystems inhabited Karimata Island are mangroves, coral reefs, and macro-algae. Karimata Island have not been optimally utilized for tourist destinations. The biggest obstacle encountered is the accessibility from Kalimantan or other island at Karimata islands. Several problems related to the utilization of coastal resources were found such as mangrove and coral reef damage, also regulation that less supportive. The results of this study are expected to provide an overview of solutions for the development of coastal tourism potentials in Karimata Island.

Dispatch Strategy Development for Grid-tied Household Energy Systems

NASA Astrophysics Data System (ADS)

Cardwell, Joseph

The prevalence of renewable generation will increase in the next several decades and offset conventional generation more and more. Yet this increase is not coming without challenges. Solar, wind, and even some water resources are intermittent and unpredictable, and thereby create scheduling challenges due to their inherent "uncontrolled" nature. To effectively manage these distributed renewable assets, new control algorithms must be developed for applications including energy management, bridge power, and system stability. This can be completed through a centralized control center though efforts are being made to parallel the control architecture with the organization of the renewable assets themselves--namely, distributed controls. Building energy management systems are being employed to control localized energy generation, storage, and use to reduce disruption on the net utility load. One such example is VOLTTRONTM, an agent-based platform for building energy control in real time. In this thesis, algorithms developed in VOLTTRON simulate a home energy management system that consists of a solar PV array, a lithium-ion battery bank, and the grid. Dispatch strategies are implemented to reduce energy charges from overall consumption (/kWh) and demand charges (/kW). Dispatch strategies for implementing storage devices are tuned on a month-to-month basis to provide a meaningful economic advantage under simulated scenarios to explore algorithm sensitivity to changing external factors. VOLTTRON agents provide automated real-time optimization of dispatch strategies to efficiently manage energy supply and demand, lower consumer costs associated with energy usage, and reduce load on the utility grid.

Alberta's systems approach to chronic disease management and prevention utilizing the expanded chronic care model.

PubMed

Delon, Sandra; Mackinnon, Blair

2009-01-01

Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective.

Advanced imaging in acute stroke management-Part I: Computed tomographic.

PubMed

Saini, Monica; Butcher, Ken

2009-01-01

Neuroimaging is fundamental to stroke diagnosis and management. Non-contrast computed tomography (NCCT) has been the primary imaging modality utilized for this purpose for almost four decades. Although NCCT does permit identification of intracranial hemorrhage and parenchymal ischemic changes, insights into blood vessel patency and cerebral perfusion are limited. Advances in reperfusion strategies have made identification of potentially salvageable brain tissue a more practical concern. Advances in CT technology now permit identification of acute and chronic arterial lesions, as well as cerebral blood flow deficits. This review outlines principles of advanced CT image acquisition and its utility in acute stroke management.

Strategies in disability management. Corporate disability management programs implemented at the work site.

PubMed

Kalina, C M

1999-10-30

Managers are challenged to demonstrate all programs as economically essential to the business, generating an appreciable return on investment. Further challenge exists to blend and integrate clinical and business objectives in program development. Disability management programs must be viewed as economically essential to the financial success of the business to assure management support for clinical interventions and return-to-work strategies essential for a successful program. This paper discusses a disability management program integrating clinical and business goals and objectives in return-to-work strategies to effect positive clinical, social-cultural, and business results. Clinical, educational, social, and economic challenges in the development, implementation, and continued management of a disability program at a large corporation with multiple global work sites are defined. Continued discussion addresses the effective clinical interventions and educational strategies utilized successfully within the workplace environment in response to each defined challenge. A multiple disciplinary team approach, clinical and business outcome measures, and quality assurance indicators are discussed as major program components. This article discusses a successful program approach focusing on business process and methodology. These parameters are used to link resources to strategy, developing a product for implementing and managing a program demonstrating economic value added through effective clinical medical case management.

Refueling Strategies for a Team of Cooperating AUVs

DTIC Science & Technology

2011-01-01

manager, and thus the constraint a centrally managed underwater network imposes on the mission. Task management utilizing Robust Decentralized Task ...the computational complexity. A bid based approach to task management has also been studied as a possible means of decentralization of group task ...currently performing another task . In [18], ground robots perform distributed task allocation using the ASyMTRy-D algorithm, which is based on CNP

Forecasting annual aboveground net primary production in the intermountain west

USDA-ARS?s Scientific Manuscript database

For many land manager’s annual aboveground net primary production, or plant growth, is a key factor affecting business success, profitability and each land manager's ability to successfully meet land management objectives. The strategy often utilized for forecasting plant growth is to assume every y...

Assessment of Resources and Needs for Water Development

ERIC Educational Resources Information Center

United Nations and Water, 1977

1977-01-01

Presents a brief history of water resource utilization, the present availability and uses of water, and strategies for water management. Three characteristic features of water demand management are explained: (1) emphasis on non-structural measures; (2) multi-dimensional organization and policies; (3) emphasis on research. (MA)

Economic impacts of increasing seasonal precipitation variation on southeast Wyoming cow-calf enterprises

USDA-ARS?s Scientific Manuscript database

Economic impacts of predicted increases in precipitation variability on cow-calf enterprises, through influences of precipitation on both forage and cattle productivity, are needed by land managers for risk management strategies. Here we utilize existing forage production and cattle performance data...

Clinical Utility of Optical Coherence Tomography in Glaucoma

PubMed Central

Dong, Zachary M.; Wollstein, Gadi; Schuman, Joel S.

2016-01-01

Optical coherence tomography (OCT) has established itself as the dominant imaging modality in the management of glaucoma and retinal diseases, providing high-resolution visualization of ocular microstructures and objective quantification of tissue thickness and change. This article reviews the history of OCT imaging with a specific focus on glaucoma. We examine the clinical utility of OCT with respect to diagnosis and progression monitoring, with additional emphasis on advances in OCT technology that continue to facilitate glaucoma research and inform clinical management strategies. PMID:27537415

Strategies of employees in the construction industry to increase their sustainable employability.

PubMed

Tonnon, Susanne C; van der Veen, Rozan; de Kruif, Anja Th C M; Robroek, Suzan J W; van der Ploeg, Hidde P; Proper, Karin I; van der Beek, Allard J

2018-01-01

The aging work force makes sustainable employability (SE) of workers a priority. However, it is unknown to what extent employees use implemented SE measures. To determine the utilization of 1) SE measures offered by employers, 2) employee SE strategies, and 3) to identify barriers and facilitators of SE strategies. Survey data were collected among 731 blue collar and 879 white collar workers to determine the utilization of employer SE measures. Focus groups were held with 16 blue collar and 17 white collar workers to identify employee SE strategies and their barriers and facilitators. Utilization of employer SE measures was highest for personal development measures. Strategies applied by blue collar workers included using equipment, suggesting improvements of their working conditions, and seeking promotion to a less physically demanding job. White collar workers named engaging in leisure time physical activity and seeking an adequate work-life balance. Implementation of these strategies was influenced by employee awareness and self-efficacy, the accessibility and costs and benefits of the strategy, management support and company culture. Usage of employer SE measures was generally low and recommendations are given for both blue and white collar workers to improve SE strategies.

Lessons learned from new construction utility demand side management programs and their implications for implementing building energy codes

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

Wise, B.K.; Hughes, K.R.; Danko, S.L.

1994-07-01

This report was prepared for the US Department of Energy (DOE) Office of Codes and Standards by the Pacific Northwest Laboratory (PNL) through its Building Energy Standards Program (BESP). The purpose of this task was to identify demand-side management (DSM) strategies for new construction that utilities have adopted or developed to promote energy-efficient design and construction. PNL conducted a survey of utilities and used the information gathered to extrapolate lessons learned and to identify evolving trends in utility new-construction DSM programs. The ultimate goal of the task is to identify opportunities where states might work collaboratively with utilities to promotemore » the adoption, implementation, and enforcement of energy-efficient building energy codes.« less

Managing innovation to overhaul a patient-care environment.

PubMed

McKenna, W

1989-01-01

Innovation in public service organizations must be managed, just as it must be in any business. However, in older, large public organizations, specific strategies are needed. One such strategy is described in development and impact. The first step was utilizing external demands to create an atmosphere in which change was accepted as necessary. This was followed by a relaxation of top down procedural direction accompanied by persistent concentration on establishing new standards and objectives. The final major component was a management system intended to guide and shape development of innovations into an integrated program effectively addressing the new objectives and standards.

Air Force Strategy Study 2020-2030

DTIC Science & Technology

2011-01-01

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

Overcoming Learning Barriers through Knowledge Management

ERIC Educational Resources Information Center

Dror, Itiel E.; Makany, Tamas; Kemp, Jonathan

2011-01-01

The ability to learn highly depends on how knowledge is managed. Specifically, different techniques for note-taking utilize different cognitive processes and strategies. In this paper, we compared dyslexic and control participants when using linear and non-linear note-taking. All our participants were professionals working in the banking and…

Energy and water quality management systems for water utility's operations: a review.

PubMed

Cherchi, Carla; Badruzzaman, Mohammad; Oppenheimer, Joan; Bros, Christopher M; Jacangelo, Joseph G

2015-04-15

Holistic management of water and energy resources is critical for water utilities facing increasing energy prices, water supply shortage and stringent regulatory requirements. In the early 1990s, the concept of an integrated Energy and Water Quality Management System (EWQMS) was developed as an operational optimization framework for solving water quality, water supply and energy management problems simultaneously. Approximately twenty water utilities have implemented an EWQMS by interfacing commercial or in-house software optimization programs with existing control systems. For utilities with an installed EWQMS, operating cost savings of 8-15% have been reported due to higher use of cheaper tariff periods and better operating efficiencies, resulting in the reduction in energy consumption of ∼6-9%. This review provides the current state-of-knowledge on EWQMS typical structural features and operational strategies and benefits and drawbacks are analyzed. The review also highlights the challenges encountered during installation and implementation of EWQMS and identifies the knowledge gaps that should motivate new research efforts. Copyright © 2015 Elsevier Ltd. All rights reserved.

Predicting Language Teachers' Classroom Management Orientations on the Basis of Their Computer Attitude and Demographic Characteristics

ERIC Educational Resources Information Center

Jalali, Sara; Panahzade, Vahid

2014-01-01

The advent of modern technologies has had a remarkable role in revolutionizing the classroom setting. It is, therefore, incumbent on teachers to utilize strategies for effective managing of the change. The aim of the present study was to find out English as a Foreign Language (EFL) teachers' beliefs regarding classroom management. In so doing, the…

Evaluation of sampling strategies to estimate crown biomass

Treesearch

Krishna P Poudel; Hailemariam Temesgen; Andrew N Gray

2015-01-01

Depending on tree and site characteristics crown biomass accounts for a significant portion of the total aboveground biomass in the tree. Crown biomass estimation is useful for different purposes including evaluating the economic feasibility of crown utilization for energy production or forest products, fuel load assessments and fire management strategies, and wildfire...

Factors that influence producer decisions to implement management strategies.

PubMed

Field, Thomas G

2014-12-01

Cow-calf enterprises in the USA are widely divergent in size, locale, resource availability, management skill, and market focus. Furthermore, variation exists in dependence on the cow-calf enterprise as a primary source of income, perception about the utility of a particular management practice or technology, and assessment of cost: benefit resulting from implementation impact decisions. Enterprises with larger cow inventories, greater dependence on income from the cattle enterprise, and that retain ownership further into the supply chain beyond the cow-calf operation are more likely to institute management protocols such as vaccination programs, defined calving seasons, and reproductive technologies. Successful cow-calf managers place the highest priority on herd nutrition, pasture and range management, herd health, financial management marketing, production management, and genetics. Management practices are more likely to be adopted when they align with a manager's perception of the utility, labor availability, favorable cost: benefit outcomes and profit motivation.

Promoting resiliency among palliative care clinicians: stressors, coping strategies, and training needs.

PubMed

Perez, Giselle K; Haime, Vivian; Jackson, Vicki; Chittenden, Eva; Mehta, Darshan H; Park, Elyse R

2015-04-01

Palliative care clinicians (PCCs) are susceptible to burnout, as they regularly witness immense patient and family suffering; however, little is known about their specific challenges and training needs to enhance their long-term sustainability. The purpose of this qualitative study was to explore common stressors, coping strategies, and training needs among PCCs in efforts to inform the development of a targeted Resiliency Program. Utilizing a semistructured interview guide, we conducted a series of in-depth interviews with 15 PCCs at the Massachusetts General Hospital. Content analysis highlighted three main areas of stressors: (1) systematic challenges related to managing large, emotionally demanding caseloads within time constraints; (2) patient factors, such as addressing patients' mutable needs, managing family dynamics, and meeting patient and family demands and expectations; and (3) personal challenges of delineating emotional and professional boundaries. Engaging in healthy behaviors and hobbies and seeking emotional support from colleagues and friends were among the most common methods of coping with stressors. In terms of programmatic topics, PCCs desired training in mind-body skills (e.g., breathing, yoga, meditation), health education about the effects of stress, and cognitive strategies to help reduce ruminative thoughts and negative self-talk. A majority of clinicians stressed the need for brief strategies that could be readily integrated in the workplace. These results suggest that an intervention aimed to enhance PCC sustainability should focus on utilizing a skill-building approach to stress reduction that imparts strategies that can be readily utilized during work hours.

Application of system dynamics for developing financially self-sustaining management policies for water and wastewater systems.

PubMed

Rehan, R; Knight, M A; Haas, C T; Unger, A J A

2011-10-15

Recently enacted regulations in Canada and elsewhere require water utilities to be financially self-sustaining over the long-term. This implies full cost recovery for providing water and wastewater services to users. This study proposes a new approach to help water utilities plan to meet the requirements of the new regulations. A causal loop diagram is developed for a financially self-sustaining water utility which frames water and wastewater network management as a complex system with multiple interconnections and feedback loops. The novel System Dynamics approach is used to develop a demonstration model for water and wastewater network management. This is the first known application of System Dynamics to water and wastewater network management. The network simulated is that of a typical Canadian water utility that has under invested in maintenance. Model results show that with no proactive rehabilitation strategy the utility will need to substantially increase its user fees to achieve financial sustainability. This increase is further exacerbated when price elasticity of water demand is considered. When the utility pursues proactive rehabilitation, financial sustainability is achieved with lower user fees. Having demonstrated the significance of feedback loops for financial management of water and wastewater networks, the paper makes the case for a more complete utility model that considers the complexity of the system by incorporating all feedback loops. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Qualitative study on maintenance management in Moroccan industries

NASA Astrophysics Data System (ADS)

Naji, Amal; El Oumami, Mohamed; Bouksour, Otmane; Beidouri, Zitouni

2018-05-01

Maintenance management is, and has been studied in depth, especially for strategies to be implemented in industry, even though, authors note that there is a gap between literature and management adopted by industries. In this paper, we present a qualitative study in five Moroccan industries to investigate “how maintenance is managed” rather than “how it should be”. The questionnaire utilized for the study consists on semi-structured and open-ended questions. We consider factors and variables related to maintenance management and we explore the relationships between those factors. The original contribution of this paper is to provide a «real view »about maintenance management in Moroccan industries, which could help to improve understanding of barriers to implementing maintenance strategy.

Science framework for the conservation and restoration strategy of DOI secretarial order 3336: Utilizing resilience and resistance concepts to assess threats to sagebrush ecosystems and greater sage-grouse, prioritize conservation and restoration actions, and inform management strategies

USGS Publications Warehouse

Chambers, Jeanne C.; Campbell, Steve; Carlson, John; Beck, Jeffrey L.; Clause, Karen J.; Dinkins, Jonathan B.; Doherty, Kevin E.; Espinosa, Shawn; Griffin, Kathleen A.; Christiansen, Thomas J.; Crist, Michele R.; Hanser, Steven E.; Havlina, Douglas W.; Henke, Kenneth F.; Hennig, Jacob D.; Kurth, Laurie L.; Maestas, Jeremy D.; Mayer, Kenneth E.; Manning, Mary E.; Mealor, Brian A.; McCarthy, Clinton; Pellant, Mike; Prentice, Karen L.; Perea, Marco A.; Pyke, David A.; Wiechman , Lief A.; Wuenschel, Amarina

2016-01-01

The Science Framework for the Conservation and Restoration Strategy of the Department of the Interior, Secretarial Order 3336 (SO 3336), Rangeland Fire Prevention, Management and Restoration, provides a strategic, multiscale approach for prioritizing areas for management and determining effective management strategies across the sagebrush biome. The emphasis of this version is on sagebrush ecosystems and greater sage-grouse. The Science Framework uses a six step process in which sagebrush ecosystem resilience to disturbance and resistance to nonnative, invasive annual grasses is linked to species habitat information based on the distribution and abundance of focal species. The predominant ecosystem and anthropogenic threats are assessed, and a habitat matrix is developed that helps decision makers evaluate risks and determine appropriate management strategies at regional and local scales. Areas are prioritized for management action using a geospatial approach that overlays resilience and resistance, species habitat information, and predominant threats. Decision tools are discussed for determining the suitability of priority areas for management and the most appropriate management actions at regional to local scales. The Science Framework and geospatial crosscut are intended to complement the mitigation strategies associated with the Greater Sage-Grouse Land Use Plan amendments for the Department of the Interior Bureaus, such as the Bureau of Land Management, and the U.S. Forest Service.

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

Maintaining Small Business Support in Times of Increased Army National Guard Utilization An Impending Crisis

DTIC Science & Technology

2006-02-13

business clientele, additional costs to hire a manager or replacement workers, complete loss of family income, and in extreme situations, bankruptcy, are...USAWC STRATEGY RESEARCH PROJECT MAINTAINING SMALL BUSINESS SUPPORT IN TIMES OF INCREASED ARMY NATIONAL GUARD UTILIZATION: AN IMPENDING CRISIS by...00-00-2005 to 00-00-2006 4. TITLE AND SUBTITLE Maintaining Small Business Support in Times of Increased Army National Guard Utilization An

Self-Management for Children with High-Functioning Autism Spectrum Disorders

ERIC Educational Resources Information Center

Wilkinson, Lee A.

2008-01-01

Supporting children with autism spectrum disorders in the general education classroom presents a unique challenge to the teachers and schools that serve them. This article addresses the utility of self-management as a proactive strategy for increasing the task engagement and compliant behavior of high-functioning students with autism. The author…

Utilizing Interns in Facilities Management

ERIC Educational Resources Information Center

Judkins, Clarissa; Morris, John P.; Molocznik, Chuck

2011-01-01

Facilities management is rapidly changing and developing from a position an individual stumbles into--or work one's way up through--to a discipline and vocation all of its own. There is a need for a collaborative strategy among leaders in practice, education, and research to share knowledge and experience and to establish professional and ethical…

The Development and Implementation of a Diversity Management Curriculum: Organizational Change through Exploration and Exploitation

ERIC Educational Resources Information Center

Danowitz, Mary Ann; Hanappi-Egger, Edeltraud; Hofmann, Roswitha

2009-01-01

Purpose: The purpose of this paper is to provide concepts and strategies to successfully introduce and implement curricular change; especially, related to incorporating diversity management into academic programs. Design/methodology/approach: Utilizing documents and accounts from two agents involved in the change process and an outside observer,…

Cost-effectiveness in the management of Dupuytren's contracture. A Canadian cost-utility analysis of current and future management strategies.

PubMed

Baltzer, H; Binhammer, P A

2013-08-01

In Canada, Dupuytren's contracture is managed with partial fasciectomy or percutaneous needle aponeurotomy (PNA). Injectable collagenase will soon be available. The optimal management of Dupuytren's contracture is controversial and trade-offs exist between the different methods. Using a cost-utility analysis approach, our aim was to identify the most cost-effective form of treatment for managing Dupuytren's contracture it and the threshold at which collagenase is cost-effective. We developed an expected-value decision analysis model for Dupuytren's contracture affecting a single finger, comparing the cost-effectiveness of fasciectomy, aponeurotomy and collagenase from a societal perspective. Cost-effectiveness, one-way sensitivity and variability analyses were performed using standard thresholds for cost effective treatment ($50 000 to $100 000/QALY gained). Percutaneous needle aponeurotomy was the preferred strategy for managing contractures affecting a single finger. The cost-effectiveness of primary aponeurotomy improved when repeated to treat recurrence. Fasciectomy was not cost-effective. Collagenase was cost-effective relative to and preferred over aponeurotomy at $875 and $470 per course of treatment, respectively. In summary, our model supports the trend towards non-surgical interventions for managing Dupuytren's contracture affecting a single finger. Injectable collagenase will only be feasible in our publicly funded healthcare system if it costs significantly less than current United States pricing.

The Preparedness Web: Utilizing Regional Collaborative Networks for Homeland Security Preparedness

DTIC Science & Technology

2007-09-01

Hughes’ conflict strategies could then be used to develop methodologies for improved conflict management . 45 D. ORGANIZATIONAL CHANGE Emergency...has training in place to develop collaborative skills (e.g., conflict management , team process skills). * 2.3 (0.7) * 4 point scale; 1...included (a) knowledge of other agencies’ capabilities, (b) communication, (c) inter-agency trust and respect, and (d) conflict management . Further

Development of an Agent Based Model to Estimate and Reduce Time to Restoration of Storm Induced Power Outages

NASA Astrophysics Data System (ADS)

Walsh, T.; Layton, T.; Mellor, J. E.

2017-12-01

Storm damage to the electric grid impacts 23 million electric utility customers and costs US consumers $119 billion annually. Current restoration techniques rely on the past experiences of emergency managers. There are few analytical simulation and prediction tools available for utility managers to optimize storm recovery and decrease consumer cost, lost revenue and restoration time. We developed an agent based model (ABM) for storm recovery in Connecticut. An ABM is a computer modeling technique comprised of agents who are given certain behavioral rules and operate in a given environment. It allows the user to simulate complex systems by varying user-defined parameters to study emergent, unpredicted behavior. The ABM incorporates the road network and electric utility grid for the state, is validated using actual storm event recoveries and utilizes the Dijkstra routing algorithm to determine the best path for repair crews to travel between outages. The ABM has benefits for both researchers and utility managers. It can simulate complex system dynamics, rank variable importance, find tipping points that could significantly reduce restoration time or costs and test a broad range of scenarios. It is a modular, scalable and adaptable technique that can simulate scenarios in silico to inform emergency managers before and during storm events to optimize restoration strategies and better manage expectations of when power will be restored. Results indicate that total restoration time is strongly dependent on the number of crews. However, there is a threshold whereby more crews will not decrease the restoration time, which depends on the total number of outages. The addition of outside crews is more beneficial for storms with a higher number of outages. The time to restoration increases linearly with increasing repair time, while the travel speed has little overall effect on total restoration time. Crews traveling to the nearest outage reduces the total restoration time, while crews going to the outage with most customers affected increases the overall restoration time but more quickly decreases the customers remaining without power. This model can give utility company managers the ability to optimize their restoration strategies before or during a storm event to reduce restoration times and costs.

Achieving Effective Risk Management Reduction Throughout Decommissioning at the Columbus Closure Project

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

Anderson, K.D.

2006-07-01

Nuclear facility decontamination, dismantlement, and demolition activities provide a myriad of challenges along the path to reaching a safe, effective, and compliant decommissioning. Among the challenges faced during decommissioning, is the constant management and technical effort to eliminate, mitigate, or minimize the potential of risks of radiation exposures and other hazards to the worker, the surrounding community, and the environment. Management strategies to eliminate, mitigate, or minimize risks include incorporating strong safety and As Low As Reasonably Achievable (ALARA) principles into an integrated work planning process. Technical and operational strategies may include utilizing predictive risk analysis tools to establish contaminationmore » limits for demolition and using remote handling equipment to reduce occupational and radiation exposures to workers. ECC and E2 Closure Services, LLC (Closure Services) have effectively utilized these management and technical tools to eliminate, mitigate, and reduce radiation exposures under contract to the U.S. Department of Energy (DOE) for the decontamination and decommissioning Columbus Closure Project (CCP). In particular, Closure Services achieved significant dose reduction during the dismantling, decontamination, and demolition activities for Building JN-1. Management strategies during the interior dismantlement, decontamination, and demolition of the facility demanded an integrated work planning processes that involved project disciplines. Integrated planning processes identified multiple opportunities to incorporate the use of remote handling equipment during the interior dismantling and demolition activities within areas of high radiation. Technical strategies employed predictive risk analysis tools to set upper bounding contamination limits, allowed for the radiological demolition of the building without exceeding administrative dose limits to the worker, general public, and the environment. Adhering to management and technical strategies during the dismantlement, decontamination, and demolition of Building JN-1 enabled Closure Services to achieve strong ALARA performance, maintain absolute compliance under the regulatory requirements and meeting licensing conditions for decommissioning. (authors)« less

Effective Strategies to Enhance and Maintain University English Teacher Motivation in Japan

ERIC Educational Resources Information Center

Harada, Rie

2017-01-01

This paper provides findings on a study which explored effective teacher motivation management strategies current university non-native EFL teachers in Japan utilize in their course of career. Teachers who have higher motivation can devote their lives more to give a lot to the learners and be productive on the education. Therefore, teacher…

An Action Research on Employing Constructivist Multi-Assessment Strategy in Teacher Education

ERIC Educational Resources Information Center

Gündogdu, Kerim

2015-01-01

The purpose of this study was to investigate the effectiveness of utilizing the multi-assessment strategy through a constructivist learning atmosphere with regard to perceptions of the pre-service teachers. The participants were 98 third year (junior) pre-service teachers attending to classroom management course in a public university in Turkey.…

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

ERIC Educational Resources Information Center

Dionisopoulos, George N.; Crable, Richard E.

1988-01-01

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

Current Management Strategy for Active Surveillance in Prostate Cancer.

PubMed

Syed, Jamil S; Javier-Desloges, Juan; Tatzel, Stephanie; Bhagat, Ansh; Nguyen, Kevin A; Hwang, Kevin; Kim, Sarah; Sprenkle, Preston C

2017-02-01

Active surveillance has been increasingly utilized as a strategy for the management of favorable-risk, localized prostate cancer. In this review, we describe contemporary management strategies of active surveillance, with a focus on traditional stratification schemes, new prognostic tools, and patient outcomes. Patient selection, follow-up strategy, and indication for delayed intervention for active surveillance remain centered around PSA, digital rectal exam, and biopsy findings. Novel tools which include imaging, biomarkers, and genetic assays have been investigated as potential prognostic adjuncts; however, their role in active surveillance remains institutionally dependent. Although 30-50% of patients on active surveillance ultimately undergo delayed treatment, the vast majority will remain free of metastasis with a low risk of dying from prostate cancer. The optimal method for patient selection into active surveillance is unknown; however, cancer-specific mortality rates remain excellent. New prognostication tools are promising, and long-term prospective, randomized data regarding their use in active surveillance will be beneficial.

A Proposed Strategy for Research Misconduct Policy: A Review on Misconduct Management in Health Research System

PubMed Central

Djalalinia, Shirin; Owlia, Parviz; Malek Afzali, Hossein; Ghanei, Mostafa; Peykari, Niloofar

2016-01-01

Background: Today, with the rapid growth of scientific production, research misconduct has become a worldwide problem. This article is intended to introduce the successful experience on the management of research paper misconducts in the field of health research. Methods: Our aim was to design and develop the strategy for research misconduct policy. Focusing on the national regulatory system, we developed a hierarchical model for paper misconduct policy in all the medical sciences universities and their affiliated research units. Results: Through our regulatory policy for paper misconduct management, specific protocol was followed in the field of health research publications through which the capabilities of covering the four main elements of prevention, investigation, punishment, and correction have come together. Conclusions: Considering the proposed strategy, regarding the strengths and weaknesses, utilization of evaluation tool can be one of the best strategies to achieving the prospective of health research papers by 2025. PMID:27512558

A Proposed Strategy for Research Misconduct Policy: A Review on Misconduct Management in Health Research System.

PubMed

Djalalinia, Shirin; Owlia, Parviz; Malek Afzali, Hossein; Ghanei, Mostafa; Peykari, Niloofar

2016-01-01

Today, with the rapid growth of scientific production, research misconduct has become a worldwide problem. This article is intended to introduce the successful experience on the management of research paper misconducts in the field of health research. Our aim was to design and develop the strategy for research misconduct policy. Focusing on the national regulatory system, we developed a hierarchical model for paper misconduct policy in all the medical sciences universities and their affiliated research units. Through our regulatory policy for paper misconduct management, specific protocol was followed in the field of health research publications through which the capabilities of covering the four main elements of prevention, investigation, punishment, and correction have come together. Considering the proposed strategy, regarding the strengths and weaknesses, utilization of evaluation tool can be one of the best strategies to achieving the prospective of health research papers by 2025.

Development of a system dynamics model for financially sustainable management of municipal watermain networks.

PubMed

Rehan, R; Knight, M A; Unger, A J A; Haas, C T

2013-12-15

This paper develops causal loop diagrams and a system dynamics model for financially sustainable management of urban water distribution networks. The developed causal loop diagrams are a novel contribution in that it illustrates the unique characteristics and feedback loops for financially self-sustaining water distribution networks. The system dynamics model is a mathematical realization of the developed interactions among system variables over time and is comprised of three sectors namely watermains network, consumer, and finance. This is the first known development of a water distribution network system dynamics model. The watermains network sector accounts for the unique characteristics of watermain pipes such as service life, deterioration progression, pipe breaks, and water leakage. The finance sector allows for cash reserving by the utility in addition to the pay-as-you-go and borrowing strategies. The consumer sector includes controls to model water fee growth as a function of service performance and a household's financial burden due to water fees. A series of policy levers are provided that allow the impact of various financing strategies to be evaluated in terms of financial sustainability and household affordability. The model also allows for examination of the impact of different management strategies on the water fee in terms of consistency and stability over time. The paper concludes with a discussion on how the developed system dynamics water model can be used by water utilities to achieve a variety of utility short and long-term objectives and to establish realistic and defensible water utility policies. It also discusses how the model can be used by regulatory bodies, government agencies, the financial industry, and researchers. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Initial resuscitation and management of pediatric septic shock

PubMed Central

Martin, Kelly; Weiss, Scott L.

2015-01-01

The pediatric sepsis syndrome remains a common cause of morbidity, mortality, and health care utilization costs worldwide. The initial resuscitation and management of pediatric sepsis is focused on 1) rapid recognition of abnormal tissue perfusion and restoration of adequate cardiovascular function, 2) eradication of the inciting invasive infection, including prompt administration of empiric broad-spectrum antimicrobial medications, and 3) supportive care of organ system dysfunction. Efforts to improve early and aggressive initial resuscitation and ongoing management strategies have improved outcomes in pediatric severe sepsis and septic shock, though many questions still remain as to the optimal therapeutic strategies for many patients. In this article, we will briefly review the definitions, epidemiology, clinical manifestations, and pathophysiology of sepsis and provide an extensive overview of both current and novel therapeutic strategies used to resuscitate and manage pediatric patients with severe sepsis and septic shock. PMID:25604591

A novel multimode hybrid energy storage system and its energy management strategy for electric vehicles

NASA Astrophysics Data System (ADS)

Wang, Bin; Xu, Jun; Cao, Binggang; Zhou, Xuan

2015-05-01

This paper proposes a novel topology of multimode hybrid energy storage system (HESS) and its energy management strategy for electric vehicles (EVs). Compared to the conventional HESS, the proposed multimode HESS has more operating modes and thus it could in further enhance the efficiency of the system. The rule-based control strategy and the power-balancing strategy are developed for the energy management strategy to realize mode selection and power distribution. Generally, the DC-DC converter will operate at peak efficiency to convey the energy from the batteries to the UCs. Otherwise, the pure battery mode or the pure ultracapacitors (UCs) mode will be utilized without the DC-DC converter. To extend the battery life, the UCs have the highest priority to recycle the energy and the batteries are isolated from being recharged directly during regenerative braking. Simulations and experiments are established to validate the proposed multimode HESS and its energy management strategy. The results reveal that the energy losses in the DC-DC converter, the total energy consumption and the overall system efficiency of the proposed multimode HESS are improved compared to the conventional HESS.

Strategies for positioning in the managed health care marketplace.

PubMed

Cohn, R

1994-01-01

Managed health care is becoming increasingly common as the demands of cost containment are placed on providers of care. This article defines managed health care, illustrates its continued growth, demonstrates its effect on clinical decision making and reimbursement issues, and suggests strategies for optimal positioning in the managed care marketplace. The hand therapy specialist, whether based in a hospital, an institution-based ambulatory care setting, or a private practice, must be aware of a managed plan's contractual limitations. Parameters discussed are patient length of stay, documentation, reimbursement, patient responsibility, alternatives to conventional treatment protocols, and the potential effects of utilization review on patient treatment. A heightened awareness of managed health care is critical for the manager and practitioner, especially because national health care reform is on the horizon. A provider must be well prepared to ensure delivery of quality care within the myriad restrictions imposed by managed care regulations.

A study of an arbiter function in the structures of a shared bus

NASA Astrophysics Data System (ADS)

Seck, J.-P.

The results of a comparative study of synchronous and asynchronous arbiters for managing user access to a shared bus is presented. The best available method is determined to be modular arbiter structures attached only to the decision module. Linear and circular arbitration strategies are examined for suitability for automatic decision-making. A multiple strategies arbiter scheme is devised, involving the superposition of various strategies of one sequential machine into another. It is then possible to modify the strategy on-line if the current strategy is ineffective. The utilization of a multiple structure of cascading arbiter devices is noted to be effective if response time is not a critical matter. Finally, attention is given to automatic circuit testing and fault detection. An example is furnished in terms of a management system for a shared memory in a multimicroprocessor structure.

A senior manager with a knowledge management portfolio: the Santa Clara County experience.

PubMed

Lindberg, Arley

2012-01-01

The agency director sought to create a systematically coordinated department that utilizes knowledge management strategies to promote evidence-informed practice. In his view, the organization was not providing needed information or organizational supports for practitioners to use knowledge effectively. To address this issue, he created a Director of Development and Operational Planning (DDOP) position with the responsibility to build structures and facilitate processes that support knowledge management. The DDOP oversees research and planning, government relations, legislative development and support, Board of Supervisors communications, staff development and training, community contracts, public information and in-house communication. The DDOP is reorganizing units under her supervision to create a knowledge management matrix that will implement new knowledge sharing strategies related to evaluation, contracts, legislation, organizational development, policy and planning, and staff development. The case study describes challenges and strategies related to: government regulations, size and complexity of the agency, staff resistance, and the developmental nature of the process. Copyright © Taylor & Francis Group, LLC

Management Control Systems and Clinical Experience of Managers in Public Hospitals.

PubMed

Lunkes, Rogério Joao; Naranjo-Gil, David; Lopez-Valeiras, Ernesto

2018-04-17

Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector.

The Effect of Reflective Portfolio Use on Student Self-Regulation Skills in Science

ERIC Educational Resources Information Center

Greenwood, Jacob C.

2010-01-01

This study investigated the use of reflective portfolios in science as a means to provide students a medium to develop a repertoire of study and self-regulation strategies. These self-regulation strategies can be accessed and utilized by students to engage in independent study and help to manage workloads from multiple teachers. The use of a…

A Perspective for Developing Strategies for Utilizing New Communication Technologies in Public Relations Programs.

ERIC Educational Resources Information Center

Ledingham, John A.; Masel-Walters, Lynne

Based on a definition of public relations that recognizes the field as a purposeful management function, this paper provides a perspective on public relations to help practitioners develop strategies for the use of new media forms in public relations programs. The paper begins with a historical review of mass media effects research and proceeds…

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

DTIC Science & Technology

1980-02-01

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

People Getting a Grip on Arthritis: A Knowledge Transfer Strategy to Empower Patients with Rheumatoid Arthritis and Osteoarthritis

ERIC Educational Resources Information Center

Brosseau, Lucie; Lineker, Sydney; Bell, Mary; Wells, George; Casimiro, Lynn; Egan, Mary; Cranney, Ann; Tugwell, Peter; Wilson, Keith G.; De Angelis, Gino; Loew, Laurianne

2012-01-01

Objective: The purpose of this study was twofold. First, to help people with arthritis become aware of and utilize Rheumatoid Arthritis (RA) and Osteoarthritis (OA) Clinical Practice Guidelines (CPGs) as they relate to self-management strategies. Second, to evaluate the impact of specific Knowledge Translation (KT) activities on CPG uptake. More…

IS THERE A DOWNSIDE TO CUSTOMIZING CARE? IMPLICATIONS OF GENERAL AND PATIENT-SPECIFIC TREATMENT STRATEGIES

PubMed Central

Johnson, Paul E.; O’Connor, Patrick J.

2009-01-01

The use of general clinical guidelines versus customization of patient care presents a dilemma for clinicians managing chronic illness. We propose that the performance of customized strategies for the management of chronic illness depends on accurate patient categorization, and inaccurate categorization can lead to worse performance than that achievable using a general clinical guideline. This paper is based on an analysis of a basic utility model differentiating outcomes between the use of general management strategies and customized strategies. Results of the analysis have four implications regarding the design and use of clinical guidelines and customization of care: (1) the balance between the applications of more general strategies versus customization depends on the specificity and accuracy of the strategies; (2) adoption of clinical guidelines may be stifled as the complexity of guidelines increases to account for growing evidence; (3) clinical inertia (i.e. the failure to intensify an indicated treatment) can be a rational response to strategy specificity and the probability of misapplication; and, (4) current clinical guidelines and other decision-support tools may be improved if they accommodate the need for customization of strategies for some patients while providing support for proper categorization of patients. PMID:20367722

Management Control Systems and Clinical Experience of Managers in Public Hospitals

PubMed Central

Naranjo-Gil, David

2018-01-01

Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector. PMID:29673192

Early Versus Delayed Surgical Decompression of Spinal Cord after Traumatic Cervical Spinal Cord Injury: A Cost-Utility Analysis.

PubMed

Furlan, Julio C; Craven, B Catharine; Massicotte, Eric M; Fehlings, Michael G

2016-04-01

This cost-utility analysis was undertaken to compare early (≤24 hours since trauma) versus delayed surgical decompression of spinal cord to determine which approach is more cost effective in the management of patients with acute traumatic cervical spinal cord injury (SCI). This study includes the patients enrolled into the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) and admitted at Toronto Western Hospital. Cases were grouped into patients with motor complete SCI and individuals with motor incomplete SCI. A cost-utility analysis was performed for each group of patients by the use of data for the first 6 months after SCI. The perspective of a public health care insurer was adopted. Costs were estimated in 2014 U.S. dollars. Utilities were estimated from the STASCIS. The baseline analysis indicates early spinal decompression is more cost-effective approach compared with the delayed spinal decompression. When we considered the delayed spinal decompression as the baseline strategy, the incremental cost-effectiveness ratio analysis revealed a saving of US$ 58,368,024.12 per quality-adjusted life years gained for patients with complete SCI and a saving of US$ 536,217.33 per quality-adjusted life years gained in patients with incomplete SCI for the early spinal decompression. The probabilistic analysis confirmed the early-decompression strategy as more cost effective than the delayed-decompression approach, even though there is no clearly dominant strategy. The results of this economic analysis suggests that early decompression of spinal cord was more cost effective than delayed surgical decompression in the management of patients with motor complete and incomplete SCI, even though no strategy was clearly dominant. Copyright © 2016 Elsevier Inc. All rights reserved.

Distribution Feeder Modeling for Time-Series Simulation of Voltage Management Strategies: Preprint

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

Giraldez Miner, Julieta I; Gotseff, Peter; Nagarajan, Adarsh

This paper presents techniques to create baseline distribution models using a utility feeder from Hawai'ian Electric Company. It describes the software-to-software conversion, steady-state, and time-series validations of a utility feeder model. It also presents a methodology to add secondary low-voltage circuit models to accurately capture the voltage at the customer meter level. This enables preparing models to perform studies that simulate how customer-sited resources integrate into legacy utility distribution system operations.

Electric utility of the year for 1984: Potomac Electric Power

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

Not Available

1984-11-01

High performance, efficiency improvements, a modest construction program, a clear balance sheet, and an effort to expend power plant life were among the qualities that earned Potomac Electric Power (PEPCO) the title of 1984 Utility of the Year. Other key elements in the utility's selection were its strategy for purchasing power, a load management plan, diversified investments into subsidiary businesses, community concern that considers the aesthetics of transmission facilities, and its interest in personnel development, especially among minorities. 3 figures.

MY SIRR: Minimalist agro-hYdrological model for Sustainable IRRigation management-Soil moisture and crop dynamics

NASA Astrophysics Data System (ADS)

Albano, Raffaele; Manfreda, Salvatore; Celano, Giuseppe

The paper introduces a minimalist water-driven crop model for sustainable irrigation management using an eco-hydrological approach. Such model, called MY SIRR, uses a relatively small number of parameters and attempts to balance simplicity, accuracy, and robustness. MY SIRR is a quantitative tool to assess water requirements and agricultural production across different climates, soil types, crops, and irrigation strategies. The MY SIRR source code is published under copyleft license. The FOSS approach could lower the financial barriers of smallholders, especially in developing countries, in the utilization of tools for better decision-making on the strategies for short- and long-term water resource management.

An interplay model for authorities' actions and rumor spreading in emergency event

NASA Astrophysics Data System (ADS)

Huo, Liang-an; Huang, Peiqing; Fang, Xing

2011-10-01

Rumor spreading influences how rational individuals assess risks and evaluate needs, especially, it affects authorities to make decisions in an emergency-affected environments. Conversely, authorities' response to emergency will induct public opinions as well. In this paper, we present a simple model to describe the interplay between rumor spreading and authorities' actions in emergency situation based on utility theory. By drawing from differential equations we found that it is possible to minimize negative social utility of rumor spreading in the control of situation. At the same time, authorities' proactive actions can improve rumor management in emergency situation and yield positive social utility. Finally, we outline strategies for authorities that can contribute to rumor management in an emergency event.

Asthma management simulation for children: translating theory, methods, and strategies to effect behavior change.

PubMed

Shegog, Ross; Bartholomew, L Kay; Gold, Robert S; Pierrel, Elaine; Parcel, Guy S; Sockrider, Marianna M; Czyzewski, Danita I; Fernandez, Maria E; Berlin, Nina J; Abramson, Stuart

2006-01-01

Translating behavioral theories, models, and strategies to guide the development and structure of computer-based health applications is well recognized, although a continued challenge for program developers. A stepped approach to translate behavioral theory in the design of simulations to teach chronic disease management to children is described. This includes the translation steps to: 1) define target behaviors and their determinants, 2) identify theoretical methods to optimize behavioral change, and 3) choose educational strategies to effectively apply these methods and combine these into a cohesive computer-based simulation for health education. Asthma is used to exemplify a chronic health management problem and a computer-based asthma management simulation (Watch, Discover, Think and Act) that has been evaluated and shown to effect asthma self-management in children is used to exemplify the application of theory to practice. Impact and outcome evaluation studies have indicated the effectiveness of these steps in providing increased rigor and accountability, suggesting their utility for educators and developers seeking to apply simulations to enhance self-management behaviors in patients.

Putting Residents First: Strategies Developed by CNAs to Prevent and Manage Resident-to-Resident Violence in Nursing Homes

PubMed Central

Snellgrove, Susan; Beck, Cornelia; Green, Angela; McSweeney, Jean C.

2015-01-01

Purpose of the Study: Resident-to-resident violence (RRV) in nursing homes (NHs) is common and threatens the safety and quality of life of both residents and caregivers. The purpose of this portion of a larger qualitative study was to explore strategies developed by certified nurses’ assistants (CNAs) to prevent and manage RRV in NHs. Design and Methods: Semistructured interviews were used to collect data. Data were analyzed utilizing content analysis and constant comparison. Results: Analysis revealed one overriding theme, “Putting Residents First” which the CNAs described as a conscious effort to put themselves or a beloved family member in the place of the resident while administering care. Within this theme, there were three related subthemes: (a) Knowing the Residents, (b) Keeping Residents Safe, and (c) Spending Quality Time. Implications: Together, these themes suggest that the formulation of strategies for decreasing and managing RRV was influenced significantly by the ability of the CNAs to empathize with the residents for whom they were caring. The results indicate that in the absence of evidence-based interventions, CNAs have developed their own strategies for the management and prevention of RRV. These strategies may provide a foundation for the development and testing of interventions aimed at preventing and managing RRV in NHs. PMID:26055786

Assessing Climate Change Perceptions, Management Strategies, and Information Needs for Indiana Agricultural and Forestry Sectors

NASA Astrophysics Data System (ADS)

Cherkauer, K. A.; Chin, N.

2016-12-01

The agricultural and forestry sectors in the state of Indiana are highly dependent on climate and, subsequently, highly vulnerable to the impacts of climate change. Higher temperatures, shifts in precipitation patterns, more widespread prevalence of pests and pathogens, and increased frequency and severity of extreme weather events could all have negative effects on these two sectors in the future. Agricultural and forest producers are already modifying their management strategies in response to perceptions of changes in climate risk, but such responses have been primarily reactive in nature and, in many cases, demonstrate a disconnect between scientific findings and stakeholder perceptions of the greatest climate risks. This research has been conducted to help improve understanding of climate change risks to agriculture and forestry in Indiana; stakeholder perceptions of climate risks and their current management strategies; and the effectiveness of these management strategies for dealing with current and future climate risk. Sector-specific focus groups, expert panel assessments and surveys have all been utilized in this work, which will also contribute to the new Indiana Climate Change Impacts Assessment report.

Use of participatory modeling workshops in a water-stressed basin of northern Mexico to assess sustainable water resources management and conduct community outreach

NASA Astrophysics Data System (ADS)

Vivoni, E. R.; Mayer, A. S.; Halvorsen, K. E.; Robles-Morua, A.; Kossak, D.

2016-12-01

A series of iterative participatory modeling workshops were held in Sonora, México with the goal of developing water resources management strategies in a water-stressed basin subject to hydro-climatic variability and change. A model of the water resources system, consisting of watershed hydrology, water resources infrastructure, and groundwater models, was developed deliberatively in the workshops, along with scenarios of future climate and development. Participants used the final version of the water resources systems model to select from supply-side and demand-side water resources management strategies. The performance of the strategies was based on the reliability of meeting current and future demands at a daily time scale over a year's period. Pre- and post-workshop surveys were developed and administered. The survey questions focused on evaluation of participants' modeling capacity and the utility and accuracy of the models. The selected water resources strategies and the associated, expected reliability varied widely among participants. Most participants could be clustered into three groups with roughly equal numbers of participants that varied in terms of reliance on expanding infrastructure vs. demand modification; expectations of reliability; and perceptions of social, environmental, and economic impacts. The wide range of strategies chosen and associated reliabilities indicate that there is a substantial degree of uncertainty in how future water resources decisions could be made in the region. The pre- and post-survey results indicate that participants believed their modeling abilities increased and beliefs in the utility of models increased as a result of the workshops

Exploring Enrollment Management for an Independent, Faith-Based, Secondary School: A Case Study

ERIC Educational Resources Information Center

McMaster, Jason Andrew

2017-01-01

This single site case study looked specifically at the foundation and the structure of an independent school in California with respect to how it managed its enrollment and retention rates. For context, the institution being studied utilized a high-tuition strategy combined with a strong financial aid program. In 2012, the school peaked in its…

An Integrated Tool for Calculating and Reducing Institution Carbon and Nitrogen Footprints

PubMed Central

Galloway, James N.; Castner, Elizabeth A.; Andrews, Jennifer; Leary, Neil; Aber, John D.

2017-01-01

Abstract The development of nitrogen footprint tools has allowed a range of entities to calculate and reduce their contribution to nitrogen pollution, but these tools represent just one aspect of environmental pollution. For example, institutions have been calculating their carbon footprints to track and manage their greenhouse gas emissions for over a decade. This article introduces an integrated tool that institutions can use to calculate, track, and manage their nitrogen and carbon footprints together. It presents the methodology for the combined tool, describes several metrics for comparing institution nitrogen and carbon footprint results, and discusses management strategies that reduce both the nitrogen and carbon footprints. The data requirements for the two tools overlap substantially, although integrating the two tools does necessitate the calculation of the carbon footprint of food. Comparison results for five institutions suggest that the institution nitrogen and carbon footprints correlate strongly, especially in the utilities and food sectors. Scenario analyses indicate benefits to both footprints from a range of utilities and food footprint reduction strategies. Integrating these two footprints into a single tool will account for a broader range of environmental impacts, reduce data entry and analysis, and promote integrated management of institutional sustainability. PMID:29350217

Distance learning strategies for weight management utilizing social media: A comparison of phone conference call versus social media platform. Rationale and design for a randomized study.

PubMed

Willis, Erik A; Szabo-Reed, Amanda N; Ptomey, Lauren T; Steger, Felicia L; Honas, Jeffery J; Al-Hihi, Eyad M; Lee, Robert; Vansaghi, Lisa; Washburn, Richard A; Donnelly, Joseph E

2016-03-01

Management of obesity in the context of the primary care physician visit is of limited efficacy in part because of limited ability to engage participants in sustained behavior change between physician visits. Therefore, healthcare systems must find methods to address obesity that reach beyond the walls of clinics and hospitals and address the issues of lifestyle modification in a cost-conscious way. The dramatic increase in technology and online social networks may present healthcare providers with innovative ways to deliver weight management programs that could have an impact on health care at the population level. A randomized study will be conducted on 70 obese adults (BMI 30.0-45.0 kg/m(2)) to determine if weight loss (6 months) is equivalent between weight management interventions utilizing behavioral strategies by either a conference call or social media approach. The primary outcome, body weight, will be assessed at baseline and 6 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity will be assessed on the same schedule. In addition, a cost analysis and process evaluation will be completed. Copyright © 2016 Elsevier Inc. All rights reserved.

Enhancing the effectiveness of biological control programs of invasive species through a more comprehensive pest management approach.

PubMed

DiTomaso, Joseph M; Van Steenwyk, Robert A; Nowierski, Robert M; Vollmer, Jennifer L; Lane, Eric; Chilton, Earl; Burch, Patrick L; Cowan, Phil E; Zimmerman, Kenneth; Dionigi, Christopher P

2017-01-01

Invasive species are one of the greatest economic and ecological threats to agriculture and natural areas in the US and the world. Among the available management tools, biological control provides one of the most economical and long-term effective strategies for managing widespread and damaging invasive species populations of nearly all taxa. However, integrating biological control programs in a more complete integrated pest management approach that utilizes increased information and communication, post-release monitoring, adaptive management practices, long-term stewardship strategies, and new and innovative ecological and genetic technologies can greatly improve the effectiveness of biological control. In addition, expanding partnerships among relevant national, regional, and local agencies, as well as academic scientists and land managers, offers far greater opportunities for long-term success in the suppression of established invasive species. In this paper we direct our recommendations to federal agencies that oversee, fund, conduct research, and develop classical biological control programs for invasive species. By incorporating these recommendations into adaptive management strategies, private and public land managers will have far greater opportunities for long-term success in suppression of established invasive species. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Vertical integration strategies: revenue effects in hospital and Medicare markets.

PubMed

Cody, M

1996-01-01

The purpose of this study was to evaluate the revenue effects of seven vertically integrated strategies on California hospitals. The strategies investigated were managed care contracts, physician affiliations, ambulatory care, ambulatory surgery, home health services, inpatient rehabilitation, and skilled nursing care. The study population included 242 not-for-profit hospitals in continuous operation from 1983 to 1990. Many hospitals developed vertically integrated programs in the 1980s as inpatient utilization fell in response to the Medicare Prospective Payment program. Net revenue rose on average by $2,080 from 1983 to 1990, but fell by $2,421 from the Medicare program. On the whole, the more physicians affiliated with a hospital, the higher the net revenue. However, in the Medicare population, the number of managed care contracts was significant. The pre-hospital strategies generated significant revenue, while the post-hospital strategies did not. In the Medicare program, inpatient rehabilitation significantly reduced revenue.

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.

Genomics and breeding in food crops

USDA-ARS?s Scientific Manuscript database

Plant biology is in the midst of a revolution. The generation of tremendous volumes of sequence information introduce new technical challenges into plant biology and agriculture. The relatively new field of bioinformatics addresses these challenges by utilizing efficient data management strategies;...

Implementation of real-time energy management strategy based on reinforcement learning for hybrid electric vehicles and simulation validation

PubMed Central

Kong, Zehui; Liu, Teng

2017-01-01

To further improve the fuel economy of series hybrid electric tracked vehicles, a reinforcement learning (RL)-based real-time energy management strategy is developed in this paper. In order to utilize the statistical characteristics of online driving schedule effectively, a recursive algorithm for the transition probability matrix (TPM) of power-request is derived. The reinforcement learning (RL) is applied to calculate and update the control policy at regular time, adapting to the varying driving conditions. A facing-forward powertrain model is built in detail, including the engine-generator model, battery model and vehicle dynamical model. The robustness and adaptability of real-time energy management strategy are validated through the comparison with the stationary control strategy based on initial transition probability matrix (TPM) generated from a long naturalistic driving cycle in the simulation. Results indicate that proposed method has better fuel economy than stationary one and is more effective in real-time control. PMID:28671967

Implementation of real-time energy management strategy based on reinforcement learning for hybrid electric vehicles and simulation validation.

PubMed

Kong, Zehui; Zou, Yuan; Liu, Teng

2017-01-01

To further improve the fuel economy of series hybrid electric tracked vehicles, a reinforcement learning (RL)-based real-time energy management strategy is developed in this paper. In order to utilize the statistical characteristics of online driving schedule effectively, a recursive algorithm for the transition probability matrix (TPM) of power-request is derived. The reinforcement learning (RL) is applied to calculate and update the control policy at regular time, adapting to the varying driving conditions. A facing-forward powertrain model is built in detail, including the engine-generator model, battery model and vehicle dynamical model. The robustness and adaptability of real-time energy management strategy are validated through the comparison with the stationary control strategy based on initial transition probability matrix (TPM) generated from a long naturalistic driving cycle in the simulation. Results indicate that proposed method has better fuel economy than stationary one and is more effective in real-time control.

Integrating disease management into the outpatient delivery system during and after managed care.

PubMed

Villagra, Victor G

2004-01-01

Managed care introduced disease management as a replacement strategy to utilization management. The focus changed from influencing treatment decisions to supporting self-care and compliance. Disease management rendered operational many elements of the chronic care model, but it did so outside the delivery system, thus escaping the financial limitations, cultural barriers, and inertia inherent in effecting radical change from within. Medical management "after managed care" should include the functional and structural integration of disease management with primary care clinics. Such integration would supply the infrastructure that primary care physicians need to coordinate the care of chronically ill patients more effectively.

Concurrent negotiation and coordination for grid resource coallocation.

PubMed

Sim, Kwang Mong; Shi, Benyun

2010-06-01

Bolstering resource coallocation is essential for realizing the Grid vision, because computationally intensive applications often require multiple computing resources from different administrative domains. Given that resource providers and consumers may have different requirements, successfully obtaining commitments through concurrent negotiations with multiple resource providers to simultaneously access several resources is a very challenging task for consumers. The impetus of this paper is that it is one of the earliest works that consider a concurrent negotiation mechanism for Grid resource coallocation. The concurrent negotiation mechanism is designed for 1) managing (de)commitment of contracts through one-to-many negotiations and 2) coordination of multiple concurrent one-to-many negotiations between a consumer and multiple resource providers. The novel contributions of this paper are devising 1) a utility-oriented coordination (UOC) strategy, 2) three classes of commitment management strategies (CMSs) for concurrent negotiation, and 3) the negotiation protocols of consumers and providers. Implementing these ideas in a testbed, three series of experiments were carried out in a variety of settings to compare the following: 1) the CMSs in this paper with the work of others in a single one-to-many negotiation environment for one resource where decommitment is allowed for both provider and consumer agents; 2) the performance of the three classes of CMSs in different resource market types; and 3) the UOC strategy with the work of others [e.g., the patient coordination strategy (PCS )] for coordinating multiple concurrent negotiations. Empirical results show the following: 1) the UOC strategy achieved higher utility, faster negotiation speed, and higher success rates than PCS for different resource market types; and 2) the CMS in this paper achieved higher final utility than the CMS in other works. Additionally, the properties of the three classes of CMSs in different kinds of resource markets are also verified.

Strategies for converting to a DBMS environment

NASA Technical Reports Server (NTRS)

Durban, D. M.

1984-01-01

The conversion to data base management systems processing techniques consists of three different strategies - one for each of the major stages in the development process. Each strategy was chosen for its approach in bringing about a smooth evolutionary type transition from one mode of operation to the next. The initial strategy of the indoctrination stage consisted of: (1) providing maximum access to current administrative data as soon as possible; (2) select and developing small prototype systems; (3) establishing a user information center as a central focal point for user training and assistance; and (4) developing a training program for programmers, management and ad hoc users in DBMS application and utilization. Security, the rate of the data dictionary, and data base tuning and capacity planning, and the development of a change of attitude in an automated office are issues meriting consideration.

Knowledge management: implications for human service organizations.

PubMed

Austin, Michael J; Claassen, Jennette; Vu, Catherine M; Mizrahi, Paola

2008-01-01

Knowledge management has recently taken a more prominent role in the management of organizations as worker knowledge and intellectual capital are recognized as critical to organizational success. This analysis explores the literature of knowledge management including the individual level of tacit and explicit knowledge, the networks and social interactions utilized by workers to create and share new knowledge, and the multiple organizational and managerial factors associated with effective knowledge management systems. Based on the role of organizational culture, structure, leadership, and reward systems, six strategies are identified to assist human service organizations with implementing new knowledge management systems.

Advancing Technological Education: Keeping America Competitive

ERIC Educational Resources Information Center

Patton, Madeline

2005-01-01

This publication profiles the strategies and best practices of Advanced Technological Education (ATE) Centers in developing faculty skills, cultivating partnerships, implementing new curricula, recruiting students, preparing for change, utilizing advisors, managing organizations, and nurturing leaders. In this report, ATE center leaders share with…

Reducing regional drought vulnerabilities and multi-city robustness conflicts using many-objective optimization under deep uncertainty

NASA Astrophysics Data System (ADS)

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

2017-06-01

Emerging water scarcity concerns in many urban regions are associated with several deeply uncertain factors, including rapid population growth, limited coordination across adjacent municipalities and the increasing risks for sustained regional droughts. Managing these uncertainties will require that regional water utilities identify coordinated, scarcity-mitigating strategies that trigger the appropriate actions needed to avoid water shortages and financial instabilities. This research focuses on the Research Triangle area of North Carolina, seeking to engage the water utilities within Raleigh, Durham, Cary and Chapel Hill in cooperative and robust regional water portfolio planning. Prior analysis of this region through the year 2025 has identified significant regional vulnerabilities to volumetric shortfalls and financial losses. Moreover, efforts to maximize the individual robustness of any of the mentioned utilities also have the potential to strongly degrade the robustness of the others. This research advances a multi-stakeholder Many-Objective Robust Decision Making (MORDM) framework to better account for deeply uncertain factors when identifying cooperative drought management strategies. Our results show that appropriately designing adaptive risk-of-failure action triggers required stressing them with a comprehensive sample of deeply uncertain factors in the computational search phase of MORDM. Search under the new ensemble of states-of-the-world is shown to fundamentally change perceived performance tradeoffs and substantially improve the robustness of individual utilities as well as the overall region to water scarcity. Search under deep uncertainty enhanced the discovery of how cooperative water transfers, financial risk mitigation tools, and coordinated regional demand management must be employed jointly to improve regional robustness and decrease robustness conflicts between the utilities. Insights from this work have general merit for regions where adjacent municipalities can benefit from cooperative regional water portfolio planning.

Is control through utilization a cost effective Prosopis juliflora management strategy?

PubMed

Wakie, Tewodros T; Hoag, Dana; Evangelista, Paul H; Luizza, Matthew; Laituri, Melinda

2016-03-01

The invasive tree Prosopis juliflora is known to cause negative impacts on invaded ranges. High P. juliflora eradication costs have swayed developing countries to follow a new and less expensive approach known as control through utilization. However, the net benefits of this new approach have not been thoroughly evaluated. Our objective was to assess the economic feasibility of selected P. juliflora eradication and utilization approaches that are currently practiced in one of the severely affected developing countries, Ethiopia. The selected approaches include converting P. juliflora infested lands into irrigated farms (conversion), charcoal production, and seed flour production. We estimate the costs and revenues of the selected P. juliflora eradication and utilization approaches by interviewing 19 enterprise owners. We assess the economic feasibility of the enterprises by performing enterprise, break-even, investment, sensitivity, and risk analyses. Our results show that conversion to irrigated cotton is economically profitable, with Net Present Value (NPV) of 5234 US$/ha over 10 years and an interest rate of 10% per year. Conversion greatly reduces the spread of P. juliflora on farmlands. Managing P. juliflora infested lands for charcoal production with a four-year harvest cycle is profitable, with NPV of 805 US$/ha. However, the production process needs vigilant regulation to protect native plants from exploitation and caution should be taken to prevent charcoal production sites from becoming potential seed sources. Though flour from P. juliflora pods can reduce invasions by destroying viable seeds, flour enterprises in Ethiopia are unprofitable. Conversion and charcoal production can be undertaken with small investment costs, while flour production requires high investment costs. Introducing new changes in the production and management steps of P. juliflora flour might be considered to make the enterprise profitable. Our study shows that control through utilization may be a viable P. juliflora management strategy under the right environmental setting. Published by Elsevier Ltd.

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.

More Becomes Less: Management Strategy Has Definitely Changed over the Past Decade of Splenic Injury—A Nationwide Population-Based Study

PubMed Central

Soo, Kwan-Ming; Lin, Tsung-Ying; Chen, Chao-Wen; Kuo, Liang-Chi; Wang, Jaw-Yuan; Lee, Wei-Che; Lin, Hsing-Lin

2015-01-01

Background. Blunt spleen injury is generally taken as major trauma which is potentially lethal. However, the management strategy has progressively changed to noninvasive treatment over the decade. This study aimed to (1) find out the incidence and trend of strategy change; (2) investigate the effect of change on the mortality rate over the study period; and (3) evaluate the risk factors of mortality. Materials and Methods. We utilized nationwide population-based data to explore the incidence of BSI during a 12-year study period. The demographic characteristics, including gender, age, surgical intervention, blood transfusion, availability of CT scans, and numbers of coexisting injuries, were collected for analysis. Mortality, hospital length of stay, and cost were as outcome variables. Results. 578 splenic injuries were recorded with an estimated incidence of 48 per million per year. The average 12-year overall mortality rate during hospital stay was 5.28% (29/549). There is a trend of decreasing operative management in patients (X 2, P = 0.004). The risk factors for mortality in BSI from a multivariate logistic regression analysis were amount of transfusion (OR 1.033, P < 0.001, CI 1.017–1.049), with or without CT obtained (OR 0.347, P = 0.026, CI 0.158–0.889), and numbers of coexisting injuries (OR 1.346, P = 0.043, CI 1.010–1.842). Conclusion. Although uncommon of BSI, management strategy is obviously changed to nonoperative treatment without increasing mortality and blood transfusion under the increase of CT utilization. Patients with more coexisting injuries and more blood transfusion had higher mortality. PMID:25629032

What Is Heartburn Worth?

PubMed Central

Heudebert, Gustavo R; Centor, Robert M; Klapow, Joshua C; Marks, Robert; Johnson, Lawrence; Wilcox, C Mel

2000-01-01

OBJECTIVE T o determine the best treatment strategy for the management of patients presenting with symptoms consistent with uncomplicated heartburn. METHODS We performed a cost-utility analysis of 4 alternatives: empirical proton pump inhibitor, empirical histamine2-receptor antagonist, and diagnostic strategies consisting of either esophagogastroduodenoscopy (EGD) or an upper gastrointestinal series before treatment. The time horizon of the model was 1 year. The base case analysis assumed a cohort of otherwise healthy 45-year-old individuals in a primary care practice. MAIN RESULTS Empirical treatment with a proton pump inhibitor was projected to provide the greatest quality-adjusted survival for the cohort. Empirical treatment with a histamine2receptor antagonist was projected to be the least costly of the alternatives. The marginal cost-effectiveness of using a proton pump inhibitor over a histamine2-receptor antagonist was approximately $10,400 per quality-adjusted life year (QALY) gained in the base case analysis and was less than $50,000 per QALY as long as the utility for heartburn was less than 0.95. Both diagnostic strategies were dominated by proton pump inhibitor alternative. CONCLUSIONS Empirical treatment seems to be the optimal initial management strategy for patients with heartburn, but the choice between a proton pump inhibitor or histamine2-receptor antagonist depends on the impact of heartburn on quality of life. PMID:10718898

The effect of new and continuing prescription drug use on cost: a longitudinal analysis of chronic and seasonal utilization.

PubMed

Fairman, K A

2000-05-01

To provide basic information about 2 factors contributing to rising prescription drug costs--utilization trends and product selection. Prescription drug costs have risen sharply in recent years, and continued growth is expected. There is little consensus about appropriate cost-management strategies, in part because quantitative data on the causes and implications of increased drug costs are lacking. This study followed 463,820 continuously enrolled adult (> or = 18 years of age on January 1, 1996) utilizers of 15 chronic or seasonal therapeutic classes for 2.5 years (January 1996 through June 1998) using a pharmacy benefit manager's multiple-payer claims database. Outcome measures included (1) change in utilization rate, (2) relationship between new use and utilization growth, (3) stability of the treated population (ie, mostly long-term use vs high rates of turnover), and (4) product mix changes (ie, cost per dispensed day for 1996 vs 1997 and for new vs continuing users, controlling for inflation). Of the 463,820 utilizers, 97% were commercially insured and 3% enrolled in Medicare risk plans; 40% were enrolled in managed care and the remainder covered by indemnity insurance. Rates of growth and turnover varied substantially by class. The highest 2-year utilization rate change was 66.7% for antihyperlipidemic agents; change was < 10% in only 3 classes. Across classes, an average of 38.7% of 1997 users were new (ie, no use in 1996) and an average of 34.0% of 1996 users were dropouts (ie, no use in 1997). Utilization growth depended heavily on treatment continuation; classes with high dropout rates (eg, antirheumatic, antiasthmatic) did not have high growth rates, even with high rates of new use. In most classes, costs were not higher for new than for continuing users. In some classes, however (eg, antipsychotic, antidiabetic), both new and continuing users increased their use of newer, more expensive products. Because factors underlying rising prescription drug costs vary by therapeutic class, cost-containment strategies should address these differences. Further research is needed to assess the clinical and economic costs and benefits of rapid growth in the utilization of certain therapeutic classes.

The Daniel K. Inouye College of Pharmacy Scripts: Updates on Clostridium difficile Infection: Advances in Laboratory Testing to Aid Diagnosis and Treatment.

PubMed

Lteif, Louis

2017-02-01

Clostridium difficile remains a major source of nosocomial infections and associated diarrhea. More recently, community-acquired cases are on the rise creating a concern for a serious public health threat. Appropriate infection control precautions as well as prevention and optimal management may help to avoid detrimental outbreaks. A key step is utilizing laboratory testing for quick and accurate diagnosis of potential cases. This overview article describes Clostridium difficile infection control and prevention methods and updates the most recent management strategies including a focus on the utilization and interpretation of laboratory diagnostic testing and appropriate treatment.

Application of a forest-simulation model to assess the energy yield and ecological impact of forest utilization for energy

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

Doyle, T W; Shugart, H H; West, D C

1981-01-01

This study examines the utilization and management of natural forest lands to meet growing wood-energy demands. An application of a forest simulation model is described for assessing energy returns and long-term ecological impacts of wood-energy harvesting under four general silvicultural practices. Results indicate that moderate energy yields could be expected from mild cutting operations which would significantly effect neither the commercial timber market nor the composition, structure, or diversity of these forests. Forest models can provide an effective tool for determining optimal management strategies that maximize energy returns, minimize environmental detriment, and complement existing land-use plans.

The Role of Interventional Radiology Techniques in the Management of Renal Angiomyolipomas.

PubMed

Kiefer, Ryan M; Stavropoulos, S William

2017-05-01

Although benign, renal angiomyolipoma (AML) may lead to serious complications without appropriate management. The purpose of this review is to describe the role of and evidence for interventional radiology techniques in the management of patients with AML. For patients with renal masses and non-diagnostic imaging studies, image-guided percutaneous biopsy is found to be highly accurate and useful in directing patient management. Once the diagnosis of AML has been made based on either imaging or biopsy, arterial embolization of tumors that are symptomatic or >4 cm has been demonstrated to reduce the risk of hemorrhage as well as tumor size. Percutaneous ablation devices have been proposed as alternative strategies but remain investigational. The utility of interventional radiology techniques including percutaneous core needle biopsy and prophylactic super-selective arterial embolization is safe and effective management strategies for patients presenting with AML tumors.

Marketing strategies of hospital service organizations in Nigeria: a study of selected privately owned hospitals in Port Harcourt.

PubMed

Okwandu, Gabriel A

2002-01-01

This study was centered on the identification of the marketing strategies of hospitals and the factors that militate against their effective adoption and implementation. A total of 80 hospitals in Port Harcourt responded to a structured questionnaire administered on them. It was found, among other things, that many hospital organizations apply marketing strategies, and that hospitals that adopt effective marketing strategies perform better than those that do not. Some of the factors militating against the effective adoption and implementation of marketing strategies include lack of planning, lack of top management support, and non-utilization of all the promotional mix elements.

Bladder Preservation for Localized Muscle-Invasive Bladder Cancer: The Survival Impact of Local Utilization Rates of Definitive Radiotherapy

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

Kozak, Kevin R.; Hamidi, Maryam; Manning, Matthew

2012-06-01

Purpose: This study examines the management and outcomes of muscle-invasive bladder cancer in the United States. Methods and Materials: Patients with muscle-invasive bladder cancer diagnosed between 1988 and 2006 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Patients were classified according to three mutually exclusive treatment categories based on the primary initial treatment: no local management, radiotherapy, or surgery. Overall survival was assessed with Kaplan-Meier analysis and Cox models based on multiple factors including treatment utilization patterns. Results: The study population consisted of 26,851 patients. Age, sex, race, tumor grade, histology, and geographic location were associated withmore » differences in treatment (all p < 0.01). Patients receiving definitive radiotherapy tended to be older and have less differentiated tumors than patients undergoing surgery (RT, median age 78 years old and 90.6% grade 3/4 tumors; surgery, median age 71 years old and 77.1% grade 3/4 tumors). No large shifts in treatment were seen over time, with most patients managed with surgical resection (86.3% for overall study population). Significant survival differences were observed according to initial treatment: median survival, 14 months with no definitive local treatment; 17 months with radiotherapy; and 43 months for surgery. On multivariate analysis, differences in local utilization rates of definitive radiotherapy did not demonstrate a significant effect on overall survival (hazard ratio, 1.002; 95% confidence interval, 0.999-1.005). Conclusions: Multiple factors influence the initial treatment strategy for muscle-invasive bladder cancer, but definitive radiotherapy continues to be used infrequently. Although patients who undergo surgery fare better, a multivariable model that accounted for patient and tumor characteristics found no survival detriment to the utilization of definitive radiotherapy. These results support continued research into bladder preservation strategies and suggest that definitive radiotherapy represents a viable initial treatment strategy for those who wish to attempt to preserve their native bladder.« less

Watershed Management Tool for Selection and Spacial Allocation of Non-Point Source Pollution Control Practices

EPA Science Inventory

Distributed-parameter watershed models are often utilized for evaluating the effectiveness of sediment and nutrient abatement strategies through the traditional {calibrate→ validate→ predict} approach. The applicability of the method is limited due to modeling approximations. In ...

Why is continuum of care from home to health facilities essential to improve perinatal survival?

PubMed

Bahl, Rajiv; Qazi, Shamim; Darmstadt, Gary L; Martines, Jose

2010-12-01

The period around the time of delivery is extremely hazardous for infants in developing countries. After the first week the risk drops sharply, and survival improves markedly. To reduce perinatal mortality, a continuum of care between the home and the various facilities is essential during pregnancy, childbirth and the newborn period. This paper reviews strategies to promote the establishment of this continuum: providing health care within or close to home by frontline workers and increasing the use of services in health facilities through community mobilization and financing strategies. As perinatal care and care for seriously sick children face common challenges and lessons could be learned from successful strategies for management of other illnesses, this paper also reviews intervention models involving community health workers (CHWs) to improve case management of sick children at the household and community levels. Available evidence suggests that the community strategy with the greatest impact on neonatal mortality is home visits by CHWs combined with community mobilization. The same strategy appears to be effective in increasing health facility utilization. An equally effective strategy for increasing health facility utilization seems to be financing health care to remove financial access barriers, particularly using conditional cash transfers or vouchers. Although the availability of information on the effect of community interventions to improve newborn health has increased in the recent past, significant gaps remain. Information on the effectiveness of strategies in different settings, particularly in sub-Saharan Africa, cost-effectiveness and sustainability are particularly needed and should be gathered in future studies. Copyright © 2010 Elsevier Inc. All rights reserved.

Gross Hematuria: Assessment and Management at the End of Life

PubMed Central

Groninger, Hunter; Phillips, Jayne M.

2013-01-01

A distressing complication for patients and families, gross hematuria at the end of life challenges hospice and palliative care clinicians to utilize skills in medical and nursing management, communication and clarification of patient goals, and relief of symptom burden. Massive hemorrhage in the genitourinary tract can radically alter the terminal trajectory for patients and necessitate intensive interventions aimed at promoting comfort. Here, a case of gross hematuria in an adult hospice patient serves to broaching decision-making challenges and management strategies. PMID:24826082

Strategic rehabilitation planning of piped water networks using multi-criteria decision analysis.

PubMed

Scholten, Lisa; Scheidegger, Andreas; Reichert, Peter; Maurer, Max; Mauer, Max; Lienert, Judit

2014-02-01

To overcome the difficulties of strategic asset management of water distribution networks, a pipe failure and a rehabilitation model are combined to predict the long-term performance of rehabilitation strategies. Bayesian parameter estimation is performed to calibrate the failure and replacement model based on a prior distribution inferred from three large water utilities in Switzerland. Multi-criteria decision analysis (MCDA) and scenario planning build the framework for evaluating 18 strategic rehabilitation alternatives under future uncertainty. Outcomes for three fundamental objectives (low costs, high reliability, and high intergenerational equity) are assessed. Exploitation of stochastic dominance concepts helps to identify twelve non-dominated alternatives and local sensitivity analysis of stakeholder preferences is used to rank them under four scenarios. Strategies with annual replacement of 1.5-2% of the network perform reasonably well under all scenarios. In contrast, the commonly used reactive replacement is not recommendable unless cost is the only relevant objective. Exemplified for a small Swiss water utility, this approach can readily be adapted to support strategic asset management for any utility size and based on objectives and preferences that matter to the respective decision makers. Copyright © 2013 Elsevier Ltd. All rights reserved.

Cost-utility analysis of radical nephrectomy versus partial nephrectomy in the management of small renal masses: Adjusting for the burden of ensuing chronic kidney disease

PubMed Central

Klinghoffer, Zachary; Tarride, Jean-Eric; Novara, Giacomo; Ficarra, Vincenzo; Kapoor, Anil; Shayegan, Bobby; Braga, Luis H.

2013-01-01

Objectives: We compare the cost-utility of laparoscopic radical nephrectomy (LRN), laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in the management of small renal masses (SRMs) when the impact of ensuing chronic kidney disease (CKD) disease is considered. Methods: We designed a Markov decision analysis model with a 10-year time horizon. Estimates of costs, utilities, complication rates and probabilities of developing CKD were derived from the literature. The base case patient was assumed to be a 65-year-old patient with a <4-cm unilateral renal mass, a normal contralateral kidney and a normal preoperative serum creatinine. Univariate and probabilistic sensitivity analyses were conducted to address the uncertainty associated with the study parameters. Results: OPN was the least costly strategy at $25 941 USD and generated 7.161 quality-adjusted life years (QALYs) over 10 years. LPN yielded 0.098 additional QALYs at an additional cost of $888 for an incremental cost-effectiveness ratio of $9057 per QALY, well below a commonly cited willingness-to-pay threshold of $50 000 per QALY. LRN was more costly and yielded fewer QALYs than OPN and LPN. Sensitivity analyses demonstrated our model to be robust to changes to key parameters. Age had no effect on preferred strategy. Conclusions: Partial nephrectomy (PN) is the preferred treatment strategy for SRMs. In centres where LPN is not available, OPN remains considerably more cost-effective than LRN. Furthermore, our study demonstrates that there is no age at which PN is not preferred to LRN. Our study provides additional evidence to advocate PN for the management of all amenable SRMs. PMID:23671525

[Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndromes].

PubMed

Baeza Román, Anna; Latour Pérez, Jaime; de Miguel Balsa, Eva; Pino Izquierdo, Karel; Coves Orts, Francisco Javier; García Ochando, Luis; de la Torre Fernández, Maria José

2014-05-20

In the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS), several studies have shown a reduction in mortality with the use of an invasive strategy in high-risk patients, including diabetic patients. Paradoxically, other studies have shown an under-utilization of this invasive strategy in these patients. The aim of this study is to determine the characteristics of patients managed conservatively and identify determinants of the use of invasive or conservative strategy. Retrospective cohort study conducted in diabetic patients with NSTE-ACS included in the ARIAM-SEMICYUC registry (n=531) in 2010 and 2011. We performed crude and adjusted unconditional logistic regression. We analyzed 531 diabetic patients, 264 (49.7%) of which received invasive strategy. Patients managed conservatively were a subgroup characterized by older age and cardiovascular comorbidity, increased risk of bleeding and the absence of high-risk electrocardiogram (ECG). In diabetic patients with NSTE-ACS, independent predictors associated with conservative strategy were low-risk ECG, initial Killip class>1, high risk of bleeding and pretreatment with clopidogrel. The fear of bleeding complications or advanced coronary lesions could be the cause of the underutilization of an invasive strategy in diabetic patients with NSTE-ACS. Copyright © 2012 Elsevier España, S.L. All rights reserved.

A Brief Exploratory Report of Coping Strategies Among Police Recruits During Academy Training.

PubMed

Patterson, George T

2016-10-01

Few longitudinal studies have investigated the use of coping strategies among police recruits. This study investigated perceived life and work stressors, appraisal, and coping over a seven-month police recruit academy training program. Participants were 81 police recruits who completed the Ways of Coping Questionnaire at three time points approximately three months apart. The average age of the recruits was 27.6 years (SD = 5.1, range 20-51). Separate repeated measures analyses of variance were conducted to examine coping scores. Statistically significant decreases, although small, were observed in reported emotion-focused, problem-focused, and seeking social support coping strategies. Results suggested that as police recruits undergo academy training, they rely on fewer coping strategies to deal with life and work stress. More longitudinal studies are needed that assess the methods police recruits utilize to manage stress during academy training. Such results can inform stress management interventions. © The Author(s) 2016.

Integrated management of carbon sequestration and biomass utilization opportunities in a changing climate: Proceedings of the 2009 National Silviculture Workshop; 2009 June 15-18; Boise, ID.

Treesearch

Theresa B. Jain; Russell T. Graham; Jonathan Sandquist

2010-01-01

Forests are important for carbon sequestration and how they are manipulated either through natural or human induced disturbances can have an effect on CO2 emissions and carbon sequestration. The 2009 National Silviculture Workshop presented scientific information and management strategies to meet a variety of objectives while simultaneously addressing carbon...

Strategies to improve the quality of life of persons post-stroke: protocol of a systematic review.

PubMed

Munce, Sarah E P; Perrier, Laure; Shin, Saeha; Adhihetty, Chamila; Pitzul, Kristen; Nelson, Michelle L A; Bayley, Mark T

2017-09-07

While many outcomes post-stroke (e.g., depression) have been previously investigated, there is no complete data on the impact of a variety of quality improvement strategies on the quality of life and physical and psychological well-being of individuals post-stroke. The current paper outlines a systematic review protocol on the impact of quality improvement strategies on quality of life as well as physical and psychological well-being of individuals with stroke. MEDLINE, CINAHL, EMBASE, and PsycINFO databases will be searched. Two independent reviewers will conduct all levels of screening, data abstraction, and quality appraisal. Only randomized controlled trials that report on the impact of quality improvement strategies on quality of life outcomes in people with stroke will be included. The secondary outcomes will be physical and psychological well-being. Quality improvement strategies include audit and feedback, case management, team changes, electronic patient registries, clinician education, clinical reminders, facilitated relay of clinical information to clinicians, patient education, (promotion of) self-management, patient reminder systems, and continuous quality improvement. Studies published since 2000 will be included to increase the relevancy of findings. Results will be grouped according to the target group of the varying quality improvement strategies (i.e., health system, health care professionals, or patients) and/or by any other noteworthy grouping variables, such as etiology of stroke or by sex. This systematic review will identify those quality improvement strategies aimed at the health system, health care professionals, and patients that impact the quality of life of individuals with stroke. Improving awareness and utilization of such strategies may enhance uptake of stroke best practices and reduce inappropriate health care utilization costs. PROSPERO, CRD42017064141.

Modelling outcomes of complex treatment strategies following a clinical guideline for treatment decisions in patients with rheumatoid arthritis.

PubMed

Tran-Duy, An; Boonen, Annelies; Kievit, Wietske; van Riel, Piet L C M; van de Laar, Mart A F J; Severens, Johan L

2014-10-01

Management of rheumatoid arthritis (RA) is characterised by a sequence of disease-modifying antirheumatic drugs (DMARDs) and biological response modifiers (BRMs). In most of the Western countries, the drug sequences are determined based on disease activity and treatment history of the patients. A model for realistic patient outcomes should reflect the treatment pathways relevant for patients with specific characteristics. This study aimed at developing a model that could simulate long-term patient outcomes and cost effectiveness of treatment strategies with and without inclusion of BRMs following a clinical guideline for treatment decisions. Discrete event simulation taking into account patient characteristics and treatment history was used for model development. Treatment effect on disease activity, costs, health utilities and times to events were estimated using Dutch observational studies. Long-term progression of physical functioning was quantified using a linear mixed-effects model. Costs and health utilities were estimated using two-part models. The treatment strategy recommended by the Dutch Society for Rheumatology where both DMARDs and BRMs were available (Strategy 2) was compared with the treatment strategy without BRMs (Strategy 1). Ten thousand theoretical patients were tracked individually until death. In the probabilistic sensitivity analysis, Monte Carlo simulations were performed with 1,000 sets of parameters sampled from appropriate probability distributions. The simulated changes over time in disease activity and physical functioning were plausible. The incremental cost per quality-adjusted life-year gained of Strategy 2 compared with Strategy 1 was 124,011. At a willingness-to-pay threshold higher than 119,167, Strategy 2 dominated Strategy 1 in terms of cost effectiveness but the probability that the Strategy 2 is cost effective never exceeded 0.87. It is possible to model the outcomes of complex treatment strategies based on a clinical guideline for the management of RA. Following the Dutch guideline and using real-life data, inclusion of BRMs in the treatment strategy for RA appeared to be less favourable in our model than in most of the existing models that compared drug sequences independent of patient characteristics and used data from randomised controlled clinical trials. Despite complexity and demand for extensive data, our modelling approach can help to identify the knowledge gaps in clinical guidelines for RA management and priorities for future research.

Incorporating hydrologic data and ecohydrologic relationships in ecological site descriptions

USDA-ARS?s Scientific Manuscript database

The purpose of this paper is to recommend a framework and methodology for inclusion of key ecohydrologic feedbacks and relationships in Ecological Site Descriptions (ESDs) and thereby enhance the utility of ESDs for assessing rangelands and guiding resilience-based management strategies. Resilience...

Elective Mutism: A Case Study of a Disorder of Childhood

PubMed Central

Louden, Delroy M.

1987-01-01

This paper reviews a number of treatment strategies utilized in the treatment of a 6-year-old boy with a history of multiple parental separations. When the patient presented to the child psychiatric clinic, he had a history of not speaking in the preceding four months, following the arrival of a stepmother in the household and a move to a new house in a new locality. Developmental and psychometric assessments are presented and their utility in early diagnosis and later prognosis are discussed. Reluctant speech is differentiated from, and compared with, elective mutism. The management of elective mutism is often complicated by these children not speaking to anyone in certain environments, and very frequently the persons with whom they do speak are not available for participation in treatment programs. Consequently, if a child does not speak to anyone who can participate in the early mapping of treatment modalities, the use of treatment strategies such as stimulus fading is impossible. Suggestions for future management to overcome this difficulty are presented and discussed. PMID:3316671

Data warehousing: toward knowledge management.

PubMed

Shams, K; Farishta, M

2001-02-01

With rapid changes taking place in the practice and delivery of health care, decision support systems have assumed an increasingly important role. More and more health care institutions are deploying data warehouse applications as decision support tools for strategic decision making. By making the right information available at the right time to the right decision makers in the right manner, data warehouses empower employees to become knowledge workers with the ability to make the right decisions and solve problems, creating strategic leverage for the organization. Health care management must plan and implement data warehousing strategy using a best practice approach. Through the power of data warehousing, health care management can negotiate bettermanaged care contracts based on the ability to provide accurate data on case mix and resource utilization. Management can also save millions of dollars through the implementation of clinical pathways in better resource utilization and changing physician behavior to best practices based on evidence-based medicine.

A cost-utility analysis of ablative therapy for Barrett’s esophagus

PubMed Central

Inadomi, John M.; Somsouk, Ma; Madanick, Ryan D.; Thomas, Jennifer P.; Shaheen, Nicholas J.

2009-01-01

Background & Aims Recommendations for patients with Barrett’s esophagus (BE) include endoscopic surveillance with esophagectomy for early-stage cancer, although new technologies to ablate dysplasia and metaplasia are available. This study compares the cost-utility of ablation with that of endoscopic surveillance strategies. Methods A decision analysis model was created to examine a population of patients with BE (mean age 50), with separate analyses for patients with no dysplasia, low-grade dysplasia (LGD), or high-grade dysplasia (HGD). Strategies compared were: no endoscopic surveillance; endoscopic surveillance with ablation for incident dysplasia; immediate ablation followed by endoscopic surveillance in all patients or limited to patients in whom metaplasia persisted, and esophagectomy. Ablation modalities modeled included radiofrequency, argon plasma coagulation, multipolar electrocoagulation and photodynamic therapy. Results Endoscopic ablation for patients with HGD could increase life expectancy by 3 quality-adjusted years at an incremental cost of < $6,000, compared with no intervention. Patients with LGD or no dysplasia can also be optimally managed with ablation, but continued surveillance after eradication of metaplasia is expensive. If ablation permanently eradicates at least 28% of LGD or 40% of non-dysplastic metaplasias, ablation would be preferred to surveillance. Conclusions Endoscopic ablation could be the preferred strategy for managing patients with BE with HGD. Ablation might also be preferred in subjects with LGD or no dysplasia, but the cost-effectiveness depends on the long-term effectiveness of ablation and whether surveillance endoscopy can be discontinued following successful ablation. As further post-ablation data become available, the optimal management strategy will be clarified. PMID:19272389

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.

Alertness management in two-person long-haul flight operations

NASA Technical Reports Server (NTRS)

Rosekind, M. R.; Gander, P. H.

1992-01-01

Long-haul flight operations involve cumulative sleep loss, circadian disruption, and extended and irregular duty schedules. These factors reduce pilot alertness and performance on the flightdeck. Conceptually and operationally, alertness management in flight operations can be divided into preventive strategies and operational countermeasures. Preventive strategies are utilized prior to a duty period to mitigate or reduce the effects of sleep loss, circadian disruption and fatigue during subsequent flight operations. Operational countermeasures are used during operations as acute techniques for maintaining performance and alertness. Results from previous NASA Ames field studies document the sleep loss and circadian disruption in three-person long-haul flying and illustrate the application of preventive strategies and operational countermeasures. One strategy that can be used in both a preventive and operational manner is strategic napping. The application and effectiveness of strategic napping in long-haul operations will be discussed. Finally, long-haul flying in two-person highly automated aircraft capable of extended range operations will create new challenges to maintaining pilot alertness and performance. Alertness management issues in this flight environment will be explored.

Challenges, coping strategies, and recommendations related to the HIV services field in the HAART era: a systematic literature review of qualitative studies from the United States and Canada.

PubMed

Kerr, Zachary Y; Miller, Katye R; Galos, Dylan; Love, Randi; Poole, Charles

2013-02-01

Qualitative research methods have been utilized to study the nature of work in the HIV services field. Yet current literature lacks a Highly Active Anti-Retroviral Treatment (HAART) era compendium of qualitative research studying challenges and coping strategies in the field. This study systematically reviewed challenges and coping strategies that qualitative researchers observed in the HIV services field during the HAART era, and their recommendations to organizations. Four online databases were searched for peer-reviewed research that utilized qualitative methods, were published from January 1998 to February 2012, utilized samples of individuals in the HIV services field; occurred in the U.S. or Canada, and contained information related to challenges and/or coping strategies. Abstracts were identified (n=846) and independently read and coded for inclusion by at least two of the four first authors. Identified articles (n=26) were independently read by at least two of the four first authors who recorded the study methodology, participant demographics, challenges and coping strategies, and recommendations. A number of challenges affecting those in the HIV services field were noted, particularly interpersonal and organizational issues. Coping strategies were problem- and emotion-focused. Summarized research recommendations called for increased support, capacity-building, and structural changes. Future research on challenges and coping strategies must provide up-to-date information to the HIV services field while creating, implementing, and evaluating interventions to manage current challenges and reduce the risk of burnout.

Critical elements in implementations of just-in-time management: empirical study of cement industry in Pakistan.

PubMed

Qureshi, Muhammad Imran; Iftikhar, Mehwish; Bhatti, Mansoor Nazir; Shams, Tauqeer; Zaman, Khalid

2013-01-01

In recent years, inventory management is continuous challenge for all organizations not only due to heavy cost associated with inventory holding, but also it has a great deal to do with the organizations production process. Cement industry is a growing sector of Pakistan's economy which is now facing problems in capacity utilization of their plants. This study attempts to identify the key strategies for successful implementation of just-in-time (JIT) management philosophy on the cement industry of Pakistan. The study uses survey responses from four hundred operations' managers of cement industry in order to know about the advantages and benefits that cement industry have experienced by Just in time (JIT) adoption. The results show that implementing the quality, product design, inventory management, supply chain and production plans embodied through the JIT philosophy which infect enhances cement industry competitiveness in Pakistan. JIT implementation increases performance by lower level of inventory, reduced operations & inventory costs was reduced eliminates wastage from the processes and reduced unnecessary production which is a big challenge for the manufacturer who are trying to maintain the continuous flow processes. JIT implementation is a vital manufacturing strategy that reaches capacity utilization and minimizes the rate of defect in continuous flow processes. The study emphasize the need for top management commitment in order to incorporate the necessary changes that need to take place in cement industry so that JIT implementation can take place in an effective manner.

Climate Change Effects of Forest Management and Substitution of Carbon-Intensive Materials and Fossil Fuels

NASA Astrophysics Data System (ADS)

Sathre, R.; Gustavsson, L.; Haus, S.; Lundblad, M.; Lundström, A.; Ortiz, C.; Truong, N.; Wikberg, P. E.

2016-12-01

Forests can play several roles in climate change mitigation strategies, for example as a reservoir for storing carbon and as a source of renewable materials and energy. To better understand the linkages and possible trade-offs between different forest management strategies, we conduct an integrated analysis where both sequestration of carbon in growing forests and the effects of substituting carbon intensive products within society are considered. We estimate the climate effects of directing forest management in Sweden towards increased carbon storage in forests, with more land set-aside for protection, or towards increased forest production for the substitution of carbon-intensive materials and fossil fuels, relative to a reference case of current forest management. We develop various scenarios of forest management and biomass use to estimate the carbon balances of the forest systems, including ecological and technological components, and their impacts on the climate in terms of cumulative radiative forcing over a 100-year period. For the reference case of current forest management, increasing the harvest of forest residues is found to give increased climate benefits. A scenario with increased set-aside area and the current level of forest residue harvest begins with climate benefits compared to the reference scenario, but the benefits cannot be sustained for 100 years because the rate of carbon storage in set-aside forests diminishes over time as the forests mature, but the demand for products and fuels remains. The most climatically beneficial scenario, expressed as reduced cumulative radiative forcing, in both the short and long terms is a strategy aimed at high forest production, high residue recovery rate, and high efficiency utilization of harvested biomass. Active forest management with high harvest level and efficient forest product utilization will provide more climate benefit, compared to reducing harvest and storing more carbon in the forest. Figure. Schematic diagram of complete modelled forest system including ecological and technological components, showing major flows of carbon.

The Systematic Use of Positive and Negative Consequences in Managing Classroom Encopresis

ERIC Educational Resources Information Center

George, Thomas W.; And Others

1977-01-01

This study reports a successful classroom intervention program which was designed to curb encopresis. It used positive consequences in combination with negative consequences, rather than negative consequences alone. Also it utilized a reversal strategy to evalulate the efficacy of the treatment variables. (Author)

Utilizing Brassicaceae seed meal as a soil amendment to suppress weed and soil borne pathogens

USDA-ARS?s Scientific Manuscript database

Increased demand for organic and sustainable agricultural production systems and restrictions on registration and use of toxic synthetic pesticides have generated demand for effective non-synthetic and environmentally friendly alternative weed and pathogen management strategies. Lack of effective a...

Navigating Financial and Supply Reliability Tradeoffs in Regional Drought Portfolios

NASA Astrophysics Data System (ADS)

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

2013-12-01

Rising development costs and growing concerns over environmental impacts have led many communities to explore more diversified regional portfolio-type approaches to managing their water supplies. These strategies coordinate existing supply infrastructure with other ';assets' such as conservation measures or water transfers, reducing the capacity and costs required to meet demand by providing greater adaptability to changing hydrologic conditions. For many water utilities, however, this additional flexibility can also cause unexpected reductions in revenue (i.e. conservation) or increased costs (i.e. transfers), fluctuations that can be very difficult for a regulated entity to manage. Thus, despite the advantages, concerns over the resulting financial disruptions provide a disincentive for utilities to develop more adaptive methods, potentially limiting the role of some very effective tools. This study seeks to design portfolio strategies that employ financial instruments (e.g. contingency funds, index insurance) to reduce fluctuations in revenues and costs and therefore do not sacrifice financial stability for improved performance (e.g. lower expected costs, high reliability). This work describes the development of regional water supply portfolios in the ';Research Triangle' region of North Carolina, an area comprising four rapidly growing municipalities supplied by nine surface water reservoirs in two separate river basins. Disparities in growth rates and the respective individual storage capacities of the reservoirs provide the region with the opportunity to increase the efficiency of the regional supply infrastructure through inter-utility water transfers, even as each utility engages in its own conservation activities. The interdependence of multiple utilities navigating shared conveyance and treatment infrastructure to engage in transfers forces water managers to consider regional objectives, as the actions of any one utility can affect the others. Results indicate the inclusion of inter-utility water transfers allows the water utilities to improve on regional operational objectives (i.e. higher reliability and lower restriction frequencies) at a lower expected cost, while financial mitigation tools introduce a tradeoff between expected costs and cost variability. Financial mitigation schemes, including both third-party financial insurance contracts and contingency funds (i.e. self-insurance), were able to reduce cost variability at a lower expected cost than mitigation schemes which use self-insurance alone. The dynamics of the Research Triangle scenario (e.g. rapid population growth, constrained supply, and sensitivity to cost/revenue swings) suggest that this work may have the potential to more generally inform utilities on the effects of coordinated regional water supply planning and the resulting financial implications of more flexible, portfolio-type management techniques.

Commonwealth of the Northern Mariana Islands Energy Action Plan

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

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

2013-07-01

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

"I've Actually Changed How I Live"-Patients' Long-Term Perceptions of a Cognitive Behavioral Pain Management Program.

PubMed

Egan, Aine; Lennon, Olive; Power, Camillus K; Fullen, Brona M

2017-02-01

To determine patients’ perceptions regarding cognitive behavioral pain management programs, and to determine what, if any, strategies learned on the program patients continue to use long-term to manage their pain. A qualitative, focus-group based study. An outpatient multidisciplinary pain management program in a university teaching hospital. Patients with chronic pain who had previously completed a 4-week cognitive behavioral pain management program (2001–2014). Sixteen patients attended one of four focus groups. A battery of semi-structured questions explored their perceptions of the cognitive behavioral program, and which strategies they found useful and continued to use long-term to manage their pain. Six key themes emerged: 1) universal long-term positive feedback on the utility of the program; 2) the program facilitated long-term changes in daily life; 3) participants now considered themselves as the “new me”; 4) request for more updates on emerging new treatments/pain knowledge; 5) recognizing that the key to maximizing gain from the program was to be open, to listen, and accept; and 6) participants sharing pain management knowledge with others in pain. There was universal positive feedback for the pain management program. Despite the years since they participated in one, patients continue to use key strategies to effectively manage their pain (pacing, relaxation), embedding them in their daily lives to maximize their quality of life.

Simulator evaluation of optimal thrust management/fuel conservation strategies for airbus aircraft on short haul routes

NASA Technical Reports Server (NTRS)

Bochem, J. H.; Mossman, D. C.; Lanier, P. D.

1977-01-01

The feasibility of incorporating optimal concepts into a practical system was determined. Various earlier theoretical analyses were confirmed, and insight was gained into the sensitivity of fuel conservation strategies to nonlinear and second order aerodynamic and engine characteristics. In addition to the investigation of optimal trajectories the study ascertained combined fuel savings by utilizing various procedure-oriented improvements such as delayed flap/decelerating approaches and great circle navigation.

Getting a handle on DNFB strategies for boosting performance.

PubMed

2015-03-01

Keeping tabs on DNFB requires a commitment from multiple departments, including clinical documentation, health information management, utilization management, and patient financial services. Monitoring DNFB performance daily, weekly, and monthly can help an organization quickly resolve short-term problems and also identify and respond to more systemic issues. By leveraging historical and comparison data, including performance information from peer organizations, hospitals and health systems can set more realistic targets and further highlight improvement opportunities.

Assessment of human resources management practices in Lebanese hospitals.

PubMed

El-Jardali, Fadi; Tchaghchagian, Victoria; Jamal, Diana

2010-01-01

Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties) in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%), lack of qualified personnel (35.1%), and lack of a system for performance evaluation (28.9%). Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%), improving salaries (14.4%), and developing retention strategies (10.3%). Mismatch between reported challenges and strategies were observed. To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully assume these responsibilities and who can continuously improve the status of employees at their organizations. The upcoming accreditation survey of Lebanese hospitals (2010-2011) presents an opportunity to strengthen HR management and enhance competencies of existing HR managers. Recognizing HR challenges and the importance of effective HR strategies should become a priority to policy-makers and top managers alike. Study findings may extend to other countries in the Eastern Mediterranean region.

Assessment of human resources management practices in Lebanese hospitals.

PubMed

El-Jardali, Fadi; Tchaghchagian, Victoria; Jamal, Diana

2009-11-12

Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties) in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%), lack of qualified personnel (35.1%), and lack of a system for performance evaluation (28.9%). Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%), improving salaries (14.4%), and developing retention strategies (10.3%). Mismatch between reported challenges and strategies were observed. To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully assume these responsibilities and who can continuously improve the status of employees at their organizations. The upcoming accreditation survey of Lebanese hospitals (2010-2011) presents an opportunity to strengthen HR management and enhance competencies of existing HR managers. Recognizing HR challenges and the importance of effective HR strategies should become a priority to policy makers and top managers alike. Study findings may extend to other countries in the Eastern Mediterranean region.

Assessment of human resources management practices in Lebanese hospitals

PubMed Central

2009-01-01

Background Sound human resources (HR) management practices are essential for retaining effective professionals in hospitals. Given the recruitment and retention reality of health workers in the twenty-first century, the role of HR managers in hospitals and those who combine the role of HR managers with other responsibilities should not be underestimated. The objective of this study is to assess the perception of HR managers about the challenges they face and the current strategies being adopted. The study also aims at assessing enabling factors including role, education, experience and HR training. Methods A cross-sectional survey design of HR managers (and those who combine their role as HR manager with other duties) in Lebanese hospitals was utilized. The survey included a combination of open- and close-ended questions. Questions included educational background, work experience, and demographics, in addition to questions about perceived challenges and key strategies being used. Quantitative data analysis included uni-variate analysis, whereas thematic analysis was used for open-ended questions. Results A total of 96 respondents from 61 hospitals responded. Respondents had varying levels of expertise in the realm of HR management. Thematic analysis revealed that challenges varied across respondents and participating hospitals. The most frequently reported challenge was poor employee retention (56.7%), lack of qualified personnel (35.1%), and lack of a system for performance evaluation (28.9%). Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees (19.6%), improving salaries (14.4%), and developing retention strategies (10.3%). Mismatch between reported challenges and strategies were observed. Conclusion To enable hospitals to deliver good quality, safe healthcare, improving HR management is critical. There is a need for a cadre of competent HR managers who can fully assume these responsibilities and who can continuously improve the status of employees at their organizations. The upcoming accreditation survey of Lebanese hospitals (2010-2011) presents an opportunity to strengthen HR management and enhance competencies of existing HR managers. Recognizing HR challenges and the importance of effective HR strategies should become a priority to policy makers and top managers alike. Study findings may extend to other countries in the Eastern Mediterranean region. PMID:19909527

Multiple UAV Cooperation for Wildfire Monitoring

NASA Astrophysics Data System (ADS)

Lin, Zhongjie

Wildfires have been a major factor in the development and management of the world's forest. An accurate assessment of wildfire status is imperative for fire management. This thesis is dedicated to the topic of utilizing multiple unmanned aerial vehicles (UAVs) to cooperatively monitor a large-scale wildfire. This is achieved through wildfire spreading situation estimation based on on-line measurements and wise cooperation strategy to ensure efficiency. First, based on the understanding of the physical characteristics of the wildfire propagation behavior, a wildfire model and a Kalman filter-based method are proposed to estimate the wildfire rate of spread and the fire front contour profile. With the enormous on-line measurements from on-board sensors of UAVs, the proposed method allows a wildfire monitoring mission to benefit from on-line information updating, increased flexibility, and accurate estimation. An independent wildfire simulator is utilized to verify the effectiveness of the proposed method. Second, based on the filter analysis, wildfire spreading situation and vehicle dynamics, the influence of different cooperation strategies of UAVs to the overall mission performance is studied. The multi-UAV cooperation problem is formulated in a distributed network. A consensus-based method is proposed to help address the problem. The optimal cooperation strategy of UAVs is obtained through mathematical analysis. The derived optimal cooperation strategy is then verified in an independent fire simulation environment to verify its effectiveness.

Wills Eye Hospital and surgical network: successful pre-positioning strategies for payment reduction and managed care pressures.

PubMed

Kessler, D M

2001-01-01

Through strategic clinical diversification, political activism, and bold expansion, Wills Eye Hospital, a teaching specialty surgical hospital, survives ravages of sudden onslaughts of managed care payment reductions while maintaining autonomy. Slack inpatient resources were re-utilized to create unique programs attractive to regional managed care organizations. Advocacy and lobbying for short-term favorable treatment from Medicare bought the Hospital valuable time and positioning. Building out a regional network of ambulatory surgical centers assures the growth and access to market required for Wills to maintain its autonomy in a managed care contracting environment.

Multidisciplinary strategies in the management of early chronic kidney disease.

PubMed

Martínez-Ramírez, Héctor R; Cortés-Sanabria, Laura; Rojas-Campos, Enrique; Hernández-Herrera, Aurora; Cueto-Manzano, Alfonso M

2013-11-01

Chronic kidney disease (CKD) is a worldwide epidemic especially in developing countries, with clear deficiencies in identification and treatment. Better care of CKD requires more than only economic resources, utilization of health research in policy-making and health systems changes that produce better outcomes. A multidisciplinary approach may facilitate and improve management of patients from early CKD in the primary health-care setting. This approach is a strategy for improving comprehensive care, initiating and maintaining healthy behaviors, promoting teamwork, eliminating barriers to achieve goals and improving the processes of care. A multidisciplinary intervention may include educational processes guided by health professional, use of self-help groups and the development of a CKD management plan. The complex and fragmented care management of patients with CKD, associated with poor outcome, enhances the importance of implementing a multidisciplinary approach in the management of this disease from the early stages. Multidisciplinary strategies should focus on the needs of patients (to increase their empowerment) and should be adapted to the resources and health systems prevailing in each country; its systematic implementation can help to improve patient care and slow the progression of CKD. Copyright © 2013 IMSS. Published by Elsevier Inc. All rights reserved.

The integrated supplier: key to cost management and multi-franchise capitation contracting.

PubMed

Schuweiler, R C

1996-05-01

Capitation...most healthcare providers do not work under it, comprehend it, or even want it, yet supply capitation contracting seminars are popping up everywhere creating the feeling that the bandwagon is leaving, and it might be time to get on board. Not true. Supply capitation is not for all organizations. Capitation contracting is not easy and there are not many successful models to help the uninitiated. If a panacea is sought for reducing supply costs, capitation is only one component of a systematic strategy to reduce materiel costs. This article suggests a direction using the Group Health Materiel Management (Group Health Cooperative of Puget Sound, WA) experience as a point of reference. It advocates a systematic approach that focuses on expense reduction in: cost of goods, holding cost of inventory, labor cost associated with all materiel processes, distribution cost (transportation and par stock pick, pack, and replenishment), product utilization, variation in product standards, and waste stream byproducts. At Group Health (GH) these issues are primarily addressed through the use of: information systems, supplier certification/selection processes, group purchasing compliance, supply channel management, supply capitation contracting programs, standardization, and utilization management. Because of managed care organizational structure, Group Health Cooperative supply capitation contracting, as performed at GH, is discussed not as a quick fix solution but in the spirit of sharing our experience with others who may be considering it as a cost savings tactic in the context of a broad-based materiel management strategy. This article highlights the experiences of GH beginning with materiel management's business process assumptions toward multiple-franchise supply capitation.

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

NASA Technical Reports Server (NTRS)

Williams, R. E.; Byrd, J.

1981-01-01

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

Water resources management in the Ganges Basin: a comparison of three strategies for conjunctive use of groundwater and surface water

USGS Publications Warehouse

Khan, Mahfuzur R.; Voss, Clifford I.; Yu, Winston; Michael, Holly A.

2014-01-01

The most difficult water resources management challenge in the Ganges Basin is the imbalance between water demand and seasonal availability. More than 80 % of the annual flow in the Ganges River occurs during the 4-month monsoon, resulting in widespread flooding. During the rest of the year, irrigation, navigation, and ecosystems suffer because of water scarcity. Storage of monsoonal flow for utilization during the dry season is one approach to mitigating these problems. Three conjunctive use management strategies involving subsurface water storage are evaluated in this study: Ganges Water Machine (GWM), Pumping Along Canals (PAC), and Distributed Pumping and Recharge (DPR). Numerical models are used to determine the efficacy of these strategies. Results for the Indian State of Uttar Pradesh (UP) indicate that these strategies create seasonal subsurface storage from 6 to 37 % of the yearly average monsoonal flow in the Ganges exiting UP over the considered range of conditions. This has clear implications for flood reduction, and each strategy has the potential to provide irrigation water and to reduce soil waterlogging. However, GWM and PAC require significant public investment in infrastructure and management, as well as major shifts in existing water use practices; these also involve spatially-concentrated pumping, which may induce land subsidence. DPR also requires investment and management, but the distributed pumping is less costly and can be more easily implemented via adaptation of existing water use practices in the basin.

Nondestructive evaluation of timber highway guardrail posts

Treesearch

James P. Wacker; Xiping Wang; David E. Kretschmann; Douglas R. Rammer

2010-01-01

Timber post guardrail systems have been utilized in several regions of the U.S. due to their beneficial energy absorbing characteristics during vehicle impacts. These posts are not routinely inspected and replacement decisions are rather arbitrary. The Federal Highway Administration recently placed emphasis on new asset management strategies that actively assess...

Evaluate the Role of Evapotranspiration Remote Sensing Data in Improving Hydrological Modeling Predictability

USDA-ARS?s Scientific Manuscript database

As the global demands for the use of freshwater resources continues to rise, it has become increasingly important to insure the sustainability of this resources. This is accomplished through the use of management strategies that often utilize monitoring and the use of hydrological models. However, m...

Research Priorities in Childhood Disability: Conference Proceedings (London, Ontario, Canada, May 10-13, 1988).

ERIC Educational Resources Information Center

Easter Seal Research Inst., Don Mills (Ontario).

The conference reported in this document utilized a conceptual matrix to organize presentations on research priorities in prevention, definitive treatment, and ongoing management of impairment, disability, and handicap. Ten research strategy recommendations developed at the conference are offered for implementation by The Easter Seal Research…

Knowledge Inertia and Organizational Learning as the Explanation of Organizational Performance

ERIC Educational Resources Information Center

Aküzüm, Cemal

2014-01-01

Knowledge is an important concept for individuals and organizations both as a power and source. Thus, knowledge management has become important subject for researchers. However, when people encounter problems, they usually try to produce solutions by utilizing their previous knowledge and experience. Such problem solving strategies are called…

75 FR 54857 - Meeting of the Chief of Naval Operations Executive Panel

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-09

... Operations (CNO) Executive Panel will deliberate on the findings and proposed recommendations of the... Navy strategy, plans, and policies regarding the utilization of technically diverse systems, primarily associated with information management systems. DATES: The meeting will be held on September 30, 2010, from 9...

76 FR 28060 - Regional Habitat Conservation Plan, Hays County, TX

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-13

... alternative features the acquisition of a modestly sized, pre-determined preserve system and limits the amount... under Alternative B, this alternative involves a conservation program that utilizes a pre-determined..., adaptive management, and other strategies designed to avoid and minimize harm to the covered species and...

Dynamic Strategic Planning in a Professional Knowledge-Based Organization

ERIC Educational Resources Information Center

Olivarius, Niels de Fine; Kousgaard, Marius Brostrom; Reventlow, Susanne; Quelle, Dan Grevelund; Tulinius, Charlotte

2010-01-01

Professional, knowledge-based institutions have a particular form of organization and culture that makes special demands on the strategic planning supervised by research administrators and managers. A model for dynamic strategic planning based on a pragmatic utilization of the multitude of strategy models was used in a small university-affiliated…

Food Therapy in Sinosphere Asia.

PubMed

Chu, Natural Hoi Sing; Yao, Chu Kion; Tan, Victoria Ping Yi

2018-02-01

Traditional Chinese Food Therapy has long been an integral part of dietary practices in Sinosphere Asia. This therapy is defined by the classification of foods into cooling (Yin) and heaty (Yang) and the manipulation of dietary intake of these foods as a therapeutic strategy for chronic diseases. Both functional dyspepsia (FD) and irritable bowel syndrome (IBS) are chronic, functional gut disorders widely prevalent in Sinosphere Asia. Diet is increasingly recognized as a symptom trigger in FD and IBS, and the evidence suggesting the utility of diet therapies as front-line management is growing, particularly in the West. Specifically, a diet low in Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols is an efficacious therapy for patients with IBS. In contrast, a proportion of patients with IBS in Sinosphere Asia utilize Chinese Food Therapy for symptom management. Chinese Food Therapy provides an attractive target for integration with evidence-based Western dietary therapies as a management strategy in FD and IBS. However, significant gaps in research exist with the utility of Chinese Food Therapy that first need to be addressed. This includes a lack of standardization for heaty and cooling classification, limited mechanistic rationale or clinical studies supporting its efficacy in FD and IBS, and the lack of an ideal practitioner for implementation of Chinese Food Therapy. Hence, the review provides a summary of the role of diet and nutrition in Sinosphere Asia with an emphasis on FD and IBS, and an examination of how modern dietary practices may be able to be integrated into practices in this region.

Towards Ubiquitous Peer Review Strategies to Sustain and Enhance a Clinical Knowledge Management Framework

PubMed Central

Rocha, Roberto A.; Bradshaw, Richard L.; Bigelow, Sharon M.; Hanna, Timothy P.; Fiol, Guilherme Del; Hulse, Nathan C.; Roemer, Lorrie K.; Wilkinson, Steven G.

2006-01-01

Widespread cooperation between domain experts and front-line clinicians is a key component of any successful clinical knowledge management framework. Peer review is an established form of cooperation that promotes the dissemination of new knowledge. The authors describe three peer collaboration scenarios that have been implemented using the knowledge management infrastructure available at Intermountain Healthcare. Utilization results illustrating the early adoption patterns of the proposed scenarios are presented and discussed, along with succinct descriptions of planned enhancements and future implementation efforts. PMID:17238422

Preparation for pain management during childbirth: the psychological aspects of coping strategy development in antenatal education.

PubMed

Escott, Diane; Slade, Pauline; Spiby, Helen

2009-11-01

During childbirth, in addition to or in place of analgesia, women manage pain using a range of coping strategies. Antenatal education provides an opportunity prior to birth to help women to prepare for an often painful event. However, this is usually carried out with little reference to the literature regarding psychological factors which influence the experience of pain. This review seeks to consider how recent developments in psychological knowledge could enhance care. Areas identified include range of coping strategies and factors influencing their efficacy and implementation. This draws on both the literature on management of acute pain in other scenarios and the limited literature related to childbirth related pain. The following recommendations for systematic evaluation in the context of antenatal education are made: (i) Increase the range of coping strategies currently utilized to include cognitive based strategies. (ii) Help women to identify and understand the nature of their own coping styles and preferences, including any unhelpful patterns of pain catastrophizing. (iii) Help women to develop their own unique set of coping strategies for labor. (iv) Strengthen feelings of coping self-efficacy by practice in class and reinforcement by the class teacher. (v) Develop implementation intentions which account for the changing context of childbirth and (vi) Actively develop prompting and reinforcement of use of identified coping strategies by birth partners.

Profiles of classroom behavior in high schools: associations with teacher behavior management strategies and classroom composition.

PubMed

Pas, Elise T; Cash, Anne H; O'Brennan, Lindsey; Debnam, Katrina J; Bradshaw, Catherine P

2015-04-01

Although there has been considerable attention to the issue of classroom management and processes in educational reform models, there has been relatively limited research on these factors in high schools. The current study utilized observational data from 1262 classrooms in 52 high schools to examine teacher classroom management strategies and ratings of student compliance, engagement, and social disruption. Latent profile analysis (LPA) was conducted to examine specific patterns of classroom-wide student behavior in relation to teachers' use of classroom management strategies and classroom composition. The LPA revealed three distinct classroom behavioral profiles where students consistently met behavioral expectations (71%), inconsistently met expectations (23%), and were noncompliant (6%). Analyses indicated a functional association between patterns of student behavior and teachers' classroom management. In classrooms where students consistently met expectations, teachers provided more opportunities to respond and less disapproval and reactive behavioral management. Classrooms with noncompliant students had teachers who used the most disapproval and reactive behavior management. In addition, classrooms characterized as consistent had fewer males and more White students than classrooms characterized by inconsistent and noncompliant behaviors. These findings highlight the link between student patterns of behavior and teacher classroom management and have important implications for screening and professional development. Copyright © 2014 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Towards a resilience management framework for complex enterprise systems upgrade implementation

NASA Astrophysics Data System (ADS)

Teoh, Say Yen; Yeoh, William; Zadeh, Hossein Seif

2017-05-01

The lack of knowledge of how resilience management supports enterprise system (ES) projects accounts for the failure of firms to leverage their investments in costly ES implementations. Using a structured-pragmatic-situational (SPS) case study research approach, this paper reports on an investigation into the resilience management of a large utility company as it implemented an ES upgrade. Drawing on the literature and on the case study findings, we developed a process-based resilience management framework that involves three strategies (developing situation awareness, demystifying threats, and executing restoration plans) and four organisational capabilities that transform resilience management concepts into practices. We identified the crucial phases of ES upgrade implementation and developed indicators for how different strategies and capabilities of resilience management can assist managers at different stages of an ES upgrade. This research advances the state of existing knowledge by providing specific and verifiable propositions for attaining a state of resilience, the knowledge being grounded in the empirical reality of a case study. Moreover, the framework offers ES practitioners a roadmap to better identify appropriate responses and levels of preparedness.

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.

Effective Sensor Selection and Data Anomaly Detection for Condition Monitoring of Aircraft Engines

PubMed Central

Liu, Liansheng; Liu, Datong; Zhang, Yujie; Peng, Yu

2016-01-01

In a complex system, condition monitoring (CM) can collect the system working status. The condition is mainly sensed by the pre-deployed sensors in/on the system. Most existing works study how to utilize the condition information to predict the upcoming anomalies, faults, or failures. There is also some research which focuses on the faults or anomalies of the sensing element (i.e., sensor) to enhance the system reliability. However, existing approaches ignore the correlation between sensor selecting strategy and data anomaly detection, which can also improve the system reliability. To address this issue, we study a new scheme which includes sensor selection strategy and data anomaly detection by utilizing information theory and Gaussian Process Regression (GPR). The sensors that are more appropriate for the system CM are first selected. Then, mutual information is utilized to weight the correlation among different sensors. The anomaly detection is carried out by using the correlation of sensor data. The sensor data sets that are utilized to carry out the evaluation are provided by National Aeronautics and Space Administration (NASA) Ames Research Center and have been used as Prognostics and Health Management (PHM) challenge data in 2008. By comparing the two different sensor selection strategies, the effectiveness of selection method on data anomaly detection is proved. PMID:27136561

Effective Sensor Selection and Data Anomaly Detection for Condition Monitoring of Aircraft Engines.

PubMed

Liu, Liansheng; Liu, Datong; Zhang, Yujie; Peng, Yu

2016-04-29

In a complex system, condition monitoring (CM) can collect the system working status. The condition is mainly sensed by the pre-deployed sensors in/on the system. Most existing works study how to utilize the condition information to predict the upcoming anomalies, faults, or failures. There is also some research which focuses on the faults or anomalies of the sensing element (i.e., sensor) to enhance the system reliability. However, existing approaches ignore the correlation between sensor selecting strategy and data anomaly detection, which can also improve the system reliability. To address this issue, we study a new scheme which includes sensor selection strategy and data anomaly detection by utilizing information theory and Gaussian Process Regression (GPR). The sensors that are more appropriate for the system CM are first selected. Then, mutual information is utilized to weight the correlation among different sensors. The anomaly detection is carried out by using the correlation of sensor data. The sensor data sets that are utilized to carry out the evaluation are provided by National Aeronautics and Space Administration (NASA) Ames Research Center and have been used as Prognostics and Health Management (PHM) challenge data in 2008. By comparing the two different sensor selection strategies, the effectiveness of selection method on data anomaly detection is proved.

Contemporary management and surveillance strategy after shunt or endoscopic third ventriculostomy procedures for hydrocephalus.

PubMed

Janjua, M Burhan; Hoffman, Caitlin E; Souweidane, Mark M

2017-11-01

The management of hydrocephalus can be challenging even in expert hands. Due to acute presentation, recurrence, accompanying complications, the need for urgent diagnosis; a robust management plan is an absolute necessity. We devised a novel time efficient surveillance strategy during emergency, and clinic follow up settings which has never been described in the literature. We searched all articles embracing management/surveillance protocol on pediatric hydrocephalus utilizing the terms "hydrocephalus follow up" or "surveillance protocol after hydrocephalus treatment". The authors present their own strategy based on vast experience in the hydrocephalus management at a single institution. The need for the diagnostic laboratory testing, age and presentation based radiological imaging, significance of neuro-opthalmological exam, and when to consider the emergent exploration have been discussed in detail. Moreover, a definitive triaging strategy has been described with the help of flow chart diagrams for clinicians, and the neurosurgeons in practice. The triage starts from detail history, physical exam, necessary labs, radiological imaging depending on the presentation, and the age of the child. A quick head CT scan helps after shunt surgery while, a FAST sequence MRI scan (fsMRI) is important in post ETV patients. The need for neuro-opthalmological exam, and the shunt series stays vital in asymptomatic patients during regular follow up. Copyright © 2017 Elsevier Ltd. All rights reserved.

Bridging the gap between preventive and restorative dentistry: identification of caries risk factors and strategies for minimizing risk.

PubMed

Maragliano-Muniz, Pamela

2013-10-01

Following the introduction of CAMBRA (Caries Management by Risk Assessment) in 2007, a number of recommendations for office protocols were introduced, and many companies have formulated products and procedures for implementing CAMBRA. As a result, the implementation of a caries management program can be confounding and overwhelming to a dental practitioner. Understanding risk factors as they contribute to the caries process can help mitigate confusion and guide the practitioner when selecting materials for their practice. Ultimately, knowing how the risk factors play a role in the progression of dental caries will lead to appropriate risk management and product recommendations. The purpose of this article is to discuss the contribution of risk factors to the caries process and to introduce strategies that restorative dentists can utilize to minimize caries risk.

Consolidation of medical groups into physician practice management organizations.

PubMed

Robinson, J C

1998-01-14

Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans. To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs). Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers. Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA Medical Management, and UniMed. Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs. Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality assurance. Physician practice management organizations and their affiliated medical groups face the challenge of continuing rapid growth, sustaining stock values, and improving practice efficiencies while maintaining the loyalty of physicians and patients.

Foundational Report Series. Advanced Distribution management Systems for Grid Modernization (Importance of DMS for Distribution Grid Modernization)

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

Wang, Jianhui

2015-09-01

Grid modernization is transforming the operation and management of electric distribution systems from manual, paper-driven business processes to electronic, computer-assisted decisionmaking. At the center of this business transformation is the distribution management system (DMS), which provides a foundation from which optimal levels of performance can be achieved in an increasingly complex business and operating environment. Electric distribution utilities are facing many new challenges that are dramatically increasing the complexity of operating and managing the electric distribution system: growing customer expectations for service reliability and power quality, pressure to achieve better efficiency and utilization of existing distribution system assets, and reductionmore » of greenhouse gas emissions by accommodating high penetration levels of distributed generating resources powered by renewable energy sources (wind, solar, etc.). Recent “storm of the century” events in the northeastern United States and the lengthy power outages and customer hardships that followed have greatly elevated the need to make power delivery systems more resilient to major storm events and to provide a more effective electric utility response during such regional power grid emergencies. Despite these newly emerging challenges for electric distribution system operators, only a small percentage of electric utilities have actually implemented a DMS. This paper discusses reasons why a DMS is needed and why the DMS may emerge as a mission-critical system that will soon be considered essential as electric utilities roll out their grid modernization strategies.« less

Analytical optimization of demand management strategies across all urban water use sectors

NASA Astrophysics Data System (ADS)

Friedman, Kenneth; Heaney, James P.; Morales, Miguel; Palenchar, John

2014-07-01

An effective urban water demand management program can greatly influence both peak and average demand and therefore long-term water supply and infrastructure planning. Although a theoretical framework for evaluating residential indoor demand management has been well established, little has been done to evaluate other water use sectors such as residential irrigation in a compatible manner for integrating these results into an overall solution. This paper presents a systematic procedure to evaluate the optimal blend of single family residential irrigation demand management strategies to achieve a specified goal based on performance functions derived from parcel level tax assessor's data linked to customer level monthly water billing data. This framework is then generalized to apply to any urban water sector, as exponential functions can be fit to all resulting cumulative water savings functions. Two alternative formulations are presented: maximize net benefits, or minimize total costs subject to satisfying a target water savings. Explicit analytical solutions are presented for both formulations based on appropriate exponential best fits of performance functions. A direct result of this solution is the dual variable which represents the marginal cost of water saved at a specified target water savings goal. A case study of 16,303 single family irrigators in Gainesville Regional Utilities utilizing high quality tax assessor and monthly billing data along with parcel level GIS data provide an illustrative example of these techniques. Spatial clustering of targeted homes can be easily performed in GIS to identify priority demand management areas.

Simulated management effects on ammonia emissions from field applied manure.

PubMed

Smith, E; Gordon, R; Bourque, C; Campbell, A; Génermont, S; Rochette, P; Mkhabela, M

2009-06-01

A need exists to improve the utilization of manure nutrients by minimizing NH(3) emissions from land application of manure. Management strategies to reduce NH(3) emissions are available; however, few have been validated under Canadian conditions. A well tested and accurate simulation model, however, can help overcome this challenge by determining appropriate management strategies for a given set of field conditions. The Volt'Air simulation model was utilized to estimate NH(3) volatilization from manure spreading for various manure spreading considerations under a range of atmospheric conditions typically encountered in eastern Canada. Considerations included: (i) soil liming, (ii) time of day of manure spreading, (iii) rainfall (timing and amount) and (iv) manure incorporation (timing, depth and manure coverage). Results demonstrated that liming to increase soil pH, increased NH(3) emissions by 3.3 kg ha(-1) for each increment of 0.1 pH (up to a 1.5 total increase), over no liming at 34.6 kg ha(-1). For each hour delay in manure spreading past 0800 h, NH(3) losses were reduced by 1.5 kg ha(-1). Rainfall (10mm) at least 20 h after manure application reduced losses, with increased reductions at higher rainfall amounts. Incorporation soon (1h) after application was best for NH(3) mitigation. Increasing the depth of incorporation by 5c m reduced NH(3) emissions by 4.4 kg ha(-1); also increasing manure coverage by incorporation reduced losses by 2 kg ha(-1) for each 10% increase in coverage, compared to surface application at 34.6 kg ha(-1). This investigation using Volt'Air yielded valuable information about simulating manure management strategies and the magnitude of their effects on NH(3) emissions.

Health promotion and disease prevention: a look at demand management programs.

PubMed

Fronstin, P

1996-09-01

This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health care expenditures while improving overall health. This goal can be achieved through the use of health risk appraisals, organizational health risk appraisals, high risk programs, awareness programs, medical call centers, return to work programs, EAPs, and smoking cessation programs. Studies of a health program's cost effectiveness must disentangle the effects of many competing factors on cost effectiveness. For example, a health risk appraisal program may identify health problems of which the patient and the health care provider were unaware, resulting in the treatment of these health problems. At the same time, the employer may have switched from a nonmanaged pharmaceutical program to a managed program with incentives for participants to utilize generic and/or mail order drugs. As a result, when evaluating a health promotion program, the long-run impact on the program's cost effectiveness is most important.

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

NASA Astrophysics Data System (ADS)

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

2013-04-01

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

Counselor-Mediated Contracts in Self-Management for Students in the New Start Program.

ERIC Educational Resources Information Center

Santa Rita, Emilio D., Jr.

In an effort to help students on academic suspension achieve full academic status and succeed in college, New York's Bronx Community College developed the New Start program, a portfolio-based intervention strategy utilizing personal success contracts. Students participating in the program complete guided self-assessments, identify problem areas,…

Market segmentation and positioning: matching creativity with fiscal responsibility.

PubMed

Kiener, M E

1989-01-01

This paper describes an approach to continuing professional education (CPE) program development in nursing within a university environment that utilizes the concepts of market segmentation and positioning. Use of these strategies enables the academic CPE enterprise to move beyond traditional needs assessment practices to create more successful and better-managed CPE programs.

Identifying and Responding to Personal Stressors: Utilizing Photo Elicitation in Health Education Courses

ERIC Educational Resources Information Center

Hunter, Theresa

2014-01-01

The "Photo Elicitation Project" teaching idea applies the techniques of photo elicitation to stress prevention and management. This activity is designed to help students identify their personal stressors and to determine which stress prevention strategies are most useful for them. Objectives: students will be able to (a) identify current…

Does pulse-grazing influence within- and between-grazing season dietary quality of yearling steers in shortgrass steppe?

USDA-ARS?s Scientific Manuscript database

Pulse-grazing, high stock density with short grazing periods (weeks) followed by long (months to > 1 year) rest periods, is a grazing management strategy posited to decrease preferential selection by cattle and increase utilization of forage, but influences on dietary quality of grazing animals in s...

77 FR 55850 - Office of the Director, National Institutes of Health; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-11

... Scientific Management Review Board (SMRB). In Fall 2011, the SMRB was asked by NIH to recommend strategies for how NIH can optimize its utilization of its Small Business Innovation Research/ Small Business... from the small business community and investors in biomedical research with interest in the SBIR/STTR...

KASP assays for powdery mildew resistance breeding in pea

USDA-ARS?s Scientific Manuscript database

Powdery mildew of pea, caused by Erysiphe pisi DC, is a serious production constraint to pea (Pisum sativum L.) production in the U.S. and elsewhere. Utilization of genetic resistance to powdery mildew using er1 has been an effective strategy to manage this disease. This gene, er1, conferring powde...

Our Cost Control Program Is Real, and Good PR Too.

ERIC Educational Resources Information Center

Harris, James; And Others

The cost control program of the Beaverton School District (Oregon) is presented in three sections. Reviewing the role of the school board in cost control development, Jean Holt (a board member) outlines the fiscal management system, long-range financial strategies, energy conservation, and utilization of facilities. The programs have resulted in a…

Renewables-Friendly Grid Development Strategies. Experience in the United States, Potential Lessons for China

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

Hurlbut, David; Zhou, Ella; Porter, Kevin

2015-10-01

This report aims to help China's reform effort by providing a concise summary of experience in the United States with "renewables-friendly"" grid management, focusing on experiences that might be applicable to China. It focuses on utility-scale renewables and sets aside issues related to distributed generation.

78 FR 15982 - Exchange Traded Concepts Trust, et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-13

... Distributors, LLC (``Quasar'') and Foreside Fund Services, LLC (``Foreside'' and each of SEI, Quasar and... proof of service on applicants, in the form of an affidavit or, for lawyers, a certificate of service... investment strategies and will attempt to achieve its investment objective by utilizing an active management...

Preclinic group education sessions reduce waiting times and costs at public pain medicine units.

PubMed

Davies, Stephanie; Quintner, John; Parsons, Richard; Parkitny, Luke; Knight, Paul; Forrester, Elizabeth; Roberts, Mary; Graham, Carl; Visser, Eric; Antill, Tracy; Packer, Tanya; Schug, Stephan A

2011-01-01

To assess the effects of preclinic group education sessions and system redesign on tertiary pain medicine units and patient outcomes. Prospective cohort study. Two public hospital multidisciplinary pain medicine units. People with persistent pain. A system redesign from a "traditional" model (initial individual medical appointments) to a model that delivers group education sessions prior to individual appointments. Based on Patient Triage Questionnaires patients were scheduled to attend Self-Training Educative Pain Sessions (STEPS), a two day eight hour group education program, followed by optional patient-initiated clinic appointments. Number of patients completing STEPS who subsequently requested individual outpatient clinic appointment(s); wait-times; unit cost per new patient referred; recurrent health care utilization; patient satisfaction; Global Perceived Impression of Change (GPIC); and utilized pain management strategies. Following STEPS 48% of attendees requested individual outpatient appointments. Wait times reduced from 105.6 to 16.1 weeks at one pain unit and 37.3 to 15.2 weeks at the second. Unit cost per new patient appointed reduced from $1,805 Australian Dollars (AUD) to AUD$541 (for STEPS). At 3 months, patients scored their satisfaction with "the treatment received for their pain" more positively than at baseline (change score=0.88; P=0.0003), GPIC improved (change score=0.46; P<0.0001) and mean number of active strategies utilized increased by 4.12 per patient (P=0.0004). The introduction of STEPS was associated with reduced wait-times and costs at public pain medicine units and increased both the use of active pain management strategies and patient satisfaction. Wiley Periodicals, Inc.

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

Hart, William Eugene

These slides describe different strategies for installing Python software. Although I am a big fan of Python software development, robust strategies for software installation remains a challenge. This talk describes several different installation scenarios. The Good: the user has administrative privileges - Installing on Windows with an installer executable, Installing with Linux application utility, Installing a Python package from the PyPI repository, and Installing a Python package from source. The Bad: the user does not have administrative privileges - Using a virtual environment to isolate package installations, and Using an installer executable on Windows with a virtual environment. The Ugly:more » the user needs to install an extension package from source - Installing a Python extension package from source, and PyCoinInstall - Managing builds for Python extension packages. The last item referring to PyCoinInstall describes a utility being developed for the COIN-OR software, which is used within the operations research community. COIN-OR includes a variety of Python and C++ software packages, and this script uses a simple plug-in system to support the management of package builds and installation.« less

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

NASA Astrophysics Data System (ADS)

Groves, D. G.; Lempert, R.

2008-12-01

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

Growing the Field: Current Approaches to Data Collection at Farmers' Markets.

PubMed

Karpyn, Allison; Kim, Sonia A; DaCosta, Rosa V; Gasinu, Sika; Law, Yi-Ming

There is limited published research about the dietary impacts of farmers' markets. We sought to understand whether market managers collect data about markets and to examine the instruments and strategies used. Of the 359 market managers contacted across the United States, representing 543 markets, 185 managers participated in a telephone survey. A subset supplied copies of data collection tools for further analysis. Ninety-three percent of market managers collect data such as customer surveys, vendor applications, customer counts, or demographics. The potential utility of the data collected by mangers and suggestions for study of the dietary impacts of farmers markets are discussed.

Managing biotechnology in a network-model health plan: a U.S. private payer perspective.

PubMed

Watkins, John B; Choudhury, Sanchita Roy; Wong, Ed; Sullivan, Sean D

2006-01-01

Emerging biotechnology poses challenges to payers, including access, coverage, reimbursement, patient selection, and affordability. Premera Blue Cross, a private regional health plan, developed an integrated cross-functional approach to managing biologics, built around a robust formulary process that is fast, flexible, fair, and transparent to stakeholders. Results are monitored by cost and use reporting from merged pharmacy and medical claims. Utilization management and case management strategies will integrate with specialty pharmacy programs to improve outcomes and cost-effectiveness. Creative approaches to provider reimbursement can align providers' incentives with those of the plan. Redesign of member benefits can also encourage appropriate use of biotechnology.

Fuelwood, agro-forestry, and natural resource management: the development significance of land tenure and other resource management/utilization systems

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

Brokensha, D.; Castro, A.P.; Kundu, M.

1984-04-01

Using a systems approach and focusing on the social context, the study examines natural resource management in relation to fuelwood production and agroforestry. An initial section describing the use and interlinkage of the concepts of ecozone and ecosystem is followed by a discussion of problem ecozones, human use of ecozones, agricultural ecosystems, resource competition, uses of trees and forest products, and tree planting. Rural resource management strategies at the household, community, local, and state levels are discussed in the context of political economy, land tenure and rights, tenancy and sharecropping, group or public landholding, and acquisition and transfer of land.

Designing management strategies for carbon dioxide storage and utilization under uncertainty using inexact modelling

NASA Astrophysics Data System (ADS)

Wang, Yu; Fan, Jie; Xu, Ye; Sun, Wei; Chen, Dong

2017-06-01

Effective application of carbon capture, utilization and storage (CCUS) systems could help to alleviate the influence of climate change by reducing carbon dioxide (CO2) emissions. The research objective of this study is to develop an equilibrium chance-constrained programming model with bi-random variables (ECCP model) for supporting the CCUS management system under random circumstances. The major advantage of the ECCP model is that it tackles random variables as bi-random variables with a normal distribution, where the mean values follow a normal distribution. This could avoid irrational assumptions and oversimplifications in the process of parameter design and enrich the theory of stochastic optimization. The ECCP model is solved by an equilibrium change-constrained programming algorithm, which provides convenience for decision makers to rank the solution set using the natural order of real numbers. The ECCP model is applied to a CCUS management problem, and the solutions could be useful in helping managers to design and generate rational CO2-allocation patterns under complexities and uncertainties.

Game theoretic sensor management for target tracking

NASA Astrophysics Data System (ADS)

Shen, Dan; Chen, Genshe; Blasch, Erik; Pham, Khanh; Douville, Philip; Yang, Chun; Kadar, Ivan

2010-04-01

This paper develops and evaluates a game-theoretic approach to distributed sensor-network management for target tracking via sensor-based negotiation. We present a distributed sensor-based negotiation game model for sensor management for multi-sensor multi-target tacking situations. In our negotiation framework, each negotiation agent represents a sensor and each sensor maximizes their utility using a game approach. The greediness of each sensor is limited by the fact that the sensor-to-target assignment efficiency will decrease if too many sensor resources are assigned to a same target. It is similar to the market concept in real world, such as agreements between buyers and sellers in an auction market. Sensors are willing to switch targets so that they can obtain their highest utility and the most efficient way of applying their resources. Our sub-game perfect equilibrium-based negotiation strategies dynamically and distributedly assign sensors to targets. Numerical simulations are performed to demonstrate our sensor-based negotiation approach for distributed sensor management.

Building alliances in unlikely places: progressive allies and the Tobacco Institute's coalition strategy on cigarette excise taxes.

PubMed

Campbell, Richard B; Balbach, Edith D

2009-07-01

The tobacco industry often utilizes third parties to advance its policy agenda. One such utilization occurred when the industry identified organized labor and progressive groups as potential allies whose advocacy could undermine public support for excise tax increases. To attract such collaboration, the industry framed the issue as one of tax fairness, creating a labor management committee to provide distance from tobacco companies and furthering progressive allies' interests through financial and logistical support. Internal industry documents indicate that this strategic use of ideas, institutions, and interests facilitated the recruitment of leading progressive organizations as allies. By placing excise taxes within a strategic policy nexus that promotes mutual public interest goals, public health advocates may use a similar strategy in forging their own excise tax coalitions.

Managing Patient Trust in Managed Care

PubMed Central

Davies, Huw T.O.; Rundall, Thomas G.

2000-01-01

Patient trust has been identified as an important element in the patient-physician relationship. However, common features of managed care, such as risk-sharing, utilization review, and limitations on benefits, may erode the traditionally high trust that patients have in their physicians. High trust is not always justified; rather, an optimal level of trust arises from the level of interdependence between patients and physicians. This analysis of the interrelationship between patient-physician trust and some of the key facets of managed care has important implications for managed care. A return to high levels of trust may be impracticable, and new strategies for balancing trust-building efforts by caregivers with checking mechanisms accessible to patients are recommended. PMID:11191451

Evolution of Biomarker Guided Therapy for Heart Failure: Current Concepts and Trial Evidence

PubMed Central

Pruett, Amanda E; Lee, Amanda K; Patterson, Herbert; Schwartz, Todd A; Glotzer, Jana M; Adams, Jr, Kirkwood F

2015-01-01

Optimizing management of patients with heart failure remains quite challenging despite many significant advances in drug and device therapy for this syndrome. Although a large body of evidence from robust clinical trials supports multiple thera-pies, utilization of these well-established treatments remains inconsistent and outcomes suboptimal in “real-world” patients with heart failure. Disease management programs may be effective, but are difficult to implement due to cost and logistical issues. Another approach to optimizing therapy is to utilize biomarkers to guide therapeutic choices. Natriuretic peptides pro-vide additional information of significant clinical value in the diagnosis and estimation of risk inpatients with heart failure. Ongoing research suggests a potential important added role for natriuretic peptides in heart failure. Guiding therapy based on serial changes in these biomarkers may be an effective strategy to optimize treatment and achieve better outcomes in this syn-drome. Initial, innovative, proof-of-concept studies have provided encouraging results and important insights into key as-pects of this strategy, but well designed, large-scale, multicenter, randomized, outcome trials are needed to definitively estab-lish this novel approach to management. Given the immense and growing public health burden of heart failure, identification of cost-effective ways to decrease the morbidity and mortality due to this syndrome is critical. PMID:24251462

Drugp-Induced Rhabdomyolysis Atlas (DIRA) for idiosyncratic adverse drug reaction management.

PubMed

Wen, Zhining; Liang, Yu; Hao, Yingyi; Delavan, Brian; Huang, Ruili; Mikailov, Mike; Tong, Weida; Li, Menglong; Liu, Zhichao

2018-06-11

Drug-induced rhabdomyolysis (DIR) is an idiosyncratic and fatal adverse drug reaction (ADR) characterized in severe muscle injuries accompanied by multiple-organ failure. Limited knowledge regarding the pathophysiology of rhabdomyolysis is the main obstacle to developing early biomarkers and prevention strategies. Given the lack of a centralized data resource to curate, organize, and standardize widespread DIR information, here we present a Drug-Induced Rhabdomyolysis Atlas (DIRA) that provides DIR-related information, including: a classification scheme for DIR based on drug labeling information; postmarketing surveillance data of DIR; and DIR drug property information. To elucidate the utility of DIRA, we used precision dosing, concomitant use of DIR drugs, and predictive modeling development to exemplify strategies for idiosyncratic ADR (IADR) management. Published by Elsevier Ltd.

Implementation of a guideline for low back pain management in primary care: a cost-effectiveness analysis.

PubMed

Becker, Annette; Held, Heiko; Redaelli, Marcus; Chenot, Jean F; Leonhardt, Corinna; Keller, Stefan; Baum, Erika; Pfingsten, Michael; Hildebrandt, Jan; Basler, Heinz-Dieter; Kochen, Michael M; Donner-Banzhoff, Norbert; Strauch, Konstantin

2012-04-15

Cost-effectiveness analysis alongside a cluster randomized controlled trial. To study the cost-effectiveness of 2 low back pain guideline implementation (GI) strategies. Several evidence-based guidelines on management of low back pain have been published. However, there is still no consensus on the effective implementation strategy. Especially studies on the economic impact of different implementation strategies are lacking. This analysis was performed alongside a cluster randomized controlled trial on the effectiveness of 2 GI strategies (physician education alone [GI] or physician education in combination with motivational counseling [MC] by practice nurses)--both compared with the postal dissemination of the guideline (control group, C). Sociodemographic data, pain characteristics, and cost data were collected by interview at baseline and after 6 and 12 months. low back pain-related health care costs were valued for 2004 from the societal perspective. For the cost analysis, 1322 patients from 126 general practices were included. Both interventions showed lower direct and indirect costs as well as better patient outcomes during follow-up compared with controls. In addition, both intervention arms showed superiority of cost-effectiveness to C. The effects attenuated when adjusting for differences of health care utilization prior to patient recruitment and for clustering of data. Trends in cost-effectiveness are visible but need to be confirmed in future studies. Researchers performing cost-evaluation studies should test for baseline imbalances of health care utilization data instead of judging on the randomization success by reviewing non-cost parameters like clinical data alone.

Flight crew fatigue management in a more flexible regulatory environment: an overview of the New Zealand aviation industry.

PubMed

Signal, T Leigh; Ratieta, Denise; Gander, Philippa H

2008-04-01

Since 1995, air transport operators in New Zealand have been able to meet the flight and duty time (FDT) regulations by operating according to prescriptive FDT limits or by seeking approval to operate under a potentially more flexible company-specific FDT scheme. There has been no formal assessment of the impact of this increased flexibility on fatigue management processes. The aim of the present study was to determine the strategies and processes that commercial aircraft operators in New Zealand have in place for managing fatigue and whether these differed according to the type of FDT system under which organizations were operating. All air transport operators in New Zealand were sent questionnaires that were to be completed by an individual in a management role, a line pilot, and an individual in a rostering role. Questions were asked about the FDT system under which the organization operated, the strategies and processes in place for managing fatigue, and the consequences of the organization's approach to managing fatigue. One hundred and fifty-three responses were received from 88 organizations (55% of all air operators) and were representative of the structure of the New Zealand industry. Air operators were most likely to report that they monitored flight and duty times and pilot workload to manage fatigue (used by 90-99% and 70-90%, respectively), while educating rostering staff and reviewing the processes for managing fatigue were the least utilized strategies (used by 36-50% and 39-60%, respectively). Within the same organization, managers were more likely than line pilots to report the use of specific fatigue management strategies. There were no differences found between organizations operating under prescriptive regulations and those using a company-specific scheme on ratings of how well fatigue was managed, the number of fatigue management strategies employed, or the frequency of use of selected strategies. Across the industry as a whole, the provision of more flexible regulatory options has not greatly changed fatigue management practices, although some operators have implemented innovative strategies. The findings suggest a need to raise the level of knowledge within the industry regarding the causes and consequences of fatigue and of processes for its management. This is further supported by the discrepancies between the responses of line pilots and managers, which raise doubts about the effectiveness of some strategies nominally being employed. The regulator and other relevant industry groups should consider how to move the industry toward a mature safety culture and solid knowledge base because these are fundamental to more flexible fatigue management regimes, as is adequate regulatory knowledge, support, and oversight.

Perioperative management of a child with glutaric aciduria type I undergoing cardiac surgery.

PubMed

Kölker, Stefan; Eichhorn, Joachim; Sebening, Christian; Klein, Berthold; Springer, Wolfgang; Bopp, Christian; Rauch, Helmut

2013-10-01

Patients with glutaric aciduria type I are at risk for acute striatal injury precipitated by catabolic stress. Here, we report the successful interdisciplinary anesthetic and perioperative management of a child with glutaric aciduria type I undergoing cardiac surgery with extracorporeal circulation. Given the central focus on prevention of acute striatal injury, our anesthetic strategy emphasized avoiding a high protein load, high-dose inotropics, especially epinephrine (associated with impaired glucose utilization), deliberate hyperventilation, and other interventions associated with systemic inflammatory response.

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

NASA Astrophysics Data System (ADS)

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

2016-09-01

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

Management of priapism with a trial of exercise in the emergency department.

PubMed

Gravel, Jonathan; LeBlanc, Constance; Varner, Catherine

2018-03-16

Priapism is characterized by persistent penile erection in the absence of sexual arousal or desire that does not subside with orgasm. Although relatively uncommon, it is a genitourinary emergency that necessities prompt work-up and appropriate management, as there is a time-dependent relationship between total duration of erection and an increasing risk of permanent erectile dysfunction. Confirming the type of priapism is key to proper management, but the majority of cases presenting to the emergency department are ischemic in nature. Conservative management strategies for ischemic priapism are sparsely described in the literature but generally include ice pack application to the area, cold showers, masturbation and rarely, exercise. These strategies lack sound evidence, but the risks of attempting them are minimal as long as access to more definitive treatment is not delayed. Lower-limb exercise as a first-line treatment warrants further study in the undifferentiated emergency department priapism population. The case we present and discuss here illustrates the potential benefits of a trial of acute lower-limb exercise, specifically stair climbing, as a treatment for medication-induced priapism. If effective, this simple non-invasive management strategy may decrease the time to effective treatment, requires minimal resource utilization, and ultimately, avoids the need for more invasive treatment.

[Should disease management be feared? (1): hospital care].

PubMed

Gaspoz, J M; Rutschmann, O

2005-11-23

The goals of disease management are: (1) an integrated health care delivery system; (2) knowledge-based care; (3) elaborate information systems; (4) continuous quality improvement. In-hospital disease management and, more specifically, critical pathways, establish standardized care plans, set goals and time actions to reach these goals. They can reduce variations in practice patterns and resource utilization without compromising quality of care. Such strategies participate to quality improvement programs in hospitals when they involve and empower all actors of a given process of care, are not imposed from outside, and use sound and rigorous development and evaluation methods.

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

Research on a power management system for thermoelectric generators to drive wireless sensors on a spindle unit.

PubMed

Li, Sheng; Yao, Xinhua; Fu, Jianzhong

2014-07-16

Thermoelectric energy harvesting is emerging as a promising alternative energy source to drive wireless sensors in mechanical systems. Typically, the waste heat from spindle units in machine tools creates potential for thermoelectric generation. However, the problem of low and fluctuant ambient temperature differences in spindle units limits the application of thermoelectric generation to drive a wireless sensor. This study is devoted to presenting a transformer-based power management system and its associated control strategy to make the wireless sensor work stably at different speeds of the spindle. The charging/discharging time of capacitors is optimized through this energy-harvesting strategy. A rotating spindle platform is set up to test the performance of the power management system at different speeds. The experimental results show that a longer sampling cycle time will increase the stability of the wireless sensor. The experiments also prove that utilizing the optimal time can make the power management system work more effectively compared with other systems using the same sample cycle.

Consensus oriented fuzzified decision support for oil spill contingency management.

PubMed

Liu, Xin; Wirtz, Kai W

2006-06-30

Studies on multi-group multi-criteria decision-making problems for oil spill contingency management are in their infancy. This paper presents a second-order fuzzy comprehensive evaluation (FCE) model to resolve decision-making problems in the area of contingency management after environmental disasters such as oil spills. To assess the performance of different oil combat strategies, second-order FCE allows for the utilization of lexical information, the consideration of ecological and socio-economic criteria and the involvement of a variety of stakeholders. On the other hand, the new approach can be validated by using internal and external checks, which refer to sensitivity tests regarding its internal setups and comparisons with other methods, respectively. Through a case study, the Pallas oil spill in the German Bight in 1998, it is demonstrated that this approach can help decision makers who search for an optimal strategy in multi-thread contingency problems and has a wider application potential in the field of integrated coastal zone management.

The Functional Architecture of the Brain Underlies Strategic Deception in Impression Management

PubMed Central

Luo, Qiang; Ma, Yina; Bhatt, Meghana A.; Montague, P. Read; Feng, Jianfeng

2017-01-01

Impression management, as one of the most essential skills of social function, impacts one's survival and success in human societies. However, the neural architecture underpinning this social skill remains poorly understood. By employing a two-person bargaining game, we exposed three strategies involving distinct cognitive processes for social impression management with different levels of strategic deception. We utilized a novel adaptation of Granger causality accounting for signal-dependent noise (SDN), which captured the directional connectivity underlying the impression management during the bargaining game. We found that the sophisticated strategists engaged stronger directional connectivity from both dorsal anterior cingulate cortex and retrosplenial cortex to rostral prefrontal cortex, and the strengths of these directional influences were associated with higher level of deception during the game. Using the directional connectivity as a neural signature, we identified the strategic deception with 80% accuracy by a machine-learning classifier. These results suggest that different social strategies are supported by distinct patterns of directional connectivity among key brain regions for social cognition. PMID:29163095

The Functional Architecture of the Brain Underlies Strategic Deception in Impression Management.

PubMed

Luo, Qiang; Ma, Yina; Bhatt, Meghana A; Montague, P Read; Feng, Jianfeng

2017-01-01

Impression management, as one of the most essential skills of social function, impacts one's survival and success in human societies. However, the neural architecture underpinning this social skill remains poorly understood. By employing a two-person bargaining game, we exposed three strategies involving distinct cognitive processes for social impression management with different levels of strategic deception. We utilized a novel adaptation of Granger causality accounting for signal-dependent noise (SDN), which captured the directional connectivity underlying the impression management during the bargaining game. We found that the sophisticated strategists engaged stronger directional connectivity from both dorsal anterior cingulate cortex and retrosplenial cortex to rostral prefrontal cortex, and the strengths of these directional influences were associated with higher level of deception during the game. Using the directional connectivity as a neural signature, we identified the strategic deception with 80% accuracy by a machine-learning classifier. These results suggest that different social strategies are supported by distinct patterns of directional connectivity among key brain regions for social cognition.

Research on a Power Management System for Thermoelectric Generators to Drive Wireless Sensors on a Spindle Unit

PubMed Central

Li, Sheng; Yao, Xinhua; Fu, Jianzhong

2014-01-01

Thermoelectric energy harvesting is emerging as a promising alternative energy source to drive wireless sensors in mechanical systems. Typically, the waste heat from spindle units in machine tools creates potential for thermoelectric generation. However, the problem of low and fluctuant ambient temperature differences in spindle units limits the application of thermoelectric generation to drive a wireless sensor. This study is devoted to presenting a transformer-based power management system and its associated control strategy to make the wireless sensor work stably at different speeds of the spindle. The charging/discharging time of capacitors is optimized through this energy-harvesting strategy. A rotating spindle platform is set up to test the performance of the power management system at different speeds. The experimental results show that a longer sampling cycle time will increase the stability of the wireless sensor. The experiments also prove that utilizing the optimal time can make the power management system work more effectively compared with other systems using the same sample cycle. PMID:25033189

Managing Space Situational Awareness Using the Space Surveillance Network

DTIC Science & Technology

2013-11-14

This  report examines  the  use   of  utility metrics  from  two  forms  of  expected  information  gain for each object‐sensor pair as well as the...examines the use of utility metrics from two forms of expected information gain for each object-sensor pair as well as the approximated stability of the...estimation errors in order to work towards a tasking strategy. The information theoretic approaches use the calculation of Fisher information gain

Possibilities of Utilizing the Method of Analytical Hierarchy Process Within the Strategy of Corporate Social Business

NASA Astrophysics Data System (ADS)

Drieniková, Katarína; Hrdinová, Gabriela; Naňo, Tomáš; Sakál, Peter

2010-01-01

The paper deals with the analysis of the theory of corporate social responsibility, risk management and the exact method of analytic hierarchic process that is used in the decision-making processes. The Chapters 2 and 3 focus on presentation of the experience with the application of the method in formulating the stakeholders' strategic goals within the Corporate Social Responsibility (CSR) and simultaneously its utilization in minimizing the environmental risks. The major benefit of this paper is the application of Analytical Hierarchy Process (AHP).

Adapting natural resource management to climate change: The South Central Oregon and Northern Rockies Adaptation Partnerships

NASA Astrophysics Data System (ADS)

Halofsky, J.; Peterson, D. L.

2015-12-01

Concrete ways to adapt to climate change are needed to help natural resource managers take the first steps to incorporate climate change into management and take advantage of opportunities to balance the negative effects of climate change. We recently initiated two science-management climate change adaptation partnerships, one with three national forests and one national park in south central Oregon, and the other with 16 national forests, three national parks and other stakeholders in the northern Rockies region. Goals of both partnerships were to: (1) synthesize published information and data to assess the exposure, sensitivity, and adaptive capacity of key resource areas, including water use, infrastructure, fisheries, and vegetation and disturbance; (2) develop science-based adaptation strategies and tactics that will help to mitigate the negative effects of climate change and assist the transition of biological systems and management to a warmer climate; (3) ensure adaptation strategies and tactics are incorporated into relevant planning documents; and (4) foster an enduring partnership to facilitate ongoing dialogue and activities related to climate change in the partnerships regions. After an initial vulnerability assessment by agency and university scientists and local resource specialists, adaptation strategies and tactics were developed in a series of scientist-manager workshops. The final vulnerability assessments and adaptation actions are incorporated in technical reports. The partnerships produced concrete adaptation options for national forest and other natural resource managers and illustrated the utility of place-based vulnerability assessments and scientist-manager workshops in adapting to climate change.

Discrete event simulation for exploring strategies: an urban water management case.

PubMed

Huang, Dong-Bin; Scholz, Roland W; Gujer, Willi; Chitwood, Derek E; Loukopoulos, Peter; Schertenleib, Roland; Siegrist, Hansruedi

2007-02-01

This paper presents a model structure aimed at offering an overview of the various elements of a strategy and exploring their multidimensional effects through time in an efficient way. It treats a strategy as a set of discrete events planned to achieve a certain strategic goal and develops a new form of causal networks as an interfacing component between decision makers and environment models, e.g., life cycle inventory and material flow models. The causal network receives a strategic plan as input in a discrete manner and then outputs the updated parameter sets to the subsequent environmental models. Accordingly, the potential dynamic evolution of environmental systems caused by various strategies can be stepwise simulated. It enables a way to incorporate discontinuous change in models for environmental strategy analysis, and enhances the interpretability and extendibility of a complex model by its cellular constructs. It is exemplified using an urban water management case in Kunming, a major city in Southwest China. By utilizing the presented method, the case study modeled the cross-scale interdependencies of the urban drainage system and regional water balance systems, and evaluated the effectiveness of various strategies for improving the situation of Dianchi Lake.

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.

Managing motherhood: strategies used by new mothers to maintain perceptions of wellness.

PubMed

Currie, Janet

2009-07-01

The first year or so of motherhood can represent a transitional lifestyle change; however, experiences are not well understood from the mother's own perspective. In a series of interviews, nine mothers related their beliefs and ideas about strategies utilized to maintain a perceived sense of wellness. The mothers used three main strategies: (a) obtaining help, (b) having a plan, and (c) taking time-out. Discovery of a successful strategy lead to a mother feeling greater confidence in the efficacy of her selected method, calmer, and in greater control. In order to achieve a true sense of increasing control over her own health, however, it is recommended a mother prioritize strategies to meet her own personal needs in addition to meeting the needs of others.

Capital Strategy in Diversification Farming Efforts Using SWOT Analysis

NASA Astrophysics Data System (ADS)

Damanhuri; Setyohadi, D. P. S.; Utami, M. M. D.; Kurnianto, M. F.; Hariono, B.

2018-01-01

Wetland farm diversification program in the district of Bojonegoro, Tulungagung, and Ponorogo can not provide an optimal contribution to the income of farmers caused because farmers are not able to cultivate high value-added commodities due to limited capital. This study aims to identify the characteristics of farming, capital pattern, stakeholder role, to analyze farming to know the pattern of planting suggestions and prospects, and to formulate capital facilitation strategy. Farming capital is obtained through loans in financial institutions with different patterns. Small farmers tend to utilize savings and credit cooperatives, microcredit, and loan sharks, while farmers with large wetland holdings tend to utilize commercial banks. P enelitian using descriptive method of farming profit analysis, and SWOT. The government through the banking institutions have provided much facilitation in the form of low-interest loans with flexible payment method. The generic strategy of selected capital facilitation is to empower farmers through farmer groups who have the capability in managing the capital needs of their members.

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

Water loss control using pressure management: life-cycle energy and air emission effects.

PubMed

Stokes, Jennifer R; Horvath, Arpad; Sturm, Reinhard

2013-10-01

Pressure management is one cost-effective and efficient strategy for controlling water distribution losses. This paper evaluates the life-cycle energy use and emissions for pressure management zones in Philadelphia, Pennsylvania, and Halifax, Nova Scotia. It compares water savings using fixed-outlet and flow-modulated pressure control to performance without pressure control, considering the embedded electricity and chemical consumption in the lost water, manufacture of pipe and fittings to repair breaks caused by excess pressure, and pressure management. The resulting energy and emissions savings are significant. The Philadelphia and Halifax utilities both avoid approximately 130 million liters in water losses annually using flow-modulated pressure management. The conserved energy was 780 GJ and 1900 GJ while avoided greenhouse gas emissions were 50 Mg and 170 Mg a year by Philadelphia and Halifax, respectively. The life-cycle financial and environmental performance of pressure management systems compares favorably to the traditional demand management strategy of installing low-flow toilets. The energy savings may also translate to cost-effective greenhouse gas emission reductions depending on the energy mix used, an important advantage in areas where water and energy are constrained and/or expensive and greenhouse gas emissions are regulated as in California, for example.

Out of control little-used clinical assets are draining healthcare budgets.

PubMed

Horblyuk, Ruslan; Kaneta, Kristopher; McMillen, Gary L; Mullins, Christopher; O'Brien, Thomas M; Roy, Ankita

2012-07-01

To improve utilization and reduce the cost of maintaining mobile clinical equipment, healthcare organization leaders should do the following: Select an initial asset group to target. Conduct a physical inventory. Evaluate the organization's asset "ecosystem." Optimize workflow processes. Phase in new processes, and phase out inventory. Devote time to change management. Develop a replacement strategy.

Gold-Diggers, Supporters and Inclusive Profilers: Strategies for Profiling Research in Swedish Higher Education

ERIC Educational Resources Information Center

Silander, Charlotte; Haake, Ulrika

2017-01-01

Widespread reforms of governance and funding of universities has taken place in most Western countries, many of them influenced by New Public Management (NPM), which includes intensified attempts by the government to steer academic research in a utility direction. One way to do this is through university profiles and priorities of research. This…

Reduction of Fusarium head blight using prothioconazole and prothioconazole-tolerant variants of the Fusarium head blight antagonist Cryptococcus flavescens OH 182.9

USDA-ARS?s Scientific Manuscript database

Integrated disease management strategies utilize a range of measures to prevent or reduce plant diseases. Combining the biological control agent Cryptococcus flavescens OH 182.9 (NRRL Y-30216) with a triazole fungicide such as prothioconazole has potential for significantly contributing to the redu...

Formal Leadership of Department Chairpersons with a Broadening Span of Control in Restructured Community Colleges: A Multi-Case Study

ERIC Educational Resources Information Center

Fattig, Teri L.

2013-01-01

Community college department chairpersons have experienced a broadening span of control due to the restructuring tactics of community colleges and the approaches utilized in order to cope with decreased budgets and increased enrollments. Many community colleges used strategies which involved flattening the middle management section of the…

Coping Strategies of Part-Time MBA Students: The Role of Boundary Management

ERIC Educational Resources Information Center

Dunagan, Marion

2012-01-01

Using the framework of boundary theory as applied to the work-life-school construct, the study focused on part-time MBA students who worked full-time, their tendency to segment or integrate their numerous roles, and the coping tactics they utilized in redistributing their efforts as they added graduate school to these roles. The research…

Teaching Social Skills to Enhance Work Performance in a Child Care Setting

ERIC Educational Resources Information Center

Gear, Sabra; Bobzien, Jonna; Judge, Sharon; Raver, Sharon A.

2011-01-01

Adults with intellectual disabilities face difficulty seeking employment in the community workforce. Using a single-subject design, this study examined the utility of role playing and self-management strategies to enhance work performance by promoting the social skills of a young woman with Down syndrome working in a community child care setting.…

Prevention Strategies Against HIV Transmission: A Proactive Approach.

PubMed

Carrion, Antonio J; Miles, Jovan D; Mosley, Juan F; Smith, Lillian L; Prather, April S; Gurley, Marcus M; Phan, Linh D; Everton, Emily C

2018-02-01

Human immunodeficiency virus (HIV) has now transformed into a manageable chronic condition. Highly active antiretroviral therapy (HAART) has proven efficacious at controlling the disease progression. Based on compelling evidence, the Department of Health and Human Services (DHHS) and the Infectious Disease Society of America (IDSA) developed guidelines for the management of persons infected with HIV. However, there are approximately 50 000 new cases of HIV in the United States each year. In this article, we review proactive methods to reduce the transmission of HIV, which include reinforcing patient education, gel-coated condoms that destroy HIV, HIV vaccinations, and adequately utilizing pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). Further development and consistent utilization of innovative prevention tools can significantly reduce the incidence of HIV infections regardless of HIV status.

The management of new primary care organizations: an international perspective.

PubMed

Meads, Geoffrey; Wild, Andrea; Griffiths, Frances; Iwami, Michiyo; Moore, Phillipa

2006-08-01

Management practice arising from parallel policies for modernizing health systems is examined across a purposive sample of 16 countries. In each, novel organizational developments in primary care are a defining feature of the proposed future direction. Semistructured interviews with national leaders in primary care policy development and local service implementation indicate that management strategies, which effectively address the organized resistance of medical professions to modernizing policies, have these four consistent characteristics: extended community and patient participation models; national frameworks for interprofessional education and representation; mechanisms for multiple funding and accountabilities; and the diversification of non-governmental organizations and their roles. The research, based on a two-year fieldwork programme, indicates that at the meso-level of management planning and practice, there is a considerable potential for exchange and transferable learning between previously unconnected countries. The effectiveness of management strategies abroad, for example, in contexts where for the first time alternative but comparable new primary care organizations are exercising responsibilities for local resource utilization, may be understood through the application of stakeholder analyses, such as those employed to promote parity of relationships in NHS primary care trusts.

Self-management improvement program combined with community involvement in Thai hypertensive population: an action research.

PubMed

Srichairattanakull, Jeamjai; Kaewpan, Wonpen; Powattana, Arpaporn; Pichayapinyo, Panan

2014-04-01

To investigate the effectiveness of a program that utilizes community involvement to improve the self-management strategies among people living with hypertension. Forty-four subjects, aged 35 to 59-year-old, with hypertension in Nakhon Pathom Province, Thailand, were randomly allocated to either an experimental group (n = 22) or a control group (n = 20). The experimental group attended a program to improve self-management methods based on social cognitive theory (SCT). The program lasted 12 weeks, consisted of 1 1/2 hours meeting once a week, including group meetings and home visit monitoring. Mann-Whitney U test and Friedman test were employed to analyze the program's effectiveness. After the program, the mean rank of the perceived self-efficacy for the self-management strategies was statistically different between the two groups (p = 0.023). In the experimental group, after the twelve week, the mean rank of perceived self-efficacy and outcome expectancy increased and diastolic blood pressure decreased after the eight week. The program applied social cognitive theory (SCT) to promote self-management techniques, increased the health promoting behavior among hypertensive people.

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

PubMed

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

2010-08-01

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

Strategies to reduce blood product utilization in obstetric practice.

PubMed

Neb, Holger; Zacharowski, Kai; Meybohm, Patrick

2017-06-01

Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice. PBM-related evidence-based benefits should be urgently adopted in the field of obstetric medicine. Intravenous iron can be considered a safe, effective strategy to replenish iron stores and to correct both pregnancy-related and hemorrhage-related iron deficiency anemia. In addition to surgical techniques and the use of uterotonics, recent findings support early administration of tranexamic acid, fibrinogen and a coagulation factor concentrate-based, viscoelastically guided practice in case of peripartum hemorrhage to manage coagulopathy. In patients with cesarean section, autologous red cell blood salvage may reduce blood product utilization, although its use in this setting is controversial. Implementation of PBM in obstetric practice offers large potential to reduce blood loss and transfusion requirements of allogeneic blood products, even though large clinical trials are lacking in this specific field. Intravenous iron supplementation may be suggested to increase peripartum hemoglobin levels. Additionally, tranexamic acid and point-of-care-guided supplementation of coagulation factors are potent methods to reduce unnecessary blood loss and blood transfusions in obstetrics.

From A to Z: Medication Cost-Management Strategies for Disproportionate Share Hospitals

PubMed Central

Henry, Andrea; Erowele, Goldina Ikezuagu; Ndefo, Uche Anadu; Milton-Brown, Jackie; Anassi, Enock; Green, Wendy; Alvidrez, Adriana; Okpara, Alphonsus U.

2011-01-01

Background Harris County Hospital District, Houston, TX, is a publicly funded hospital system that provides care to residents of Harris County with a need-based payment system. The Harris County Hospital District pharmacy department, with a drug budget of more than $75 million in fiscal year 2010, utilizes a closed formulary system that is managed by the Formulary Management and Pharmacoeconomics Service, along with the medical staff. This service is comprised of clinical pharmacists whose goal is to provide a comprehensive, safe, and cost-effective formulary. Objective To describe the unique formulary management process at a county hospital system and what makes this process cost-effective, which may benefit pharmacy departments in institutions serving an indigent patient population. Summary The Harris County Hospital District drug formulary is overseen by the Pharmacy & Therapeutics committee, which is supported by 5 therapeutic subcommittees, including antimicrobials, cardiovascular, general formulary, central nervous system, and oncology. The Pharmacy & Therapeutics Committee consists of a medical staff committee that is supported by clinical pharmacists, who serve as the facilitators of these 5 subcommittees. Their responsibilities include the provision of drug information for formulary decisions, providing parameters to govern the use of certain medications, communicating changes to the formulary, conducting class reviews and medication utilization evaluations, coordinating annual pharmaceutical bids, reviewing and writing medication use policies and procedures, facilitating the use of cost-effective medications, and monitoring the use of medications in the hospital system. Conclusion The processes incorporated by Harris County Hospital District in its formulary management are cost-effective and may be beneficial to other pharmacy departments, especially those institutions that serve an indigent patient population and are interested in cost-effective management strategies. PMID:25126349

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

PubMed

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

2009-05-01

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

Frequent consulting and multiple morbidity: a qualitative comparison of ‘high’ and ‘low’ consulters of GPs

PubMed Central

Wyke, Sally; Hunt, Kate

2008-01-01

Background. Frequent consulting is associated with multiple and complex social and health conditions. It is not known how the impact of multiple conditions, the ability to self-manage and patient perception of the GP consultation combines to influence consulting frequency. Objective. To investigate reasons for frequent consultation among people with multiple morbidity but contrasting consulting rates. Methods. Qualitative study with in-depth interviews in the west of Scotland. Participants were 23 men and women aged about 50 years with four or more chronic illnesses; 11 reported consulting seven or more times in the last year [the frequent consulters (FCs)] and 12, three or fewer times [the less frequent consulters (LFCs)]. The main outcome measures were the participants’ accounts of their symptoms, self-management strategies and reasons for consulting a GP. Results. All participants used multiple self-management strategies. FCs described: more disruptive symptoms, which were resistant to self-management strategies; less access to fewer treatments and resources and more medical monitoring, for unstable conditions and drug regimens. The LFCs reported: less severe and more containable symptoms; accessing more efficacious self-management strategies and infrequent GP monitoring for stable conditions and routine drug regimens. All participants conveyed consulting as a ‘last resort’. However, the GP was seen as ‘ally’, for the FCs, and as ‘innocent bystander’, for the LFCs. Conclusions. This qualitative investigation into the combined significance of multiple morbidities and self-management on the GP consultation suggests that current models of self-management might have limited potential to reduce utilization rates among this vulnerable group. Severity of symptoms, stability of condition and complexity of drug regimens combine to influence the availability of effective resources and influence frequency of GP consultations. PMID:18448858

Building Alliances in Unlikely Places: Progressive Allies and the Tobacco Institute's Coalition Strategy on Cigarette Excise Taxes

PubMed Central

Balbach, Edith D.

2009-01-01

The tobacco industry often utilizes third parties to advance its policy agenda. One such utilization occurred when the industry identified organized labor and progressive groups as potential allies whose advocacy could undermine public support for excise tax increases. To attract such collaboration, the industry framed the issue as one of tax fairness, creating a labor management committee to provide distance from tobacco companies and furthering progressive allies' interests through financial and logistical support. Internal industry documents indicate that this strategic use of ideas, institutions, and interests facilitated the recruitment of leading progressive organizations as allies. By placing excise taxes within a strategic policy nexus that promotes mutual public interest goals, public health advocates may use a similar strategy in forging their own excise tax coalitions. PMID:19443832

Regional Approach for Managing for Resilience Linking Ecosystem Services and Livelihood Strategies for Agro-Pastoral Communities in the Mongolian Steppe Ecosystem

NASA Astrophysics Data System (ADS)

Ojima, D. S.; Togtohyn, C.; Qi, J.; Galvin, K.

2011-12-01

Dramatic changes due to climate and land use dynamics in the Mongolian Plateau are affecting ecosystem services and agro-pastoral livelihoods in Mongolia and China. Recently, evaluation of pastoral systems, where humans depend on livestock and grassland ecosystem services, have demonstrated the vulnerability of the social-ecological system to climate change. Current social-ecological changes in ecosystem services are affecting land productivity and carrying capacity, land-atmosphere interactions, water resources, and livelihood strategies. Regional dust events, changes in hydrological cycle, and land use changes contribute to changing interactions between ecosystem and landscape processes which then affect social-ecological systems. The general trend involves greater intensification of resource exploitation at the expense of traditional patterns of extensive range utilization. Thus we expect climate-land use-land cover relationships to be crucially modified by the socio-economic forces. The analysis incorporates information of the socio-economic transitions taking place in the region which affect land-use, food security, and ecosystem dynamics. The region of study extends from the Mongolian plateau in Mongolia and China to the fertile northeast China plain. Sustainability of agro-pastoral systems in the region needs to integrate the impact of climate change on ecosystem services with socio-economic changes shaping the livelihood strategies of pastoral systems in the region. Adaptation strategies which incorporate landscape management provides a potential framework to link ecosystem services across space and time more effectively to meet the needs of agro-pastoral land use, herd quality, and herder's living standards. Under appropriate adaptation strategies agro-pastoralists will have the opportunity to utilize seasonal resources and enhance their ability to process and manufacture products from the available ecosystem services in these dynamic social-ecological systems.

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

PubMed

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

2016-10-01

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

Strategies for ensuring global consistency/comparability of water-quality data

USGS Publications Warehouse

Klein, J.M.

1999-01-01

In the past 20 years the water quality of the United States has improved remarkably-the waters are safer for drinking, swimming, and fishing. However, despite many accomplishments, it is still difficult to answer such basic questions as: 'How clean is the water?' and 'How is it changing over time?' These same questions exist on a global scale as well. In order to focus water-data issues in the United States, a national Intergovernmental Task Force on Monitoring Water Quality (ITFM) was initiated for public and private organizations, whereby key elements involved in data collection, analysis, storage, and management could be made consistent and comparable. The ITFM recommended and its members are implementing a nationwide strategy to improve water-quality monitoring, assessment, and reporting activities. The intent of this paper is to suggest that a voluntary effort be initiated to ensure the comparability and utility of hydrological data on a global basis. Consistent, long-term data sets that are comparable are necessary in order to formulate ideas regarding regional and global trends in water quantity and quality. The author recommends that a voluntary effort similar to the ITFM effort be utilized. The strategy proposed would involve voluntary representation from countries and international organizations (e.g. World Health Organization) involved in drinking-water assessments and/or ambient water-quality monitoring. Voluntary partnerships such as this will improve curability to reduce health risks and achieve a better return on public and private investments in monitoring, environmental protection, and natural resource management, and result in a collaborative process that will save millions of dollars.In this work it is suggested that a voluntary effort be initiated to ensure the comparability and utility of hydrological data on a global basis. The strategy proposed would involve voluntary representation from countries and international organizations involved in drinking-water assessments and/or ambient water-quality monitoring.

Engineering for reliability in at-home chronic disease management

PubMed Central

Kendall, Logan; Eschler, Jordan; Lozano, Paula; McClure, Jennifer B.; Vizer, Lisa M.; Ralston, James D.; Pratt, Wanda

2014-01-01

Individuals with chronic conditions face challenges with maintaining lifelong adherence to self-management activities. Although reminders can help support the cognitive demands of managing daily and future health tasks, we understand little of how they fit into people’s daily lives. Utilizing a maximum variation sampling method, we interviewed and compared the experiences of 20 older adults with diabetes and 19 mothers of children with asthma to understand reminder use for at-home chronic disease management. Based on our participants’ experiences, we contend that many self-management failures should be viewed as systems failures, rather than individual failures and non-compliance. Furthermore, we identify key principles from reliability engineering that both explain current behavior and suggest strategies to improve patient reminder systems. PMID:25954384

Engineering for reliability in at-home chronic disease management.

PubMed

Kendall, Logan; Eschler, Jordan; Lozano, Paula; McClure, Jennifer B; Vizer, Lisa M; Ralston, James D; Pratt, Wanda

2014-01-01

Individuals with chronic conditions face challenges with maintaining lifelong adherence to self-management activities. Although reminders can help support the cognitive demands of managing daily and future health tasks, we understand little of how they fit into people's daily lives. Utilizing a maximum variation sampling method, we interviewed and compared the experiences of 20 older adults with diabetes and 19 mothers of children with asthma to understand reminder use for at-home chronic disease management. Based on our participants' experiences, we contend that many self-management failures should be viewed as systems failures, rather than individual failures and non-compliance. Furthermore, we identify key principles from reliability engineering that both explain current behavior and suggest strategies to improve patient reminder systems.

Regional Approach for Linking Ecosystem Services and Livelihood Strategies Under Climate Change of Pastoral Communities in the Mongolian Steppe Ecosystem

NASA Astrophysics Data System (ADS)

Ojima, D. S.; Galvin, K.; Togtohyn, C.

2012-12-01

Dramatic changes due to climate and land use dynamics in the Mongolian Plateau affecting ecosystem services and agro-pastoral systems in Mongolia. Recently, market forces and development strategies are affecting land and water resources of the pastoral communities which are being further stressed due to climatic changes. Evaluation of pastoral systems, where humans depend on livestock and grassland ecosystem services, have demonstrated the vulnerability of the social-ecological system to climate change. Current social-ecological changes in ecosystem services are affecting land productivity and carrying capacity, land-atmosphere interactions, water resources, and livelihood strategies. The general trend involves greater intensification of resource exploitation at the expense of traditional patterns of extensive range utilization. Thus we expect climate-land use-land cover relationships to be crucially modified by the social-economic forces. The analysis incorporates information about the social-economic transitions taking place in the region which affect land-use, food security, and ecosystem dynamics. The region of study extends from the Mongolian plateau in Mongolia. Our research indicate that sustainability of pastoral systems in the region needs to integrate the impact of climate change on ecosystem services with socio-economic changes shaping the livelihood strategies of pastoral systems in the region. Adaptation strategies which incorporate integrated analysis of landscape management and livelihood strategies provides a framework which links ecosystem services to critical resource assets. Analysis of the available livelihood assets provides insights to the adaptive capacity of various agents in a region or in a community. Sustainable development pathways which enable the development of these adaptive capacity elements will lead to more effective adaptive management strategies for pastoral land use and herder's living standards. Pastoralists will have the opportunity to utilize seasonal resources and enhance their ability to process and manufacture products from the available ecosystem services in these dynamic social-ecological systems.

Does lean muddy the quality improvement waters? A qualitative study of how a hospital management team understands lean in the context of quality improvement.

PubMed

Savage, Carl; Parke, Louise; von Knorring, Mia; Mazzocato, Pamela

2016-10-19

Health care has experimented with many different quality improvement (QI) approaches with greater variation in name than content. This has been dubbed pseudoinnovation. However, it could also be that the subtleties and differences are not clearly understood. To explore this further, the purpose of this study was to explore how hospital managers perceive lean in the context of QI. We used a qualitative study design with semi-structured interviews to explore twelve top managers' perceptions of the relationship between lean and quality improvement (QI) at a university-affiliated hospital. Managers described that QI and lean shared the same overall purpose: focus on patient needs and improve efficiency and effectiveness. Employee involvement was emphasized in both strategies, as well as the support offered by managers of staff initiatives. QI was perceived as a strategy that could support structural changes at the organizational level whereas lean was seen as applicable at the operational level. Moreover, lean carried a negative connotation, lacked the credibility of QI, and was perceived as a management fad. Aspects of QI and lean were misunderstood. In a context where lean remains an abstract term, and staff associate lean with automotive applications and cost reduction, it may be fruitful for managers to invest time and resources to develop a strategy for continual improvement and utilize vocabulary that resonates with health care staff. This could reduce the risk that improvement efforts are rejected out of hand.

How do informal self-care strategies evolve among patients with chronic obstructive pulmonary disease managed in primary care? A qualitative study.

PubMed

Apps, Lindsay D; Harrison, Samantha L; Williams, Johanna E A; Hudson, Nicky; Steiner, Michael; Morgan, Mike D; Singh, Sally J

2014-01-01

There is much description in the literature of how patients with chronic obstructive pulmonary disease (COPD) manage their breathlessness and engage in self-care activities; however, little of this is from the perspective of those with less severe disease, who are primarily managed in primary care. This study aimed to understand the self-care experiences of patients with COPD who are primarily managed in primary care, and to examine the challenges of engaging in such behaviors. Semistructured interviews were carried out with 15 patients with COPD as part of a larger project evaluating a self-management intervention. Thematic analysis was supported by NVivo software (version 8, QSR International, Melbourne, Australia). Three main themes are described, ie, experiencing and understanding symptoms of COPD, current self-care activities, and the importance of family perceptions in managing COPD. Self-care activities evolved spontaneously as participants experienced symptoms of COPD. However, there was a lack of awareness about whether these strategies would impact upon symptoms. Perceptions of COPD by family members posed a challenge to self-care for some participants. Health care professionals should elicit patients' prior disease experiences and utilize spontaneous attempts at disease management in future self-management. These findings have implications for promoting self-management and enhancing quality of life.

Optimizing delivery of recovery-oriented online self-management strategies for bipolar disorder: a review.

PubMed

Leitan, Nuwan D; Michalak, Erin E; Berk, Lesley; Berk, Michael; Murray, Greg

2015-03-01

Self-management is emerging as a viable alternative to difficult-to-access psychosocial treatments for bipolar disorder (BD), and has particular relevance to recovery-related goals around empowerment and personal meaning. This review examines data and theory on BD self-management from a recovery-oriented perspective, with a particular focus on optimizing low-intensity delivery of self-management tools via the web. A critical evaluation of various literatures was undertaken. Literatures on recovery, online platforms, and self-management in mental health and BD are reviewed. The literature suggests that the self-management approach aligns with the recovery framework. However, studies have identified a number of potential barriers to the utilization of self-management programs for BD and it has been suggested that utilizing an online environment may be an effective way to surmount many of these barriers. Online self-management programs for BD are rapidly developing, and in parallel the recovery perspective is becoming the dominant paradigm for mental health services worldwide, so research is urgently required to assess the efficacy and safety of optimization methods such as professional and/or peer support, tailoring and the development of 'online communities'. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Laboratory Testing of Demand-Response Enabled Household Appliances

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

Sparn, B.; Jin, X.; Earle, L.

2013-10-01

With the advent of the Advanced Metering Infrastructure (AMI) systems capable of two-way communications between the utility's grid and the building, there has been significant effort in the Automated Home Energy Management (AHEM) industry to develop capabilities that allow residential building systems to respond to utility demand events by temporarily reducing their electricity usage. Major appliance manufacturers are following suit by developing Home Area Network (HAN)-tied appliance suites that can take signals from the home's 'smart meter,' a.k.a. AMI meter, and adjust their run cycles accordingly. There are numerous strategies that can be employed by household appliances to respond tomore » demand-side management opportunities, and they could result in substantial reductions in electricity bills for the residents depending on the pricing structures used by the utilities to incent these types of responses.The first step to quantifying these end effects is to test these systems and their responses in simulated demand-response (DR) conditions while monitoring energy use and overall system performance.« less

Laboratory Testing of Demand-Response Enabled Household Appliances

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

Sparn, B.; Jin, X.; Earle, L.

2013-10-01

With the advent of the Advanced Metering Infrastructure (AMI) systems capable of two-way communications between the utility's grid and the building, there has been significant effort in the Automated Home Energy Management (AHEM) industry to develop capabilities that allow residential building systems to respond to utility demand events by temporarily reducing their electricity usage. Major appliance manufacturers are following suit by developing Home Area Network (HAN)-tied appliance suites that can take signals from the home's 'smart meter,' a.k.a. AMI meter, and adjust their run cycles accordingly. There are numerous strategies that can be employed by household appliances to respond tomore » demand-side management opportunities, and they could result in substantial reductions in electricity bills for the residents depending on the pricing structures used by the utilities to incent these types of responses. The first step to quantifying these end effects is to test these systems and their responses in simulated demand-response (DR) conditions while monitoring energy use and overall system performance.« less

Economic evaluation of empirical antisecretory therapy versus Helicobacter pylori test for management of dyspepsia: a randomized trial in primary care.

PubMed

Jarbol, Dorte Ejg; Bech, Mickael; Kragstrup, Jakob; Havelund, Troels; Schaffalitzky de Muckadell, Ove B

2006-01-01

An economic evaluation was performed of empirical antisecretory therapy versus test for Helicobacter pylori in the management of dyspepsia patients presenting in primary care. A randomized trial in 106 general practices in the County of Funen, Denmark, was designed to include prospective collection of clinical outcome measures and resource utilization data. Dyspepsia patients (n = 722) presenting in general practice with more than 2 weeks of epigastric pain or discomfort were managed according to one of three initial management strategies: (i) empirical antisecretory therapy, (ii) testing for Helicobacter pylori, or (iii) empirical antisecretory therapy, followed by Helicobacter pylori testing if symptoms improved. Cost-effectiveness and incremental cost-effectiveness ratios of the strategies were determined. The mean proportion of days without dyspeptic symptoms during the 1-year follow-up was 0.59 in the group treated with empirical antisecretory therapy, 0.57 in the H. pylori test-and-eradicate group, and 0.53 in the combination group. After 1 year, 23 percent, 26 percent, and 22 percent, respectively, were symptom-free. Applying the proportion of days without dyspeptic symptoms, the cost-effectiveness for empirical treatment, H. pylori test and the combination were 12,131 Danish kroner (DKK), 9,576 DKK, and 7,301 DKK, respectively. The incremental cost-effectiveness going from the combination strategy to empirical antisecretory treatment or H. pylori test alone was 54,783 DKK and 39,700 DKK per additional proportion of days without dyspeptic symptoms. Empirical antisecretory therapy confers a small insignificant benefit but costs more than strategies based on test for H. pylori and is probably not a cost-effective strategy for the management of dyspepsia in primary care.

Reducing ambulance response times using discrete event simulation.

PubMed

Wei Lam, Sean Shao; Zhang, Zhong Cheng; Oh, Hong Choon; Ng, Yih Ying; Wah, Win; Hock Ong, Marcus Eng

2014-01-01

The objectives of this study are to develop a discrete-event simulation (DES) model for the Singapore Emergency Medical Services (EMS), and to demonstrate the utility of this DES model for the evaluation of different policy alternatives to improve ambulance response times. A DES model was developed based on retrospective emergency call data over a continuous 6-month period in Singapore. The main outcome measure is the distribution of response times. The secondary outcome measure is ambulance utilization levels based on unit hour utilization (UHU) ratios. The DES model was used to evaluate different policy options in order to improve the response times, while maintaining reasonable fleet utilization. Three policy alternatives looking at the reallocation of ambulances, the addition of new ambulances, and alternative dispatch policies were evaluated. Modifications of dispatch policy combined with the reallocation of existing ambulances were able to achieve response time performance equivalent to that of adding 10 ambulances. The median (90th percentile) response time was 7.08 minutes (12.69 minutes). Overall, this combined strategy managed to narrow the gap between the ideal and existing response time distribution by 11-13%. Furthermore, the median UHU under this combined strategy was 0.324 with an interquartile range (IQR) of 0.047 versus a median utilization of 0.285 (IQR of 0.051) resulting from the introduction of additional ambulances. Response times were shown to be improved via a more effective reallocation of ambulances and dispatch policy. More importantly, the response time improvements were achieved without a reduction in the utilization levels and additional costs associated with the addition of ambulances. We demonstrated the effective use of DES as a versatile platform to model the dynamic system complexities of Singapore's national EMS systems for the evaluation of operational strategies to improve ambulance response times.

Interpersonal conflict strategies and their impact on positive symptom remission in persons aged 55 and older with schizophrenia spectrum disorders.

PubMed

Cohen, Carl I; Solanki, Dishal; Sodhi, Dimple

2013-01-01

Although interpersonal interactions are thought to affect psychopathology in schizophrenia, there is a paucity of data about how older adults with schizophrenia manage interpersonal conflicts. This paper examines interpersonal conflict strategies and their impact on positive symptom remission in older adults with schizophrenia spectrum disorders. The schizophrenia group consisted of 198 persons aged 55 years and over living in the community who developed schizophrenia before age 45. A community comparison group (n = 113) was recruited using randomly selected block-groups. Straus' Conflict Tactics Scale (CTS) was used to assess the ways that respondents handled interpersonal conflicts. Seven conflict management subscales were created based on a principal component analysis with equamax rotation of items from the CTS. The order of the frequency of the tactics that was used was similar for both the schizophrenia and community groups. Calm and Pray tactics were the most commonly used, and the Violent and Aggressive tactics were rarely utilized. In two separate logistic regression analysis, after controlling for confounding variables, positive symptom remission was found to be associated significantly with both the Calm and Pray subscales. The findings suggest that older persons with schizophrenia approximate normal distribution patterns of conflict management strategies and the most commonly used strategies are associated with positive symptom remission.

Livelihood analysis of floating net cages fish farmers at Sendang Village Sub-district of Gajah Mungkur Reservoir of Wonogiri Regency

NASA Astrophysics Data System (ADS)

Nissa, Z. N. A.; Suadi; Sukardi

2018-03-01

Floating net cages farming (KJA) is one of the main livelihood resources in Sendang Village, Gajah Mungkur Reservoir. The purposes of this study were to determine the livelihood asset of fish farmers, the problems of livelihood asset management and the utilization strategy to support aquaculture businesses also farmers livelihood. The study showed that the natural capital, provides easiest way to farmer in fish cultivation. The fish farmers also have good technical capabilities in fish cultivation and the product has high demand and value which is essential for farmers livelihood. The main problems faced by small-scale farmers and all large-scale farmers were transition period, and the rise of cost price which sometime cause the failure in the business. The strategies to deal the problems include technological adjustment, managing the pattern of stocking of tilapia seeds and income source diversification. There were differences in dealing the rise of cost. The small-scale farmers borrow from the bank, while medium-scale farmers use their savings. Another difference of livelihood strategy was the management of financial capital. However, various strategies were still required to increase the livelihood of fish farmers and could address the vulnerabilities in the cultivation of KJA as a common pool resources.

Adolescent asthma self-management: patient and parent-caregiver perspectives on using social media to improve care.

PubMed

Panzera, Anthony D; Schneider, Tali K; Martinasek, Mary P; Lindenberger, James H; Couluris, Marisa; Bryant, Carol A; McDermott, Robert J

2013-12-01

Self-management of asthma can now leverage new media technologies. To optimize implementation they must employ a consumer-oriented developmental approach. This study explored benefits of and barriers to improved asthma self-management and identified key elements for the development of a digital media tool to enhance asthma control. Between August 2010 and January 2011, 18 teens with asthma and 18 parent-caregivers participated in semistructured in-depth interviews to identify mechanisms for improving asthma self-management and propose characteristics for developing a digital media tool to aid such efforts. Teens and caregivers enumerated physician-recommended strategies for asthma management as well as currently employed strategies. Both groups thought of a potential digital media solution as positive, but indicated specific design requirements for such a solution to have utility. Whereas most participants perceived mobile platforms to be viable modes to improve asthma self-management, interest in having social networking capabilities was mixed. A digital media product capable of tracking conditions, triggers, and related asthma activities can be a core element of improved asthma control for youth. Improved asthma control will help decrease school absenteeism. © 2013, American School Health Association.

Cost-utility Analysis: Thiopurines Plus Endoscopy-guided Biological Step-up Therapy is the Optimal Management of Postoperative Crohn's Disease.

PubMed

Candia, Roberto; Naimark, David; Sander, Beate; Nguyen, Geoffrey C

2017-11-01

Postoperative recurrence of Crohn's disease is common. This study sought to assess whether the postoperative management should be based on biological therapy alone or combined with thiopurines and whether the therapy should be started immediately after surgery or guided by either endoscopic or clinical recurrence. A Markov model was developed to estimate expected health outcomes in quality-adjusted life years (QALYs) and costs in Canadian dollars (CAD$) accrued by hypothetical patients with high recurrence risk after ileocolic resection. Eight strategies of postoperative management were evaluated. A lifetime time horizon, an annual discount rate of 5%, a societal perspective, and a cost-effectiveness threshold of 50,000 CAD$/QALY were assumed. Deterministic and probabilistic sensitivity analyses were conducted. The model was validated against randomized trials and historical cohorts. Three strategies dominated the others: endoscopy-guided full step-up therapy (14.80 QALYs, CAD$ 462,180), thiopurines immediately post-surgery plus endoscopy-guided biological step-up therapy (14.89 QALYs, CAD$ 464,099) and combination therapy immediately post-surgery (14.94 QALYs, CAD$ 483,685). The second strategy was the most cost-effective, assuming a cost-effectiveness threshold of 50,000 CAD$/QALY. Probabilistic sensitivity analysis showed that the second strategy has the highest probability of being the optimal alternative in all comparisons at cost-effectiveness thresholds from 30,000 to 100,000 CAD$/QALY. The strategies guided only by clinical recurrence and those using biologics alone were dominated. According to this decision analysis, thiopurines immediately after surgery and addition of biologics guided by endoscopic recurrence is the optimal strategy of postoperative management in patients with Crohn's disease with high risk of recurrence (see Video Abstract, Supplemental Digital Content 1, http://links.lww.com/IBD/B654).

Incorporating the treat-to-target concept in rheumatoid arthritis.

PubMed

Ruderman, Eric M; Nola, Kamala M; Ferrell, Stanley; Sapir, Tamar; Cameron, Davecia R

2012-01-01

Recent publications have proposed revisions to disease classification criteria, new definitions of remission, and guidelines for implementing treat-to-target strategies for the management of patients with rheumatoid arthritis (RA). Despite developments leading to this practice-changing approach, the concept of treat to target has not yet been widely accepted or implemented in managed care. At the 24th Annual Meeting Expo of the Academy of Managed Care Pharmacy (AMCP), held in San Francisco on April 18, 2012, a 4-hour activity titled Incorporating New Treat-to-Target Guidance and Strategies in RA: What Managed Care Needs to Know was conducted in association with AMCP's Continuing Professional Education Partner Program. The practicum featured didactic presentations, a roundtable session, and an expert panel discussion detailing research evidence, ideas, and discussion topics central to the treat-to target concept in RA and its applications to managed care. To (a) discuss recent advances in RA management, (b) evaluate strategies to optimize the use of disease-modifying antirheumatic drugs(DMARDs), and (c) explain how to incorporate the treat-to-target paradigm in contemporary clinical practice and clinical care models in order to improve outcomes for patients. The past decade has seen a tremendous amount of change in the field of rheumatology. The early and aggressive treatment of RA, including the use of novel biologic agents, has been shown to have favorable patient outcomes in reducing synovial inflammation, delaying joint damage,and maintaining functional status, leading to the recently published revisions in classification criteria and updated recommendations for the utilization of conventional DMARDs and biologic agents in the treatment of RA. The revised classification criteria can be used to diagnose RA patients at an earlier point in the disease course by placing greater emphasis on clinical features that manifest early in the disease process. The concept of achieving tight control of RA and treating to target has been well established and utilizes early diagnosis, aggressive treatment, and regular monitoring,leading to positive outcomes in a significant number of patients with RA who achieve current treatment goals of low levels of disease activity or clinical remission.

Working Sandwich Generation Women Utilize Strategies within and between Roles to Achieve Role Balance.

PubMed

Evans, Kiah L; Millsteed, Jeannine; Richmond, Janet E; Falkmer, Marita; Falkmer, Torbjorn; Girdler, Sonya J

2016-01-01

Increasingly, women simultaneously balance the roles of mother, parental carer and worker. However, individual role balance strategies among these working 'sandwich' generation women have not been thoroughly explored. Eighteen women combining these three roles were interviewed about their individual role balance strategies. Findings were identified through the framework analysis technique, underpinned by the Model of Juggling Occupations. Achieving and maintaining role balance was explained as a complex process accomplished through a range of strategies. Findings revealed the women used six within-role balance strategies: living with integrity, being the best you can, doing what you love, loving what you do, remembering why and searching for signs of success. The women also described six between-role balance strategies: maintaining health and wellbeing, repressing perfectionism, managing time and energy, releasing responsibility, nurturing social connection and reciprocating. These findings provide a basis for health care providers to understand and potentially support working 'sandwich' generation women.

To Meet or Not To Meet Physical vs. Virtual Configuration Control Board

NASA Technical Reports Server (NTRS)

Rice, Shelley

2017-01-01

This presentation will define the CCB, discuss its functions and members. We will look into traditional processes of managing change control via the CCB meeting and advanced practices utilizing enhanced product tools and technologies. Well step through a summary of the feedback from the community of CM professionals at NASA Goddard Space Flight Center of best practices as well as pros and cons for facilitating both a physical CCB and managing stakeholder approvals in a virtual environment. Attendees will come away with current industry strategies to determine if process for managing change control and approvals can be streamlined within their local work environments.

Developing purchasing strategy: a case study of a District Health Authority using soft systems methodology.

PubMed

Brown, A D

1997-02-01

This paper examines the attempt by a District Health Authority (DHA) to create structures (called Purchasing Strategy Groups or PSGs) to facilitate the effective development of its purchasing strategy. The paper is based on a case study design conducted using Soft Systems Methodology (SSM). The research contribution the paper makes is twofold. First, it analyses some of the fundamental management-related difficulties that a DHA can experience when attempting to come to terms with its role and responsibilities in the 1990s. Second, it provides a discussion and evaluation of the utility of SSM for qualitative research in the National Health Service (NHS) in the UK.

The Emerging Role of Mindfulness Meditation as Effective Self-Management Strategy, Part 2: Clinical Implications for Chronic Pain, Substance Misuse, and Insomnia.

PubMed

Khusid, Marina A; Vythilingam, Meena

2016-09-01

Mindfulness-based interventions have been increasingly utilized in the management of chronic pain since 1982. This second review of a two-part series evaluates the efficacy, mechanism, and safety of mindfulness meditation for chronic pain, substance use disorder, tobacco use disorder, and insomnia frequently co-occurring after return from deployment. Standard databases were searched until August 4, 2015. 72 relevant systematic reviews and clinical trials met the inclusion criteria. The Strength of Recommendation Taxonomy was used to assess the quality of individual studies and to rate the strength of recommendation (SOR) for each clinical condition. Mindfulness-based interventions effectively and durably reduce pain intensity, improve functional status, pain-related psychological consequences, quality of life (SOR B). They can also be utilized as an adjunctive intervention aimed at improving health-related quality of life in individuals with substance use disorders interested in self-management strategies (SOR B). Mindfulness training for smokers used adjunctively with pharmacotherapy shows efficacy in maintaining abstinence comparable to that of the current standard of care (SOR B). Future large, well-designed randomized clinical trials using active controls in service members and veterans with co-occurring pain and psychological health conditions are necessary to provide more precise clinical guidance. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Stakeholder Analysis in Utilizing of Environmental Services and Natural Attractions in Tuk Semuncar Utilization Zone of Gunung Merbabu National Park: A literature review

NASA Astrophysics Data System (ADS)

Setiawan, Muhammad Arif; Muhammad, Fuad

2018-02-01

Many stakeholders in the utilizing of environmental services and natural attraction of Tuk Semuncar Utilization Zone needs to get the attention of the Gunung Merbabu National Park Officer. The existence of natural resources has an important role for the life of the community, making the complexity of the relationship between various parties who have interests in natural resource management. The existence of stakeholders and their interests should receive attention and be considered to be accommodated as an effort to prevent the occurrence of losses to the conservation area of Gunung Merbabu National Park. Every stakeholder's interest can have a positive and negative impact on other stakeholders. Stakeholder analysis can help in understanding the conflict on the utilizing of environmental services and natural attraction that is happening, as well as input strategy in involving stakeholders for the achievement of goals.

Stanford Chronic Disease Self-Management Program in myotonic dystrophy: New opportunities for occupational therapists: Stanford Chronic Disease Self-Management Program dans la dystrophie myotonique : De nouvelles opportunités pour les ergothérapeutes.

PubMed

Raymond, Kateri; Levasseur, Mélanie; Chouinard, Maud-Christine; Mathieu, Jean; Gagnon, Cynthia

2016-06-01

Chronic disease self-management is a priority in health care. Personal and environmental barriers for populations with neuromuscular disorders might diminish the efficacy of self-management programs, although they have been shown to be an effective intervention in many populations. Owing to their occupational expertise, occupational therapists might optimize self-management program interventions. This study aimed to adapt the Stanford Chronic Disease Self-Management Program (CDSMP) for people with myotonic dystrophy type 1 (DM1) and assess its acceptability and feasibility in this population. Using an adapted version of the Stanford CDSMP, a descriptive pilot study was conducted with 10 participants (five adults with DM1 and their caregivers). A semi-structured interview and questionnaires were used. The Stanford CDSMP is acceptable and feasible for individuals with DM1. However, improvements are required, such as the involvement of occupational therapists to help foster concrete utilization of self-management strategies into day-to-day tasks using their expertise in enabling occupation. Although adaptations are needed, the Stanford CDSMP remains a relevant intervention with populations requiring the application of self-management strategies. © CAOT 2016.

Insecticide Resistance: Challenge to Pest Management and Basic Research

NASA Astrophysics Data System (ADS)

Brattsten, L. B.; Holyoke, C. W.; Leeper, J. R.; Raffa, K. F.

1986-03-01

The agricultural use of synthetic insecticides usually protects crops but imposes strong selection pressures that can result in the development of resistance. The most important resistance mechanisms are enhancement of the capacity to metabolically detoxify insecticides and alterations in target sites that prevent insecticides from binding to them. Insect control methods must incorporate strategies to minimize resistance development and preserve the utility of the insecticides. The most promising approach, integrated pest management, includes the use of chemical insecticides in combination with improved cultural and biologically based techniques.

Rethinking Funding Strategies: Integrated Planning and Resource Development for the Small Two-Year College of 1990.

ERIC Educational Resources Information Center

Bender, Louis; Daniel, David

1986-01-01

Presents management models showing the evolution of public expectancy as reflected in legislated policy: the petty cash model, the public utility model, and the business model. Discusses the John A. Walker Community Center at Wilkes Community College (North Carolina) as an example of the integrated planning/resource development (i.e., business)…

A Comparative Analysis of Computer-Assisted Instruction and Traditional Lecture Instruction for Administration and Management Topics in Physical Therapy Education

ERIC Educational Resources Information Center

Hyland, Matthew R.; Pinto-Zipp, Genevieve; Olson, Valerie; Lichtman, Steven W.

2010-01-01

Technological advancements and competition in student recruitment have challenged educational institutions to expand upon traditional teaching methods in order to attract, engage and retain students. One strategy to meet this shift from educator-directed teaching to student-centered learning is greater computer utilization as an integral aspect of…

Development and validation of breeder-friendly KASPar markers for er1, a powdery mildew resistance gene in pea (Pisum sativum L.)

USDA-ARS?s Scientific Manuscript database

Powdery mildew of pea is caused by Erysiphe pisi DC and is a serious threat to pea (Pisum sativum L.) production throughout much of the world. Development and utilization of genetic resistance to powdery mildew is considered an effective and sustainable strategy to manage this disease. One gene, er1...

Woody biomass utilization trends, barriers, and strategies: Perspectives of U.S. Forest Service managers

Treesearch

Shiloh Sundstrom; Max Nielsen-Pincus; Cassandra Moseley; Sarah McCaffrey

2012-01-01

The use of woody biomass is being promoted across the United States as a means of increasing energy independence, mitigating climate change, and reducing the cost of hazardous fuels reduction treatments and forest restoration projects. The opportunities and challenges for woody biomass use on the national forest system are unique. In addition to making woody biomass...

Community energy self-reliance

NASA Astrophysics Data System (ADS)

1980-07-01

Goals of a workshop/conference on community renewable energy systems are: (1) to encourage decentralization in attacking energy problems, (2) to show how renewable energy can meet community goals, (3) to present examples of successful projects, (4) to discuss the planning and management of renewable energy systems, (5) to identify sources of financial support, (6) to share legal strategies, and (7) to examine utility roles.

The Utilization of Psychologists for Staff Development in a Large Public School System: A Staff Development Director's Perspective.

ERIC Educational Resources Information Center

Stone, James L., Jr.

This model proposes the TAP Team approach as an on-site delivery system for local school staff development in large, urban school systems. TAP emphasizes in-service training for both upgrading skills of staff and for helping staff acquire new skills in the areas of coping strategies, classroom management, communication skills, instructional…

How School Facilities Managers and Business Officials Are Reducing Operating Costs and Saving Money. Energy-Smart Building Choices.

ERIC Educational Resources Information Center

Department of Energy, Washington, DC.

This guide addresses contributions that school facility administrators and business officials can make in an effort to reduce operating costs and free up money for capital improvements. The guide explores opportunities available to utilize energy-saving strategies at any stage in a building's life, from its initial design phase through renovation.…

Adapting Natural Resource Management to Climate Change: The Blue Mountains and Northern Rockies Adaptation Partnerships

NASA Astrophysics Data System (ADS)

Halofsky, J.; Peterson, D. L.

2014-12-01

Concrete ways to adapt to climate change are needed to help natural resource managers take the first steps to incorporate climate change into management and take advantage of opportunities to balance the negative effects of climate change. We recently initiated two science-management climate change adaptation partnerships, one with three national forests and other key stakeholders in the Blue Mountains region of northeastern Oregon, and the other with 16 national forests, three national parks and other stakeholders in the northern Rockies region. Goals of both partnerships were to: (1) synthesize published information and data to assess the exposure, sensitivity, and adaptive capacity of key resource areas, including water use, infrastructure, fisheries, and vegetation and disturbance; (2) develop science-based adaptation strategies and tactics that will help to mitigate the negative effects of climate change and assist the transition of biological systems and management to a warmer climate; (3) ensure adaptation strategies and tactics are incorporated into relevant planning documents; and (4) foster an enduring partnership to facilitate ongoing dialogue and activities related to climate change in the partnerships regions. After an initial vulnerability assessment by agency and university scientists and local resource specialists, adaptation strategies and tactics were developed in a series of scientist-manager workshops. The final vulnerability assessments and adaptation actions are incorporated in technical reports. The partnerships produced concrete adaptation options for national forest and other natural resource managers and illustrated the utility of place-based vulnerability assessments and scientist-manager workshops in adapting to climate change.

Health care professionals' familiarity with non-pharmacological strategies for managing cancer pain.

PubMed

Zaza, C; Sellick, S M; Willan, A; Reyno, L; Browman, G P

1999-01-01

Many studies have confirmed unnecessary suffering among cancer patients, due to the inadequate use of analgesic medication and other effective interventions. While pharmacological treatments are appropriately the central component of cancer pain management, the under-utilization of effective nonpharmacological strategies (NPS) may contribute to the problem of pain and suffering among cancer patients. The purpose of this study was to determine health care professionals' familiarity with, and perceptions regarding, NPS for managing cancer pain, and to assess their interest in learning more about NPS as adjuncts to pharmacological analgesics. Two-hundred and fourteen health care professionals were surveyed at two cancer treatment centres in Ontario, Canada. The self-report questionnaire included questions regarding 11 psychological strategies (e.g. imagery) and eight other NPS (e.g. acupuncture). The response rate was 67% (141/214). Subjects were found to be the least familiar with autogenic training, operant conditioning, and cognitive therapy. Other than radiation and surgery, subjects most commonly reported recommending support groups (67%), imagery (54%), music or art therapy (49%) and meditation (43%) for managing cancer pain. Participants were most interested in learning more about acupuncture, massage therapy, therapeutic touch, hypnosis, and biofeedback. Participants were somewhat familiar with most of the 19 NPS presented; however, they use or recommend few NPS for managing cancer pain. Health professionals' interest in NPS has important implications for the supportive care of cancer patients.

The complete "how to" guide for selecting a disease management vendor.

PubMed

Linden, Ariel; Roberts, Nancy; Keck, Kevin

2003-01-01

Decision-makers in health plans, large medical groups, and self-insured employers face many challenges in selecting and implementing disease management programs. One strategy is the "buy" approach, utilizing one or more of the many vendors to provide disease management services for the purchasing organization. As a relatively new field, the disease management vendor landscape is continually changing, uncovering the many uncertainties about demonstrating outcomes, corporate stability, or successful business models. Given the large investment an organization may make in each disease management program (many cost 1 million dollars or more in annual fees for a moderately sized population), careful consideration must be given in selecting a disease management partner. This paper describes, in detail, the specific steps necessary and the issues to consider in achieving a successful contract with a vendor for full-service disease management.

Evaluation of Facility Management by Multivariate Statistics - Factor Analysis

NASA Astrophysics Data System (ADS)

Singovszki, Miloš; Vranayová, Zuzana

2013-06-01

Facility management is evolving, there is no exact than other sciences, although its development is fast forward. The knowledge and practical skills in facility management is not replaced, on the contrary, they complement each other. The existing low utilization of science in the field of facility management is mainly caused by the management of support activities are many variables and prevailing immediate reaction to the extraordinary situation arising from motives of those who have substantial experience and years of proven experience. Facility management is looking for a system that uses organized knowledge and will form the basis, which grows from a wide range of disciplines. Significant influence on its formation as a scientific discipline is the "structure, which follows strategy". The paper deals evaluate technology building as part of an facility management by multivariate statistic - factor analysis.

Population-based worksite obesity management interventions: a qualitative case study.

PubMed

Romney, Martha C; Thomson, Erin; Kash, Kathryn

2011-06-01

Due to the increased prevalence of obesity and associated direct and indirect costs to employers, weight management programs have become an integral component of employer and insurer benefits plans. The programs vary in foci, scope, breadth, and implementation. The aim of this study was to explore promising employer-sponsored population-based obesity management programs. A case study that utilized a telephonic semi-structured questionnaire was conducted with small and large organizations located in different regions of the United States that had been recruited to participate. Eight employers and 1 health care advocacy coalition who met the inclusion criteria were interviewed about features of their weight management programs. The case study revealed a number of themes consistent with reports in the literature and reflecting cited best practices. Key findings include confirmation that weight management is a significant component of the wellness strategy in all participating organizations because employers are invested in population health programs and cost savings. Based upon their experience and knowledge, occupational health specialists are responsible for designing, implementing, managing, and evaluating employee health programs. Almost all employers utilize electronic media as a prominent component of wellness and disease management initiatives. Experience has shown that incentives-both financial and nonmonetary-are effective motivators for employee engagement and outcomes. However, while employers report success, favorable outcomes have been difficult to quantify.

Optimizing nonpharmacological management following an acute exacerbation of chronic obstructive pulmonary disease.

PubMed

Harrison, Samantha L; Goldstein, Roger; Desveaux, Laura; Tulloch, Verity; Brooks, Dina

2014-01-01

Though the guidelines for the optimal management of chronic obstructive pulmonary disease (COPD) following an acute exacerbation (AE) are well established, issues associated with poor adherence to nonpharmacological interventions such as self-management advice and pulmonary rehabilitation will impact on hospital readmission rates and health care costs. Systems developed for clinically stable patients with COPD may not be sufficient for those who are post-exacerbation. A redesign of the manner in which such interventions are delivered to patients following an AECOPD is necessary. Addressing two or more components of the chronic care model is effective in reducing health care utilization in patients with COPD, with self-management support contributing a key role. By refining self-management support to incorporate the identification and treatment of psychological symptoms and by providing health care professionals adequate time and training to deliver respiratory-specific advice and self-management strategies, adherence to nonpharmacological therapies following an AE may be enhanced. Furthermore, following up patients in their own homes allows for the tailoring of advice and for the delivery of consistent health care messages which may enable knowledge to be retained. By refining the delivery of nonpharmacological therapies following an AECOPD according to components of the chronic care model, adherence may be improved, resulting in better disease management and possibly reducing health care utilization.

Progressive Tinnitus Management Level 3 Skills Education: A 5-Year Clinical Retrospective.

PubMed

Edmonds, Catherine M; Ribbe, Cheri; Thielman, Emily J; Henry, James A

2017-09-18

The primary purpose of this study was to determine whether progressive tinnitus management Level 3 skills education workshops conducted at the Bay Pines and Boston Veterans Affairs hospitals result in consistent use of the presented tinnitus management strategies by patients 1-5 years after completing the workshops. In fiscal year (FY) 2015, the tinnitus workshop follow-up form was mailed to all veterans who completed the Level 3 workshops between FY 2010 and FY 2014. Data were compiled to determine which, if any, of the skills taught in the workshops were being used 1-5 years after completion of the workshops and the impact on quality-of-life indicators. All self-management skills were being utilized up to 5 years postcompletion; therapeutic sound was utilized the most. The majority of patients reported an improved ability to manage reactions to tinnitus and improved quality-of-life indicators. Over 90% of patients from both sites recommended the program to others with tinnitus. The self-management skills taught in the progressive tinnitus management Level 3 workshops are sustained over time even when limited resources prevent the full complement of workshops or the involvement of mental health services. The workshops can also be successfully implemented through remote delivery via videoconferencing (telehealth). https://doi.org/10.23641/asha.5370883.

Pharmacy Utilization and the Medicare Modernization Act

PubMed Central

Maio, Vittorio; Pizzi, Laura; Roumm, Adam R; Clarke, Janice; Goldfarb, Neil I; Nash, David B; Chess, David

2005-01-01

To control expenditures and use medications appropriately, the Medicare drug coverage program has established pharmacy utilization management (PUM) measures. This article assesses the effects of these strategies on the care of seniors. The literature suggests that although caps on drug benefits lower pharmaceutical costs, they may also increase the use of other health care services and hurt health outcomes. Our review raises concerns regarding the potential unintended effects of the Medicare drug program's PUM policies for beneficiaries. Therefore, the economic and clinical impact of PUM measures on seniors should be studied further to help policymakers design better drug benefit plans. PMID:15787955

Office-based Management of Recurrent Respiratory Papilloma.

PubMed

Motz, Kevin M; Hillel, Alexander T

2016-06-01

This review will highlight the indications and benefits of office-based therapy for recurrent respiratory papillomatosis (RRP) and discuss the utilization of photo-dynamic lasers and adjuvant medical therapy in office-based settings. Office-based management of RRP allows for more timely interventions, is preferred by the majority of patients, and negates the risk of general anesthesia. Current literature argues for the utilization of KTP laser over CO 2 laser for office-based treatment of RRP. Medical therapies for RRP are limited, but agents such as bevacizumab are promising and have been shown to reduce disease burden. Medical therapies that can induce disease remission are still needed. Office-based procedures save time and healthcare expenses compared to like procedures in the operating room. However, the increased frequency for office-based procedures predicts similar overall healthcare costs for office-based and OR laser excision of RRP. Office-based management of RRP is a feasible and well-tolerated strategy in appropriately selected patients with adequate local anesthesia.

Cost-effectiveness of outpatient management for febrile neutropenia in children with cancer.

PubMed

Teuffel, Oliver; Amir, Eitan; Alibhai, Shabbir M H; Beyene, Joseph; Sung, Lillian

2011-02-01

Inpatient management remains the standard of care for treatment of febrile neutropenia (FN) in children with cancer. Clinical data suggest, however, that outpatient management might be a safe and efficacious alternative for patients with low-risk FN episodes. A cost-utility model was created to compare 4 treatment strategies for low-risk FN. The base case considered pediatric cancer patients with low-risk FN. The model used a health care payer's perspective and a time horizon of 1 FN episode. Four treatment strategies were evaluated: (1) entire treatment in hospital with intravenous antibiotics (HospIV); (2) early discharge consisting of 48 hours of inpatient observation with intravenous antibiotics followed by oral outpatient treatment (EarlyDC); (3) entirely outpatient management with intravenous antibiotics (HomeIV); and (4) entirely outpatient management with oral antibiotics (HomePO). Outcome measures were quality-adjusted FN episodes (QAFNEs), costs (Canadian dollars), and incremental cost-effectiveness ratios. Parameter uncertainty was assessed with probabilistic sensitivity analyses. The most cost-effective strategy was HomeIV. It was cost-saving ($2732 vs $2757) and more effective (0.66 vs 0.55 QAFNE) as compared with HomePO. EarlyDC was slightly more effective (0.68 QAFNE) but significantly more expensive ($5579) than HomeIV, which resulted in an unacceptably high incremental cost-effectiveness ratio of more than $130 000 per QAFNE. HospIV was the least cost-effective strategy because it was more expensive ($14 493) and less effective (0.65 QAFNE) than EarlyDC. The findings of this decision-analytic model indicate that the substantially higher costs of inpatient management cannot be justified on the basis of safety and efficacy considerations or patient/parent preferences.

Managing Financial Risk to Hydropower in Snow Dominated Systems: A Hetch Hetchy Case Study

NASA Astrophysics Data System (ADS)

Hamilton, A. L.; Characklis, G. W.; Reed, P. M.

2017-12-01

Hydropower generation in snow dominated systems is vulnerable to severe shortfalls in years with low snowpack. Meanwhile, generators are also vulnerable to variability in electricity demand and wholesale electricity prices, both of which can be impacted by factors such as temperature and natural gas price. Year-to-year variability in these underlying stochastic variables leads to financial volatility and the threat of low revenue periods, which can be highly disruptive for generators with large fixed operating costs and debt service. In this research, the Hetch Hetchy Power system is used to characterize financial risk in a snow dominated hydropower system. Owned and operated by the San Francisco Public Utilities Commission, Hetch Hetchy generates power for its own municipal operations and sells excess power to irrigation districts, as well as on the wholesale market. This investigation considers the effects of variability in snowpack, temperature, and natural gas price on Hetch Hetchy Power's yearly revenues. This information is then used to evaluate the effectiveness of various financial risk management tools for hedging against revenue variability. These tools are designed to mitigate against all three potential forms of financial risk (i.e. low hydropower generation, low electricity demand, and low/high electricity price) and include temperature-based derivative contracts, natural gas price-based derivative contracts, and a novel form of snowpack-based index insurance contract. These are incorporated into a comprehensive risk management portfolio, along with self-insurance in which the utility buffers yearly revenue volatility using a contingency fund. By adaptively managing the portfolio strategy, a utility can efficiently spread yearly risks over a multi-year time horizon. The Borg Multiobjective Evolutionary Algorithm is used to generate a set of Pareto optimal portfolio strategies, which are used to compare the tradeoffs in objectives such as expected revenues, low revenues, revenue volatility, and portfolio complexity.

A review of mobile applications to help adolescent and young adult cancer patients

PubMed Central

Wesley, Kimberly M; Fizur, Philip J

2015-01-01

Objective To review research articles utilizing mobile applications with adolescent and young adult (AYA) cancer patients. Materials and methods We identified articles via online searches and reference lists (eg, PsycInfo, PubMed). Articles were reviewed by two study team members for target population, stated purpose, technological utilization, sample size, demographic characteristics, and outcome data. Strengths and weaknesses of each study were described. Results Of 19 identified manuscripts, six met full inclusion criteria for this review (four smartphone applications and two tablet applications). One additional article that included an application not specific to oncology but included AYA patients with cancer within the target sample was also reviewed. Uses of these applications included symptom tracking, pain management, monitoring of eating habits following bone marrow transplant, monitoring of mucositis, and improving medication management. Utility results from pilot studies are presented. Conclusion Mobile applications are growing in number and increasingly available to AYAs with and without chronic illness. These applications may prove useful in helping to support AYAs throughout their cancer treatment and beyond. However, few applications provide empirical data supporting their utility. Numerous strengths and benefits of these applications include increased accessibility to educational resources and self-management strategies, more frequent physical and emotional symptom tracking, and increased access to peer support. Despite these strengths, numerous limitations are identified, highlighting the need for future research in this area. PMID:26316835

Integrated water resources management using engineering measures

NASA Astrophysics Data System (ADS)

Huang, Y.

2015-04-01

The management process of Integrated Water Resources Management (IWRM) consists of aspects of policies/strategies, measures (engineering measures and non-engineering measures) and organizational management structures, etc., among which engineering measures such as reservoirs, dikes, canals, etc., play the backbone that enables IWRM through redistribution and reallocation of water in time and space. Engineering measures are usually adopted for different objectives of water utilization and water disaster prevention, such as flood control and drought relief. The paper discusses the planning and implementation of engineering measures in IWRM of the Changjiang River, China. Planning and implementation practices of engineering measures for flood control and water utilization, etc., are presented. Operation practices of the Three Gorges Reservoir, particularly the development and application of regulation rules for flood management, power generation, water supply, ecosystem needs and sediment issues (e.g. erosion and siltation), are also presented. The experience obtained in the implementation of engineering measures in Changjiang River show that engineering measures are vital for IWRM. However, efforts should be made to deal with changes of the river system affected by the operation of engineering measures, in addition to escalatory development of new demands associated with socio-economic development.

Dose-response effects for disease management programs on hospital utilization in Illinois Medicaid.

PubMed

Berg, Gregory D; Donnelly, Shawn; Miller, Mary; Medina, Wendie; Warnick, Kathleen

2012-12-01

The objective of this study is to estimate a dose-response impact of disease management contacts on inpatient admissions. Multivariate regression analysis of panel data was used to test the hypothesis that increased disease management contacts lower the odds of an inpatient admission. Subjects were 40,452 members of Illinois' noninstitutionalized Medicaid-only aged, blind, or disabled population diagnosed with asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, and/or heart failure. All members are also in the state's Illinois Health Connect program, a medical home strategy in place for most of the 2.4 million Illinois Medicaid beneficiaries. The statistical measure is the odds ratio, which is a measure of association between the monthly inpatient admission indicator and the number of contacts (doses) a member has had for each particular disease management intervention. Statistically significant contacts are between 8 and 12 for heart failure, between 4 and 12 contacts for diabetes, and between 8 and 13 contacts for asthma. Total inpatient savings during the study period is estimated to be $12.4 million. This study shows the dose-response pattern of inpatient utilization improvements through the number of disease management contacts.

The future of the US electric utility industry

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

Dar, V.K.

1995-07-01

The future of the electricity industry will be shaped by five forces, already unleashed, and industry leaders` reaction to them. The opportunities for heady executives in well-positioned companies will extend far beyond the borders of today`s confined industry. How the game is played will determine whether utilities are the conquerors or vanquished. The future history of the industry will be written by those who are beginning to fashion their strategic responses to these forces: the deregulation of energy distribution, technological change, intellectual capital, interindustry convergence, and cultural dissonance. For most utilities, strategies are now being contemplated - come coherently, othersmore » inchoately - according to the perceived competences and weaknesses of each company in the eyes of its management and board.« less

Leadership skills for the California electric utility industry: A qualitative study

NASA Astrophysics Data System (ADS)

Hubbell, Michael

The purpose of this qualitative study was to determine the skills and knowledge necessary for leaders in the California electric utility industry in 2020. With rapid industry changes, skills to effectively lead and stay competitive are undetermined. Leaders must manage an increasingly hostile social and political environment, incorporate new technology, and deal with an aging workforce and infrastructure. Methodology. This study utilized a qualitative case study design to determine the factors that influence the skills leaders will require in 2020. It incorporated the perspectives of current electric utility leaders while looking with a future lens. Findings. Interviews were conducted with transmission and distribution (T&D) directors at 3 investor-owned public electric utilities headquartered in California. The questions followed an open-ended format to gather responses as perceived by electric utility leaders for each research question category: overall skills, aging workforce, regulation, technology, and leading younger generations. The research resulted in 18 major themes: 5 for overall skills, 3 for aging workforce, 4 for regulation, 3 for technology, and 3 for leading younger generations. Conclusions. The study identified leadership skills including the ability to embrace, leverage, and stay current with technology; understand and provide a clear vision for the future; increase creativity; manage the next set of workers; motivate during a time of great change; prepare for knowledge transfer and change in workforce culture; manage regulatory expectations; expand potential utility opportunities; leverage "big data"; allow worker collaboration; and understand what drives younger generations. Recommendations. California-based electric utility leaders can remain effective by implementing key strategies identified herein. Further research could examine perspectives of additional utility leaders who lead in organizational units outside of T&D, expand the research to include additional states, and/or demonstrate how to acquire the identified skills. It is also recommended that a replication of this study be undertaken to include a perspective and analysis of union or "field" workers.

The SmartH2O project: a platform supporting residential water management through smart meters and data intensive modeling

NASA Astrophysics Data System (ADS)

Cominola, A.; Nanda, R.; Giuliani, M.; Piga, D.; Castelletti, A.; Rizzoli, A. E.; Maziotis, A.; Garrone, P.; Harou, J. J.

2014-12-01

Designing effective urban water demand management strategies at the household level does require a deep understanding of the determinants of users' consumption. Low resolution data on residential water consumption, as traditionally metered, can only be used to model consumers' behavior at an aggregate level whereas end uses breakdown and the motivations and individual attitudes of consumers are hidden. The recent advent of smart meters allows gathering high frequency consumption data that can be used both to provide instantaneous information to water utilities on the state of the network and continuously inform the users on their consumption and savings. Smart metered data also allow for the characterization of water end uses: this information, coupled with users' psychographic variables, constitutes the knowledge basis for developing individual and multi users models, through which water utilities can test the impact of different management strategies. SmartH2O is an EU funded project which aims at creating an ICT platform able to (i) capture and store quasi real time, high resolution residential water usage data measured with smart meters, (ii) infer the main determinants of residential water end uses and build customers' behavioral models and (iii) predict how the customer behavior can be influenced by various water demand management strategies, spanning from dynamic water pricing schemes to social awareness campaigns. The project exploits a social computing approach for raising users' awareness about water consumption and pursuing water savings in the residential sector. In this work, we first present the SmartH2O platform and data collection, storage and analysis components. We then introduce some preliminary models and results on total water consumption disaggregation into end uses and single user behaviors using innovative fully automated algorithms and overcoming the need of invasive metering campaigns at the fixture level.

What information strategy responding to social needs should be?

NASA Astrophysics Data System (ADS)

Fujii, Kunihiko

With the contemporary social phenomena that people think much of diversity of value, they are concerned with differentiation from others. Consumers' tendency to seek unique goods is common to all, giving impetus to makers' attitude that they try to produce varieties of goods but small amount for each. Consequently, life cycle of goods has become smaller than ever, and rapid and creative information gathering and utilization have become essential when makers produce goods responding to consumers' need. The author discusses how information strategy should be worked in the comprehensive business activities, and how information should be located as the powerful management resource.

Adaptive management for subsurface pressure and plume control in application to geological CO2 storage

NASA Astrophysics Data System (ADS)

Gonzalez-Nicolas, A.; Cihan, A.; Birkholzer, J. T.; Petrusak, R.; Zhou, Q.; Riestenberg, D. E.; Trautz, R. C.; Godec, M.

2016-12-01

Industrial-scale injection of CO2 into the subsurface can cause reservoir pressure increases that must be properly controlled to prevent any potential environmental impact. Excessive pressure buildup in reservoir may result in ground water contamination stemming from leakage through conductive pathways, such as improperly plugged abandoned wells or distant faults, and the potential for fault reactivation and possibly seal breaching. Brine extraction is a viable approach for managing formation pressure, effective stress, and plume movement during industrial-scale CO2 injection projects. The main objectives of this study are to investigate suitable different pressure management strategies involving active brine extraction and passive pressure relief wells. Adaptive optimized management of CO2 storage projects utilizes the advanced automated optimization algorithms and suitable process models. The adaptive management integrates monitoring, forward modeling, inversion modeling and optimization through an iterative process. In this study, we employ an adaptive framework to understand primarily the effects of initial site characterization and frequency of the model update (calibration) and optimization calculations for controlling extraction rates based on the monitoring data on the accuracy and the success of the management without violating pressure buildup constraints in the subsurface reservoir system. We will present results of applying the adaptive framework to test appropriateness of different management strategies for a realistic field injection project.

A game theory analysis of green infrastructure stormwater management policies

NASA Astrophysics Data System (ADS)

William, Reshmina; Garg, Jugal; Stillwell, Ashlynn S.

2017-09-01

Green stormwater infrastructure has been demonstrated as an innovative water resources management approach that addresses multiple challenges facing urban environments. However, there is little consensus on what policy strategies can be used to best incentivize green infrastructure adoption by private landowners. Game theory, an analysis framework that has historically been under-utilized within the context of stormwater management, is uniquely suited to address this policy question. We used a cooperative game theory framework to investigate the potential impacts of different policy strategies used to incentivize green infrastructure installation. The results indicate that municipal regulation leads to the greatest reduction in pollutant loading. However, the choice of the "best" regulatory approach will depend on a variety of different factors including politics and financial considerations. Large, downstream agents have a disproportionate share of bargaining power. Results also reveal that policy impacts are highly dependent on agents' spatial position within the stormwater network, leading to important questions of social equity and environmental justice.

Design and feasibility of a memory intervention with focus on self-management for cognitive impairment in epilepsy.

PubMed

Caller, Tracie A; Secore, Karen L; Ferguson, Robert J; Roth, Robert M; Alexandre, Faith P; Henegan, Patricia L; Harrington, Jessica J; Jobst, Barbara C

2015-03-01

The aim of this study was to assess the feasibility of a self-management intervention targeting cognitive dysfunction to improve quality of life and reduce memory-related disability in adults with epilepsy. The intervention incorporates (1) education on cognitive function in epilepsy, (2) self-awareness training, (3) compensatory strategies, and (4) application of these strategies in day-to-day life using problem-solving therapy. In addition to the behavioral modification, formal working memory training was conducted by utilizing a commercially available program in a subgroup of patients. Our findings suggest that a self-management intervention targeting cognitive dysfunction was feasible for delivery to a rural population with epilepsy, with 13 of 16 enrolled participants completing the 8-session program. Qualitative data indicate high satisfaction and subjective improvement in cognitive functioning in day-to-day life. These findings provide support for further evaluation of the efficacy of this intervention through a randomized controlled trial. Copyright © 2015 Elsevier Inc. All rights reserved.

Management strategies on the industrialization road of state-of-the-art technologies for e-waste recycling: the case study of electrostatic separation--a review.

PubMed

Xue, Mianqiang; Li, Jia; Xu, Zhenming

2013-02-01

Electronic waste (e-waste) management is pressing as global production has increased significantly in the past few years and is rising continuously at a fast rate. Many countries are facing hazardous e-waste mountains, most of which are disposed of by backyard recyclers, creating serious threats to public health and ecosystems. Industrialization of state-of-the-art recycling technologies is imperative to enhance the comprehensive utilization of resources and to protect the environment. This article aims to provide an overview of management strategies solving the crucial problems during the process of industrialization. A typical case study of electrostatic separation for recycling waste printed circuit boards was discussed in terms of parameters optimization, materials flow control, noise assessment, risk assessment, economic evaluation and social benefits analysis. The comprehensive view provided by the review could be helpful to the progress of the e-waste recycling industry.

Randomized Trial of Hypnosis as a Pain and Symptom Management Strategy in Adults with Sickle Cell Disease

PubMed Central

Wallen, Gwenyth R; Middleton, Kimberly R; Ames, Nancy; Brooks, Alyssa T; Handel, Daniel

2014-01-01

Sickle cell disease (SCD) is the most common genetic disease in African-Americans, characterized by recurrent painful vaso-occlusive crises. Medical therapies for controlling or preventing crises are limited because of efficacy and/or toxicity. This is a randomized, controlled, single-crossover protocol of hypnosis for managing pain in SCD patients. Participants receive hypnosis from a trained hypnosis therapist followed by six weeks of self-hypnosis using digital media. Those in the control arm receive SCD education followed by a six-week waiting period before crossing over to the hypnosis arm of the study. Outcome measures include assessments of pain (frequency, intensity and quality), anxiety, coping strategies, sleep, depression, and health care utilization. To date, there are no published randomized, controlled trials evaluating the efficacy of hypnosis on SCD pain modulation in adults. Self-hypnosis for pain management may be helpful in modulating chronic pain, improving sleep quality, and decreasing use of narcotics in patients with SCD. TRIAL REGISTRATION ClinicalTrials.gov: NCT00393250 PMID:25520557

Review of Strategies and Technologies for Demand-Side Management on Isolated Mini-Grids

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

Harper, Meg

This review provides an overview of strategies and currently available technologies used for demandside management (DSM) on mini-grids throughout the world. For the purposes of this review, mini-grids are defined as village-scale electricity distribution systems powered by small local generation sources and not connected to a main grid.1 Mini-grids range in size from less than 1 kW to several hundred kW of installed generation capacity and may utilize different generation technologies, such as micro-hydro, biomass gasification, solar, wind, diesel generators, or a hybrid combination of any of these. This review will primarily refer to AC mini-grids, though much of themore » discussion could apply to DC grids as well. Many mini-grids include energy storage, though some rely solely on real-time generation.« less

A plant-based diet for type 2 diabetes: scientific support and practical strategies.

PubMed

Trapp, Caroline; Barnard, Neal; Katcher, Heather

2010-01-01

The purpose of this review is to provide educators with the knowledge and tools to utilize plant-based nutrition education as an intervention for type 2 diabetes. Scientific support for the efficacy, acceptability, and nutritional adequacy of a plant-based diet for people with type 2 diabetes is presented, and practical considerations such as medication adjustment and risk of hypoglycemia are reviewed. Plant-based meal planning is an acceptable and effective strategy that educators can use to improve diabetes management and reduce risk of complications. Studies show that dietary changes that are effective for reducing cardiac risk may also be helpful for management of type 2 diabetes. A low-fat, plant-based diet reduces body weight and improves glycemic control, and has been shown to be remarkably well accepted by patients.

Improving the relevance and impact of decision support research: A co-production framework and water management case study

NASA Astrophysics Data System (ADS)

Smith, R.; Kasprzyk, J. R.; Dilling, L.; Basdekas, L.; Kaatz, L.

2016-12-01

In light of the unpredictable effects of climate change and population shifts, responsible resource management will require new types of information and strategies going forward. For water utilities, this means that water supply infrastructure systems must be expanded and/or managed for changes in overall supply and increased extremes. Utilities have begun seeking innovative tools and methods to support planning and decision making, but there are limited channels through which they can gain exposure to emerging tools from the research world, and for researchers to uptake important real-world planning and decision context. A transdisciplinary team of engineers, social and climate scientists, and water managers designed this study to develop and apply a co-production framework which explores the potential of an emerging decision support tool to enhance flexibility and adaptability in water utility planning. It also demonstrates how to improve the link between research and practice in the water sector. In this study we apply the co-production framework to the use of Multiobjective Evolutionary Algorithms (MOEAs). MOEAs have shown promise in being able to generate and evaluate new planning alternatives but they have had little testing or application in water utilities. Anchored by two workshops, this study (1) elicited input from water managers from six water suppliers on the Front Range of Colorado, USA, to create a testbed MOEA application, and (2) evaluated the managers' responses to multiobjective optimization results. The testbed consists of a Front Range-relevant hypothetical water supply model, the Borg MOEA, hydrology and demand scenarios, and a set of planning decisions and performance objectives that drive the link between the algorithm and the model. In this presentation we describe researcher-manager interactions at the initial workshop that served to establish relationships and provide in-depth information to researchers about regional water management context. We also describe the development of, and experiences from, the second workshop which included activities for water managers to interact directly with MOEA testbed results. Finally, we evaluate the co-production framework itself and the potential for the feedback from managers to shape future development of decision support tools.

Managed care redux: health plans shift responsibilities to consumers.

PubMed

Draper, Debra A; Claxton, Gary

2004-03-01

Confronted with conflicting pressures to stem double-digit premium increases and provide unfettered access to care, health plans are developing products that shift more financial and care management responsibilities to consumers, according to findings from the Center for Studying Health System Change's (HSC) 2002-03 site visits to 12 nationally representative communities. Plans are pursuing these strategies in collaboration with employers that want to gain control over rapidly rising premiums while continuing to respond to employee demands for less restrictive managed care practices. Mindful of the managed care backlash, health plans also are stepping up utilization management activities for high-cost services and focusing care management on high-cost patients. While the move toward greater consumer engagement is clear, the impact on costs and consumer willingness to assume these new responsibilities remain to be seen.

Prevention and management of infections associated with combat-related extremity injuries.

PubMed

Murray, Clinton K; Hsu, Joseph R; Solomkin, Joseph S; Keeling, John J; Andersen, Romney C; Ficke, James R; Calhoun, Jason H

2008-03-01

Orthopedic injuries suffered by casualties during combat constitute approximately 65% of the total percentage of injuries and are evenly distributed between upper and lower extremities. The high-energy explosive injuries, environmental contamination, varying evacuation procedures, and progressive levels of medical care make managing combat-related injuries challenging. The goals of orthopedic injury management are to prevent infection, promote fracture healing, and restore function. It appears that 2% to 15% of combat-related extremity injuries develop osteomyelitis, although lower extremity injuries are at higher risk of infections than upper extremity. Management strategies of combat-related injuries primarily focus on early surgical debridement and stabilization, antibiotic administration, and delayed primary closure. Herein, we provide evidence-based recommendations from military and civilian data to the management of combat-related injuries of the extremity. Areas of emphasis include the utility of bacterial cultures, antimicrobial therapy, irrigation fluids and techniques, timing of surgical care, fixation, antibiotic impregnated beads, wound closure, and wound coverage with negative pressure wound therapy. Most of the recommendations are not supported by randomized controlled trials or adequate cohorts studies in a military population and further efforts are needed to answer best treatment strategies.

Utility and Scope of Rapid Prototyping in Patients with Complex Muscular Ventricular Septal Defects or Double-Outlet Right Ventricle: Does it Alter Management Decisions?

PubMed

Bhatla, Puneet; Tretter, Justin T; Ludomirsky, Achi; Argilla, Michael; Latson, Larry A; Chakravarti, Sujata; Barker, Piers C; Yoo, Shi-Joon; McElhinney, Doff B; Wake, Nicole; Mosca, Ralph S

2017-01-01

Rapid prototyping facilitates comprehension of complex cardiac anatomy. However, determining when this additional information proves instrumental in patient management remains a challenge. We describe our experience with patient-specific anatomic models created using rapid prototyping from various imaging modalities, suggesting their utility in surgical and interventional planning in congenital heart disease (CHD). Virtual and physical 3-dimensional (3D) models were generated from CT or MRI data, using commercially available software for patients with complex muscular ventricular septal defects (CMVSD) and double-outlet right ventricle (DORV). Six patients with complex anatomy and uncertainty of the optimal management strategy were included in this study. The models were subsequently used to guide management decisions, and the outcomes reviewed. 3D models clearly demonstrated the complex intra-cardiac anatomy in all six patients and were utilized to guide management decisions. In the three patients with CMVSD, one underwent successful endovascular device closure following a prior failed attempt at transcatheter closure, and the other two underwent successful primary surgical closure with the aid of 3D models. In all three cases of DORV, the models provided better anatomic delineation and additional information that altered or confirmed the surgical plan. Patient-specific 3D heart models show promise in accurately defining intra-cardiac anatomy in CHD, specifically CMVSD and DORV. We believe these models improve understanding of the complex anatomical spatial relationships in these defects and provide additional insight for pre/intra-interventional management and surgical planning.

Linking Internet strategy to high-quality, cost-effective managed care.

PubMed

Beauregard, T R

2000-01-01

This article describes an experimental pilot project incorporating e-commerce and the Internet into the traditional process of health benefit negotiations through the utilization of an HMO Internet auction. The timeline and process of the auction are described, with the final auction taking place during the last week of negotiations. The results reveal an efficient and effective system to augment the traditional benefit negotiation process.

A Behavioral Theory of the Merger: Dynamics of the Post-Merger Integration Process

DTIC Science & Technology

2014-05-01

management’s integration strategy that often accompanies a merger. Although, some real-world managers do indeed take a laissez faire approach to...1971). Future models might instead utilize other theoretical characteristics to select exchange partners, such as relative expertise, leadership ...Byrne, 1971). Future modelers could also consider other characteristics such as relative expertise, leadership style, and resource availability in this

Bringing indices of species vulnerability to climate change into geographic space: an assessment across the Coronado national forest

Treesearch

Jennifer E. Davison; Sharon Coe; Deborah Finch; Erika Rowland; Megan Friggens; Lisa J. Graumlich

2012-01-01

Indices that rate the vulnerability of species to climate change in a given area are increasingly used to inform conservation and climate change adaptation strategies. These species vulnerability indices (SVI) are not commonly associated with landscape features that may affect local-scale vulnerability. To do so would increase their utility by allowing managers to...

Information transfer and shared mental models for decision making

NASA Technical Reports Server (NTRS)

Orasanu, Judith; Fischer, Ute

1991-01-01

A study to determine how communication influences flight crew performance is presented. This analysis focuses on the content of communication, principally asking what an utterance does from a cognitive, problem solving viewpoint. Two questions are addressed in this study: how is language utilized to manage problems in the cockpit, and are there differences between two- and three-member crews in their communication and problem solving strategies?

A Study of Placing Army Requirements on Contract

DTIC Science & Technology

2016-04-01

perhaps being unable to control the external environment, has management authority over business and technical aspects of a specific program. The PM...research is the last element of the planning phase addressing both business and technical considerations. The acquisition team equips themselves with...report is the final product utilizing documented findings and supports the business strategy (DoD, Guidebook for the Acquisition of Services, 2011

Cow weights and calf production for pasture 12-C Lehmann lovegrass grazing trials, 1982 to 1993

Treesearch

Phil R. Ogden; E. Lamar Smith

2003-01-01

The purpose of the grazing trials described in this paper was to provide information to aid in the development of grazing management strategies where Lehmann lovegrass has become a dominant species. Seven pastures were utilized from 1984 to 1987 for a comparison of four yearlong stocking rates to seasonal grazing rotated through three pastures. A second trial, 1988 to...

Development and Pilot of the Caregiver Strategies Inventory.

PubMed

Kirby, Anne V; Little, Lauren M; Schultz, Beth; Watson, Linda R; Zhang, Wanqing; Baranek, Grace T

2016-01-01

Children with autism spectrum disorder often demonstrate unusual behavioral responses to sensory stimuli (i.e., sensory features). To manage everyday activities, caregivers may implement strategies to address these features during family routines. However, investigation of specific strategies used by caregivers is limited by the lack of empirically developed measures. In this study, we describe the development and pilot results of the Caregiver Strategies Inventory (CSI), a supplement to the Sensory Experiences Questionnaire Version 3.0 (SEQ 3.0; Baranek, 2009) that measures caregivers' strategies in response to their children's sensory features. Three conceptually derived and empirically grounded strategy types were tested: cognitive-behavioral, sensory-perceptual, and avoidance. Results indicated that the CSI demonstrated good internal consistency and that strategy use was related to child age and cognition. Moreover, parent feedback after completing the CSI supported its utility and social validity. The CSI may be used alongside the SEQ 3.0 to facilitate a family-centered approach to assessment and intervention planning. Copyright © 2016 by the American Occupational Therapy Association, Inc.

Decision analysis to define the optimal management of athletes with anomalous aortic origin of a coronary artery.

PubMed

Mery, Carlos M; Lopez, Keila N; Molossi, Silvana; Sexson-Tejtel, S Kristen; Krishnamurthy, Rajesh; McKenzie, E Dean; Fraser, Charles D; Cantor, Scott B

2016-11-01

The goal of this study was to use decision analysis to evaluate the impact of varying uncertainties on the outcomes of patients with anomalous aortic origin of a coronary artery. Two separate decision analysis models were created: one for anomalous left coronary artery (ALCA) and one for anomalous right coronary artery (ARCA). Three strategies were compared: observation, exercise restriction, and surgery. Probabilities and health utilities were estimated on the basis of existing literature. Deterministic and probabilistic sensitivity analyses were performed. Surgery was the optimal management strategy for patients <30 years of age with ALCA. As age increased, observation became an equivalent strategy and eventually surpassed surgery as the treatment of choice. The advantage on life expectancy for surgery over observation ranged from 2.6 ± 1.7 years for a 10-year-old patient to -0.03 ± 0.1 for a 65-year old patient. In patients with ARCA, observation was the optimal strategy for most patients with a life expectancy advantage over surgery of 0.1 ± 0.1 years to 0.2 ± 0.4 years, depending on age. Surgery was the preferred strategy only for patients <25 years of age when the perceived risk of sudden cardiac death was high and the perioperative mortality was low. Exercise restriction was a suboptimal strategy for both ALCA and ARCA in all scenarios. The optimal management in anomalous aortic origin of a coronary artery depends on multiple factors, including individual patient characteristics. Decision analysis provides a tool to understand how these characteristics affect the outcomes with each management strategy and thus may aid in the decision making process for a particular patient. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Urban water resources management for semi-arid region

NASA Astrophysics Data System (ADS)

Guan, Huaimin; Ye, Qian; Liu, Zihui

2005-09-01

Due to the rapidly process of urbanization, the water consumption is increasing speedily in Beijing, the capital city of China, during recent decades. Despite great efforts have been done, the daily life of residents and economic construction is threatened continuous in the city. Because of the limitation of sound water management in Beijing the water resources exploitation and utilization are not rational, economically efficiency. The water environment has been degraded in vary levels. The aim of this study is improvement of water management in Beijing. An investigation and collection of the data related to the water management was carried out. The study has made appraisal on the amount of water available and water demands in the region. The reasonable policies, feasible alternatives and institutional management measures have been drawn out from the study for the water management strategies. They can be considered as a base of decision making and macroscopic management for the long-term planning of Beijing.

Cost utility modeling of early vs late total knee replacement in osteoarthritis patients.

PubMed

Mari, K; Dégieux, P; Mistretta, F; Guillemin, F; Richette, P

2016-12-01

Given the dramatic increase in the number of total knee replacement (TKR) surgeries in developed countries, the issue of the best time for surgery needs to be addressed from an economic perspective. To assess, from the perspective of the healthcare payer, the cost-utility of two surgical strategies in which knee replacement is performed at the early or late stage of the disease in patients with knee osteoarthritis (OA). Patient data and evidence from published literature on economic costs and outcomes in OA, including utilities, non-pharmacological, pharmacological and surgical options, combined with population life tables were entered in a Markov model of OA. The model represented the lifetime experience of a cohort of patients following their therapeutic management, discounting costs (euros) and utilities (quality-adjusted life-years) at 4% annually. In the base-case scenario, early TKR cost €6,624 more than late TKR (€76,223 vs €69,599) with a 0.15 gain in QALYs (18.675 vs 18.524). This yielded an incremental cost-utility ratio (ICUR) of 43,631 €/QALY. Sensitivity analyses of the most influential uncertain parameters were performed and did not modify the direction of the conclusions: early TKR cost between €3,655 and €7,194 more than late TKR with a gain in QALYs between 0.15 and 0.39. The ICUR ranged from 17,131 €/QALY to 48,241 €/QALY. Our data do not support the early TKR strategy over the late TKR strategy in knee OA patients from a medico-economic perspective. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Overcoming learning barriers through knowledge management.

PubMed

Dror, Itiel E; Makany, Tamas; Kemp, Jonathan

2011-02-01

The ability to learn highly depends on how knowledge is managed. Specifically, different techniques for note-taking utilize different cognitive processes and strategies. In this paper, we compared dyslexic and control participants when using linear and non-linear note-taking. All our participants were professionals working in the banking and financial sector. We examined comprehension, accuracy, mental imagery & complexity, metacognition, and memory. We found that participants with dyslexia, when using a non-linear note-taking technique outperformed the control group using linear note-taking and matched the performance of the control group using non-linear note-taking. These findings emphasize how different knowledge management techniques can avoid some of the barriers to learners. Copyright © 2010 John Wiley & Sons, Ltd.

A web based relational database management system for filariasis control

PubMed Central

Murty, Upadhyayula Suryanarayana; Kumar, Duvvuri Venkata Rama Satya; Sriram, Kumaraswamy; Rao, Kadiri Madhusudhan; Bhattacharyulu, Chakravarthula Hayageeva Narasimha Venakata; Praveen, Bhoopathi; Krishna, Amirapu Radha

2005-01-01

The present study describes a RDBMS (relational database management system) for the effective management of Filariasis, a vector borne disease. Filariasis infects 120 million people from 83 countries. The possible re-emergence of the disease and the complexity of existing control programs warrant the development of new strategies. A database containing comprehensive data associated with filariasis finds utility in disease control. We have developed a database containing information on the socio-economic status of patients, mosquito collection procedures, mosquito dissection data, filariasis survey report and mass blood data. The database can be searched using a user friendly web interface. Availability http://www.webfil.org (login and password can be obtained from the authors) PMID:17597846

D-WISE: Diabetes Web-Centric Information and Support Environment: conceptual specification and proposed evaluation.

PubMed

Abidi, Samina; Vallis, Michael; Raza Abidi, Syed Sibte; Piccinini-Vallis, Helena; Imran, Syed Ali

2014-06-01

To develop and evaluate Diabetes Web-Centric Information and Support Environment (D-WISE) that offers 1) a computerized decision-support system to assist physicians to A) use the Canadian Diabetes Association clinical practice guidelines (CDA CPGs) to recommend evidence-informed interventions; B) offer a computerized readiness assessment strategy to help physicians administer behaviour-change strategies to help patients adhere to disease self-management programs; and 2) a patient-specific diabetes self-management application, accessible through smart mobile devices, that offers behaviour-change interventions to engage patients in self-management. The above-mentioned objectives were pursued through a knowledge management approach that involved 1) Translation of paper-based CDA CPGs and behaviour-change models as computerized decision-support tools that will assist physicians to offer evidence-informed and personalized diabetes management and behaviour-change strategies; 2) Engagement of patients in their diabetes care by generating a diabetes self-management program that takes into account their preferences, challenges and needs; 3) Empowering patients to self-manage their condition by providing them with personalized educational and motivational messages through a mobile self-management application. The theoretical foundation of our research is grounded in behaviour-change models and healthcare knowledge management. We used 1) knowledge modelling to computerize the paper-based CDA CPGs and behaviour-change models, in particular, the behaviour-change strategy elements of A) readiness-to-change assessments; B) motivation-enhancement interventions categorized along the lines of patients' being ready, ambivalent or not ready; and C) self-efficacy enhancement. The CDA CPGs and the behaviour-change models are modelled and computerized in terms of A) a diabetes management ontology that serves as the knowledge resource for all the services offered by D-WISE; B) decision support services that use logic-based reasoning algorithms to utilize the knowledge encoded within the diabetes management ontology to assist physicians by recommending patient-specific diabetes-management interventions and behaviour-change strategies; C) a mobile diabetes self-management application to engage and educate diabetes patients to self-manage their condition in a home-based setting while working in concert with their family physicians. We have been successful in creating and conducting a usability assessment of the physician decision support tool. These results will be published once the patient self- management application has been evaluated. D-WISE will be evaluated through pilot studies measuring 1) the usability of the e-Health interventions; and 2) the impact of the interventions on patients' behaviour changes and diabetes control. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Soil indicators to assess the effectiveness of restoration strategies in dryland ecosystems

NASA Astrophysics Data System (ADS)

Costantini, E. A. C.; Branquinho, C.; Nunes, A.; Schwilch, G.; Stavi, I.; Valdecantos, A.; Zucca, C.

2015-12-01

Soil indicators may be used for assessing both land suitability for restoration and the effectiveness of restoration strategies in restoring ecosystem functioning and services. In this review paper, several soil indicators, which can be used to assess the effectiveness of restoration strategies in dryland ecosystems at different spatial and temporal scales, are discussed. The selected indicators represent the different viewpoints of pedology, ecology, hydrology, and land management. The recovery of soil capacity to provide ecosystem services is primarily obtained by increasing soil rooting depth and volume, and augmenting water accessibility for vegetation. Soil characteristics can be used either as indicators of suitability, that is, inherently slow-changing soil qualities, or as indicators for modifications, namely dynamic, thus "manageable" soil qualities. Soil organic matter forms, as well as biochemistry, micro- and meso-biology, are among the most utilized dynamic indicators. On broader territorial scales, the Landscape Function Analysis uses a functional approach, where the effectiveness of restoration strategies is assessed by combining the analysis of spatial pattern of vegetation with qualitative soil indicators. For more holistic and comprehensive projects, effective strategies to combat desertification should integrate soil indicators with biophysical and socio-economic evaluation and include participatory approaches. The integrated assessment protocol of Sustainable Land Management developed by the World Overview of Conservation Approaches and Technologies network is thoroughly discussed. Two overall outcomes stem from the review: (i) the success of restoration projects relies on a proper understanding of their ecology, namely the relationships between soil, plants, hydrology, climate, and land management at different scales, which is particularly complex due to the heterogeneous pattern of ecosystems functioning in drylands, and (ii) the selection of the most suitable soil indicators follows a clear identification of the different and sometimes competing ecosystem services that the project is aimed at restoring.

Tradeoffs in Risk and Return of Financial Hedging Solutions to Mitigate Drought-Related Financial Risks for Water Utilities

NASA Astrophysics Data System (ADS)

Baum, R.; Characklis, G. W.

2016-12-01

Financial hedging solutions have been examined as tools for effectively mitigating water scarcity related financial risks for water utilities, and have become more prevalent as conservation (resulting in reduced revenues) and water transfers (resulting in increased costs) play larger roles in drought management. Individualized financial contracts (i.e. designed for a single utility) provide evidence of the potential benefits of financial hedging. However, individualized contracts require substantial time and information to develop, limiting their widespread implementation. More generalized contracts have also shown promise, and would allow the benefits of risk pooling to be more effectively realized, resulting in less expensive contracts. Risk pooling reduces the probability of an insurer making payouts that deviate significantly from the mean, but given that the financial risks of drought are spatially correlated amongst utilities, these more extreme "fat tail" risks remain. Any group offering these hedging contracts, whether a third-party insurer or a "mutual" comprised of many utilities, will need to balance the costs (i.e. additional risk) and benefits (i.e. returns) of alternative approaches to managing the extreme risks (e.g. through insurance layers). The balance of these different approaches will vary depending on the risk pool being considered, including the number, size and exposure of the participating utilities. This work first establishes a baseline of the tradeoffs between risk and expected return in insuring against the financial risks of water scarcity without alternative hedging approaches for water utilities across all climate divisions of the United States. Then various scenarios are analyzed to provide insight into how to maximize returns for risk pooling portfolios at various risk levels through balancing different insurance layers and hedging approaches. This analysis will provide valuable information for designing optimal financial risk management strategies for water utilities across the United States.

Glaucoma and cataract surgery: two roads merging into one.

PubMed

Shah, Manjool; Law, Geoffrey; Ahmed, Iqbal Ike K

2016-01-01

To discuss the increasing utilization of cataract extraction in the management of glaucoma and to highlight advances in surgical care that can promote synergistic treatment of these comorbid conditions. Recent years have demonstrated significant advances in the management of glaucoma through the use of novel microinvasive glaucoma devices. Furthermore, an increased understanding of the role of cataract surgery in the treatment of various glaucomas warrants review. Nevertheless, cataract surgery in the glaucoma patient warrants specific preoperative, intraoperative, and postoperative planning to optimize visual function and quality of life while mitigating potential risk factors for adverse events. Although the challenges of performing cataract extraction on glaucoma patients exist, the potential benefit to these patients is substantial. With attention to pre- and perioperative surgical planning and intraoperative technique, as well as with awareness and potential utilization of novel devices and treatment strategies, cataract extraction offers a unique platform for anatomical and functional improvement in this increasingly common cohort of patients.

Modeling, simulation and control for a cryogenic fluid management facility, preliminary report

NASA Technical Reports Server (NTRS)

Turner, Max A.; Vanbuskirk, P. D.

1986-01-01

The synthesis of a control system for a cryogenic fluid management facility was studied. The severe demand for reliability as well as instrumentation and control unique to the Space Station environment are prime considerations. Realizing that the effective control system depends heavily on quantitative description of the facility dynamics, a methodology for process identification and parameter estimation is postulated. A block diagram of the associated control system is also produced. Finally, an on-line adaptive control strategy is developed utilizing optimization of the velocity form control parameters (proportional gains, integration and derivative time constants) in appropriate difference equations for direct digital control. Of special concern are the communications, software and hardware supporting interaction between the ground and orbital systems. It is visualized that specialist in the OSI/ISO utilizing the Ada programming language will influence further development, testing and validation of the simplistic models presented here for adaptation to the actual flight environment.

Palliative Care in Heart Failure.

PubMed

Sood, Abhinav; Dobbie, Krista; Wilson Tang, W H

2018-04-19

This review illustrates the dynamic role of palliative care in heart failure management and encapsulates the commonly utilized pharmacologic and non-pharmacologic therapeutic strategies for symptom palliation in heart failure. In addition, we provide our experience regarding patient care issues common to the domain of heart failure and palliative medicine which are commonly encountered by heart failure teams. Addition of palliative care to conventional heart failure management plan results in improvement in quality of life, anxiety, depression, and spiritual well-being among patients. Palliative care should not be confused with hospice care. Palliative care teams should be involved early in the care of heart failure patients with the aims of improving symptom palliation, discussing goals of care and improving quality of life without compromising utilization of evidence-based heart failure therapies. A consensus on the appropriate timing of involvement and evidence for many symptom palliation therapies is still emerging.

Low utilization of health care services following screening for hypertension in Dar es Salaam (Tanzania): a prospective population-based study

PubMed Central

Bovet, Pascal; Gervasoni, Jean-Pierre; Mkamba, Mashombo; Balampama, Marianna; Lengeler, Christian; Paccaud, Fred

2008-01-01

Background Drug therapy in high-risk individuals has been advocated as an important strategy to reduce cardiovascular disease in low income countries. We determined, in a low-income urban population, the proportion of persons who utilized health services after having been diagnosed as hypertensive and advised to seek health care for further hypertension management. Methods A population-based survey of 9254 persons aged 25–64 years was conducted in Dar es Salaam. Among the 540 persons with high blood pressure (defined here as BP ≥ 160/95 mmHg) at the initial contact, 253 (47%) had high BP on a 4th visit 45 days later. Among them, 208 were untreated and advised to attend health care in a health center of their choice for further management of their hypertension. One year later, 161 were seen again and asked about their use of health services during the interval. Results Among the 161 hypertensive persons advised to seek health care, 34% reported to have attended a formal health care provider during the 12-month interval (63% public facility; 30% private; 7% both). Antihypertensive treatment was taken by 34% at some point of time (suggesting poor uptake of health services) and 3% at the end of the 12-month follow-up (suggesting poor long-term compliance). Health services utilization tended to be associated with older age, previous history of high BP, being overweight and non-smoking, but not with education or wealth. Lack of symptoms and cost of treatment were the reasons reported most often for not attending health care. Conclusion Low utilization of health services after hypertension screening suggests a small impact of a patient-centered screen-and-treat strategy in this low-income population. These findings emphasize the need to identify and address barriers to health care utilization for non-communicable diseases in this setting and, indirectly, the importance of public health measures for primary prevention of these diseases. PMID:19087300

Advanced Concepts and Controversies in Emergency Department Pain Management.

PubMed

Motov, Sergey M; Nelson, Lewis S

2016-06-01

Pain is the most common complaint for which patients come to the emergency department (ED). Emergency physicians are responsible for pain relief in a timely, efficient, and safe manner in the ED. The improvement in our understanding of the neurobiology of pain has balanced the utilization of nonopioid and opioid analgesia, and simultaneously has led to more rational and safer opioid prescribing practices. This article reviews advances in pain management in the ED for patients with acute and chronic pain as well as describes several newer strategies and controversies. Copyright © 2016 Elsevier Inc. All rights reserved.

Analysis of Managing Safety in Small Enterprises: Dual-Effects of Employee Prosocial Safety Behavior and Government Inspection

PubMed Central

2018-01-01

This paper aims to promote a national and international occupational health and safety (OHS) intervention for small and medium enterprises (SMEs) within internal and external resources. Based on the characteristics of small SME management, the work environment and occupational health may be positively affected by the dual-effects of employees and government. Evolutionary game theory is utilized to identify relevant interactions among the government, small enterprises, and employees. Furthermore, dynamic simulations of the evolutionary game model are used to explore stability strategies and to identify modes of equilibrium. PMID:29707574

Organizational capacity needs of consumer-run organizations.

PubMed

Wituk, Scott; Vu, Chi C; Brown, Louis D; Meissen, Greg

2008-05-01

Consumer-run organizations (CROs) are self-help oriented organizations that are run entirely by consumers (people who use or have used mental health services). The current study utilizes an organizational capacity framework to explore the needs of operating CROs. This framework includes four core capacity areas: (1) technical, (2) management, (3) leadership, and (4) adaptive capacity. An analysis reveals that the greatest organizational needs are related to technical and management capacities. Implications are discussed in terms of strategies and activities that CRO leaders and mental health professionals and administrators can use to strengthen the organizational capacity of CROs in their community.

Inferring Clinical Workflow Efficiency via Electronic Medical Record Utilization

PubMed Central

Chen, You; Xie, Wei; Gunter, Carl A; Liebovitz, David; Mehrotra, Sanjay; Zhang, He; Malin, Bradley

2015-01-01

Complexity in clinical workflows can lead to inefficiency in making diagnoses, ineffectiveness of treatment plans and uninformed management of healthcare organizations (HCOs). Traditional strategies to manage workflow complexity are based on measuring the gaps between workflows defined by HCO administrators and the actual processes followed by staff in the clinic. However, existing methods tend to neglect the influences of EMR systems on the utilization of workflows, which could be leveraged to optimize workflows facilitated through the EMR. In this paper, we introduce a framework to infer clinical workflows through the utilization of an EMR and show how such workflows roughly partition into four types according to their efficiency. Our framework infers workflows at several levels of granularity through data mining technologies. We study four months of EMR event logs from a large medical center, including 16,569 inpatient stays, and illustrate that over approximately 95% of workflows are efficient and that 80% of patients are on such workflows. At the same time, we show that the remaining 5% of workflows may be inefficient due to a variety of factors, such as complex patients. PMID:26958173

Evolution of strategic risks under future scenarios for improved utility master plans.

PubMed

Luís, Ana; Lickorish, Fiona; Pollard, Simon

2016-01-01

Integrated, long-term risk management in the water sector is poorly developed. Whilst scenario planning has been applied to singular issues (e.g. climate change), it often misses a link to risk management because the likelihood of impacts in the long-term are frequently unaccounted for in these analyses. Here we apply the morphological approach to scenario development for a case study utility, Empresa Portuguesa das Águas Livres (EPAL). A baseline portfolio of strategic risks threatening the achievement of EPAL's corporate objectives was evolved through the lens of three future scenarios, 'water scarcity', 'financial resource scarcity' and 'strong economic growth', built on drivers such as climate, demographic, economic, regulatory and technological changes and validated through a set of expert workshops. The results represent how the baseline set of risks might develop over a 30 year period, allowing threats and opportunities to be identified and enabling strategies for master plans to be devised. We believe this to be the first combined use of risk and futures methods applied to a portfolio of strategic risks in the water utility sector. Copyright © 2015 Elsevier Ltd. All rights reserved.

Improving the value of costly genetic reference laboratory testing with active utilization management.

PubMed

Dickerson, Jane A; Cole, Bonnie; Conta, Jessie H; Wellner, Monica; Wallace, Stephanie E; Jack, Rhona M; Rutledge, Joe; Astion, Michael L

2014-01-01

Tests that are performed outside of the ordering institution, send-out tests, represent an area of risk to patients because of complexity associated with sending tests out. Risks related to send-out tests include increased number of handoffs, ordering the wrong or unnecessary test, specimen delays, data entry errors, preventable delays in reporting and acknowledging results, and excess financial liability. Many of the most expensive and most misunderstood tests are send-out genetic tests. To design and develop an active utilization management program to reduce the risk to patients and improve value of genetic send-out tests. Send-out test requests that met defined criteria were reviewed by a rotating team of doctoral-level consultants and a genetic counselor in a pediatric tertiary care center. Two hundred fifty-one cases were reviewed during an 8-month period. After review, nearly one-quarter of genetic test requests were modified in the downward direction, saving a total of 2% of the entire send-out bill and 19% of the test requests under management. Ultimately, these savings were passed on to patients. Implementing an active utilization strategy for expensive send-out tests can be achieved with minimal technical resources and results in improved value of testing to patients.

SWMM5 Application Programming Interface and PySWMM: A ...

EPA Pesticide Factsheets

In support of the OpenWaterAnalytics open source initiative, the PySWMM project encompasses the development of a Python interfacing wrapper to SWMM5 with parallel ongoing development of the USEPA Stormwater Management Model (SWMM5) application programming interface (API). ... The purpose of this work is to increase the utility of the SWMM dll by creating a Toolkit API for accessing its functionality. The utility of the Toolkit is further enhanced with a wrapper to allow access from the Python scripting language. This work is being prosecuted as part of an Open Source development strategy and is being performed by volunteer software developers.

American Recovery and Reinvestment Act of 2009: Final Report on Customer Acceptance, Retention, and Response to Time-Based Rates from Consumer Behavior Studies

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

Cappers, Peter; Scheer, Rich

Time-based rate programs, enabled by utility investments in advanced metering infrastructure (AMI), are increasingly being considered by utilities as tools to reduce peak demand and enable customers to better manage consumption and costs. Under the Smart Grid Investment Grant Program (SGIG), the U.S. Department of Energy (DOE) partnered with several electric utilities to conduct consumer behavior studies (CBS). The goals involved applying randomized and controlled experimental designs for estimating customer responses more precisely and credibly to advance understanding of time-based rates and customer systems, and provide new information for improving program designs, implementation strategies, and evaluations. The intent was tomore » produce more robust and credible analysis of impacts, costs, benefits, and lessons learned and assist utility and regulatory decision makers in evaluating investment opportunities involving time-based rates.« less

Climate Narratives: Combing multiple sources of information to develop risk management strategies for a municipal water utility

NASA Astrophysics Data System (ADS)

Yates, D. N.; Basdekas, L.; Rajagopalan, B.; Stewart, N.

2013-12-01

Municipal water utilities often develop Integrated Water Resource Plans (IWRP), with the goal of providing a reliable, sustainable water supply to customers in a cost-effective manner. Colorado Springs Utilities, a 5-service provider (potable and waste water, solid waste, natural gas and electricity) in Colorado USA, recently undertook an IWRP. where they incorporated water supply, water demand, water quality, infrastructure reliability, environmental protection, and other measures within the context of complex water rights, such as their critically important 'exchange potential'. The IWRP noted that an uncertain climate was one of the greatest sources of uncertainty to achieving a sustainable water supply to a growing community of users. We describe how historic drought, paleo-climate, and climate change projections were blended together into climate narratives that informed a suite of water resource systems models used by the utility to explore the vulnerabilities of their water systems.

Challenges and Strength of Current Industrial Energy Efficiency Management Practices in Steam Industries

NASA Astrophysics Data System (ADS)

Nkosi, S. B.; Pretorius, J. H. C.

2017-07-01

The aim of this study is to achieve greater output by examining the existing way of coordinating the determined attempts of Steam Industries in South Africa to successfully reach a sustainable industrial development by using energy source adequately in a more competent way. Furthermore into the study we look at obstacles that prevent and those that leads to maximum utilization of energy management measures and also highlights the effects of implementing cheap available energy source in South Africa. The investigation and analysis have shown that energy is not well managed in Steam Industries and that the use of energy is minimized and not fully utilized due to poor management and lack of knowledge. Another detection was that lack of government structured and strategic measures of implementing and motivating the use of energy effectively. The effective and rational use of available power by Steam Industries in South Africa is a key player in developing a sustainable industrial development. The use of energy efficiency management strategies has contributed an increase in economic and improve environmentally friendly in the industrial sector. The slow pace adoption of energy saving and cost effective management programmes are negatively impacting on the benefits to Steam Industries in South Africa. In conclusion the study finds that the economy can be boosted by implementing energy efficiency management programmes and environmentally friendly. These will also stabilize the negative impact of energy raising prices.

Evapotranspiration management based on the application of SWAT for balancing water consumption: A case study in Guantao, China

NASA Astrophysics Data System (ADS)

Liu, Bin; Gan, Hong

2018-06-01

Rapid social and economic development results in increased demand for water resources. This can lead to the unsustainable development and exploitation of water resources which in turn causes significant environmental problems. Conventional water resource management approaches, such as supply and demand management strategies, frequently fail to restore regional water balance. This paper introduces the concept of water consumption balance, the balance between actual evapotranspiration (ET) and target ET, and establishes a framework to realize regional water balance. The framework consists of three stages: (1) determination of target ET and actual ET; (2) quantification of the water-saving requirements for the region; and (3) reduction of actual ET by implementing various water saving management strategies. Using this framework, a case study was conducted for Guantao County, China. The SWAT model was utilized to aid in the selection of the best water saving management strategy by comparing the ET of different irrigation methods and crop pattern adjustments. Simulation results revealed that determination of SWAT model parameters using remote sensing ET is feasible and that the model is a valuable tool for ET management. Irrigation was found to have a greater influence on the ET of winter wheat as compared to that of maize, indicating that reduction in winter wheat cultivation is the most effective way to reduce regional ET. However, the effect of water-saving irrigation methods on the reduction of ET was not obvious. This indicates that it would be difficult to achieve regional ET reduction using water-saving irrigation methods only. Furthermore, selecting the best water saving management strategy by relying solely on the amount of reduced ET was insufficient, because it ignored the impact of water conservation measures on the livelihood of the agricultural community. Incorporating these considerations with our findings, we recommend changing the current irrigation method to sprinkler irrigation and replacing 20% of the winter wheat-maize cultivated area with cotton, as the best strategy to achieve water balance in the study area.

Temporomandibular disorders. Part 2: conservative management

PubMed Central

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

2014-01-01

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

Assessing the Utility of Work Team Theory in a Unified Command Environment at Catastrophic Incidents

DTIC Science & Technology

2005-03-01

between agencies that potentially affects command post (CP) interactions . All of the foregoing factors contribute to a turbulent management environment...requiring special strategy consideration with and IMT preparation. “Conflict refers to a process of social interaction involving a struggle over...from interactions . These schemas can be grouped as cultural norms perpetuated generationally from seasoned officers to raw recruits, and shared by

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

Trujillo, Angelina Michelle

Strategy, Planning, Acquiring- very large scale computing platforms come and go and planning for immensely scalable machines often precedes actual procurement by 3 years. Procurement can be another year or more. Integration- After Acquisition, machines must be integrated into the computing environments at LANL. Connection to scalable storage via large scale storage networking, assuring correct and secure operations. Management and Utilization – Ongoing operations, maintenance, and trouble shooting of the hardware and systems software at massive scale is required.

'Renewables-Friendly' Grid Development Strategies: Experience in the United States, Potential Lessons for China (Chinese Translation) (in Chinese)

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

Hurlbut, David; Zhou, Ella; Porter, Kevin

2015-10-03

This is a Chinese translation of NREL/TP-6A20-64940. This report aims to help China's reform effort by providing a concise summary of experience in the United States with 'renewables-friendly' grid management, focusing on experiences that might be applicable to China. It focuses on utility-scale renewables and sets aside issues related to distributed generation.

Working Sandwich Generation Women Utilize Strategies within and between Roles to Achieve Role Balance

PubMed Central

Girdler, Sonya J.

2016-01-01

Increasingly, women simultaneously balance the roles of mother, parental carer and worker. However, individual role balance strategies among these working ‘sandwich’ generation women have not been thoroughly explored. Eighteen women combining these three roles were interviewed about their individual role balance strategies. Findings were identified through the framework analysis technique, underpinned by the Model of Juggling Occupations. Achieving and maintaining role balance was explained as a complex process accomplished through a range of strategies. Findings revealed the women used six within-role balance strategies: living with integrity, being the best you can, doing what you love, loving what you do, remembering why and searching for signs of success. The women also described six between-role balance strategies: maintaining health and wellbeing, repressing perfectionism, managing time and energy, releasing responsibility, nurturing social connection and reciprocating. These findings provide a basis for health care providers to understand and potentially support working ‘sandwich’ generation women. PMID:27305074

Practical strategies for developing the business case for hospital glycemic control teams.

PubMed

Magee, Michelle F; Beck, Adam

2008-09-01

Many business models may be used to make the business case for support of a multidisciplinary team to implement targeted glucose control in the hospital. Models may be hospital-supported or self-supporting. In the former, the hospital provides financial support based on improved documentation opportunities, reduction in length of stay, and improved resource utilization. In the latter, clinical revenues for diabetes management offsets costs of salary, fringe benefits, and overheads. A combination of these strategies may also be used. The business plan presented to administration must justify return on investment. It is imperative to involve hospital administration, particularly representatives from coding, billing, and finance, in the development of the business plan. The business case for hospital support will be based on opportunities related to improving accuracy of documentation and coding for diabetes-related diagnoses, including level of control and complications present, on reduction in length of stay and on optimization of resource utilization through reduction in morbidity and mortality (cost aversion). The case for revenue generation through billing for clinical services will be based on opportunities to increase the provision of glycemic management services in the hospital. Examples from the literature and of analyses to support each of these models are presented. (c) 2008 Society of Hospital Medicine.

Integrating Hydrologic and Water Quality Models as a Decision Support Tool for Implementation of Low Impact Development in a Coastal Urban Watershed under Climate Variability and Sea Level Rise

NASA Astrophysics Data System (ADS)

Chang, N. B.

2016-12-01

Many countries concern about development and redevelopment efforts in urban regions to reduce the flood risk by considering hazards such as high-tide events, storm surge, flash floods, stormwater runoff, and impacts of sea level rise. Combining these present and future hazards with vulnerable characteristics found throughout coastal communities such as majority low-lying areas and increasing urban development, create scenarios for increasing exposure of flood hazard. As such, the most vulnerable areas require adaptation strategies and mitigation actions for flood hazard management. In addition, in the U.S., Numeric Nutrient Criteria (NNC) are a critical tool for protecting and restoring the designated uses of a waterbody with regard to nitrogen and phosphorus pollution. Strategies such as low impact development (LID) have been promoted in recent years as an alternative to traditional stormwater management and drainage to control both flooding and water quality impact. LID utilizes decentralized multifunctional site designs and incorporates on-site storm water management practices rather than conventional storm water management approaches that divert flow toward centralized facilities. How to integrate hydrologic and water quality models to achieve the decision support becomes a challenge. The Cross Bayou Watershed of Pinellas County in Tampa Bay, a highly urbanized coastal watershed, is utilized as a case study due to its sensitivity to flood hazards and water quality management within the watershed. This study will aid the County, as a decision maker, to implement its stormwater management policy and honor recent NNC state policy via demonstration of an integrated hydrologic and water quality model, including the Interconnected Channel and Pond Routing Model v.4 (ICPR4) and the BMPTRAIN model as a decision support tool. The ICPR4 can be further coupled with the ADCIRC/SWAN model to reflect the storm surge and seal level rise in coastal regions.

Data quality and processing for decision making: divergence between corporate strategy and manufacturing processes

NASA Astrophysics Data System (ADS)

McNeil, Ronald D.; Miele, Renato; Shaul, Dennis

2000-10-01

Information technology is driving improvements in manufacturing systems. Results are higher productivity and quality. However, corporate strategy is driven by a number of factors and includes data and pressure from multiple stakeholders, which includes employees, managers, executives, stockholders, boards, suppliers and customers. It is also driven by information about competitors and emerging technology. Much information is based on processing of data and the resulting biases of the processors. Thus, stakeholders can base inputs on faulty perceptions, which are not reality based. Prior to processing, data used may be inaccurate. Sources of data and information may include demographic reports, statistical analyses, intelligence reports (e.g., marketing data), technology and primary data collection. The reliability and validity of data as well as the management of sources and information is critical element to strategy formulation. The paper explores data collection, processing and analyses from secondary and primary sources, information generation and report presentation for strategy formulation and contrast this with data and information utilized to drive internal process such as manufacturing. The hypothesis is that internal process, such as manufacturing, are subordinate to corporate strategies. The impact of possible divergence in quality of decisions at the corporate level on IT driven, quality-manufacturing processes based on measurable outcomes is significant. Recommendations for IT improvements at the corporate strategy level are given.

Dynamic Voltage Frequency Scaling Simulator for Real Workflows Energy-Aware Management in Green Cloud Computing

PubMed Central

Cotes-Ruiz, Iván Tomás; Prado, Rocío P.; García-Galán, Sebastián; Muñoz-Expósito, José Enrique; Ruiz-Reyes, Nicolás

2017-01-01

Nowadays, the growing computational capabilities of Cloud systems rely on the reduction of the consumed power of their data centers to make them sustainable and economically profitable. The efficient management of computing resources is at the heart of any energy-aware data center and of special relevance is the adaptation of its performance to workload. Intensive computing applications in diverse areas of science generate complex workload called workflows, whose successful management in terms of energy saving is still at its beginning. WorkflowSim is currently one of the most advanced simulators for research on workflows processing, offering advanced features such as task clustering and failure policies. In this work, an expected power-aware extension of WorkflowSim is presented. This new tool integrates a power model based on a computing-plus-communication design to allow the optimization of new management strategies in energy saving considering computing, reconfiguration and networks costs as well as quality of service, and it incorporates the preeminent strategy for on host energy saving: Dynamic Voltage Frequency Scaling (DVFS). The simulator is designed to be consistent in different real scenarios and to include a wide repertory of DVFS governors. Results showing the validity of the simulator in terms of resources utilization, frequency and voltage scaling, power, energy and time saving are presented. Also, results achieved by the intra-host DVFS strategy with different governors are compared to those of the data center using a recent and successful DVFS-based inter-host scheduling strategy as overlapped mechanism to the DVFS intra-host technique. PMID:28085932

Dynamic Voltage Frequency Scaling Simulator for Real Workflows Energy-Aware Management in Green Cloud Computing.

PubMed

Cotes-Ruiz, Iván Tomás; Prado, Rocío P; García-Galán, Sebastián; Muñoz-Expósito, José Enrique; Ruiz-Reyes, Nicolás

2017-01-01

Nowadays, the growing computational capabilities of Cloud systems rely on the reduction of the consumed power of their data centers to make them sustainable and economically profitable. The efficient management of computing resources is at the heart of any energy-aware data center and of special relevance is the adaptation of its performance to workload. Intensive computing applications in diverse areas of science generate complex workload called workflows, whose successful management in terms of energy saving is still at its beginning. WorkflowSim is currently one of the most advanced simulators for research on workflows processing, offering advanced features such as task clustering and failure policies. In this work, an expected power-aware extension of WorkflowSim is presented. This new tool integrates a power model based on a computing-plus-communication design to allow the optimization of new management strategies in energy saving considering computing, reconfiguration and networks costs as well as quality of service, and it incorporates the preeminent strategy for on host energy saving: Dynamic Voltage Frequency Scaling (DVFS). The simulator is designed to be consistent in different real scenarios and to include a wide repertory of DVFS governors. Results showing the validity of the simulator in terms of resources utilization, frequency and voltage scaling, power, energy and time saving are presented. Also, results achieved by the intra-host DVFS strategy with different governors are compared to those of the data center using a recent and successful DVFS-based inter-host scheduling strategy as overlapped mechanism to the DVFS intra-host technique.

Adverse Drug Events in Children: How Big is the Problem?

PubMed

Zed, Peter J

2015-01-01

Adverse drug events in children is an under appreciated but significant cause of health care contact resulting in ED visits and hospital admissions with associated resource utilization. In recent years we have started to better understand the impact of ADEs in children but there remains significant questions that must be addressed to further improve our understanding of the etiology of these ADEs and strategies for prevention and management. This paper will describe what is known regarding the frequency, severity, preventability and classification of ADEs in children. It will also describe some of the challenges and unanswered questions regarding patient, drug and system factors, which contribute to ADEs in children. Finally, areas of future research will be identified to further improve our understanding of ADEs in children to inform prevention strategies as well as early recognition and management approaches to minimize the significant ADEs can have on children, families and our health care system.

Denial and Acceptance Coping Styles and Medication Adherence in Schizophrenia

PubMed Central

Aldebot, Stephanie; Weisman de Mamani, Amy G.

2009-01-01

Antipsychotics are often the first line of treatment for individuals with schizophrenia (Fialko et al., 2008). One challenge to effective treatment is lack of adherence to prescribed medication. Lower rates of adherence are associated with considerably higher rates of relapse and poorer course of illness. Therefore studying characteristics that may be related to medication adherence is important. Coping styles may be one such factor. Individuals utilize a variety of coping mechanisms to manage and navigate difficult life events, including mental illness (Cooke et al., 2007). In the present study, forty individuals with schizophrenia were assessed regarding their coping styles and medication adherence practices. As hypothesized, it was found that denial coping was inversely related to medication adherence. However, contrary to expectations, acceptance coping was not related to medication adherence. These findings suggest that targeting denial coping strategies in treatment may help foster more optimal strategies for managing schizophrenia. PMID:19684494

Integrated vector management: the Zambian experience.

PubMed

Chanda, Emmanuel; Masaninga, Fred; Coleman, Michael; Sikaala, Chadwick; Katebe, Cecilia; Macdonald, Michael; Baboo, Kumar S; Govere, John; Manga, Lucien

2008-08-27

The Zambian Malaria Control Programme with the Roll Back Malaria (RBM) partners have developed the current National Malaria Strategic Plan (NMSP 2006-2011) which focuses on prevention based on the Integrated Vector Management (IVM) strategy. The introduction and implementation of an IVM strategy was planned in accordance with the World Health Organization (WHO) steps towards IVM implementation namely Introduction Phase, Consolidation Phase and Expansion Phase. IVM has created commitment for Legal and Regulatory policy review, monitoring, Research and a strong stewardship by the chemical suppliers. It has also leveraged additional resources, improved inter-sectoral collaboration, capacity building and enhanced community participation which facilitated a steady scaling up in coverage and utilisation of key preventive interventions. Thus, markedly reducing malaria incidence and case fatalities in the country. Zambia has successfully introduced, consolidated and expanded IVM activities. Resulting in increased coverage and utilization of interventions and markedly reducing malaria-related morbidity and mortality while ensuring a better protection of the environment.

Build infrastructure in publishing scientific journals to benefit medical scientists

PubMed Central

Dai, Ni; Xu, Dingyao; Zhong, Xiyao; Li, Li; Ling, Qibo

2014-01-01

There is urgent need for medical journals to optimize their publishing processes and strategies to satisfy the huge need for medical scientists to publish their articles, and then obtain better prestige and impact in scientific and research community. These strategies include optimizing the process of peer-review, utilizing open-access publishing models actively, finding ways of saving costs and getting revenue, smartly dealing with research fraud or misconduct, maintaining sound relationship with pharmaceutical companies, and managing to provide relevant and useful information for clinical practitioners and researchers. Scientists, publishers, societies and organizations need to work together to publish internationally renowned medical journals. PMID:24653634

Build infrastructure in publishing scientific journals to benefit medical scientists.

PubMed

Dai, Ni; Xu, Dingyao; Zhong, Xiyao; Li, Li; Ling, Qibo; Bu, Zhaode

2014-02-01

There is urgent need for medical journals to optimize their publishing processes and strategies to satisfy the huge need for medical scientists to publish their articles, and then obtain better prestige and impact in scientific and research community. These strategies include optimizing the process of peer-review, utilizing open-access publishing models actively, finding ways of saving costs and getting revenue, smartly dealing with research fraud or misconduct, maintaining sound relationship with pharmaceutical companies, and managing to provide relevant and useful information for clinical practitioners and researchers. Scientists, publishers, societies and organizations need to work together to publish internationally renowned medical journals.

Enhancing marketing recruitment strategies: administrator tenure and nursing expenditures.

PubMed

Gunby, Norris White

2005-01-01

When recruiting nurses, long-term care facilities require an ability to identify salient organizational characteristics that are attractive to potential nursing services candidates vis-à-vis their competitors. The findings of this study suggest that information on administrative tenure can be utilized to attract applicants by appealing to criteria within their high-involvement job search activities. High-involvement applicants proactively seek recruitment content that provides essential job attributes that match their needs and skills and are more apt to be a higher quality candidate. Based upon the study's findings, managers are offered marketing strategy recommendations for tailoring recruiting messages that appeal to high-involvement job seekers.

A conceptual framework for addressing complexity and unfolding transition dynamics when developing sustainable adaptation strategies in urban water management.

PubMed

Fratini, C F; Elle, M; Jensen, M B; Mikkelsen, P S

2012-01-01

To achieve a successful and sustainable adaptation to climate change we need to transform the way we think about change. Much water management research has focused on technical innovation with a range of new solutions developed to achieve a 'more sustainable and integrated urban water management cycle'. But Danish municipalities and utility companies are struggling to bring such solutions into practice. 'Green infrastructure', for example, requires the consideration of a larger range of aspects related to the urban context than the traditional urban water system optimization. There is the need for standardized methods and guidelines to organize transdisciplinary processes where different types of knowledge and perspectives are taken into account. On the basis of the macro-meso-micro pattern inspired by complexity science and transition theory, we developed a conceptual framework to organize processes addressing the complexity characterizing urban water management in the context of climate change. In this paper the framework is used to organize a research process aiming at understanding and unfolding urban dynamics for sustainable transition. The final goal is to enable local authorities and utilities to create the basis for managing and catalysing the technical and organizational innovation necessary for a sustainable transition towards climate change adaptation in urban areas.

The demographics and costs of inpatient vesicoureteral reflux management in the USA.

PubMed

Spencer, John David; Schwaderer, Andrew; McHugh, Kirk; Vanderbrink, Brian; Becknell, Brian; Hains, David S

2011-11-01

This study evaluates the impact of vesicoureteral reflux (VUR) on the economy and inpatient healthcare utilization in the USA. A retrospective analysis was performed on children ≤ 18 years of age, hospitalized with the principal discharge diagnosis of VUR between 2000 and 2006, using the Healthcare Cost and Utilization Project Kids' Inpatient Database. The results are stratified as follows. First, by hospitalizations: between 2000 and 2006, 6,655  ±  720 (standard error) children/year were hospitalized with VUR. Since 2003, both the length of each hospitalization and the number of hospitalizations have decreased. Second, by related procedures/diagnoses: ureteral reimplantation was the most common procedure, accounting for 89% of hospitalizations. Congenital genitourinary anomalies, disorders of the kidney/ureter/bladder, and urinary tract infections (UTI) were the most common related diagnoses. Thirdly, by hospital economics: since 2000, hospital charges for VUR increased despite decreased lengths of hospitalization. By 2006, hospital charges rose to $18,798/hospitalization, and aggregate national charges exceeded $100 million. Our results indicate that fewer children with VUR are requiring inpatient management. Children with VUR are often hospitalized for ureteral reimplantation or the management of related diagnoses. Since 2000, hospital charges for inpatient VUR management have increased. More efforts are needed to evaluate cost-effective strategies for the evaluation and management of VUR.

Rejection of an innovation: health information management training materials in east Africa.

PubMed

Gladwin, J; Dixon, R A; Wilson, T D

2002-12-01

A shift towards decentralization in many low-income countries has meant more skills are demanded of primary health care managers, including data and information handling at all levels of the health care system. Ministries of Health are changing their central reporting health information systems to health management information systems with emphasis on managers utilizing information at the point of collection. This paper reports on a research study to investigate the introduction of new information management strategies intended to promote an informational approach to management at the operational health service level in low-income countries. It aims to understand the process taking place when externally developed training materials (PHC MAP), which are intended to strengthen health management information systems, are introduced to potential users in an east African country. A case study has been undertaken and this research has demonstrated that the dynamic equilibrium approach to organizational change is applicable to the introduction of new information management strategies and management approaches in low-income countries. Although PHC MAP developers envisaged a technical innovation needing implementation, potential users saw the situation as one of organizational change. Contributions to theory have been made and many implications for introducing new information systems or the informational approach to management are identified. This theoretical framework could also facilitate the introduction of future information management innovations and would allow practitioners to perceive the introduction of information management innovations as one of organizational change that needs to be managed. Consequently, issues that may facilitate or inhibit adoption could be identified in advance.

Evaluation of synergistic effects of resynchronization therapy and a β-blocker up-titration strategy based on a predefined patient-management program: the RESTORE study.

PubMed

Palmisano, Pietro; Ammendola, Ernesto; D'Onofrio, Antonio; Accogli, Michele; Calò, Leonardo; Ruocco, Antonio; Rapacciuolo, Antonio; Del Giorno, Giuseppe; Bianchi, Valter; Malacrida, Maurizio; Valsecchi, Sergio; Gronda, Edoardo

2015-01-01

Prior studies have suggested that a substantial number of eligible heart failure (HF) patients fail to receive β-blocker therapy, or receive it at a suboptimal dose. The aim of this study is to assess the benefit of a predefined management program designed for β-blocker up-titration, evaluating the synergistic effect of cardiac resynchronization therapy (CRT) and β-blockers in a HF population. The Resynchronization Therapy and β-Blocker Titration (RESTORE) study is a prospective, case-control, multicenter cohort study designed to test the hypothesis that a β-blocker up-titration strategy based on a predefined management program maximizes the beneficial effect of CRT, increasing the number of patients reaching the target dose of β-blockers and improving their clinical outcome. All study patients receive an implantable defibrillator for CRT delivery in accordance with current guidelines. Enrollments started in December 2011 and are scheduled to end in December 2014. Approximately 250 consecutive patients will be prospectively enrolled in 6 Italian centers and followed up for 24 months after implantation. The primary endpoint is to demonstrate that CRT may allow titration of β-blockers until the optimal dose, or at least to the effective dose, in patients with HF. This study might provide important information about the benefit of a predefined management program for β-blocker up-titration in patients receiving CRT. Moreover, assessment of health-care utilization and the consumption of resources will allow estimating the potential utility of remote monitoring by means of an automated telemedicine system in facilitating the titration of β-blockers in comparison with a standard in-hospital approach. © 2015 Wiley Periodicals, Inc.

Ecological and Economic Aspects of the Application of Sewage Sludge in Energetic Plant Plantations - A Swot Analysis

NASA Astrophysics Data System (ADS)

Wójcik, Marta; Stachowicz, Feliks; Masłoń, Adam

2017-12-01

Sewage sludge management in Poland is a relatively new field of waste management called "in statu nascendi", the standards of which have not been recognized yet. It also requires the implementation of new solutions in the field of sewage sludge. So far, the most popular method of sewage sludge utilization has been landfill disposal. In line with the restriction placed on landfill waste with a calorific value above 6 MJ/kg introduced on 1 January 2016, agricultural use and thermal methods are particularly applied. Municipal sewage sludge may be successfully used in the cultivation of energetic plant plantations. The aforementioned waste could be treated as an alternative to traditional mineral fertilizers, which in turn might successfully provide valuable nutrients for plants. This paper illustrates the SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) associated with the use of sewage sludge from Świlcza-Kamyszyn WTTP (Podkarpackie Province, Poland) for agricultural purposes. This analysis could be useful in evaluating the utility of sewage sludge in perennial plant plantations in order to determine the appropriate waste management strategies.

Architecture for Integrated Medical Model Dynamic Probabilistic Risk Assessment

NASA Technical Reports Server (NTRS)

Jaworske, D. A.; Myers, J. G.; Goodenow, D.; Young, M.; Arellano, J. D.

2016-01-01

Probabilistic Risk Assessment (PRA) is a modeling tool used to predict potential outcomes of a complex system based on a statistical understanding of many initiating events. Utilizing a Monte Carlo method, thousands of instances of the model are considered and outcomes are collected. PRA is considered static, utilizing probabilities alone to calculate outcomes. Dynamic Probabilistic Risk Assessment (dPRA) is an advanced concept where modeling predicts the outcomes of a complex system based not only on the probabilities of many initiating events, but also on a progression of dependencies brought about by progressing down a time line. Events are placed in a single time line, adding each event to a queue, as managed by a planner. Progression down the time line is guided by rules, as managed by a scheduler. The recently developed Integrated Medical Model (IMM) summarizes astronaut health as governed by the probabilities of medical events and mitigation strategies. Managing the software architecture process provides a systematic means of creating, documenting, and communicating a software design early in the development process. The software architecture process begins with establishing requirements and the design is then derived from the requirements.

Integrated Electronic Health Record Database Management System: A Proposal.

PubMed

Schiza, Eirini C; Panos, George; David, Christiana; Petkov, Nicolai; Schizas, Christos N

2015-01-01

eHealth has attained significant importance as a new mechanism for health management and medical practice. However, the technological growth of eHealth is still limited by technical expertise needed to develop appropriate products. Researchers are constantly in a process of developing and testing new software for building and handling Clinical Medical Records, being renamed to Electronic Health Record (EHR) systems; EHRs take full advantage of the technological developments and at the same time provide increased diagnostic and treatment capabilities to doctors. A step to be considered for facilitating this aim is to involve more actively the doctor in building the fundamental steps for creating the EHR system and database. A global clinical patient record database management system can be electronically created by simulating real life medical practice health record taking and utilizing, analyzing the recorded parameters. This proposed approach demonstrates the effective implementation of a universal classic medical record in electronic form, a procedure by which, clinicians are led to utilize algorithms and intelligent systems for their differential diagnosis, final diagnosis and treatment strategies.

Tools and Strategies for Product Life Cycle Management ñ A Case Study in Foundry

NASA Astrophysics Data System (ADS)

Patil, Rajashekar; Kumar, S. Mohan; Abhilash, E.

2012-08-01

Advances in information and communication technology (ICT) have opened new possibilities of collaborations among the customers, suppliers, manufactures and partners to effectively tackle various business challenges. Product Life Cycle Management(PLM) has been a proven approach for Original Equipment Manufacturers (OEMs) to increase their productivity, improve their product quality, speed up delivery, and increase their profit and to become more efficient. However, their Tier 2 and Tier 3 suppliers like foundry industries are still in their infancy without adopting PLM. Hence to enhance their understanding, the basic concepts, the tools and strategies for PLM are presented is this paper. By selecting and implementing appropriate PLM strategies in a small foundry, an attempt was also made to understand the immediate benefits of using PLM tools (commercial PLM software and digital manufacturing tools). This study indicated a reduction in lead time and improved utilization of organizational resources in the production of automobile impeller. These observations may be further extrapolated to other multiproduct, multi-discipline and multi-customer companies to realize the advantages of using PLM technology

Barriers and Opportunities to Broader Adoption of Integrated Demand Side Management at Electric Utilities: A Scoping Study

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

Potter, Jennifer; Stuart, Elizabeth; Cappers, P

Integrated demand-side management (IDSM) is a strategic approach to designing and delivering a portfolio of demand side management (DSM) programs to customers. IDSM typically delivers customer centric strategies with the goal of increasing the amount of DSM in the field, but doing so in a way that integrates various measures and technologies to improve their collective performance and/or penetration. Specifically, IDSM can be defined as the integrated or coordinated delivery of three or more of: (1) energy efficiency (EE), (2) demand response (DR), (3) distributed generation (DG), (4) storage, (5) electric vehicle (EV) technologies, and (6) time-based rate programs tomore » residential and commercial electric utility customers. The electric industry’s limited experience deploying IDSM to date suggests that significant barriers may exist. A Berkeley Lab report “Barriers and Opportunities to Broader Adoption of Integrated Demand Side Management at Electric Utilities: A Scoping Study” explores recent electric utility experience with IDSM to provide an assessment of the barriers and potential benefits perceived or experienced by program administrators in their attempts to implement integrated programs. The research draws on surveys and interviews with eleven staff from a sample of eight DSM program administrators and program implementers who were currently implementing or had previously attempted to implement an IDSM program or initiative. Respondents provided their perspectives on drivers for IDSM and barriers to broader deployment. They also reported on actions they had undertaken to promote expanded delivery of IDSM and provided their assessments of the most important under-tapped opportunities for expanding IDSM efforts, both for program administrator and regulatory organizations.« less

Exploring the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups.

PubMed

Whitehurst, David G T; Bryan, Stirling; Lewis, Martyn; Hill, Jonathan; Hay, Elaine M

2012-11-01

Stratified management for low back pain according to patients' prognosis and matched care pathways has been shown to be an effective treatment approach in primary care. The aim of this within-trial study was to determine the economic implications of providing such an intervention, compared with non-stratified current best practice, within specific risk-defined subgroups (low-risk, medium-risk and high-risk). Within a cost-utility framework, the base-case analysis estimated the incremental healthcare cost per additional quality-adjusted life year (QALY), using the EQ-5D to generate QALYs, for each risk-defined subgroup. Uncertainty was explored with cost-utility planes and acceptability curves. Sensitivity analyses were performed to consider alternative costing methodologies, including the assessment of societal loss relating to work absence and the incorporation of generic (ie, non-back pain) healthcare utilisation. The stratified management approach was a cost-effective treatment strategy compared with current best practice within each risk-defined subgroup, exhibiting dominance (greater benefit and lower costs) for medium-risk patients and acceptable incremental cost to utility ratios for low-risk and high-risk patients. The likelihood that stratified care provides a cost-effective use of resources exceeds 90% at willingness-to-pay thresholds of £4000 (≈ 4500; $6500) per additional QALY for the medium-risk and high-risk groups. Patients receiving stratified care also reported fewer back pain-related days off work in all three subgroups. Compared with current best practice, stratified primary care management for low back pain provides a highly cost-effective use of resources across all risk-defined subgroups.

Disease management, coping, and functional disability in pediatric sickle cell disease.

PubMed

Oliver-Carpenter, Gloria; Barach, Ilana; Crosby, Lori E; Valenzuela, Jessica; Mitchell, Monica J

2011-02-01

Youth with sickle cell disease (SCD) experience chronic symptoms that significantly interfere with physical, academic, and social-emotional functioning. Thus, to effectively manage SCD, youth and caregivers must work collaboratively to ensure optimal functioning. The goal of the current study was to examine the level of involvement in disease management tasks for youth with SCD and their caregivers. The study also examined the relationship between involvement in disease management tasks, daily functioning, and coping skills. The study utilized collaborative care and disease management theoretical frameworks. Youth and caregivers participated in the study during an annual research and education day event. Forty-seven patients with SCD aged 6 to 18 years and their caregivers completed questionnaires examining level of involvement in disease management tasks, youth functional disability, and youth coping strategies. Caregivers also completed a demographic and medical history form. Parents and youth agreed that parents were significantly more involved in disease management tasks than youth, although level of involvement varied by task. Decreased parent involvement was related to greater coping strategies used by patients, including massage, prayer, and positive thinking. Higher functional disability (lower functioning) was related to greater parent involvement in disease management tasks, suggesting that greater impairment may encourage increased parent involvement. Health professionals working with families of youth with SCD should discuss with parents and youth how disease management tasks and roles will be shared and transferred during adolescence. Parents and youth may also benefit from a discussion of these issues within their own families.

Multi-model groundwater-management optimization: reconciling disparate conceptual models

NASA Astrophysics Data System (ADS)

Timani, Bassel; Peralta, Richard

2015-09-01

Disagreement among policymakers often involves policy issues and differences between the decision makers' implicit utility functions. Significant disagreement can also exist concerning conceptual models of the physical system. Disagreement on the validity of a single simulation model delays discussion on policy issues and prevents the adoption of consensus management strategies. For such a contentious situation, the proposed multi-conceptual model optimization (MCMO) can help stakeholders reach a compromise strategy. MCMO computes mathematically optimal strategies that simultaneously satisfy analogous constraints and bounds in multiple numerical models that differ in boundary conditions, hydrogeologic stratigraphy, and discretization. Shadow prices and trade-offs guide the process of refining the first MCMO-developed `multi-model strategy into a realistic compromise management strategy. By employing automated cycling, MCMO is practical for linear and nonlinear aquifer systems. In this reconnaissance study, MCMO application to the multilayer Cache Valley (Utah and Idaho, USA) river-aquifer system employs two simulation models with analogous background conditions but different vertical discretization and boundary conditions. The objective is to maximize additional safe pumping (beyond current pumping), subject to constraints on groundwater head and seepage from the aquifer to surface waters. MCMO application reveals that in order to protect the local ecosystem, increased groundwater pumping can satisfy only 40 % of projected water demand increase. To explore the possibility of increasing that pumping while protecting the ecosystem, MCMO clearly identifies localities requiring additional field data. MCMO is applicable to other areas and optimization problems than used here. Steps to prepare comparable sub-models for MCMO use are area-dependent.

Improving Population Health Management Strategies: Identifying Patients Who Are More Likely to Be Users of Avoidable Costly Care and Those More Likely to Develop a New Chronic Disease.

PubMed

Hibbard, Judith H; Greene, Jessica; Sacks, Rebecca M; Overton, Valerie; Parrotta, Carmen

2017-08-01

To explore using the Patient Activation Measure (PAM) for identifying patients more likely to have ambulatory care-sensitive (ACS) utilization and future increases in chronic disease. Secondary data are extracted from the electronic health record of a large accountable care organization. This is a retrospective cohort design. The key predictor variable, PAM score, is measured in 2011, and is used to predict outcomes in 2012-2014. Outcomes include ACS utilization and the likelihood of a new chronic disease. Our sample of 98,142 adult patients was drawn from primary care clinic users. To be included, patients had to have a PAM score in 2011 and at least one clinic visit in each of the three subsequent years. PAM level is a significant predictor of ACS utilization. Less activated patients had significantly higher odds of ACS utilization compared to those with high PAM scores. Similarly, patients with low PAM scores were more likely to have a new chronic disease diagnosis over each of the years of observation. Assessing patient activation may help to identify patients who could benefit from greater support. Such an approach may help ACOs reach population health management goals. © Health Research and Educational Trust.

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

Eto, Joe; Eto, Joe; Lesieutre, Bernard

The increased need to manage California?s electricity grid in real time is a result of the ongoing transition from a system operated by vertically-integrated utilities serving native loads to one operated by an independent system operator supporting competitive energy markets. During this transition period, the traditional approach to reliability management -- construction of new transmission lines -- has not been pursued due to unresolved issues related to the financing and recovery of transmission project costs. In the absence of investments in new transmission infrastructure, the best strategy for managing reliability is to equip system operators with better real-time information aboutmore » actual operating margins so that they can better understand and manage the risk of operating closer to the edge. A companion strategy is to address known deficiencies in offline modeling tools that are needed to ground the use of improved real-time tools. This project: (1) developed and conducted first-ever demonstrations of two prototype real-time software tools for voltage security assessment and phasor monitoring; and (2) prepared a scoping study on improving load and generator response models. Additional funding through two separate subsequent work authorizations has already been provided to build upon the work initiated in this project.« less

Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice.

PubMed

Slemon, Allie; Jenkins, Emily; Bungay, Vicky

2017-10-01

The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self-harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re-centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re-evaluating the risk management culture that gives rise to and legitimizes harmful practices. © 2017 The Authors Nursing Inquiry published by John Wiley & Sons Ltd.

Analysis on the adaptive countermeasures to ecological management under changing environment in the Tarim River Basin, China

NASA Astrophysics Data System (ADS)

Yang, Fan; Xue, Lianqing; Zhang, Luochen; Chen, Xinfang; Chi, Yixia

2017-12-01

This article aims to explore the adaptive utilization strategies of flow regime versus traditional practices in the context of climate change and human activities in the arid area. The study presents quantitative analysis of climatic and anthropogenic factors to streamflow alteration in the Tarim River Basin (TRB) using the Budyko method and adaptive utilization strategies to eco-hydrological regime by comparing the applicability between autoregressive moving average model (ARMA) model and combined regression model. Our results suggest that human activities played a dominant role in streamflow deduction in the mainstream with contribution of 120.7%~190.1%. While in the headstreams, climatic variables were the primary determinant of streamflow by 56.5~152.6% of the increase. The comparison revealed that combined regression model performed better than ARMA model with the qualified rate of 80.49~90.24%. Based on the forecasts of streamflow for different purposes, the adaptive utilization scheme of water flow is established from the perspective of time and space. Our study presents an effective water resources scheduling scheme for the ecological environment and provides references for ecological protection and water allocation in the arid area.

Daylighting as a design and energy strategy: Overview of opportunities and conflicts

NASA Astrophysics Data System (ADS)

Selkowitz, S.

1981-06-01

The potentials and problems associated with using daylight both to improve visual performance and interior aesthetics and to reduce electrical lighting energy consumption and peak electric loads are reviewed. Use of daylighting as a design strategy is not always synonymous with effective use of daylighting as an energy-saving strategy unless both approaches are jointly pursued by the design team. Criteria for visual performance, disability and discomfort glare, historical perspectives on daylight utilization, building form as a limit to daylight penetration, beam sunlighting strategies, luminous efficacy of daylight versus efficient electric light sources, comparative thermal impacts, peak load and load management potential, and nonenergy benefits are reviewed. Although the energy benefits of daylighting can be oversold, it is concluded that in most cases a solid understanding of the energy and design issues should produce energy efficiency and pleasing working environments.

Modeling and managing urban water demand through smart meters: Benefits and challenges from current research and emerging trends

NASA Astrophysics Data System (ADS)

Cominola, A.; Giuliani, M.; Castelletti, A.; Piga, D.; Rizzoli, A. E.

2015-12-01

Urban population growth, climate and land use change are expected to boost residential water demand in urban contexts in the next decades. In such a context, developing suitable demand-side management strategies is essential to meet future water demands, pursue water savings, and reduce the costs for water utilities. Yet, the effectiveness of water demand management strategies (WDMS) relies on our understanding of water consumers' behavior, their consumption habits, and the water use drivers. While low spatial and temporal resolution water consumption data, as traditionally gathered for billing purposes, hardly support this understanding, the advent of high-resolution, smart metering technologies allowed for quasi real-time monitoring water consumption at the single household level. This, in turn, is advancing our ability in characterizing consumers' behavior, modeling, and designing user-oriented residential water demand management strategies. Several water smart metering programs have been rolled-out in the last two decades worldwide, addressing one or more of the following water demand management phases: (i) data gathering, (ii) water end-uses characterization, (iii) user modeling, (iv) design and implementation of personalized WDMS. Moreover, the number of research studies in this domain is quickly increasing and big economic investments are currently being devoted worldwide to smart metering programs. With this work, we contribute the first comprehensive review of more than 100 experiences in the field of residential water demand modeling and management, and we propose a general framework for their classification. We revise consolidated practices, identify emerging trends and highlight the challenges and opportunities for future developments given by the use of smart meters advancing residential water demand management. Our analysis of the status quo of smart urban water demand management research and market constitutes a structured collection of information supporting the development of integrated procedures in the field of urban water management, as well as common actions aiding the collaboration with other sectors, as the nexus with energy demand management.

Adaptive invasive species distribution models: A framework for modeling incipient invasions

USGS Publications Warehouse

Uden, Daniel R.; Allen, Craig R.; Angeler, David G.; Corral, Lucia; Fricke, Kent A.

2015-01-01

The utilization of species distribution model(s) (SDM) for approximating, explaining, and predicting changes in species’ geographic locations is increasingly promoted for proactive ecological management. Although frameworks for modeling non-invasive species distributions are relatively well developed, their counterparts for invasive species—which may not be at equilibrium within recipient environments and often exhibit rapid transformations—are lacking. Additionally, adaptive ecological management strategies address the causes and effects of biological invasions and other complex issues in social-ecological systems. We conducted a review of biological invasions, species distribution models, and adaptive practices in ecological management, and developed a framework for adaptive, niche-based, invasive species distribution model (iSDM) development and utilization. This iterative, 10-step framework promotes consistency and transparency in iSDM development, allows for changes in invasive drivers and filters, integrates mechanistic and correlative modeling techniques, balances the avoidance of type 1 and type 2 errors in predictions, encourages the linking of monitoring and management actions, and facilitates incremental improvements in models and management across space, time, and institutional boundaries. These improvements are useful for advancing coordinated invasive species modeling, management and monitoring from local scales to the regional, continental and global scales at which biological invasions occur and harm native ecosystems and economies, as well as for anticipating and responding to biological invasions under continuing global change.

Near-Real-Time Earth Observation Data Supporting Wildfire Management

NASA Astrophysics Data System (ADS)

Ambrosia, V. G.; Zajkowski, T.; Quayle, B.

2013-12-01

During disaster events, the most critical element needed by responding personnel and management teams is situational intelligence / awareness. During rapidly-evolving events such as wildfires, the need for timely information is critical to save lives, property and resources. The wildfire management agencies in the US rely heavily on remote sensing information both from airborne platforms as well as from orbital assets. The ability to readily have information from those systems, not just data, is critical to effective control and damage mitigation. NASA has been collaborating with the USFS to mature and operationalize various asset-information capabilities to effect improved knowledge of fire-prone areas, monitor wildfire events in real-time, assess effectiveness of fire management strategies, and provide rapid, post-fire assessment for recovery operations. Specific examples of near-real-time remote sensing asset utility include daily MODIS data employed to assess fire potential / wildfire hazard areas, and national-scale hot-spot detection, airborne thermal sensor collected during wildfire events to effect management strategies, EO-1 ALI 'pointable' satellite sensor data to assess fire-retardant application effectiveness, and Landsat 8 and other sensor data to derive burn severity indices for post-fire remediation work. These cases of where near-real-time data is used operationally during the previous few fire seasons will be presented.

Trait Affect, Emotion Regulation, and the Generation of Negative and Positive Interpersonal Events.

PubMed

Hamilton, Jessica L; Burke, Taylor A; Stange, Jonathan P; Kleiman, Evan M; Rubenstein, Liza M; Scopelliti, Kate A; Abramson, Lyn Y; Alloy, Lauren B

2017-07-01

Positive and negative trait affect and emotion regulatory strategies have received considerable attention in the literature as predictors of psychopathology. However, it remains unclear whether individuals' trait affect is associated with responses to state positive affect (positive rumination and dampening) or negative affect (ruminative brooding), or whether these affective experiences contribute to negative or positive interpersonal event generation. Among 304 late adolescents, path analyses indicated that individuals with higher trait negative affect utilized dampening and brooding rumination responses, whereas those with higher trait positive affect engaged in rumination on positive affect. Further, there were indirect relationships between trait negative affect and fewer positive and negative interpersonal events via dampening, and between trait positive affect and greater positive and negative interpersonal events via positive rumination. These findings suggest that individuals' trait negative and positive affect may be associated with increased utilization of emotion regulation strategies for managing these affects, which may contribute to the occurrence of positive and negative events in interpersonal relationships. Copyright © 2017. Published by Elsevier Ltd.

Development of emotional intelligence in a team-based learning internal medicine clerkship.

PubMed

Borges, Nicole J; Kirkham, Karen; Deardorff, Adam S; Moore, Jeremy A

2012-01-01

Although increasing number of articles have been published on team-based learning (TBL), none has explored team emotional intelligence. We extend the literature by examining changes in team emotional intelligence during a third year clerkship where TBL is a primary instructional strategy. We hypothesized that team emotional intelligence will change in a positive direction (i.e., increase) during the clerkship. With IRB approval, during the 2009-2010 academic year third-year students in their internal medicine clerkship (N = 105, 100% response rate) completed the Workgroup Emotional Intelligence Profile - Short Version (WEIP-S) at the beginning and at the end of their 12-week clerkship. TBL is an instructional strategy utilized during the internal medicine clerkship. Paired t-tests showed that team emotional intelligence increased significantly pre to post clerkship for three of the four areas: awareness of own emotions (p = 0.018), recognizing emotions in others (p = 0.031), and ability to manage other's emotions (p = 0.013). There was no change for ability to control own emotions (p = 0.570). In an internal medicine clerkship, where TBL is utilized as an instructional strategy, team emotional intelligence increases. This supports TBL as an adjunctive tool to traditional medical education pedagogy.

Electric vehicle (EV) storage supply chain risk and the energy market: A micro and macroeconomic risk management approach

NASA Astrophysics Data System (ADS)

Aguilar, Susanna D.

As a cost effective storage technology for renewable energy sources, Electric Vehicles can be integrated into energy grids. Integration must be optimized to ascertain that renewable energy is available through storage when demand exists so that cost of electricity is minimized. Optimization models can address economic risks associated with the EV supply chain- particularly the volatility in availability and cost of critical materials used in the manufacturing of EV motors and batteries. Supply chain risk can reflect itself in a shortage of storage, which can increase the price of electricity. We propose a micro-and macroeconomic framework for managing supply chain risk through utilization of a cost optimization model in combination with risk management strategies at the microeconomic and macroeconomic level. The study demonstrates how risk from the EVs vehicle critical material supply chain affects manufacturers, smart grid performance, and energy markets qualitatively and quantitatively. Our results illustrate how risk in the EV supply chain affects EV availability and the cost of ancillary services, and how EV critical material supply chain risk can be mitigated through managerial strategies and policy.

Adaptive Management Using Remote Sensing and Ecosystem Modeling in Response to Climate Variability and Invasive Aquatic Plants for the California Sacramento-San Joaquin Delta Water Resource

NASA Technical Reports Server (NTRS)

Bubenheim, David; Potter, Christopher; Zhang, Minghua; Madsen, John

2017-01-01

The California Sacramento-San Joaquin River Delta is the hub for California's water supply and supports important ecosystem services, agriculture, and communities in Northern to Southern California. Expansion of invasive aquatic plants in the Delta coupled with impacts of changing climate and long-term drought is detrimental to the San Francisco Bay/California Delta complex. NASA Ames Research Center and the USDA-ARS partnered with the State of California to develop science-based, adaptive-management strategies for invasive aquatic plant in the Sacramento-San Joaquin Delta. Specific mapping tools developed utilizing satellite and airborne platforms provide regular assessments of population dynamics on a landscape scale and support both strategic planning and operational decision making for resource managers. San Joaquin and Sacramento River watersheds water quality input to the Delta is modeled using the Soil-Water Assessment Tool (SWAT) and a modified SWAT tool has been customized to account for unique landscape and management of agricultural water supply and drainage within the Delta. Environmental response models for growth of invasive aquatic weeds are being parameterized and coupled with spatial distribution/biomass density mapping and water quality to study ecosystem response to climate and aquatic plant management practices. On the water validation and operational utilization of these tools by management agencies and how they are improving decision making, management effectiveness and efficiency will be discussed. The project combines science, operations, and economics related to integrated management scenarios for aquatic weeds to help land and water resource managers make science-informed decisions regarding management and outcomes.

Report of the Defense Science Board Task Force on DoD Energy Strategy, More Fight - Less Fuel

DTIC Science & Technology

2008-02-01

Budgeting, and Execution System PUC Public Utility Commission Q R RAMCAP Risk Analysis and Management for Critical Asset Protection R&D Research and...0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing...DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT 15. SUBJECT TERMS 16

Experience with ethylene plant computer control

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

Nasi, M.; Darby, M.L.; Sourander, M.

This article discusses the control strategies, results and opinions of management and operations of a computer based ethylene plant control system. The ethylene unit contains 9 cracking heaters, and its nameplate capacity is 200,000 tpa ethylene. Reports on control performance during different unit loading and using different feedstock types. By converting the yield and utility consumption benefits due to computer control into monetary units, the payback time of the system is less than 2 yrs.

An Analysis of the Budget Formulation and Execution Process in United States Naval Dental Centers and Performance Measure Utilization in the Process

DTIC Science & Technology

2002-12-01

Accounting and Reporting System-Field Level SWOT Strengths Weaknesses Opportunities Threats TMA Tricare Management Activity TOA Total Obligational...progression of the four principles. [Ref 3] The organization uses SWOT analysis to assist in developing the mission and business...strategy. SWOT stands for the strengths and weaknesses of the organization and the opportunities for and threats to the organization

Selection of Fusion Levels Using the Fulcrum Bending Radiograph for the Management of Adolescent Idiopathic Scoliosis Patients with Alternate Level Pedicle Screw Strategy: Clinical Decision-making and Outcomes.

PubMed

Samartzis, Dino; Leung, Yee; Shigematsu, Hideki; Natarajan, Deepa; Stokes, Oliver; Mak, Kin-Cheung; Yao, Guanfeng; Luk, Keith D K; Cheung, Kenneth M C

2015-01-01

Selecting fusion levels based on the Luk et al criteria for operative management of thoracic adolescent idiopathic scoliosis (AIS) with hook and hybrid systems yields acceptable curve correction and balance parameters; however, it is unknown whether utilizing a purely pedicle screw strategy is effective. Utilizing the fulcrum bending radiographic (FBR) to assess curve flexibility to select fusion levels, the following study assessed the efficacy of pedicle screw fixation with alternate level screw strategy (ALSS) for thoracic AIS. A retrospective study with prospective radiographic data collection/analyses (preoperative, postoperative 1-week and minimum 2-year follow-up) of 28 operative thoracic AIS patients undergoing ALSS was performed. Standing coronal/sagittal and FBR Cobb angles, FBR flexibility, fulcrum bending correction index (FBCI), trunkal shift, radiographic shoulder height (RSH), and list were assessed on x-rays. Fusion level selection was based on the Luk et al criteria and compared to conventional techniques. In the primary curve, the mean preoperative and postoperative 1 week and last follow-up standing coronal Cobb angles were 59.9, 17.2 and 20.0 degrees, respectively. Eighteen patients (64.3%) had distal levels saved (mean: 1.6 levels) in comparison to conventional techniques. Mean immediate and last follow-up FBCIs were 122.6% and 115.0%, respectively. Sagittal alignment did not statistically differ between any assessment intervals (p>0.05). A decrease in trunkal shift was noted from preoperative to last follow-up (p = 0.003). No statistically significant difference from preoperative to last follow-up was noted in RSH and list (p>0.05). No "add-on" of other vertebra or decompensation was noted and all patients achieved fusion. This is the first report to note that using the FBR for decision-making in selecting fusion levels in thoracic AIS patients undergoing management with pedicle screw constructs (e.g. ALSS) is a cost-effective strategy that can achieve clinically-relevant deformity correction that is maintained and without compromising fusion levels.

Modeling the Dynamic Water Resource Needs of California's Coastal Watersheds

NASA Astrophysics Data System (ADS)

Alford, C.

2009-12-01

Many watersheds face formidable water supply challenges when it comes to managing water availability to meet diverse water supply and ecosystem management objectives. California’s central coast watersheds are no exception, and both the scarcity of water resources during drier water years and mandates to establish minimum instream flows for salmon habitat have prompted interests in reassessing water management strategies for several of these watersheds. Conventional supply-oriented hydrologic models, however, are not adequate to fully investigate and describe the reciprocal implications of surface water demands for human use and the maintenance of instream flows for salmon habitat that vary both temporally and spatially within a watershed. In an effort to address this issue I developed a coastal watershed management model based on the San Gregorio watershed utilizing the Water Evaluation and Planning (WEAP) system, which permits demand-side prioritization at a time step interval and spatial resolution that captures functional supply and demand relationships. Physiographic input data such as soil type, land cover, elevation, habitat, and water demand sites were extrapolated at a sub-basin level in a GIS. Time-series climate data were collected and processed utilizing the Berkeley Water Center Data Cube at daily time steps for the period 1952 through September 2009. Recent synoptic flow measurements taken at seven tributary sites during the 2009 water year, water depth measured by pressure transducers at six sites within the watershed from September 2005 through September 2009, and daily gauge records from temporary gauges installed in 1981 were used to assess the hydrologic patterns of sub-basins and supplement historic USGS gauge flow records. Empirical functions were used to describe evapotranspiration, surface runoff, sub-surface runoff, and deep percolation. Initial model simulations carried out under both dry and wet water year scenarios were able to capture representative hydrological conditions in both the sample watershed case and an initial test case that utilized base data from a watershed with minimal land disturbance. Results from this study provide valuable insight into the effects of water use through a variety of climactic conditions and provide potential strategies for policy makers, regulators, and stakeholders to strengthen adaptive capacity to achieve sustainable water use within coastal watersheds.

Coping strategies and social support needs of experienced and inexperienced nurses performing shiftwork.

PubMed

Gifkins, Jane; Loudoun, Rebecca; Johnston, Amy

2017-12-01

The aim of this investigation was to compare perceptions of nurses exposed to short or longer term shift work and their experiences working under this type of scheduling. Shift work is a crucial component of nurses' working lives, ensuring continuous care for patients. This study fills a research gap around the personal experiences of shift working nurses and the strategies used to manage the impacts of shift work. Qualitative case study design. Constructivist methodology, including in-depth semi-structured interviews conducted in 2015, was used for the study. Iterative review and inductive analysis of transcripts from nine recently graduated nurses and twelve experienced nurses enabled identification and verification of key themes. Three main areas of difference between new and experienced nurses relating to shift work challenges in a nursing environment emerged: perceptions about the utility of working in shifts, coping strategies and social support at home and work. Most experienced nurses found shift work advantageous, especially those with dependents. Coping strategies included flexible shift arrangements in both groups. Experienced nurses detailed the importance of support from family and friends while inexperienced nurses described feeling disconnected from social supports. Experienced nurses cited a lack of support from nursing managers as problematic. Findings suggest shift selection mitigated challenges of shift work for both inexperienced and experienced nurses, indicating autonomous roster selection is critical. Similarly, social support at work from senior nurses and management and at home played an important role in nurses' coping. © 2017 John Wiley & Sons Ltd.

Applying the Analytic Hierarchy Process to Oil Sands Environmental Compliance Risk Management

NASA Astrophysics Data System (ADS)

Roux, Izak Johannes, III

Oil companies in Alberta, Canada, invested $32 billion on new oil sands projects in 2013. Despite the size of this investment, there is a demonstrable deficiency in the uniformity and understanding of environmental legislation requirements that manifest into increased project compliance risks. This descriptive study developed 2 prioritized lists of environmental regulatory compliance risks and mitigation strategies and used multi-criteria decision theory for its theoretical framework. Information from compiled lists of environmental compliance risks and mitigation strategies was used to generate a specialized pairwise survey, which was piloted by 5 subject matter experts (SMEs). The survey was validated by a sample of 16 SMEs, after which the Analytic Hierarchy Process (AHP) was used to rank a total of 33 compliance risks and 12 mitigation strategy criteria. A key finding was that the AHP is a suitable tool for ranking of compliance risks and mitigation strategies. Several working hypotheses were also tested regarding how SMEs prioritized 1 compliance risk or mitigation strategy compared to another. The AHP showed that regulatory compliance, company reputation, environmental compliance, and economics ranked the highest and that a multi criteria mitigation strategy for environmental compliance ranked the highest. The study results will inform Alberta oil sands industry leaders about the ranking and utility of specific compliance risks and mitigations strategies, enabling them to focus on actions that will generate legislative and public trust. Oil sands leaders implementing a risk management program using the risks and mitigation strategies identified in this study will contribute to environmental conservation, economic growth, and positive social change.

Creating a competitive PSO: a case study.

PubMed

Calvaruso, J T

1999-06-01

Mount Carmel Health System, an integrated delivery system in Columbus, Ohio, became a Medicare+Choice contractor in response to unsatisfactory payment proposals from the Medicare contractors it serviced and to compete with the increasing number of managed care providers in its market. To meet HCFA's operational requirements, Mount Carmel upgraded and expanded its administrative and health information systems and solicited the support of its network physicians. It also developed a marketing strategy to promote its health plan. In the two years after instituting its provider-sponsored organization, Mount Carmel surpassed its original enrollment projections, decreased its patient management and utilization costs, and increased payments to its network members.

A review of cetacean lung morphology and mechanics.

PubMed

Piscitelli, Marina A; Raverty, Stephen A; Lillie, Margo A; Shadwick, Robert E

2013-12-01

Cetaceans possess diverse adaptations in respiratory structure and mechanics that are highly specialized for an array of surfacing and diving behaviors. Some of these adaptations and air management strategies are still not completely understood despite over a century of study. We have compiled the historical and contemporary knowledge of cetacean lung anatomy and mechanics in regards to normal lung function during ventilation and air management while diving. New techniques are emerging utilizing pulmonary mechanics to measure lung function in live cetaceans. Given the diversity of respiratory adaptations in cetaceans, interpretations of these results should consider species-specific anatomy, mechanics, and behavior. Copyright © 2013 Wiley Periodicals, Inc.

Multiattribute risk analysis in nuclear emergency management.

PubMed

Hämäläinen, R P; Lindstedt, M R; Sinkko, K

2000-08-01

Radiation protection authorities have seen a potential for applying multiattribute risk analysis in nuclear emergency management and planning to deal with conflicting objectives, different parties involved, and uncertainties. This type of approach is expected to help in the following areas: to ensure that all relevant attributes are considered in decision making; to enhance communication between the concerned parties, including the public; and to provide a method for explicitly including risk analysis in the process. A multiattribute utility theory analysis was used to select a strategy for protecting the population after a simulated nuclear accident. The value-focused approach and the use of a neutral facilitator were identified as being useful.

Fishing decisions under uncertainty

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

Harrison, C.G.

1982-02-01

The drilling manager often is forced by an extended fishing operation to choose between the known costs incurred with abandonment of retrieval attempts and the unknown costs of continuing fishing operations. The successful manager makes the decision that costs the company the least money. Continuing fishing operations beyond some economic limit is failure, even if the fish is retrieved and that portion of the hole saved, because more money has been spent in the fishing attempt than would have been spent by not fishing. The strategy is to minimize losses. This analysis closely follows the theory of utility developed bymore » J. von Neuman and O. Morgenstern. 1 ref.« less

A model for reducing health care employee turnover.

PubMed

Nowak, Paul; Holmes, Gary; Murrow, Jim

2010-01-01

Explaining the rationale as to why employees leave their jobs has led to many different strategies to retain employees. The model presented here seeks to explain why employees choose to stay or to leave their place of employment. The information from the analysis will provide managers with well-tested tools to reduce turnover and to ascertain what employees value from their work environment in order to help the organization to retain those employees. The model identifies key factors that management can utilize to provide barriers to exit and retain professional employees in their health care units. Recommendations are provided that reward loyalty and build barriers to exit.

Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.

PubMed

Escribano Ferrer, Blanca; Hansen, Kristian Schultz; Gyapong, Margaret; Bruce, Jane; Narh Bana, Solomon A; Narh, Clement T; Allotey, Naa-Korkor; Glover, Roland; Azantilow, Naa-Charity; Bart-Plange, Constance; Sagoe-Moses, Isabella; Webster, Jayne

2017-07-05

Ghana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). The aim of the study was to assess the cost-effectiveness of these strategies under programme conditions. A cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8 years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey. Appropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates, facility costs and iCCM and CHPS utilization, but not when iCCM appropriate treatment was reduced by 50%. Due to low numbers of carers visiting a CBA in the Northern Region it was not possible to conduct a cost-effectiveness analysis in this region. However, the cost analysis showed that iCCM in the Northern Region had higher cost per malaria, diarrhoea and suspected pneumonia case diagnosed and treated when compared to the Volta Region and to the CHPS strategy in the Northern Region. Integrated community case management was more cost-effective than CHPS for the treatment of malaria, diarrhoea and suspected pneumonia when utilized by carers of children under-5 years in the Volta Region. A revision of the iCCM strategy in the Northern Region is needed to improve its cost-effectiveness. Long-term financing strategies should be explored including potential inclusion in the National Health Insurance Scheme (NHIS) benefit package. An acceptability study of including iCCM in the NHIS should be conducted.

“I just start crying for no reason”: The experience of stress and depression in pregnant urban African American adolescents and their perception of yoga as a management strategy

PubMed Central

Kinser, Patricia; Masho, Saba

2015-01-01

Purpose Perinatal health disparities are of particular concern with pregnant urban African American adolescents who have high rates of stress and depression during pregnancy, higher rates of adverse pregnancy and neonatal outcomes, and many barriers to effective treatment. The purpose of this study was to explore pregnant urban African American teenagers’ experience of stress and depression and examine their perceptions of adjunctive non-pharmacologic management strategies, such as yoga. Methods This community-based qualitative study utilized non-therapeutic focus groups to allow for exploration of attitudes, concerns, beliefs and values regarding stress and depression in pregnancy and non-pharmacologic management approaches, such as mind-body therapies and other prenatal activities. Findings The sample consisted of pregnant African-American low-income adolescents (n=17) who resided in a large urban area in the United States. The themes that arose in the focus group discussions were: (1) stress and depression symptoms are pervasive in daily life; (2) participants felt a generalized sense of isolation; (3) stress/depression-management techniques should be group-based, interactive, and focused on the specific needs of teenagers; (4) yoga is an appealing stress-management technique to this population. Conclusions The findings from this study suggest that pregnant urban adolescents are highly stressed, they interpret depression-like symptoms to be signs of stress, they desire group-based, interactive activities, and they are interested in yoga classes for stress/depression management and relationship-building. It is imperative that healthcare providers and researchers focus on these needs, particularly when designing prevention and intervention strategies. PMID:25648492

Development of a fuel cell plug-in hybrid electric vehicle and vehicle simulator for energy management assessment

NASA Astrophysics Data System (ADS)

Meintz, Andrew Lee

This dissertation offers a description of the development of a fuel cell plug-in hybrid electric vehicle focusing on the propulsion architecture selection, propulsion system control, and high-level energy management. Two energy management techniques have been developed and implemented for real-time control of the vehicle. The first method is a heuristic method that relies on a short-term moving average of the vehicle power requirements. The second method utilizes an affine function of the short-term and long-term moving average vehicle power requirements. The development process of these methods has required the creation of a vehicle simulator capable of estimating the effect of changes to the energy management control techniques on the overall vehicle energy efficiency. Furthermore, the simulator has allowed for the refinement of the energy management methods and for the stability of the method to be analyzed prior to on-road testing. This simulator has been verified through on-road testing of a constructed prototype vehicle under both highway and city driving schedules for each energy management method. The results of the finalized vehicle control strategies are compared with the simulator predictions and an assessment of the effectiveness of both strategies is discussed. The methods have been evaluated for energy consumption in the form of both hydrogen fuel and stored electricity from grid charging.

Science to Help Understand and Manage Important Ground-Water Resources

USGS Publications Warehouse

Nickles, James

2008-01-01

Throughout California, as pressure on water resources continues to grow, water-supply agencies are looking to the state?s biggest ?reservoir? ? its ground-water basins ? for supply and storage. To better utilize that resource, the Sweetwater Authority and other local partners, including the city of San Diego and Otay Water Districts, are working with the U.S. Geological Survey (USGS) to develop the first comprehensive study of the coastal ground-water resources of southern San Diego County. USGS research is providing the integrated geologic and hydrologic knowledge necessary to help effectively utilize this resource on a coordinated, regional basis. USGS scientists are building a real-time well-monitoring network and gathering information about how the aquifers respond to different pumping and recharge-management strategies. Real-time ground-water levels are recorded every hour and are viewable on a project web site (http://ca.water.usgs.gov/sandiego/index.html). Data from the wells are helping to define the geology and hydrogeology of the area, define ground-water quality, and assess ground-water levels. The wells also are strategi-cally placed and designed to be usable by the local agencies for decades to come to help manage surface-water and ground-water operations. Additionally, the knowledge gained from the USGS study will help local, state, and federal agencies; water purveyors; and USGS scientists to understand the effects of urbanization on the local surface-water, ground-water, and biological resources, and to better critique ideas and opportuni-ties for additional ground-water development in the San Diego area.

Establishing ecological reference conditions and tracking post-application effectiveness of lanthanum-saturated bentonite clay (Phoslock®) for reducing phosphorus in aquatic systems: an applied paleolimnological approach.

PubMed

Moos, M T; Taffs, K H; Longstaff, B J; Ginn, B K

2014-08-01

Innovative management strategies for nutrient enrichment of freshwater are important in the face of this increasing global problem, however many strategies are not assessed over long enough time periods to establish effectiveness. Paleolimnological techniques using diatoms as biological indicators were utilized to establish ecological reference conditions, environmental variation, and the effectiveness of lanthanum-saturated bentonite clay (brand name: Phoslock(®)) applied to reduce water column phosphorus (P) concentrations in four waterbodies in Ontario, Canada, and eastern Australia. In sediment cores from the two Canadian sites, there were short-lived changes to diatom assemblages, relative to inferred background conditions, and a temporary reduction in both measured and diatom-inferred total phosphorus (TP) before returning to pre-application conditions (particularly in the urban stormwater management pond which has a high flushing rate and responds rapidly to precipitation and surface run-off). The two Australian sites (a sewage treatment pond and a shallow recreational lake), recorded no reduction in diatom-inferred TP. Based on our pre-application environmental reconstruction, changes to the diatom assemblages and diatom-inferred TP appeared to be driven by larger, climatic factors. While laboratory tests involving this product showed sharp reductions in water column TP, management strategies require detailed information on pre-application environmental conditions and variations in order to accurately assess the effectiveness of new technologies for lake management. Copyright © 2014 Elsevier Ltd. All rights reserved.

A strategy to assist management in workforce engagement and employee retention in the high tech engineering environment.

PubMed

Kennedy, Elizabeth; Daim, Tugrul U

2010-11-01

Many companies use survey methods in an attempt to gauge employees' attitudes and opinions toward the company. These attitudes and opinions are directly related to an employee's engagement within the company. In many instances, employees wait in vain for the survey response and the subsequent employer actions, but the truth is sometimes management does not know what to do with the results. For this reason, we theorize that this type of survey, typically utilizing the Likert-scale, is not adequately assisting management in addressing employee engagement and retention issues. For instance, in many occasions, once the survey results are tabulated, companies are doing little or nothing to address the issues. In fact, far too many companies make the mistake of conducting employee engagement surveys, and then ignore the answers. Thus, we propose that a company should take advantage of the survey results, and utilize them to provide data to bridge employees' needs and goals with stakeholders' responsibilities and goals by refining and incorporating them into a hierarchical decision model (HDM). Thus, this would essentially be utilizing the quantitative data to determine what to measure qualitatively. We use a case from the high tech industry, specifically focusing on the engineering environment. Engineering environments are known to be more creative and such approaches would be more beneficial. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

Healthcare cost differences with participation in a community-based group physical activity benefit for medicare managed care health plan members.

PubMed

Ackermann, Ronald T; Williams, Barbara; Nguyen, Huong Q; Berke, Ethan M; Maciejewski, Matthew L; LoGerfo, James P

2008-08-01

To determine whether participation in a physical activity benefit by Medicare managed care enrollees is associated with lower healthcare utilization and costs. Retrospective cohort study. Medicare managed care. A cohort of 1,188 older adult health maintenance organization enrollees who participated at least once in the EnhanceFitness (EF) physical activity benefit and a matched group of enrollees who never used the program. Healthcare costs and utilization were estimated. Ordinary least squares regression was used, adjusting for demographics, comorbidity, indicators of preventive service use, and baseline utilization or cost. Robustness of findings was tested in sensitivity analyses involving continuous propensity score adjustment and generalized linear models with nonconstant variance assumptions. EF participants had similar total healthcare costs during Year 1 of the program, but during Year 2, adjusted total costs were $1,186 lower (P=.005) than for non-EF users. Differences were partially attributable to lower inpatient costs (-$3,384; P=.02), which did not result from high-cost outliers. Enrollees who attended EF an average of one visit or more per week had lower adjusted total healthcare costs in Year 1 (-$1,929; P<.001) and Year 2 (-$1,784; P<.001) than nonusers. Health plan coverage of a preventive physical activity benefit for seniors is a promising strategy to avoid significant healthcare costs in the short term.

Essential coastal habitats for fish in the Baltic Sea

NASA Astrophysics Data System (ADS)

Kraufvelin, Patrik; Pekcan-Hekim, Zeynep; Bergström, Ulf; Florin, Ann-Britt; Lehikoinen, Annukka; Mattila, Johanna; Arula, Timo; Briekmane, Laura; Brown, Elliot John; Celmer, Zuzanna; Dainys, Justas; Jokinen, Henri; Kääriä, Petra; Kallasvuo, Meri; Lappalainen, Antti; Lozys, Linas; Möller, Peter; Orio, Alessandro; Rohtla, Mehis; Saks, Lauri; Snickars, Martin; Støttrup, Josianne; Sundblad, Göran; Taal, Imre; Ustups, Didzis; Verliin, Aare; Vetemaa, Markus; Winkler, Helmut; Wozniczka, Adam; Olsson, Jens

2018-05-01

Many coastal and offshore fish species are highly dependent on specific habitat types for population maintenance. In the Baltic Sea, shallow productive habitats in the coastal zone such as wetlands, vegetated flads/lagoons and sheltered bays as well as more exposed rocky and sandy areas are utilized by fish across many life history stages including spawning, juvenile development, feeding and migration. Although there is general consensus about the critical importance of these essential fish habitats (EFH) for fish production along the coast, direct quantitative evidence for their specific roles in population growth and maintenance is still scarce. Nevertheless, for some coastal species, indirect evidence exists, and in many cases, sufficient data are also available to carry out further quantitative analyses. As coastal EFH in the Baltic Sea are often found in areas that are highly utilized and valued by humans, they are subjected to many different pressures. While cumulative pressures, such as eutrophication, coastal construction and development, climate change, invasive species and fisheries, impact fish in coastal areas, the conservation coverage for EFH in these areas remains poor. This is mainly due to the fact that historically, fisheries management and nature conservation are not integrated neither in research nor in management in Baltic Sea countries. Setting joint objectives for fisheries management and nature conservation would hence be pivotal for improved protection of EFH in the Baltic Sea. To properly inform management, improvements in the development of monitoring strategies and mapping methodology for EFH are also needed. Stronger international cooperation between Baltic Sea states will facilitate improved management outcomes across ecologically arbitrary boundaries. This is especially important for successful implementation of international agreements and legislative directives such as the Baltic Sea Action Plan, the Marine Strategy Framework Directive, the Habitats Directive, and the Maritime Spatial Planning Directive, but also for improving the communication of information related to coastal EFH among researchers, stakeholders, managers and decision makers. In this paper, efforts are made to characterize coastal EFH in the Baltic Sea, their importance and the threats/pressures they face, as well as their current conservation status, while highlighting knowledge gaps and outlining perspectives for future work in an ecosystem-based management framework.

Adaptive Management and the Value of Information: Learning Via Intervention in Epidemiology

PubMed Central

Shea, Katriona; Tildesley, Michael J.; Runge, Michael C.; Fonnesbeck, Christopher J.; Ferrari, Matthew J.

2014-01-01

Optimal intervention for disease outbreaks is often impeded by severe scientific uncertainty. Adaptive management (AM), long-used in natural resource management, is a structured decision-making approach to solving dynamic problems that accounts for the value of resolving uncertainty via real-time evaluation of alternative models. We propose an AM approach to design and evaluate intervention strategies in epidemiology, using real-time surveillance to resolve model uncertainty as management proceeds, with foot-and-mouth disease (FMD) culling and measles vaccination as case studies. We use simulations of alternative intervention strategies under competing models to quantify the effect of model uncertainty on decision making, in terms of the value of information, and quantify the benefit of adaptive versus static intervention strategies. Culling decisions during the 2001 UK FMD outbreak were contentious due to uncertainty about the spatial scale of transmission. The expected benefit of resolving this uncertainty prior to a new outbreak on a UK-like landscape would be £45–£60 million relative to the strategy that minimizes livestock losses averaged over alternate transmission models. AM during the outbreak would be expected to recover up to £20.1 million of this expected benefit. AM would also recommend a more conservative initial approach (culling of infected premises and dangerous contact farms) than would a fixed strategy (which would additionally require culling of contiguous premises). For optimal targeting of measles vaccination, based on an outbreak in Malawi in 2010, AM allows better distribution of resources across the affected region; its utility depends on uncertainty about both the at-risk population and logistical capacity. When daily vaccination rates are highly constrained, the optimal initial strategy is to conduct a small, quick campaign; a reduction in expected burden of approximately 10,000 cases could result if campaign targets can be updated on the basis of the true susceptible population. Formal incorporation of a policy to update future management actions in response to information gained in the course of an outbreak can change the optimal initial response and result in significant cost savings. AM provides a framework for using multiple models to facilitate public-health decision making and an objective basis for updating management actions in response to improved scientific understanding. PMID:25333371

Adaptive management and the value of information: learning via intervention in epidemiology

USGS Publications Warehouse

Shea, Katriona; Tildesley, Michael J.; Runge, Michael C.; Fonnesbeck, Christopher J.; Ferrari, Matthew J.

2014-01-01

Optimal intervention for disease outbreaks is often impeded by severe scientific uncertainty. Adaptive management (AM), long-used in natural resource management, is a structured decision-making approach to solving dynamic problems that accounts for the value of resolving uncertainty via real-time evaluation of alternative models. We propose an AM approach to design and evaluate intervention strategies in epidemiology, using real-time surveillance to resolve model uncertainty as management proceeds, with foot-and-mouth disease (FMD) culling and measles vaccination as case studies. We use simulations of alternative intervention strategies under competing models to quantify the effect of model uncertainty on decision making, in terms of the value of information, and quantify the benefit of adaptive versus static intervention strategies. Culling decisions during the 2001 UK FMD outbreak were contentious due to uncertainty about the spatial scale of transmission. The expected benefit of resolving this uncertainty prior to a new outbreak on a UK-like landscape would be £45–£60 million relative to the strategy that minimizes livestock losses averaged over alternate transmission models. AM during the outbreak would be expected to recover up to £20.1 million of this expected benefit. AM would also recommend a more conservative initial approach (culling of infected premises and dangerous contact farms) than would a fixed strategy (which would additionally require culling of contiguous premises). For optimal targeting of measles vaccination, based on an outbreak in Malawi in 2010, AM allows better distribution of resources across the affected region; its utility depends on uncertainty about both the at-risk population and logistical capacity. When daily vaccination rates are highly constrained, the optimal initial strategy is to conduct a small, quick campaign; a reduction in expected burden of approximately 10,000 cases could result if campaign targets can be updated on the basis of the true susceptible population. Formal incorporation of a policy to update future management actions in response to information gained in the course of an outbreak can change the optimal initial response and result in significant cost savings. AM provides a framework for using multiple models to facilitate public-health decision making and an objective basis for updating management actions in response to improved scientific understanding.

Economics, health-related quality of life, and cost-effectiveness methods for the TACTICS (Treat Angina With Aggrastat [tirofiban

PubMed

Weintraub, W S; Culler, S D; Kosinski, A; Becker, E R; Mahoney, E; Burnette, J; Spertus, J A; Feeny, D; Cohen, D J; Krumholz, H; Ellis, S G; Demopoulos, L; Robertson, D; Boccuzzi, S J; Barr, E; Cannon, C P

1999-02-01

Concern over escalating health care costs has led to increasing focus on economics and assessment of outcome measures for expensive forms of therapy. This is being investigated in the Treat Angina With Aggrastat [tirofiban] and Determine Cost of Therapy with Invasive or Conservative Strategy (TACTICS)-TIMI 18 trial, a randomized trial comparing outcome of patients with unstable angina or non-Q-wave myocardial infarction treated with tirofiban and then randomized to an invasive versus a conservative strategy. Hospital and professional costs initially and over 6 months, including outpatient costs, will be assessed. Hospital costs will be determined for patients in the United States from the UB92 formulation of the hospital bill, with costs derived from charges using departmental cost to charge ratios. Professional costs will be determined by accounting for professional services and then converted to resource units using the Resource Based Relative Value Scale and then to costs using the Medicare conversion factor. Follow-up resource consumption, including medications, testing and office visits, will be carefully measured with a Patient Economic Form, and converted to costs from the Medicare fee schedule. Health-related quality of life will be assessed with a specific instrument, the Seattle Angina Questionnaire, and a general instrument, the Health Utilities Index at baseline, 1, and 6 months. The Health Utilities Index will also be used to construct a utility. By knowing utility and survival, quality-adjusted life years will be determined. These measures will permit the performance of a cost-effectiveness analysis, with the cost-effectiveness of the invasive strategy defined and the difference in cost between the invasive and conservative strategies divided by the difference in quality-adjusted life years. The economic and health-related quality of life aspects of TACTICS-TIMI 18 are an integral part of the study design and will provide a comprehensive understanding of the impact of invasive versus conservative management strategies on a broad range of outcomes after hospitalization for unstable angina or non-Q-wave myocardial infarction.

National Readmission Patterns of Isolated Splenic Injuries Based on Initial Management Strategy.

PubMed

Rosenberg, Graeme M; Knowlton, Lisa; Rajasingh, Charlotte; Weng, Yingjie; Maggio, Paul M; Spain, David A; Staudenmayer, Kristan L

2017-12-01

Options for managing splenic injuries have evolved with a focus on nonoperative management. Long-term outcomes, such as readmissions and delayed splenectomy rate, are not well understood. To describe the natural history of isolated splenic injuries in the United States and determine whether patterns of readmission were influenced by management strategy. The Healthcare Cost and Utilization Project's Nationwide Readmission Database is an all-payer, all-ages, longitudinal administrative database that provides data on more than 35 million weighted US discharges yearly. The database was used to identify patients with isolated splenic injuries and the procedures that they received. Adult patients with isolated splenic injuries admitted from January 1 through June 30, 2013, and from January 1 through June 30, 2014, were included. Those who died during the index hospitalization or who had an additional nonsplenic injury with an Abbreviated Injury Score of 2 or greater were excluded. Univariate and mixed-effects logistic regression analysis controlling for center effect were used. Weighted numbers are reported. Initial management strategy at the time of index hospitalization, including nonprocedural management, angioembolization, and splenectomy. All-cause 6-month readmission rate. Secondary outcome was delayed splenectomy rate. A weighted sample of 3792 patients (2146 men [56.6%] and 1646 women [43.4%]; mean [SE] age, 48.5 [0.7] years) with 5155 admission events was included. During the index hospitalization, 825 (21.8%) underwent splenectomy, 293 (7.7%) underwent angioembolization, and 2673 (70.5%) had no procedure. The overall readmission rate was 21.1% (799 patients). Readmission rates did not differ based on initial management strategy (195 patients undergoing splenectomy [23.6%], 70 undergoing angioembolism [23.9%], and 534 undergoing no procedure [20%]; P = .33). Splenectomy was performed in 36 of 799 readmitted patients (4.5%) who did not have a splenectomy at their index hospitalization, leading to an overall delayed splenectomy rate of 1.2% (36 of 2967 patients). In mixed-effects logistic regression analysis controlling for patient, injury, clinical, and hospital characteristics, the choice of splenectomy (odds ratio, 0.93; 95% CI, 0.66-1.31) vs angioembolization (odds ratio, 1.19; 95% CI, 0.72-1.97) as initial management strategy was not associated with readmission. This national evaluation of the natural history of isolated splenic injuries from index admission through 6 months found that approximately 1 in 5 patients are readmitted within 6 months of discharge after an isolated splenic injury. However, the chance of readmission for splenectomy after initial nonoperative management was 1.2%. This finding suggests that the current management strategies used for isolated splenic injuries in the United States are well matched to patient need.

Assessing the value of disease management: impact of 2 disease management strategies in an underserved asthma population.

PubMed

Galbreath, Autumn Dawn; Smith, Brad; Wood, Pamela R; Inscore, Stephen; Forkner, Emma; Vazquez, Marilu; Fallot, Andre; Ellis, Robert; Peters, Jay I

2008-12-01

The goal of disease management (DM) is to improve health outcomes and reduce cost through decreasing health care utilization. Although some studies have shown that DM improves asthma outcomes, these interventions have not been examined in a large randomized controlled trial. To compare the effectiveness of 2 previously successful DM programs with that of traditional care. Nine hundred two individuals with asthma (429 adults; 473 children) were randomly assigned to telephonic DM, augmented DM (ADM; DM plus in-home visits by a respiratory therapist), or traditional care. Data were collected at enrollment and at 6 and 12 months. Primary outcomes were time to first asthma-related event, quality of life (QOL), and rates of asthma-related health care utilization. Secondary outcomes included rate of controller medication initiation, number of oral corticosteroid bursts, asthma symptom scores, and number of school days missed. There were no significant differences between groups in time to first asthma-related event or health care utilization. Adult participants in the ADM group had greater improvement in QOL (P = .04) and a decrease in asthma symptoms (P = .001) compared with other groups. Of children not receiving controller medications at enrollment (13%), those in the intervention groups were more likely to have controller medications initiated than the control group (P = .01). Otherwise, there were no differences in outcomes. Overall, participation in asthma DM did not result in significant differences in utilization or clinical outcomes. The only significant impact was a higher rate of controllermedication initiation in children and improvement in asthma symptoms and QOL in adults who received ADM.

Weight maintenance: challenges, tools and strategies for primary care physicians[Link

PubMed Central

Soleymani, T.; Daniel, S.

2015-01-01

Summary Obesity is recognized as a chronic disease and one of the major healthcare challenges facing us today. Weight loss can be achieved via lifestyle, pharmacological and surgical interventions, but weight maintenance remains a lifetime challenge for individuals with obesity. Guidelines for the management of obesity have highlighted the role of primary care providers (PCPs). This review examines the long‐term outcomes of clinical trials to identify effective weight maintenance strategies that can be utilized by PCPs. Because of the broad nature of the topic, a structured PubMed search was conducted to identify relevant research articles, peer‐reviewed reviews, guidelines and articles published by regulatory bodies. Trials have demonstrated the benefit of sustained weight loss in managing obesity and its comorbidities. Maintaining 5–10% weight loss for ≥1 year is known to ameliorate many comorbidities. Weight maintenance with lifestyle modification – although challenging – is possible but requires long‐term support to reinforce diet, physical activity and behavioural changes. The addition of pharmacotherapy to lifestyle interventions promotes greater and more sustained weight loss. Clinical evidence and recently approved pharmacotherapy has given PCPs improved strategies to support their patients with maintenance of weight loss. Further studies are needed to assess the translation of these strategies into clinical practice. PMID:26490059

Development strategy research of low-carbon tourist city

NASA Astrophysics Data System (ADS)

Dong, Xiaohong

2017-04-01

Construction of low-carbon tourist city has become a strategic choice for the development of city construction in our country, becoming the direction and goal of future city development in China. In this paper, the development strategy of low-carbon tourist city is put forward from the aspects of building low-carbon tourism culture, strengthening and perfecting the relevant rules and regulations, establishing and perfecting the decision-making management mechanism of low-carbon tourist city construction, establishing accurate, timely, efficient and comprehensive ecological environment monitoring and supervision network, building economical resource utilization system, strengthening science and technology supporting of low-carbon city construction, establishing low-carbon tourism scenic spot, low-carbon community or low-carbon demonstration area, etc.

The Use of Social Ecological Hotspots Mapping: Co-Developing Adaptation Strategies for Resource Management by Communities and Policy Makers

NASA Astrophysics Data System (ADS)

Alessa, L.

2014-12-01

Ultimately, adaptation is based on a set of trade-offs rather than optimal conditions, something that is rarely seen in messy social ecological systems (SES). In this talk, we discuss the role of spatial hot-spot mapping using social and biophysical data to understand the feedbacks in SES. We review the types of data needed, their means of acquisition and the analytic methods involved. In addition, we outline the challenges faced in co-developing this type of inquiry based on lessons learned from several long-term programs. Finally, we present the utility of SES hotspots in developing adaptation strategies on the ground by communities and policy makers.

Burp Charging Nickel Metal Hydride Cells

NASA Technical Reports Server (NTRS)

Darcy, Eric; Pollard, Richard

1997-01-01

The SKYNET 4 constellation consists of three spacecraft which were launched between December 1988 and August 1990. The spacecraft are three-axis stabilized geostationary earth-orbiting military communications satellites with a design life of seven years on station. With the mission objective achieved all the batteries continue to give excellent performance. This paper presents a review of the history of the six batteries from cell procurement to the end of their design life and beyond. Differences in operational strategies are discussed and the lifetime trends in performance are analyzed. The combination of procurement acceptance criteria and the on-station battery management strategy utilized are presented as the prime factors in achieving completely successful battery performance throughout the mission.

Suboxone misuse along the opiate maintenance treatment pathway.

PubMed

Furst, R Terry

2013-01-01

This study explores strategies that Suboxone misusers utilize while in drug treatment. Ethnographic interviews were conducted with 14 patients who had cycled in and out of Suboxone treatment. The objective of the study is to identify strategies implemented by patients who intermittently use opiates/opioids while in Suboxone treatment. Findings indicate that some patients serially stop and start treatment in a Harm Reduction setting in New York City. Many patients suggest that they manage their opiate/opioid dependency through a sequential use of Suboxone and heroin to avoid withdrawal and to continue their misuse of opiates/opioids. Results are discussed in conjunction with the difficulties inherent to substance abuse treatment and suggestions for improvement are offered.

Adaptive Management Using Remote Sensing and Ecosystem Modeling in Response to Climate Variability and Invasive Aquatic Plants for the California Sacramento-San Joaquin Delta Water Resource

NASA Astrophysics Data System (ADS)

Bubenheim, D.; Potter, C. S.; Zhang, M.; Madsen, J.

2017-12-01

The California Sacramento-San Joaquin River Delta is the hub for California's water supply and supports important ecosystem services, agriculture, and communities in Northern and Southern California. Expansion of invasive aquatic plants in the Delta coupled with impacts of changing climate and long-term drought is detrimental to the San Francisco Bay/California Delta complex. NASA Ames Research Center and the USDA-ARS partnered with the State of California to develop science-based, adaptive-management strategies for invasive aquatic plant management in the California Sacramento-San Joaquin Delta. Specific mapping tools developed utilizing satellite and airborne platforms provide regular assessments of population dynamics on a landscape scale and support both strategic planning and operational decision making for resource managers. San Joaquin and Sacramento River watersheds water quality input to the Delta is modeled using the Soil-Water Assessment Tool (SWAT) and a modified SWAT tool has been customized to account for unique landscape and management of agricultural water supply and drainage within the Delta. Environmental response models for growth of invasive aquatic weeds are being parameterized and coupled with spatial distribution/biomass density mapping and water quality to study ecosystem response to climate and aquatic plant management practices. On the water validation and operational utilization of these tools by management agencies and how they improve decision making, management effectiveness and efficiency will be discussed. The project combines science, operations, and economics related to integrated management scenarios for aquatic weeds to help land and water resource managers make science-informed decisions regarding management and outcomes.

An effective utilization management strategy by dual approach of influencing physician ordering and gate keeping.

PubMed

Elnenaei, Manal O; Campbell, Samuel G; Thoni, Andrea J; Lou, Amy; Crocker, Bryan D; Nassar, Bassam A

2016-02-01

There is increasing recognition of the importance of appropriate laboratory test utilization. We investigate the effect of a multifaceted educational approach that includes physician feedback on individual test ordering, in conjunction with targeted restriction, on the utilization of selected laboratory tests. Scientific evidence was compiled on the usefulness and limitations of tests suspected of being over utilized in our laboratories. A variety of approaches were used to deliver education on each of the targeted tests, with greater focus on primary care physicians (PCPs). Feedback on requesting behavior of these tests was also communicated to the latter group which included an educational component. Laboratory based restriction of testing was also exercised, including the unbundling of our electrolyte panel. PCP requesting patterns for the selected tests were found to be markedly skewed. The interventions implemented over the study period resulted in a substantial 51% reduction in overall ordering of five of the targeted tests equating to an annual marginal cost saving of $60,124. Unbundling of the electrolyte panel resulted in marginal cost savings that equated annually to $42,500 on chloride and $48,000 on total CO2. A multifaceted educational approach combined with feedback on utilization and laboratory driven gate-keeping significantly reduced the number of laboratory tests suspected of being redundant or unjustifiably requested. Laboratory professionals are well positioned to manage demand on laboratory tests by utilizing evidence base in developing specific test ordering directives and gate-keeping rules. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Multimodal Pain Management Protocol Versus Patient Controlled Narcotic Analgesia for Postoperative Pain Control after Shoulder Arthroplasty.

PubMed

Nicholson, Thema; Maltenfort, Mitchell; Getz, Charles; Lazarus, Mark; Williams, Gerald; Namdari, Surena

2018-05-01

Our institution's traditional pain management strategy after shoulder arthroplasty has involved the utilization of postoperative patient-controlled narcotic analgesia. More recently, we have implemented a protocol (TLC) that utilizes a multimodal approach. The purpose of this study was to determine whether this change has improved pain control and decreased narcotic utilization. Patients undergoing primary total shoulder or reverse arthroplasty were retrospectively studied. All patients underwent interscalene brachial plexus blockade. "Traditional" patients were provided a patient-controlled analgesic pump postoperatively. TLC patients were given preoperative and postoperative multimodal, non-narcotic analgesic medications and breakthrough narcotics. Morphine equivalent units (MEU) consumed and Visual Analog Scale (VAS) scores for pain (0, 8, 16, and 24 hours) were considered. There were 108 patients in each group. Total postoperative narcotic consumption in the first 24 postoperative hours was 38.5 +/- 81.1 MEU in the "Traditional group" compared to 59.3 +/- 59.1 MEU in the TLC group ( P<0.001 ). Of patients in the TLC group, 88% utilized breakthrough narcotics. VAS pain was significantly higher in the "Traditional group" at 16 hours (4.1 +/- 2.9 vs 3.2 +/- 2.7, P=0.020 ) and 24 hours (4.8 +/- 2.7 vs 3.7 +/- 2.6, P=0.004 ). Those treated with the TLC protocol had greater narcotic utilization but better VAS pain scores at 24 hours after surgery. Both groups experienced rebound pain. While the TLC protocol led to an improved pain experience, further modification of the currently protocol may be necessary to reduce overall narcotic utilization.

The correlation between occupational stress, coping strategies, and the levels of psychological distress among nurses working in mental health hospital in Jordan.

PubMed

Hasan, Abd Alhadi; Tumah, Hussein

2018-05-21

Psychiatric nurses encounter variety of demanding and stressful events such as dealing with aggressive patients, and hostile. This study purposed to assess workplace stress, coping strategies, and psychiatric distress among psychiatric nurses. A descriptive explanatory design was employed. One hundred and nineteen psychiatric nurses were recruited in the study and data were collected in the period between June and September 2017. The results showed that participants experienced moderate level of occupational stress and psychiatric distress. In addition, they utilized different coping mechanism. Stress management techniques program is very effective in helping psychiatric nurse to deal with occupational stress which might influence their wellbeing. Moreover, this program assists them to use more effective coping strategies as problem solving. © 2018 Wiley Periodicals, Inc.

Diagnosis and management of small intestinal bacterial overgrowth.

PubMed

Bohm, Matthew; Siwiec, Robert M; Wo, John M

2013-06-01

Small intestinal bacterial overgrowth (SIBO) can result from failure of the gastric acid barrier, failure of small intestinal motility, anatomic alterations, or impairment of systemic and local immunity. The current accepted criteria for the diagnosis of SIBO is the presence of coliform bacteria isolated from the proximal jejunum with >10(5) colony-forming units/mL. A major concern with luminal aspiration is that it is only one random sampling of the small intestine and may not always be representative of the underlying microbiota. A new approach to examine the underlying microbiota uses rapid molecular sequencing, but its clinical utilization is still under active investigation. Clinical manifestations of SIBO are variable and include bloating, flatulence, abdominal distention, abdominal pain, and diarrhea. Severe cases may present with nutrition deficiencies due to malabsorption of micro- and macronutrients. The current management strategies for SIBO center on identifying and correcting underlying causes, addressing nutrition deficiencies, and judicious utilization of antibiotics to treat symptomatic SIBO.

Outcomes of a Behavioral Intervention to Reduce HIV Risk among Drug-involved Female Sex Workers

PubMed Central

Surratt, Hilary L.; O’Grady, Catherine; Kurtz, Steven P.; Levi-Minzi, Maria A.; Chen, Minxing

2014-01-01

Although street-based female sex workers (FSWs) are highly vulnerable to HIV, they often lack access to needed health services and medical care. This paper reports the results of a recently completed randomized intervention trial for FSWs in Miami, Florida, which tested the relative efficacy of two case management interventions that aimed to link underserved FSWs with health services and to reduce risk behaviors for HIV. Participants were recruited using targeted sampling strategies and were randomly assigned to: a Strengths-Based/Professional Only (PO) or a Strengths-Based/Professional-Peer condition (PP). Follow-up data were collected 3 and 6 months post-baseline. Outcome analyses indicated that both intervention groups displayed significant reductions in HIV risk behaviors and significant increases in services utilization; the Professional-Peer condition provided no added benefit. HIV seropositive FSWs responded particularly well to the interventions, suggesting the utility of brief strengths-based case management interventions for this population in future initiatives. PMID:24558098

Optimal management of colorectal liver metastases in older patients: a decision analysis

PubMed Central

Yang, Simon; Alibhai, Shabbir MH; Kennedy, Erin D; El-Sedfy, Abraham; Dixon, Matthew; Coburn, Natalie; Kiss, Alex; Law, Calvin HL

2014-01-01

Background Comparative trials evaluating management strategies for colorectal cancer liver metastases (CLM) are lacking, especially for older patients. This study developed a decision-analytic model to quantify outcomes associated with treatment strategies for CLM in older patients. Methods A Markov-decision model was built to examine the effect on life expectancy (LE) and quality-adjusted life expectancy (QALE) for best supportive care (BSC), systemic chemotherapy (SC), radiofrequency ablation (RFA) and hepatic resection (HR). The baseline patient cohort assumptions included healthy 70-year-old CLM patients after a primary cancer resection. Event and transition probabilities and utilities were derived from a literature review. Deterministic and probabilistic sensitivity analyses were performed on all study parameters. Results In base case analysis, BSC, SC, RFA and HR yielded LEs of 11.9, 23.1, 34.8 and 37.0 months, and QALEs of 7.8, 13.2, 22.0 and 25.0 months, respectively. Model results were sensitive to age, comorbidity, length of model simulation and utility after HR. Probabilistic sensitivity analysis showed increasing preference for RFA over HR with increasing patient age. Conclusions HR may be optimal for healthy 70-year-old patients with CLM. In older patients with comorbidities, RFA may provide better LE and QALE. Treatment decisions in older cancer patients should account for patient age, comorbidities, local expertise and individual values. PMID:24961482

Tools for beach health data management, data processing, and predictive model implementation

USGS Publications Warehouse

,

2013-01-01

This fact sheet describes utilities created for management of recreational waters to provide efficient data management, data aggregation, and predictive modeling as well as a prototype geographic information system (GIS)-based tool for data visualization and summary. All of these utilities were developed to assist beach managers in making decisions to protect public health. The Environmental Data Discovery and Transformation (EnDDaT) Web service identifies, compiles, and sorts environmental data from a variety of sources that help to define climatic, hydrologic, and hydrodynamic characteristics including multiple data sources within the U.S. Geological Survey and the National Oceanic and Atmospheric Administration. The Great Lakes Beach Health Database (GLBH-DB) and Web application was designed to provide a flexible input, export, and storage platform for beach water quality and sanitary survey monitoring data to compliment beach monitoring programs within the Great Lakes. A real-time predictive modeling strategy was implemented by combining the capabilities of EnDDaT and the GLBH-DB for timely, automated prediction of beach water quality. The GIS-based tool was developed to map beaches based on their physical and biological characteristics, which was shared with multiple partners to provide concepts and information for future Web-accessible beach data outlets.

Evolving technologies drive the new roles of Biomedical Engineering.

PubMed

Frisch, P H; St Germain, J; Lui, W

2008-01-01

Rapidly changing technology coupled with the financial impact of organized health care, has required hospital Biomedical Engineering organizations to augment their traditional operational and business models to increase their role in developing enhanced clinical applications utilizing new and evolving technologies. The deployment of these technology based applications has required Biomedical Engineering organizations to re-organize to optimize the manner in which they provide and manage services. Memorial Sloan-Kettering Cancer Center has implemented a strategy to explore evolving technologies integrating them into enhanced clinical applications while optimally utilizing the expertise of the traditional Biomedical Engineering component (Clinical Engineering) to provide expanded support in technology / equipment management, device repair, preventive maintenance and integration with legacy clinical systems. Specifically, Biomedical Engineering is an integral component of the Medical Physics Department which provides comprehensive and integrated support to the Center in advanced physical, technical and engineering technology. This organizational structure emphasizes the integration and collaboration between a spectrum of technical expertise for clinical support and equipment management roles. The high cost of clinical equipment purchases coupled with the increasing cost of service has driven equipment management responsibilities to include significant business and financial aspects to provide a cost effective service model. This case study details the dynamics of these expanded roles, future initiatives and benefits for Biomedical Engineering and Memorial Sloan Kettering Cancer Center.

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

PubMed

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

2014-01-01

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

Understanding the links between resilience and type-2 diabetes self-management: a qualitative study in South Australia.

PubMed

Wilson, A L; McNaughton, D; Meyer, S B; Ward, P R

2017-01-01

Research conducted by Ward, Muller, Tsourtos, et al. (Soc Sci Med 72(7):1140-1148, 2011) has led to the development of the psycho-social interactive model of resilience, which reveals the interaction between individual resilience factors (i.e. coping, confidence and self esteem) and external resilience environments (i.e. employment, supportive family environments and health promoting policies) in facilitating the development of resilience. This present study explored the utility of this model of resilience for understanding how people self-manage type-2 diabetes. Data were collected via 14 semi-structured life-history interviews with women and men living with type-2 diabetes mellitus (T2DM). Participants varied according to socio-demographics (gender, age, education level, income) and were recruited based on their self-reported management (or lack thereof) of T2DM. The inter-play of internal traits and external resources with additive and subtractive resilience strategies were consistent with the psycho-social interactive model of resilience. Self-management was influenced by life history. Differences in self-management and material disadvantage were also identified. Alongside increased disadvantage are higher levels of external barriers to self-management practices. This paper supports the concepts of additive and subtractive resilience strategies for use with diabetes populations; providing health professionals and policy makers with an increased understanding of how to recognize and foster patient resilience for the improvement of self-care, disease management and ultimately health outcomes.

Flight-management strategies for escape from microburst encounters. M.S. Thesis - George Washington Univ.

NASA Technical Reports Server (NTRS)

Hinton, David A.

1988-01-01

An effort is underway by NASA, FAA, and industry to reduce the threat of convective microburst wind shear phenomena to aircraft. The goal is to develop and test a candidate set of strategies for recovery from inadvertent microburst encounters during takeoff. Candidate strategies were developed and evaluated using a fast-time simulation consisting of a simple point-mass performance model of a transport-category airplane and an analytical microburst model. The results indicate that the recovery strategy characteristics that best utilize available airplane energy include an initial reduction in pitch attitude to reduce the climb rate, followed by an increase in pitch up to the stick shaker angle of attack. The stick shaker angle of attack should be reached just as the airplane is exiting the microburst. The shallowest angle of climb necessary for obstacle clearance should be used. If the altitude is higher than necessary, an intentional descent to reduce the airspeed deceleration should be used. Of the strategies tested, two flight-path-angle based strategies had the highest recovery altitudes and the least sensitivity to variations in the encounter scenarios.

Economic evaluation of an implementation strategy for the management of low back pain in general practice.

PubMed

Jensen, Cathrine Elgaard; Riis, Allan; Petersen, Karin Dam; Jensen, Martin Bach; Pedersen, Kjeld Møller

2017-05-01

In connection with the publication of a clinical practice guideline on the management of low back pain (LBP) in general practice in Denmark, a cluster randomised controlled trial was conducted. In this trial, a multifaceted guideline implementation strategy to improve general practitioners' treatment of patients with LBP was compared with a usual implementation strategy. The aim was to determine whether the multifaceted strategy was cost effective, as compared with the usual implementation strategy. The economic evaluation was conducted as a cost-utility analysis where cost collected from a societal perspective and quality-adjusted life years were used as outcome measures. The analysis was conducted as a within-trial analysis with a 12-month time horizon consistent with the follow-up period of the clinical trial. To adjust for a priori selected covariates, generalised linear models with a gamma family were used to estimate incremental costs and quality-adjusted life years. Furthermore, both deterministic and probabilistic sensitivity analyses were conducted. Results showed that costs associated with primary health care were higher, whereas secondary health care costs were lower for the intervention group when compared with the control group. When adjusting for covariates, the intervention was less costly, and there was no significant difference in effect between the 2 groups. Sensitivity analyses showed that results were sensitive to uncertainty. In conclusion, the multifaceted implementation strategy was cost saving when compared with the usual strategy for implementing LBP clinical practice guidelines in general practice. Furthermore, there was no significant difference in effect, and the estimate was sensitive to uncertainty.

Natural resource manager perceptions of agency performance on climate change.

PubMed

Lemieux, Christopher J; Thompson, Jessica L; Dawson, Jackie; Schuster, Rudy M

2013-01-15

An important precursor to the adoption of climate change adaptation strategies is to understand the perceived capacity to implement and operationalize such strategies. Utilizing an importance-performance analysis (IPA) evaluation framework, this article presents a comparative case study of federal and state land and natural resource manager perceptions of agency performance on factors influencing adaptive capacity in two U.S. regions (northern Colorado and southwestern South Dakota). Results revealed several important findings with substantial management implications. First, none of the managers ranked the adaptive capacity factors as a low priority. Second, managers held the perception that their agencies were performing either neutrally or poorly on most factors influencing adaptive capacity. Third, gap analysis revealed that significant improvements are required to facilitate optimal agency functioning when dealing with climate change-related management issues. Overall, results suggest that a host of institutional and policy-oriented (e.g., lack of clear mandate to adapt to climate change), financial and human resource (e.g., inadequate staff and financial resources), informational (e.g., inadequate research and monitoring programs) and contextual barriers (e.g., sufficient regional networks to mitigate potential transboundary impacts) currently challenge the efficient and effective integration of climate change into decision-making and management within agencies working in these regions. The IPA framework proved to be an effective tool to help managers identify and understand agency strengths, areas of concern, redundancies, and areas that warrant the use of limited funds and/or resource re-allocation in order to enhance adaptive capacity and maximize management effectiveness with respect to climate change. Copyright © 2012 Elsevier Ltd. All rights reserved.

Disease Management, Coping, and Functional Disability in Pediatric Sickle Cell Disease

PubMed Central

Oliver-Carpenter, Gloria; Barach, Ilana; Crosby, Lori E.; Valenzuela, Jessica; Mitchell, Monica J.

2016-01-01

Background Youth with sickle cell disease (SCD) experience chronic symptoms that significantly interfere with physical, academic, and social-emotional functioning. Thus, to effectively manage SCD, youth and caregivers must work collaboratively to ensure optimal functioning. The goal of the current study was to examine the level of involvement in disease management tasks for youth with SCD and their caregivers. The study also examined the relationship between involvement in disease management tasks, daily functioning, and coping skills. The study utilized collaborative care and disease management theoretical frameworks. Methods Youth and caregivers participated in the study during an annual research and education day event. Forty-seven patients with SCD aged 6 to 18 years and their caregivers completed questionnaires examining level of involvement in disease management tasks, youth functional disability and youth coping strategies. Caregivers also completed a demographic and medical history form. Results Parents and youth agreed that parents are significantly more involved in disease management tasks than youth, although level of involvement varied by task. Decreased parent involvement was related to greater coping strategies used by patients, including massage, prayer, and positive thinking. Higher functional disability (lower functioning) was related to greater parent involvement in disease management tasks, suggesting that greater impairment may encourage increased parent involvement. Conclusions Health professionals working with families of youth with SCD should discuss with parents and youth how disease management tasks and roles will be shared and transferred during adolescence. Parents and youth may also benefit from a discussion of these issues within their own families. PMID:21443065

Diabetes benefit management: evolving strategies for payers.

PubMed

Tzeel, Albert L

2011-11-01

Over the next quarter century, the burden of type 2 diabetes mellitus (T2DM) is expected to at least double. Currently, 1 in every 10 healthcare dollars is spent on diabetes management; by 2050, it has been projected that the annual costs of managing T2DM will rise to $336 billion. Without substantial, systemic changes, T2DM management costs will lead to a potentially untenable strain on the healthcare system. However, the appropriate management of diabetes can reduce associated mortality and delay comorbidities. In addition, adequate glycemic control can improve patient outcomes and significantly reduce diabetes-related complications. This article provides an overview of key concepts associated with a value-based insurance design (VBID) approach to T2DM coverage. By promoting the use of services or treatments that provide high benefits relative to cost, and by alternatively discouraging patients from utilizing services whose benefits do not justify their cost, VBID improves the quality of healthcare while simultaneously reining in spending. VBID initiatives tend to focus on chronic disease management and generally target prescription drug use. However, some programs have expanded their scope by incorporating services traditionally offered by wellness and disease management programs. The concept of VBID is growing, and it is increasingly being implemented by a diverse and growing number of public and private entities, including pharmacy benefit managers, health plans, and employers. This article provides key background on VBID strategies, with a focus on T2DM management. It also provides a road map for health plans seeking to implement VBID as part of their programs.

Decision-Making in Critical Limb Ischemia: A Markov Simulation.

PubMed

Deutsch, Aaron J; Jain, C Charles; Blumenthal, Kimberly G; Dickinson, Mark W; Neilan, Anne M

2017-11-01

Critical limb ischemia (CLI) is a feared complication of peripheral vascular disease that often requires surgical management and may require amputation of the affected limb. We developed a decision model to inform clinical management for a 63-year-old woman with CLI and multiple medical comorbidities, including advanced heart failure and diabetes. We developed a Markov decision model to evaluate 4 strategies: amputation, surgical bypass, endovascular therapy (e.g. stent or revascularization), and medical management. We measured the impact of parameter uncertainty using 1-way, 2-way, and multiway sensitivity analyses. In the base case, endovascular therapy yielded similar discounted quality-adjusted life months (26.50 QALMs) compared with surgical bypass (26.34 QALMs). Both endovascular and surgical therapies were superior to amputation (18.83 QALMs) and medical management (11.08 QALMs). This finding was robust to a wide range of periprocedural mortality weights and was most sensitive to long-term mortality associated with endovascular and surgical therapies. Utility weights were not stratified by patient comorbidities; nonetheless, our conclusion was robust to a range of utility weight values. For a patient with CLI, endovascular therapy and surgical bypass provided comparable clinical outcomes. However, this finding was sensitive to long-term mortality rates associated with each procedure. Both endovascular and surgical therapies were superior to amputation or medical management in a range of scenarios. Copyright © 2017 Elsevier Inc. All rights reserved.

Incentive-compatible demand-side management for smart grids based on review strategies

NASA Astrophysics Data System (ADS)

Xu, Jie; van der Schaar, Mihaela

2015-12-01

Demand-side load management is able to significantly improve the energy efficiency of smart grids. Since the electricity production cost depends on the aggregate energy usage of multiple consumers, an important incentive problem emerges: self-interested consumers want to increase their own utilities by consuming more than the socially optimal amount of energy during peak hours since the increased cost is shared among the entire set of consumers. To incentivize self-interested consumers to take the socially optimal scheduling actions, we design a new class of protocols based on review strategies. These strategies work as follows: first, a review stage takes place in which a statistical test is performed based on the daily prices of the previous billing cycle to determine whether or not the other consumers schedule their electricity loads in a socially optimal way. If the test fails, the consumers trigger a punishment phase in which, for a certain time, they adjust their energy scheduling in such a way that everybody in the consumer set is punished due to an increased price. Using a carefully designed protocol based on such review strategies, consumers then have incentives to take the socially optimal load scheduling to avoid entering this punishment phase. We rigorously characterize the impact of deploying protocols based on review strategies on the system's as well as the users' performance and determine the optimal design (optimal billing cycle, punishment length, etc.) for various smart grid deployment scenarios. Even though this paper considers a simplified smart grid model, our analysis provides important and useful insights for designing incentive-compatible demand-side management schemes based on aggregate energy usage information in a variety of practical scenarios.

A Meta-Analysis of Health Status, Health Behaviors, and Health Care Utilization Outcomes of the Chronic Disease Self-Management Program

PubMed Central

Murphy, Louise; O’Colmain, Benita J.; Beauchesne, Danielle; Daniels, Brandy; Greenberg, Michael; House, Marnie; Chervin, Doryn

2013-01-01

Introduction The Chronic Disease Self-Management Program (CDSMP) is a community-based self-management education program designed to help participants gain confidence (self-efficacy) and skills to better manage their chronic conditions; it has been implemented worldwide. The objective of this meta-analysis was to quantitatively synthesize the results of CDSMP studies conducted in English-speaking countries to determine the program’s effects on health behaviors, physical and psychological health status, and health care utilization at 4 to 6 months and 9 to 12 months after baseline. Methods We searched 8 electronic databases to identify CDSMP-relevant literature published from January 1, 1999, through September 30, 2009; experts identified additional unpublished studies. We combined the results of all eligible studies to calculate pooled effect sizes. We included 23 studies. Eighteen studies presented data on small English-speaking groups; we conducted 1 meta-analysis on these studies and a separate analysis on results by other delivery modes. Results Among health behaviors for small English-speaking groups, aerobic exercise, cognitive symptom management, and communication with physician improved significantly at 4- to 6-month follow-up; aerobic exercise and cognitive symptom management remained significantly improved at 9 to 12 months. Stretching/strengthening exercise improved significantly at 9 to 12 months. All measures of psychological health improved significantly at 4 to 6 months and 9 to 12 months. Energy, fatigue, and self-rated health showed small but significant improvements at 4 to 6 months but not at 9 to 12 months. The only significant change in health care utilization was a small improvement in the number of hospitalization days or nights at 4 to 6 months Conclusion Small to moderate improvements in psychological health and selected health behaviors that remain after 12 months suggest that CDSMP delivered in small English-speaking groups produces health benefits for participants and would be a valuable part of comprehensive chronic disease management strategy. PMID:23327828

Optimal Battery Utilization Over Lifetime for Parallel Hybrid Electric Vehicle to Maximize Fuel Economy

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

Patil, Chinmaya; Naghshtabrizi, Payam; Verma, Rajeev

This paper presents a control strategy to maximize fuel economy of a parallel hybrid electric vehicle over a target life of the battery. Many approaches to maximizing fuel economy of parallel hybrid electric vehicle do not consider the effect of control strategy on the life of the battery. This leads to an oversized and underutilized battery. There is a trade-off between how aggressively to use and 'consume' the battery versus to use the engine and consume fuel. The proposed approach addresses this trade-off by exploiting the differences in the fast dynamics of vehicle power management and slow dynamics of batterymore » aging. The control strategy is separated into two parts, (1) Predictive Battery Management (PBM), and (2) Predictive Power Management (PPM). PBM is the higher level control with slow update rate, e.g. once per month, responsible for generating optimal set points for PPM. The considered set points in this paper are the battery power limits and State Of Charge (SOC). The problem of finding the optimal set points over the target battery life that minimize engine fuel consumption is solved using dynamic programming. PPM is the lower level control with high update rate, e.g. a second, responsible for generating the optimal HEV energy management controls and is implemented using model predictive control approach. The PPM objective is to find the engine and battery power commands to achieve the best fuel economy given the battery power and SOC constraints imposed by PBM. Simulation results with a medium duty commercial hybrid electric vehicle and the proposed two-level hierarchical control strategy show that the HEV fuel economy is maximized while meeting a specified target battery life. On the other hand, the optimal unconstrained control strategy achieves marginally higher fuel economy, but fails to meet the target battery life.« less

Diabetes mellitus and infection: an evaluation of hospital utilization and management costs in the United States.

PubMed

Korbel, Lindsey; Spencer, John David

2015-03-01

The objective of this study is to evaluate the number of diabetics that seek medical treatment in emergency departments or require hospitalization for infection management in the United States. This study also assesses the socioeconomic impact of inpatient infection management among diabetics. We accessed the Healthcare Cost and Utilization Project's Nationwide Emergency Department Sample database and the Nationwide Inpatient Sample database to perform a retrospective analysis on diabetics presenting to the emergency department or hospitalized for infection management from 2006 to 2011. Emergency Department: Since 2006, nearly 10 million diabetics were annually evaluated in the emergency department. Infection was the primary reason for presentation in 10% of these visits. Among those visits, urinary tract infection was the most common infection, accounting for over 30% of emergency department encounters for infections. Other common infections included sepsis, skin and soft tissue infections, and pneumonia. Diabetics were more than twice as likely to be hospitalized for infection management than patients without diabetes. Hospitalization: Since 2006, nearly 6 million diabetics were annually hospitalized. 8-12% of these patients were hospitalized for infection management. In 2011, the inpatient care provided to patients with DM, and infection was responsible for over $48 billion dollars in aggregate hospital charges. Diabetics commonly present to the emergency department and require hospitalization for infection management. The care provided to diabetics for infection management has a large economic impact on the United States healthcare system. More efforts are needed to develop cost-effective strategies for the prevention of infection in patients with diabetes. Copyright © 2015 Elsevier Inc. All rights reserved.

State of the Art Management of Acute Vaso-occlusive Pain in Sickle Cell Disease.

PubMed

Puri, Latika; Nottage, Kerri A; Hankins, Jane S; Anghelescu, Doralina L

2018-02-01

Acute vaso-occlusive crisis (VOC) is a hallmark of sickle cell disease (SCD). Multiple complex pathophysiological processes can result in pain during a VOC. Despite significant improvements in the understanding and management of SCD, little progress has been made in the management of pain in SCD, although new treatments are being explored. Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment of VOC pain, but new classes of drugs are being tested to prevent and treat acute pain. Advancements in the understanding of the pathophysiology of SCD and pain and the pharmacogenomics of opioids have yet to be effectively utilized in the management of VOC. Opioid tolerance and opioid-induced hyperalgesia are significant problems associated with the long-term use of opioids, and better strategies for chronic pain therapy are needed. This report reviews the mechanisms of pain associated with acute VOC, describes the current management of VOC, and describes some of the new therapies under evaluation for the management of acute VOC in SCD.

Why are You Late?: Investigating the Role of Time Management in Time-Based Prospective Memory

PubMed Central

Waldum, Emily R; McDaniel, Mark A.

2016-01-01

Time-based prospective memory tasks (TBPM) are those that are to be performed at a specific future time. Contrary to typical laboratory TBPM tasks (e.g., “hit the “z” key every 5 minutes”), many real-world TBPM tasks require more complex time-management processes. For instance to attend an appointment on time, one must estimate the duration of the drive to the appointment and then utilize this estimate to create and execute a secondary TBPM intention (e.g., “I need to start driving by 1:30 to make my 2:00 appointment on time”). Future under- and overestimates of drive time can lead to inefficient TBPM performance with the former lending to missed appointments and the latter to long stints in the waiting room. Despite the common occurrence of complex TBPM tasks in everyday life, to date, no studies have investigated how components of time management, including time estimation, affect behavior in such complex TBPM tasks. Therefore, the current study aimed to investigate timing biases in both older and younger adults and further to determine how such biases along with additional time management components including planning and plan fidelity influence complex TBPM performance. Results suggest for the first time that younger and older adults do not always utilize similar timing strategies, and as a result, can produce differential timing biases under the exact same environmental conditions. These timing biases, in turn, play a vital role in how efficiently both younger and older adults perform a later TBPM task that requires them to utilize their earlier time estimate. PMID:27336325

A proposal of optimal sampling design using a modularity strategy

NASA Astrophysics Data System (ADS)

Simone, A.; Giustolisi, O.; Laucelli, D. B.

2016-08-01

In real water distribution networks (WDNs) are present thousands nodes and optimal placement of pressure and flow observations is a relevant issue for different management tasks. The planning of pressure observations in terms of spatial distribution and number is named sampling design and it was faced considering model calibration. Nowadays, the design of system monitoring is a relevant issue for water utilities e.g., in order to manage background leakages, to detect anomalies and bursts, to guarantee service quality, etc. In recent years, the optimal location of flow observations related to design of optimal district metering areas (DMAs) and leakage management purposes has been faced considering optimal network segmentation and the modularity index using a multiobjective strategy. Optimal network segmentation is the basis to identify network modules by means of optimal conceptual cuts, which are the candidate locations of closed gates or flow meters creating the DMAs. Starting from the WDN-oriented modularity index, as a metric for WDN segmentation, this paper proposes a new way to perform the sampling design, i.e., the optimal location of pressure meters, using newly developed sampling-oriented modularity index. The strategy optimizes the pressure monitoring system mainly based on network topology and weights assigned to pipes according to the specific technical tasks. A multiobjective optimization minimizes the cost of pressure meters while maximizing the sampling-oriented modularity index. The methodology is presented and discussed using the Apulian and Exnet networks.

Cost effectiveness of outpatient treatment for febrile neutropaenia in adult cancer patients.

PubMed

Teuffel, O; Amir, E; Alibhai, S; Beyene, J; Sung, L

2011-04-26

There is uncertainty whether low-risk episodes of febrile neutropaenia (FN) in adult cancer patients are best managed in the in- or outpatient setting. A Monte Carlo cost-utility model was created to compare four treatment strategies for low-risk FN: (1) treatment in hospital with intravenous antibiotics (HospIV); (2) early discharge after 48 h in-patient observation, followed by oral outpatient treatment (EarlyDC); (3) outpatient management with IV antibiotics (HomeIV); and (4) outpatient management with oral antibiotics (HomePO). The model used a health-care payer perspective and a time horizon of one FN episode. Outcome measures were quality-adjusted FN episodes (QAFNE), costs (Canadian dollars) and incremental cost-effectiveness ratios (ICER). Parameter uncertainty was assessed with probabilistic sensitivity analyses. HomePO was cost saving ($3470 vs $4183), but less effective (0.65 QAFNE vs 0.72 QAFNE) than HomeIV. The corresponding ICER was $10,186 per QAFNE. Both EarlyDC ($6115; 0.66 QAFNE) and HospIV ($13,557; 0.62 QAFNE) were dominated strategies. At a willingness-to-pay (WTP) threshold of $4,000 per QAFNE, HomePO and HomeIV were cost effective in 54 and 38% of simulations, respectively. For adult cancer patients with an episode of low-risk FN, treatment in hospital is more expensive and less effective than outpatient strategies.

Cost effectiveness of outpatient treatment for febrile neutropaenia in adult cancer patients

PubMed Central

Teuffel, O; Amir, E; Alibhai, S; Beyene, J; Sung, L

2011-01-01

Background: There is uncertainty whether low-risk episodes of febrile neutropaenia (FN) in adult cancer patients are best managed in the in- or outpatient setting. Methods: A Monte Carlo cost–utility model was created to compare four treatment strategies for low-risk FN: (1) treatment in hospital with intravenous antibiotics (HospIV); (2) early discharge after 48 h in-patient observation, followed by oral outpatient treatment (EarlyDC); (3) outpatient management with IV antibiotics (HomeIV); and (4) outpatient management with oral antibiotics (HomePO). The model used a health-care payer perspective and a time horizon of one FN episode. Outcome measures were quality-adjusted FN episodes (QAFNE), costs (Canadian dollars) and incremental cost-effectiveness ratios (ICER). Parameter uncertainty was assessed with probabilistic sensitivity analyses. Results: HomePO was cost saving ($3470 vs $4183), but less effective (0.65 QAFNE vs 0.72 QAFNE) than HomeIV. The corresponding ICER was $10 186 per QAFNE. Both EarlyDC ($6115; 0.66 QAFNE) and HospIV ($13 557; 0.62 QAFNE) were dominated strategies. At a willingness-to-pay (WTP) threshold of $4 000 per QAFNE, HomePO and HomeIV were cost effective in 54 and 38% of simulations, respectively. Interpretation: For adult cancer patients with an episode of low-risk FN, treatment in hospital is more expensive and less effective than outpatient strategies. PMID:21468048

California Women and the Strategies Utilized on the Path to the Superintendency

ERIC Educational Resources Information Center

Guzman, Anna-Maria

2012-01-01

Purpose: The purpose of this study was to identify leadership strategies utilized and the barriers encountered by females in pursuit of the role of superintendent. This study also intended to identify the strategies women used to overcome these barriers. Methodology: This study utilized descriptive research. Descriptive research involves gathering…

Overcoming structural constraints to patient utilization of electronic medical records: a critical review and proposal for an evaluation framework.

PubMed

Winkelman, Warren J; Leonard, Kevin J

2004-01-01

There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An evaluation framework is proposed for use when considering adaptation of existing EPR systems for online patient access. Exemplars of patient-accessible EPR systems from the literature are evaluated utilizing the framework. From this study, it appears that traditional information system research and development methods may not wholly capture many pertinent social issues that arise when expanding access of EPR systems to patients. Critically rooted methods such as action research can directly inform development strategies so that these systems may positively influence health outcomes.

Adapting an IPCC-Compliant Full Forest Carbon Accounting Model to Determine the Effects of Different Forest Management Strategies in California

NASA Astrophysics Data System (ADS)

Starrs, C.; Stewart, W.; Potts, M. D.

2016-12-01

As California experiences increasing rates of disturbance events such as wildfire, drought, and insect outbreaks, understanding how different management strategies affect long-term forest carbon stock changes in the forest and in harvested wood products used by society will be key to determining strategies to best maximize forest-related carbon sequestration in the future. California's forest area is roughly evenly split across three ownership types: private timberlands, National Forest timberlands, and reserved forests. Forest management strategies in California generally vary by these ownerships; management in reserved lands sequesters carbon within the forest (i.e. leaves wood in the forest), while on private and National Forest timberlands a significant amount of wood is removed from the forest and converted to harvested wood products. The Carbon Budget Model of the Canadian Forest Sector (CBM-CFS3) is an IPCC-compliant full forest carbon accounting model developed for use in Canada that has been adapted for use in other countries. Changes in natural disturbances in the forest and technological innovation in the use of harvested wood products could substantially alter future carbon trajectories of forests under different management regimes. A key advantage of the CBM-CFS3 model is that in addition to tracking live tree, dead tree, and dead organic matter (DOM) carbon pools in the forest, it also tracks carbon stock changes in harvested wood products. We calibrated the CBM-CFS3 model with US Forest Service Forest Inventory and Analysis (FIA) data for seven forest types across three ownership types to predict carbon stock changes under different natural disturbance and harvested wood product utilization futures. Our results illustrate the importance of using a tractable model that can integrate future changes in forest carbon cycling to keep pace with our changing climate and usage of wood products.

Cost-Utility Analysis of Screening Strategies for Diabetic Retinopathy in Korea.

PubMed

Kim, Sang-Won; Kang, Gil-Won

2015-12-01

This study involved a cost-utility analysis of early diagnosis and treatment of diabetic retinopathy depending on the screening strategy used. The four screening strategies evaluated were no screening, opportunistic examination, systematic fundus photography, and systematic examination by an ophthalmologists. Each strategy was evaluated in 10,000 adults aged 40 yr with newly diagnosed diabetes mellitus (hypothetical cohort). The cost of each strategy was estimated in the perspective of both payer and health care system. The utility was estimated using quality-adjusted life years (QALY). Incremental Cost Effectiveness Ratio (ICER) for the different screening strategies was analyzed. After exclusion of the weakly dominating opportunistic strategy, the ICER of systematic photography was 57,716,867 and that of systematic examination by ophthalmologists was 419,989,046 from the perspective of the healthcare system. According to the results, the systematic strategy is preferable to the opportunistic strategy from the perspective of both a payer and a healthcare system. Although systematic examination by ophthalmologists may have higher utility than systematic photography, it is associated with higher cost. The systematic photography is the best strategy in terms of cost-utility. However systematic examination by ophthalmologists can also be a suitable policy alternative, if the incremental cost is socially acceptable.

Emerging issues in biodiversity & conservation management: The need for a palaeoecological perspective

NASA Astrophysics Data System (ADS)

Froyd, C. A.; Willis, K. J.

2008-09-01

The study of Quaternary environmental change is directly applicable to on-going issues of global conservation. Palaeoecological research techniques provide the tools to address some of the key questions presently being asked by conservation ecologists and land management organizations. But is this type of analysis currently being utilized to its full potential? Are the results of palaeoenvironmental analyses routinely applied to practical issues of natural resource management, and if not what can be done to expand the application of this research within the conservation community? This paper reviews recent developments in the application of the analysis of late Quaternary environmental change to key environmental issues of biodiversity and conservation management and examines areas which could be strengthened in the future including: (i) determination of baselines and natural ecosystem variability; (ii) understanding ecological thresholds and resilience; (iii) climate change conservation strategies; (iv) biological invasions; and (v) conservation and culture.

Trench Safety–Using a Qualitative Approach to Understand Barriers and Develop Strategies to Improve Trenching Practices

PubMed Central

FLYNN, MICHAEL A.; SAMPSON, JULIE M.

2015-01-01

Despite efforts to ensure workplace safety and health, injuries and fatalities related to trenching and excavation remain alarmingly high in the construction industry. Because properly installed trenching protective systems can potentially reduce the significant number of trenching fatalities, there is clearly a need to identify the barriers to the use of these systems and to develop strategies to ensure these systems are utilized consistently. The current study reports on the results of focus groups with construction workers and safety management personnel to better understand these barriers and to identify solutions. The results suggest several factors, from poor planning to pressures from experienced workers and supervisors, which present barriers to safe trenching practices. Based on the results, it is recommended that safety trainings incorporate unique messages for new workers, experienced workers and management in an effort to motivate each group to work safely as well as provide them with solutions to overcome the identified barriers. PMID:26550006

Game theoretic approaches to operating room management.

PubMed

Marco, Alan P

2002-05-01

All interactions between people can be considered games with rules and outcomes. However, modern business practices demand that the players in the game go beyond traditional game theory and look at new ways to improve the outcome of the game. Choosing the right strategy is important to a player's success. A new business strategy, "co-opetition," can be used to increase the value of the game ("create a bigger pie") through cooperative behavior, whereas competition is used to divided the "pie." By looking at how the players adopt simultaneous roles such as complementor and competitor the stakeholders in the operating room (managers, surgeons, anesthesiologists, and nursing staff) can apply the principles of co-opetition to improve the overall success of their facility. Such stakeholders can utilize knowledge of how populations act in games to enhance cooperative play. Adopting such a perspective may lead to increases in the satisfaction and morale of those involved with the operating rooms. Increased morale should increase productivity and staff retention and reduce recruiting needs.

Evaluation of alternative airway management strategies in surgical repair of severe cranio-maxillofacial trauma.

PubMed

Zhang, Xinpei; Wang, Xing; Gu, Qianping; Zhang, Jie; Wu, Ruihan; Zhuang, Qianwei; Na, Li; Meng, Jian

2016-12-01

Severe cranio-maxillofacial trauma requires the utilization of alternative airway management techniques when oral and nasal routes of tracheal intubation are either not possible or contraindicated. This retrospective study evaluated the techniques of submental intubation, retromolar intubation and tracheostomy in terms of their frequency of use, time required, costs involved and associated complications in a total of 200 patients. Frequency of utilization of alternative airway management techniques was 3.63%. Tracheostomy was associated with the most severe complications, took the most time to establish and was the most expensive technique. Although retromolar intubation was not associated with any complications, it was not suitable in adults with erupted third molars and interfered with the surgical field. Submental intubation was associated with minor complications, was suitable in all cases and did not interfere with surgical access. Retromolar intubation must be considered as a first choice alternative in patients with unerupted third molars provided the surgeon is adept at working in the presence of an oral tube. Submental intubation is a good second choice when retromolar intubation is not possible or is not acceptable to the surgeon. Tracheostomy is only indicated in patients who require long term control of the airway.

Leveraging modern climatology to increase adaptive capacity across protected area networks

USGS Publications Warehouse

Davison, J.E.; Graumlich, L.J.; Rowland, E.L.; Pederson, G.T.; Breshears, D.D.

2012-01-01

Human-driven changes in the global environment pose an increasingly urgent challenge for the management of ecosystems that is made all the more difficult by the uncertain future of both environmental conditions and ecological responses. Land managers need strategies to increase regional adaptive capacity, but relevant and rapid assessment approaches are lacking. To address this need, we developed a method to assess regional protected area networks across biophysically important climatic gradients often linked to biodiversity and ecosystem function. We plot the land of the southwestern United States across axes of historical climate space, and identify landscapes that may serve as strategic additions to current protected area portfolios. Considering climate space is straightforward, and it can be applied using a variety of relevant climate parameters across differing levels of land protection status. The resulting maps identify lands that are climatically distinct from existing protected areas, and may be utilized in combination with other ecological and socio-economic information essential to collaborative landscape-scale decision-making. Alongside other strategies intended to protect species of special concern, natural resources, and other ecosystem services, the methods presented herein provide another important hedging strategy intended to increase the adaptive capacity of protected area networks. ?? 2011 Elsevier Ltd.

Addressing Methodological Challenges in Large Communication Data Sets: Collecting and Coding Longitudinal Interactions in Home Hospice Cancer Care.

PubMed

Reblin, Maija; Clayton, Margaret F; John, Kevin K; Ellington, Lee

2016-07-01

In this article, we present strategies for collecting and coding a large longitudinal communication data set collected across multiple sites, consisting of more than 2000 hours of digital audio recordings from approximately 300 families. We describe our methods within the context of implementing a large-scale study of communication during cancer home hospice nurse visits, but this procedure could be adapted to communication data sets across a wide variety of settings. This research is the first study designed to capture home hospice nurse-caregiver communication, a highly understudied location and type of communication event. We present a detailed example protocol encompassing data collection in the home environment, large-scale, multisite secure data management, the development of theoretically-based communication coding, and strategies for preventing coder drift and ensuring reliability of analyses. Although each of these challenges has the potential to undermine the utility of the data, reliability between coders is often the only issue consistently reported and addressed in the literature. Overall, our approach demonstrates rigor and provides a "how-to" example for managing large, digitally recorded data sets from collection through analysis. These strategies can inform other large-scale health communication research.

Addressing Methodological Challenges in Large Communication Datasets: Collecting and Coding Longitudinal Interactions in Home Hospice Cancer Care

PubMed Central

Reblin, Maija; Clayton, Margaret F; John, Kevin K; Ellington, Lee

2015-01-01

In this paper, we present strategies for collecting and coding a large longitudinal communication dataset collected across multiple sites, consisting of over 2000 hours of digital audio recordings from approximately 300 families. We describe our methods within the context of implementing a large-scale study of communication during cancer home hospice nurse visits, but this procedure could be adapted to communication datasets across a wide variety of settings. This research is the first study designed to capture home hospice nurse-caregiver communication, a highly understudied location and type of communication event. We present a detailed example protocol encompassing data collection in the home environment, large-scale, multi-site secure data management, the development of theoretically-based communication coding, and strategies for preventing coder drift and ensuring reliability of analyses. Although each of these challenges have the potential to undermine the utility of the data, reliability between coders is often the only issue consistently reported and addressed in the literature. Overall, our approach demonstrates rigor and provides a “how-to” example for managing large, digitally-recorded data sets from collection through analysis. These strategies can inform other large-scale health communication research. PMID:26580414

Stochastic optimal generation bid to electricity markets with emissions risk constraints.

PubMed

Heredia, F-Javier; Cifuentes-Rubiano, Julián; Corchero, Cristina

2018-02-01

There are many factors that influence the day-ahead market bidding strategies of a generation company (GenCo) within the framework of the current energy market. Environmental policy issues are giving rise to emission limitation that are becoming more and more important for fossil-fueled power plants, and these must be considered in their management. This work investigates the influence of the emissions reduction plan and the incorporation of the medium-term derivative commitments in the optimal generation bidding strategy for the day-ahead electricity market. Two different technologies have been considered: the high-emission technology of thermal coal units and the low-emission technology of combined cycle gas turbine units. The Iberian Electricity Market (MIBEL) and the Spanish National Emissions Reduction Plan (NERP) defines the environmental framework for dealing with the day-ahead market bidding strategies. To address emission limitations, we have extended some of the standard risk management methodologies developed for financial markets, such as Value-at-Risk (VaR) and Conditional Value-at-Risk (CVaR), thus leading to the new concept of Conditional Emission at Risk (CEaR). This study offers electricity generation utilities a mathematical model for determining the unit's optimal generation bid to the wholesale electricity market such that it maximizes the long-term profits of the utility while allowing it to abide by the Iberian Electricity Market rules as well as the environmental restrictions set by the Spanish National Emissions Reduction Plan. We analyze the economic implications for a GenCo that includes the environmental restrictions of this National Plan as well as the NERP's effects on the expected profits and the optimal generation bid. Copyright © 2017 Elsevier Ltd. All rights reserved.

Which interventions are used by health care professionals to enhance medication adherence in cardiovascular patients? A survey of current clinical practice.

PubMed

Berben, Lut; Bogert, Laura; Leventhal, Marcia E; Fridlund, Bengt; Jaarsma, Tiny; Norekvål, Tone M; Smith, Karen; Strömberg, Anna; Thompson, David R; De Geest, Sabina

2011-03-01

Complex medication regimens are often required to manage cardiovascular diseases. As non-adherence, which can have severe negative outcomes, is common among cardiovascular patients, various interventions to improve adherence should be implemented in daily practice. To assess which strategies cardiovascular nurses and allied health professionals utilize to (1) assess patients' adherence to medication regimen, and (2) enhance medication adherence via educational/cognitive, counseling/behavioral, and psychological/affective interventions. A 45-item questionnaire to assess adherence assessment and interventional strategies utilized by health care professionals in daily clinical practice was distributed to a convenience sample of attendants of the 10th Annual Spring Meeting of the European Society of Cardiology Council on Cardiovascular Nursing and Allied Professions conference in Geneva (Switzerland) in March 2010. Respondents not in direct clinical practice were excluded. Descriptive statistics were used to describe practice patterns regarding adherence management. Of 276 distributed questionnaires, 171 (62%) were returned, of which 34 (20%) were excluded as respondents performed no direct patient care. Questioning patients about non-adherence during follow-up was the most frequently reported assessment strategy (56%). Educational/cognitive adherence enhancing interventions were used most frequently, followed by counseling/behavioral interventions. Psychological/affective interventions were less frequently used. The most frequent intervention used was providing reading materials (66%) followed by training patients regarding medication taking during inpatient recovery (48%). Slightly over two-thirds (69%) reported using a combination of interventions to improve patient's adherence. Educational interventions are used most in clinical practice, although evidence shows they are less effective than behavioral interventions at enhancing medication adherence. Copyright © 2010 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Developing RCM Strategy for Hydrogen Fuel Cells Utilizing On Line E-Condition Monitoring

NASA Astrophysics Data System (ADS)

Baglee, D.; Knowles, M. J.

2012-05-01

Fuel cell vehicles are considered to be a viable solution to problems such as carbon emissions and fuel shortages for road transport. Proton Exchange Membrane (PEM) Fuel Cells are mainly used in this purpose because they can run at low temperatures and have a simple structure. Yet high maintenance costs and the inherent dangers of maintaining equipment using hydrogen are two main issues which need to be addressed. The development of appropriate and efficient strategies is currently lacking with regard to fuel cell maintenance. A Reliability Centered Maintenance (RCM) approach offers considerable benefit to the management of fuel cell maintenance since it includes an identification and consideration of the impact of critical components. Technological developments in e-maintenance systems, radio-frequency identification (RFID) and personal digital assistants (PDAs) have proven to satisfy the increasing demand for improved reliability, efficiency and safety. RFID technology is used to store and remotely retrieve electronic maintenance data in order to provide instant access to up-to-date, accurate and detailed information. The aim is to support fuel cell maintenance decisions by developing and applying a blend of leading-edge communications and sensor technology including RFID. The purpose of this paper is to review and present the state of the art in fuel cell condition monitoring and maintenance utilizing RCM and RFID technologies. Using an RCM analysis critical components and fault modes are identified. RFID tags are used to store the critical information, possible faults and their cause and effect. The relationship between causes, faults, symptoms and long term implications of fault conditions are summarized. Finally conclusions are drawn regarding suggested maintenance strategies and the optimal structure for an integrated, cost effective condition monitoring and maintenance management system.

An advanced optical system for laser ablation propulsion in space

NASA Astrophysics Data System (ADS)

Bergstue, Grant; Fork, Richard; Reardon, Patrick

2014-03-01

We propose a novel space-based ablation driven propulsion engine concept utilizing transmitted energy in the form of a series of ultra-short optical pulses. Key differences are generating the pulses at the transmitting spacecraft and the safe delivery of that energy to the receiving spacecraft for propulsion. By expanding the beam diameter during transmission in space, the energy can propagate at relatively low intensity and then be refocused and redistributed to create an array of ablation sites at the receiver. The ablation array strategy allows greater control over flight dynamics and eases thermal management. Research efforts for this transmission and reception of ultra-short optical pulses include: (1) optical system design; (2) electrical system requirements; (3) thermal management; (4) structured energy transmission safety. Research has also been focused on developing an optical switch concept for the multiplexing of the ultra-short pulses. This optical switch strategy implements multiple reflectors polished into a rotating momentum wheel device to combine the pulses from different laser sources. The optical system design must minimize the thermal load on any one optical element. Initial specifications and modeling for the optical system are being produced using geometrical ray-tracing software to give a better understanding of the optical requirements. In regards to safety, we have advanced the retro-reflective beam locking strategy to include look-ahead capabilities for long propagation distances. Additional applications and missions utilizing multiplexed pulse transmission are also presented. Because the research is in early development, it provides an opportunity for new and valuable advances in the area of transmitted energy for propulsion as well as encourages joint international efforts. Researchers from different countries can cooperate in order to find constructive and safe uses of ordered pulse transmission for propulsion in future space-based missions.

The evolving role of interventional pulmonary in the interdisciplinary approach to the staging and management of lung cancer. Part III: diagnosis and management of malignant pleural effusions.

PubMed

Yoneda, Ken Y; Mathur, Praveen N; Gasparini, Stefano

2007-11-01

The diagnosis and management of a malignant pleural effusion can be one of the most vexing problems faced by physicians and their patients. Lung cancer is the most common primary tumor of origin with a prognosis that is limited, but variable and correlated with performance status (PS). Therefore, with a poor PS and known advanced lung cancer, establishing whether or not an effusion is malignant might not be necessary. Conversely, identifiable subsets of patients will have a much better survival, and establishing a definitive diagnosis could be of critical importance. In the great majority of cases, a diagnosis can be determined by serial thoracenteses with or without closed pleural biopsy. However, thoracoscopy is increasingly being utilized and can expedite the workup by obviating the need for repeated thoracenteses and/or closed pleural biopsy, while in the same setting providing definitive palliative treatment. Although studies comparing diagnostic and treatment strategies are limited, we will present the available data with the intention of providing the practicing oncologist with a practical strategy for the diagnosis and management of malignant pleural effusions due to lung cancer. The interventional pulmonologist can play an important role from diagnosis to palliation, greatly facilitating the care of patients with malignant pleural effusions.

Global isotope metabolomics reveals adaptive strategies for nitrogen assimilation

DOE PAGES

Kurczy, Michael E.; Forsberg, Erica M.; Thorgersen, Michael P.; ...

2016-04-05

Nitrogen cycling is a microbial metabolic process essential for global ecological/agricultural balance. To investigate the link between the well-established ammonium and the alternative nitrate assimilation metabolic pathways, global isotope metabolomics was employed to examine three nitrate reducing bacteria using 15NO 3 as a nitrogen source. In contrast to a control ( Pseudomonas stutzeri RCH2), the results show that two of the isolates from Oak Ridge, Tennessee ( Pseudomonas N2A2 and N2E2) utilize nitrate and ammonia for assimilation concurrently with differential labeling observed across multiple classes of metabolites including amino acids and nucleotides. The data reveal that the N2A2 and N2E2more » strains conserve nitrogen-containing metabolites, indicating that the nitrate assimilation pathway is a conservation mechanism for the assimilation of nitrogen. Co-utilization of nitrate and ammonia is likely an adaption to manage higher levels of nitrite since the denitrification pathways utilized by the N2A2 and N2E2 strains from the Oak Ridge site are predisposed to the accumulation of the toxic nitrite. In conclusion, the use of global isotope metabolomics allowed for this adaptive strategy to be investigated, which would otherwise not have been possible to decipher.« less

Global isotope metabolomics reveals adaptive strategies for nitrogen assimilation

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

Kurczy, Michael E.; Forsberg, Erica M.; Thorgersen, Michael P.

Nitrogen cycling is a microbial metabolic process essential for global ecological/agricultural balance. To investigate the link between the well-established ammonium and the alternative nitrate assimilation metabolic pathways, global isotope metabolomics was employed to examine three nitrate reducing bacteria using 15NO 3 as a nitrogen source. In contrast to a control ( Pseudomonas stutzeri RCH2), the results show that two of the isolates from Oak Ridge, Tennessee ( Pseudomonas N2A2 and N2E2) utilize nitrate and ammonia for assimilation concurrently with differential labeling observed across multiple classes of metabolites including amino acids and nucleotides. The data reveal that the N2A2 and N2E2more » strains conserve nitrogen-containing metabolites, indicating that the nitrate assimilation pathway is a conservation mechanism for the assimilation of nitrogen. Co-utilization of nitrate and ammonia is likely an adaption to manage higher levels of nitrite since the denitrification pathways utilized by the N2A2 and N2E2 strains from the Oak Ridge site are predisposed to the accumulation of the toxic nitrite. In conclusion, the use of global isotope metabolomics allowed for this adaptive strategy to be investigated, which would otherwise not have been possible to decipher.« less

Opioid Analgesics for Chronic Non-Cancer Pain: A Guideline on Opioid Prescribing.

PubMed

Van Demark, Robert; Chang, Peter; Heinemann, Daniel

2016-01-01

Over the past decade, the use of opioid analgesics has risen dramatically both in the U.S. and South Dakota. Opioids have been increasingly used to treat chronic non-cancer pain; however, the utilization of opioids for this role has limited and questionable utility. The U.S. has also seen a rise of opioid abuse, addiction, misuse, and overdose. The various pharmacological and non-pharmacological strategies to help physicians manage chronic non-cancer pain and a guideline on appropriate opioid prescribing are presented. Before the decision is made to begin opioid therapy for chronic non-cancer pain, other pharmacological and non-pharmacological therapeutic strategies should be explored. The schema for responsible opioid prescribing can be dived into the following: the initial assessment, initiating opioid therapy, maintenance therapy, and the discontinuation of opioid treatment. These categories are explored, and a general approach to prescribing opioids for chronic non-cancer pain is presented. The Centers for Disease Control and Prevention (CDC) has declared opioid prescription abuse an "epidemic." There are a variety of methods clinicians can utilize to relieve chronic non-cancer pain. If opioid therapy is sought, clinicians should be mindful of the current state of opioid abuse and misuse. This guideline may aid clinicians in appropriate opioid prescribing.

Optimization under Uncertainty of a Biomass-integrated Renewable Energy Microgrid with Energy Storage

NASA Astrophysics Data System (ADS)

Zheng, Yingying

The growing energy demands and needs for reducing carbon emissions call more and more attention to the development of renewable energy technologies and management strategies. Microgrids have been developed around the world as a means to address the high penetration level of renewable generation and reduce greenhouse gas emissions while attempting to address supply-demand balancing at a more local level. This dissertation presents a model developed to optimize the design of a biomass-integrated renewable energy microgrid employing combined heat and power with energy storage. A receding horizon optimization with Monte Carlo simulation were used to evaluate optimal microgrid design and dispatch under uncertainties in the renewable energy and utility grid energy supplies, the energy demands, and the economic assumptions so as to generate a probability density function for the cost of energy. Case studies were examined for a conceptual utility grid-connected microgrid application in Davis, California. The results provide the most cost effective design based on the assumed energy load profile, local climate data, utility tariff structure, and technical and financial performance of the various components of the microgrid. Sensitivity and uncertainty analyses are carried out to illuminate the key parameters that influence the energy costs. The model application provides a means to determine major risk factors associated with alternative design integration and operating strategies.

Primary care physicians' perceived barriers, facilitators and strategies to enhance conservative care for older adults with chronic kidney disease: a qualitative descriptive study.

PubMed

Tam-Tham, Helen; Hemmelgarn, Brenda R; Campbell, David J T; Thomas, Chandra M; Fruetel, Karen; Quinn, Robert R; King-Shier, Kathryn M

2016-11-01

Although primary care physicians (PCPs) are often responsible for the routine care of older adults with chronic kidney disease (CKD), there is a paucity of evidence regarding their perspectives and practice of conservative (non-dialysis) care. We undertook a qualitative study to describe barriers, facilitators and strategies to enhance conservative, non-dialysis, CKD care by PCPs in the community. Semi-structured telephone and face-to-face interviews were conducted with PCPs from Alberta, Canada. Participants were identified using a snowball sampling strategy and purposively sampled based on sex, age and rural/urban location of clinical practice. Eligible participants had managed at least one patient ≥75 years with Stage 5 CKD (estimated glomerular filtration rate <15 mL/min/1.73 m 2 , not on dialysis) in the prior year. Participant recruitment ceased when data saturation was reached. Transcripts were analyzed thematically using conventional content analysis. In total, 27 PCPs were interviewed. The majority were male (15/27), were aged 40-60 years (15/27) and had practiced in primary care for >20 years (14/27). Perceived barriers to conservative CKD care included: managing expectations of kidney failure for patients and their families; dealing with the complexity of medical management of patients requiring conservative care; and challenges associated with managing patients jointly with specialists. Factors that facilitated conservative CKD care included: establishing patient/family expectations early; preserving continuity of care; and utilizing a multidisciplinary team approach. Suggested strategies for improving conservative care included having: direct telephone access to clinicians familiar with conservative care; treatment decision aids for patients and their families; and a conservative care clinical pathway to guide management. PCPs identified important barriers and facilitators to conservative care for their older patients with Stage 5 CKD. Further investigation of potential strategies that address barriers and enable facilitators is required to improve the quality of conservative care for older adults in the community. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Design an optimum safety policy for personnel safety management - A system dynamic approach

NASA Astrophysics Data System (ADS)

Balaji, P.

2014-10-01

Personnel safety management (PSM) ensures that employee's work conditions are healthy and safe by various proactive and reactive approaches. Nowadays it is a complex phenomenon because of increasing dynamic nature of organisations which results in an increase of accidents. An important part of accident prevention is to understand the existing system properly and make safety strategies for that system. System dynamics modelling appears to be an appropriate methodology to explore and make strategy for PSM. Many system dynamics models of industrial systems have been built entirely for specific host firms. This thesis illustrates an alternative approach. The generic system dynamics model of Personnel safety management was developed and tested in a host firm. The model was undergone various structural, behavioural and policy tests. The utility and effectiveness of model was further explored through modelling a safety scenario. In order to create effective safety policy under resource constraint, DOE (Design of experiment) was used. DOE uses classic designs, namely, fractional factorials and central composite designs. It used to make second order regression equation which serve as an objective function. That function was optimized under budget constraint and optimum value used for safety policy which shown greatest improvement in overall PSM. The outcome of this research indicates that personnel safety management model has the capability for acting as instruction tool to improve understanding of safety management and also as an aid to policy making.

Long-Term Trends (1986–2003) in the Use of Coronary Reperfusion Strategies in Patients Hospitalized With Acute Myocardial Infarction in Central Massachusetts

PubMed Central

Goldberg, Robert J.; Spencer, Frederick A.; Okolo, Joseph; Lessard, Darleen; Yarzebski, Jorge; Gore, Joel M.

2008-01-01

Background The objectives of our study were to examine long-term (1986–2003) trends in the use of percutaneous coronary interventions (PCI) and thrombolytic therapy in the management of patients hospitalized at all Central Massachusetts medical centers with acute myocardial infarction (AMI). Our secondary study goal was to examine factors associated with use of these coronary reperfusion strategies. Limited contemporary data are available about changing trends in the use of coronary reperfusion strategies, particularly from a population-based perspective. Methods The sample consisted of 9,422 greater Worcester (MA) residents hospitalized with AMI at all metropolitan Worcester medical centers in 10 annual periods between 1986 and 2003. Results Divergent trends in the use of PCI and thrombolytic therapy during hospitalization for AMI were noted. Use of thrombolytic therapy increased after its introduction to clinical practice in the mid-1980’s through the early 1990’s with a progressive decline in use thereafter. In 2003, 3.5% of patients hospitalized with AMI were treated with clot lysing therapy. Marked increases in the use of PCI during hospitalization for AMI were noted over time. In 2003, 42.1% of patients with AMI received a PCI. Several demographic and clinical factors were associated with the use of these different treatment strategies. Conclusions The results of our study in a large New England (United States) community suggest evolving changes in the hospital management of patients with AMI. Current management practices emphasize the utilization of PCI to restore coronary reperfusion to the infarct related artery. PMID:18191479

A Case Study on Neural Inspired Dynamic Memory Management Strategies for High Performance Computing.

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

Vineyard, Craig Michael; Verzi, Stephen Joseph

As high performance computing architectures pursue more computational power there is a need for increased memory capacity and bandwidth as well. A multi-level memory (MLM) architecture addresses this need by combining multiple memory types with different characteristics as varying levels of the same architecture. How to efficiently utilize this memory infrastructure is an unknown challenge, and in this research we sought to investigate whether neural inspired approaches can meaningfully help with memory management. In particular we explored neurogenesis inspired re- source allocation, and were able to show a neural inspired mixed controller policy can beneficially impact how MLM architectures utilizemore » memory.« less

Integrated manufacturing approach to attain benchmark team performance

NASA Astrophysics Data System (ADS)

Chen, Shau-Ron; Nguyen, Andrew; Naguib, Hussein

1994-09-01

A Self-Directed Work Team (SDWT) was developed to transfer a polyimide process module from the research laboratory to our wafer fab facility for applications in IC specialty devices. The SDWT implemented processes and tools based on the integration of five manufacturing strategies for continuous improvement. These were: Leadership Through Quality (LTQ), Total Productive Maintenance (TMP), Cycle Time Management (CTM), Activity-Based Costing (ABC), and Total Employee Involvement (TEI). Utilizing these management techniques simultaneously, the team achieved six sigma control of all critical parameters, increased Overall Equipment Effectiveness (OEE) from 20% to 90%, reduced cycle time by 95%, cut polyimide manufacturing cost by 70%, and improved its overall team member skill level by 33%.

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

PubMed

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

2017-10-01

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

Near-infrared fluorescent nanoprobes for cancer molecular imaging: status and challenges

PubMed Central

He, Xiaoxiao; Gao, Jinhao; Gambhir, Sanjiv Sam; Cheng, Zhen

2010-01-01

Near-infrared fluorescence (NIRF) imaging promises to improve cancer imaging and management; advances in nanomaterials allow scientists to combine new nanoparticles with NIRF imaging techniques, thereby fulfilling this promise. Here, we present a synopsis of current developments in NIRF nanoprobes, their use in imaging small living subjects, their pharmacokinetics and toxicity and finally their integration into multimodal imaging strategies. We also discuss challenges impeding the clinical translation of NIRF nanoprobes for molecular imaging of cancer. Whereas utilization of most NIRF nanoprobes remains at a proof-of-principle stage, optimizing the impact of nanomedicine in cancer patient diagnosis and management will likely be realized through persistent interdisciplinary amalgamation of diverse research fields. PMID:20870460

Evaluation and Management of Hepatic Encephalopathy: Current Status and Future Directions

PubMed Central

Suraweera, Duminda; Sundaram, Vinay; Saab, Sammy

2016-01-01

Hepatic encephalopathy is a spectrum of neurocognitive manifestations often seen in patients with liver injury or rarely in patients with portosystemic shunting without liver injury. It can be divided into minimal (covert) hepatic encephalopathy and overt hepatic encephalopathy, depending on the severity. Patients with hepatic encephalopathy have compromised clinical outcomes, decreased quality of life, and increased healthcare utilization, often resulting in a heavy financial and personal burden on caregivers. The diagnosis remains largely clinical, with the exclusion of possible other causes for the altered mental status. Current treatment strategies include nonabsorbable disaccharides and antibiotics. This review will focus on the diagnosis, management and clinical impact of hepatic encephalopathy. PMID:27377741

Economic Evaluations in the Diagnosis and Management of Traumatic Brain Injury: A Systematic Review and Analysis of Quality.

PubMed

Alali, Aziz S; Burton, Kirsteen; Fowler, Robert A; Naimark, David M J; Scales, Damon C; Mainprize, Todd G; Nathens, Avery B

2015-07-01

Economic evaluations provide a unique opportunity to identify the optimal strategies for the diagnosis and management of traumatic brain injury (TBI), for which uncertainty is common and the economic burden is substantial. The objective of this study was to systematically review and examine the quality of contemporary economic evaluations in the diagnosis and management of TBI. Two reviewers independently searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, Health Technology Assessment Database, EconLit, and the Tufts CEA Registry for comparative economic evaluations published from 2000 onward (last updated on August 30, 2013). Data on methods, results, and quality were abstracted in duplicate. The results were summarized quantitatively and qualitatively. Of 3539 citations, 24 economic evaluations met our inclusion criteria. Nine were cost-utility, five were cost-effectiveness, three were cost-minimization, and seven were cost-consequences analyses. Only six studies were of high quality. Current evidence from high-quality studies suggests the economic attractiveness of the following strategies: a low medical threshold for computed tomography (CT) scanning of asymptomatic infants with possible inflicted TBI, selective CT scanning of adults with mild TBI as per the Canadian CT Head Rule, management of severe TBI according to the Brain Trauma Foundation guidelines, management of TBI in dedicated neurocritical care units, and early transfer of patients with TBI with nonsurgical lesions to neuroscience centers. Threshold-guided CT scanning, adherence to Brain Trauma Foundation guidelines, and care for patients with TBI, including those with nonsurgical lesions, in specialized settings appear to be economically attractive strategies. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Evaluation of three harvest control rules for Bigeye Tuna ( Thunnus obesus) fisheries in the Indian Ocean

NASA Astrophysics Data System (ADS)

Tong, Yuhe; Chen, Xinjun; Kolody, Dale

2014-10-01

The stock of Bigeye tuna ( Thunnus obesus) in the Indian Ocean supports an important international fishery and is considered to be fully exploited. The responsible management agency, the Indian Ocean Tuna Commission (IOTC), does not have an explicit management decision-making framework in place to prevent over-fishing. In this study, we evaluated three harvest control rules, i) constant fishing mortality (CF), from 0.2 to 0.6, ii) constant catch (CC), from 60000 to 140000 t, and iii) constant escapement (CE), from 0.3 to 0.7. The population dynamics simulated by the operating model was based on the most recent stock assessment using Stock Synthesis version III (SS3). Three simulation scenarios (low, medium and high productivity) were designed to cover possible uncertainty in the stock assessment and biological parameters. Performances of three harvest control rules were compared on the basis of three management objectives (over 3, 10 and 25 years): i) the probability of maintaining spawning stock biomass above a level that can sustain maximum sustainable yield (MSY) on average, ii) the probability of achieving average catches between 0.8 MSY and 1.0 MSY, and iii) inter-annual variability in catches. The constant escapement strategy ( CE=0.5), constant fishing mortality strategy ( F=0.4) and constant catch ( CC=80000) were the most rational among the respective management scenarios. It is concluded that the short-term annual catch is suggested at 80000 t, and the potential total allowable catch for a stable yield could be set at 120000 t once the stock had recovered successfully. All the strategies considered in this study to achieve a `tolerable' balance between resource conservation and utilization have been based around the management objectives of the IOTC.

National water management in the Republic of South Africa — Towards a consultative partnership with diverse users in a semi-arid country

NASA Astrophysics Data System (ADS)

Conley, Alan H.; Midgley, Desmond C.

1988-07-01

A resourceful holistic water management strategy has been developed for ensuring equitable provision of adequate quantities of water of satisfactory quality at acceptable risk and affordable cost to a wide international range of competing user groups subject to adverse physical and hydrological factors and under rapidly changing social conditions. Scarce resource allocation strategies, based on scientific studies and supported by modern data processing facilities, focus primarily on supply, demand and quality. Supply management implies creation of the best combination of affordable elements of infrastructure for bulk water supplies from available runoff, groundwater, re-use, imports and unconventional sources, sized to meet determinable requirements with appropriate degrees of assurance, coupled with continuous optimization of system operation. Demand management seeks optimum allocation of available supplies to towns, power generation, industry, mining, agriculture, forestry, recreation and ecology, according to priority criteria determined from scientific, economic and socioeconomic studies. Quality management strategies relate to the control of salination, eutrophication and pollution from both diffuse and point sources. As the combined demands of complex First and Third World societies and economies on the available resources rise, increasing attention has to be paid to finding practical compromises to facilitate handling of conflict between legitimate users having widely divergent interests, aspirations and levels of sophistication. For optimum joint utilization, the central regulating authority is striving to forge a consultative partnership within which to promote, among the widest possible spectrum of users, enlightened understanding of the opportunities and limitations in handling complex international, social, political, legal, economic and financial issues associated with water development. These cannot readily be resolved by the methods of traditional hydrological sciences alone.

Optimizing the Moisture Management Tightrope with Wound Bed Preparation 2015©.

PubMed

Sibbald, R Gary; Elliott, James A; Ayello, Elizabeth A; Somayaji, Ranjani

2015-10-01

To provide an overview of moisture management and its importance in wound care. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Summarize causes and treatments for moisture balance issues of chronic wounds.2. Recognize the properties of dressings used for treatment for moisture management of chronic wounds and antiseptic agent cytotoxicity.3. Explain study findings of the effectiveness of dressing choices for treatment of chronic wounds. To provide an overview of moisture management and its importance in wound care. The authors evaluate the impact of moisture management for optimal wound care and assess current wound management strategies relating to antisepsis and moist wound healing utilizing the wound bed preparation paradigm 2015 update. The discussion distinguishes the form and function of wound care dressing classes available for optimal moisture management. Moisture management for chronic wounds is best achieved with modern moist interactive dressings if the wound has the ability to heal.

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

PubMed

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

2018-01-01

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

Innovative Approaches to Collaborative Groundwater Governance in the United States: Case Studies from Three High-Growth Regions in the Sun Belt.

PubMed

Megdal, Sharon B; Gerlak, Andrea K; Huang, Ling-Yee; Delano, Nathaniel; Varady, Robert G; Petersen-Perlman, Jacob D

2017-05-01

Groundwater is an increasingly important source of freshwater, especially where surface water resources are fully or over-allocated or becoming less reliable due to climate change. Groundwater reliance has created new challenges for sustainable management. This article examines how regional groundwater users coordinate and collaborate to manage shared groundwater resources, including attention to what drives collaboration. To identify and illustrate these facets, this article examines three geographically diverse cases of groundwater governance and management from the United States Sun Belt: Orange County Water District in southern California; Prescott Active Management Area in north-central Arizona; and the Central Florida Water Initiative in central Florida. These regions have different surface water laws, groundwater allocation and management laws and regulations, demographics, economics, topographies, and climate. These cases were selected because the Sun Belt faces similar pressures on groundwater due to historical and projected population growth and limited availability of usable surface water supplies. Collectively, they demonstrate groundwater governance trends in the United States, and illustrate distinctive features of regional groundwater management strategies. Our research shows how geophysical realities and state-level legislation have enabled and/or stimulated regions to develop groundwater management plans and strategies to address the specific issues associated with their groundwater resources. We find that litigation involvement and avoidance, along with the need to finance projects, are additional drivers of regional collaboration to manage groundwater. This case study underscores the importance of regionally coordinated and sustained efforts to address serious groundwater utilization challenges faced by the regions studied and around the world.

Innovative Approaches to Collaborative Groundwater Governance in the United States: Case Studies from Three High-Growth Regions in the Sun Belt

NASA Astrophysics Data System (ADS)

Megdal, Sharon B.; Gerlak, Andrea K.; Huang, Ling-Yee; Delano, Nathaniel; Varady, Robert G.; Petersen-Perlman, Jacob D.

2017-05-01

Groundwater is an increasingly important source of freshwater, especially where surface water resources are fully or over-allocated or becoming less reliable due to climate change. Groundwater reliance has created new challenges for sustainable management. This article examines how regional groundwater users coordinate and collaborate to manage shared groundwater resources, including attention to what drives collaboration. To identify and illustrate these facets, this article examines three geographically diverse cases of groundwater governance and management from the United States Sun Belt: Orange County Water District in southern California; Prescott Active Management Area in north-central Arizona; and the Central Florida Water Initiative in central Florida. These regions have different surface water laws, groundwater allocation and management laws and regulations, demographics, economics, topographies, and climate. These cases were selected because the Sun Belt faces similar pressures on groundwater due to historical and projected population growth and limited availability of usable surface water supplies. Collectively, they demonstrate groundwater governance trends in the United States, and illustrate distinctive features of regional groundwater management strategies. Our research shows how geophysical realities and state-level legislation have enabled and/or stimulated regions to develop groundwater management plans and strategies to address the specific issues associated with their groundwater resources. We find that litigation involvement and avoidance, along with the need to finance projects, are additional drivers of regional collaboration to manage groundwater. This case study underscores the importance of regionally coordinated and sustained efforts to address serious groundwater utilization challenges faced by the regions studied and around the world.

What Causes a Memory Strategy Utilization Deficiency?

ERIC Educational Resources Information Center

Miller, Patricia H.; And Others

1994-01-01

In memory strategy utilization deficiency, a child spontaneously produces an appropriate strategy but receives little or no benefit from it for recall. Three studies suggest two causes: children's failure to relate the task situation to their event knowledge, or to link the strategy to a second strategy, in this case linking a selective attention…

The Examination of the Relation between Teacher Candidates' Problem Solving Appraisal and Utilization of Motivated Strategies for Learning

ERIC Educational Resources Information Center

Turgut, Ozden; Ocak, Gurbuz

2017-01-01

This study examines the relation between teacher candidates' problem solving appraisal and utilization of motivated strategies for learning. The study has been carried out with 416 teacher candidates. A correlation has been used between problem solving appraisal and utilization of motivated strategies for learning. Besides, regression analysis has…

LOX, GOX and Pressure Relief

NASA Technical Reports Server (NTRS)

McLeod, Ken; Stoltzfus, Joel

2006-01-01

Oxygen relief systems present a serious fire hazard risk with often severe consequences. This presentation offers a risk management solution strategy which encourages minimizing ignition hazards, maximizing best materials, and utilizing good practices. Additionally, the relief system should be designed for cleanability and ballistic flow. The use of the right metals, softgoods, and lubricants, along with the best assembly techniques, is stressed. Materials should also be tested if data is not available and a full hazard analysis should be conducted in an effort to minimize risk and harm.

Advanced life support technology development for the Space Exploration Initiative

NASA Technical Reports Server (NTRS)

Evanich, Peggy L.; Voecks, Gerald E.; Seshan, P. K.

1990-01-01

An overview is presented of NASA's advanced life support technology development strategy for the Space Exploration Initiative. Three basic life support technology areas are discussed in detail: air revitalization, water reclamation, and solid waste management. It is projected that regenerative life support systems will become increasingly more complex as system closure is maximized. Advanced life support technology development will utilize three complementary elements, including the Research and Technology Program, the Regenerative Life Support Program, and the Technology Testbed Validations.

An update on the management of chronic inflammatory demyelinating polyneuropathy

PubMed Central

2012-01-01

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune mediated disorder of the peripheral nervous system with clinical features that include weakness, sensory loss, imbalance, pain and impaired ambulation which may lead to substantial disability. This review highlights current treatment strategies for CIDP, how best to utilize proven therapies such as intravenous immunoglobulin, oral prednisone, pulse dexamethasone, and plasma exchange, and when and how to use alternative immunosuppressive agents when first-line therapies are ineffective or poorly tolerated. PMID:23139706

Healthy Harlem: empowering health consumers through social networking, tailoring and web 2.0 technologies.

PubMed

Khan, Sharib A; McFarlane, Delano J; Li, Jianhua; Ancker, Jessica S; Hutchinson, Carly; Cohall, Alwyn; Kukafka, Rita

2007-10-11

Consumer health informatics has emerged as a strategy to inform and empower patients for self management of their health. The emergence of and explosion in use of user-generated online media (e.g.,blogs) has created new opportunities to inform and educate people about healthy living. Under a prevention research project, we are developing a website that utilizes social content collaboration mediums in conjunction with open-source technologies to create a community-driven resource that provides users with tailored health information.

An approach to industrial water conservation--a case study involving two large manufacturing companies based in Australia.

PubMed

Agana, Bernard A; Reeve, Darrell; Orbell, John D

2013-01-15

This study presents the application of an integrated water management strategy at two large Australian manufacturing companies that are contrasting in terms of their respective products. The integrated strategy, consisting of water audit, pinch analysis and membrane process application, was deployed in series to systematically identify water conservation opportunities. Initially, a water audit was deployed to completely characterize all water streams found at each production site. This led to the development of a water balance diagram which, together with water test results, served as a basis for subsequent enquiry. After the water audit, commercially available water pinch software was utilized to identify possible water reuse opportunities, some of which were subsequently implemented on site. Finally, utilizing a laboratory-scale test rig, membrane processes such as UF, NF and RO were evaluated for their suitability to treat the various wastewater streams. The membranes tested generally showed good contaminant rejection rates, slow flux decline rates, low energy usage and were well suited for treatment of specific wastewater streams. The synergy between the various components of this strategy has the potential to reduce substantial amounts of Citywater consumption and wastewater discharge across a diverse range of large manufacturing companies. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Gene Therapy in Heart Failure.

PubMed

Fargnoli, Anthony S; Katz, Michael G; Bridges, Charles R; Hajjar, Roger J

2017-01-01

Heart failure is a significant burden to the global healthcare system and represents an underserved market for new pharmacologic strategies, especially therapies which can address root cause myocyte dysfunction. Modern drugs, surgeries, and state-of-the-art interventions are costly and do not improve survival outcome measures. Gene therapy is an attractive strategy, whereby selected gene targets and their associated regulatory mechanisms can be permanently managed therapeutically in a single treatment. This in theory could be sustainable for the patient's life. Despite the promise, however, gene therapy has numerous challenges that must be addressed together as a treatment plan comprising these key elements: myocyte physiologic target validation, gene target manipulation strategy, vector selection for the correct level of manipulation, and carefully utilizing an efficient delivery route that can be implemented in the clinic to efficiently transfer the therapy within safety limits. This chapter summarizes the key developments in cardiac gene therapy from the perspective of understanding each of these components of the treatment plan. The latest pharmacologic gene targets, gene therapy vectors, delivery routes, and strategies are reviewed.

Finite Control Set Model Predictive Control for Multiple Distributed Generators Microgrids

NASA Astrophysics Data System (ADS)

Babqi, Abdulrahman Jamal

This dissertation proposes two control strategies for AC microgrids that consist of multiple distributed generators (DGs). The control strategies are valid for both grid-connected and islanded modes of operation. In general, microgrid can operate as a stand-alone system (i.e., islanded mode) or while it is connected to the utility grid (i.e., grid connected mode). To enhance the performance of a micrgorid, a sophisticated control scheme should be employed. The control strategies of microgrids can be divided into primary and secondary controls. The primary control regulates the output active and reactive powers of each DG in grid-connected mode as well as the output voltage and frequency of each DG in islanded mode. The secondary control is responsible for regulating the microgrid voltage and frequency in the islanded mode. Moreover, it provides power sharing schemes among the DGs. In other words, the secondary control specifies the set points (i.e. reference values) for the primary controllers. In this dissertation, Finite Control Set Model Predictive Control (FCS-MPC) was proposed for controlling microgrids. FCS-MPC was used as the primary controller to regulate the output power of each DG (in the grid-connected mode) or the voltage of the point of DG coupling (in the islanded mode of operation). In the grid-connected mode, Direct Power Model Predictive Control (DPMPC) was implemented to manage the power flow between each DG and the utility grid. In the islanded mode, Voltage Model Predictive Control (VMPC), as the primary control, and droop control, as the secondary control, were employed to control the output voltage of each DG and system frequency. The controller was equipped with a supplementary current limiting technique in order to limit the output current of each DG in abnormal incidents. The control approach also enabled smooth transition between the two modes. The performance of the control strategy was investigated and verified using PSCAD/EMTDC software platform. This dissertation also proposes a control and power sharing strategy for small-scale microgrids in both grid-connected and islanded modes based on centralized FCS-MPC. In grid-connected mode, the controller was capable of managing the output power of each DG and enabling flexible power regulation between the microgrid and the utility grid. In islanded mode, the controller regulated the microgrid voltage and frequency, and provided a precise power sharing scheme among the DGs. In addition, the power sharing can be adjusted flexibly by changing the sharing ratio. The proposed control also enabled plug-and-play operation. Moreover, a smooth transition between the two modes of operation was achieved without any disturbance in the system. Case studies were carried out in order to validate the proposed control strategy with the PSCAD/EMTDA software package.

Utility of Risk Stratification for Paclitaxel Hypersensitivity Reactions.

PubMed

Otani, Iris M; Lax, Timothy; Long, Aidan A; Slawski, Benjamin R; Camargo, Carlos A; Banerji, Aleena

2017-10-03

Hypersensitivity reactions (HSRs) are a common impediment to paclitaxel therapy. Management strategies to guide care after a paclitaxel-induced HSR are needed. The objective was to evaluate the utility and safety of risk stratification on the basis of severity of the initial HSR. A risk stratification pathway was developed on the basis of a retrospective review of the management and outcome of 130 patients with paclitaxel-induced HSRs at Massachusetts General Hospital. This pathway was then studied prospectively in patients referred to Allergy/Immunology with paclitaxel-induced HSRs. The study population (n = 35) had a mean age of 56.1 ± 12 years and most were women (n = 33 [94%]). All 5 patients (15%) with grade 1 initial HSRs were successfully reexposed to paclitaxel, 1 patient at the standard infusion rate and 4 patients at 50% of the standard infusion rate. Thirty patients (85%) with grade 2 to 4 initial HSRs underwent initial paclitaxel desensitization based on the risk stratification pathway. No patients developed severe HSRs using the pathway. Eleven (31%) patients had HSRs that were mild to moderate in nature (grade 1, n = 4 [11%]; grade 2, n = 6 [17%]; grade 3, n = 1 [3%]) during their first desensitization. Sixteen (46%) of the 35 patients safely returned to the outpatient infusion setting for paclitaxel treatment at 50% of the standard infusion rate. Seven (20%) discontinued paclitaxel before the completion of the risk stratification pathway because of disease progression, completion of therapy, or death. A management strategy using the initial HSR severity for risk stratification allowed patients to receive paclitaxel safely. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Aspiring Pain Practitioners in India: Assessing Challenges and Building Opportunities.

PubMed

Bhatnagar, Sushma; Patel, Anuradha; Raja, Srinivasa N

2018-01-01

Pain medicine is a developing specialty, aimed at relieving pain and suffering, enhancing function, and improving the quality of life of patients. Pain is often ignored, under-reported and mismanaged by health-care providers. Aspiring pain physicians in India face many challenges and barriers in advancing their specialty. The objective of this study is to determine the challenges in establishing a pain practice in India and to discuss the opportunities and strategies to overcome these barriers. Face-to-face interactive sessions were held with 60 aspiring pain physicians of India who were chosen as registrants to an International Association for the Study of Pain-Indian Society for Study of Pain multidisciplinary evidence-based pain management program conducted at Delhi and Mumbai. The available opportunities, practical issues and the hurdles in becoming a pain specialist were analyzed and summarized in this commentary. The major barriers identified were: (1) Inadequate knowledge and absence of structured, educational and training courses, (2) bureaucratic hurdles, and (3) concerns of opioid misuse and addiction. The opportunities for personal growth and that of the specialty that could be utilized include the creation of a pain resource team, increasing community awareness, changing attitudes of other physicians toward pain specialty, and research and evidence building of the effectiveness of pain management strategies. India needs a structured teaching and training program in the area of pain medicine that is affiliated by the Medical Council of India or other reputed boards of medical education and certification. There is an urgent need to include pain management in the undergraduate and postgraduate medical curriculum. Enhancing community level awareness by public health education campaigns, developing networks of pain physicians, and appropriate marketing of the specialty is needed to make pain medicine recognized and utilized as a valuable specialty.

Adaptive Flood Risk Management Under Climate Change Uncertainty Using Real Options and Optimization.

PubMed

Woodward, Michelle; Kapelan, Zoran; Gouldby, Ben

2014-01-01

It is well recognized that adaptive and flexible flood risk strategies are required to account for future uncertainties. Development of such strategies is, however, a challenge. Climate change alone is a significant complication, but, in addition, complexities exist trying to identify the most appropriate set of mitigation measures, or interventions. There are a range of economic and environmental performance measures that require consideration, and the spatial and temporal aspects of evaluating the performance of these is complex. All these elements pose severe difficulties to decisionmakers. This article describes a decision support methodology that has the capability to assess the most appropriate set of interventions to make in a flood system and the opportune time to make these interventions, given the future uncertainties. The flood risk strategies have been explicitly designed to allow for flexible adaptive measures by capturing the concepts of real options and multiobjective optimization to evaluate potential flood risk management opportunities. A state-of-the-art flood risk analysis tool is employed to evaluate the risk associated to each strategy over future points in time and a multiobjective genetic algorithm is utilized to search for the optimal adaptive strategies. The modeling system has been applied to a reach on the Thames Estuary (London, England), and initial results show the inclusion of flexibility is advantageous, while the outputs provide decisionmakers with supplementary knowledge that previously has not been considered. © 2013 HR Wallingford Ltd.

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

PubMed

Hewner, Sharon; Casucci, Sabrina; Castner, Jessica

2016-08-01

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

What does it mean to be an exemplary science teacher?

NASA Astrophysics Data System (ADS)

Tobin, Kenneth; Fraser, Barry J.

In order to provide a refreshing alternative to the majority of research reports, which malign science education and highlight its major problems and shortcomings, a series of case studies of exemplary practice was initiated to provide a focus on the successful and positive facets of schooling. The major data-collection approach was qualitative and involved 13 researchers in hundreds of hours of intensive classroom observation involving 20 exemplary teachers and a comparison group of nonexemplary teachers. A distinctive feature of the methodology was that the qualitative information was complemented by quantitative information obtained from the administration of questionnaires assessing student perceptions of classroom psychosocial environment. The major trends were that exemplary science teachers (1) used management strategies that facilitated sustained student engagement, (2) used strategies designed to increase student understanding of science, (3) utilized strategies that encouraged students to participate in learning activities, and (4) maintained a favorable classroom learning environment.

Techniques for detecting effects of urban and rural land-use practices on stream-water chemistry in selected watersheds in Texas, Minnesota,and Illinois

USGS Publications Warehouse

Walker, J.F.

1993-01-01

Selected statistical techniques were applied to three urban watersheds in Texas and Minnesota and three rural watersheds in Illinois. For the urban watersheds, single- and paired-site data-collection strategies were considered. The paired-site strategy was much more effective than the singlesite strategy for detecting changes. Analysis of storm load regression residuals demonstrated the potential utility of regressions for variability reduction. For the rural watersheds, none of the selected techniques were effective at identifying changes, primarily due to a small degree of management-practice implementation, potential errors introduced through the estimation of storm load, and small sample sizes. A Monte Carlo sensitivity analysis was used to determine the percent change in water chemistry that could be detected for each watershed. In most instances, the use of regressions improved the ability to detect changes.