42 CFR 456.524 - Notification of Administrator's action and duration of variance.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote...

42 CFR 456.231 - Continued stay review required.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan... a review of each recipient's continued stay in the mental hospital to decide whether it is needed...

42 CFR 456.133 - Subsequent continued stay review dates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan....128 and 456.134(a); (b) The committee assigns a subsequent review date each time it decides under...

42 CFR 456.133 - Subsequent continued stay review dates.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan....128 and 456.134(a); (b) The committee assigns a subsequent review date each time it decides under...

42 CFR 456.125 - Time limits for admission review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Time limits for admission review. 456.125 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan: Review of Need for Admission 1 § 456.125 Time limits for admission review. Except as required under § 456...

42 CFR 456.125 - Time limits for admission review.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Time limits for admission review. 456.125 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan: Review of Need for Admission 1 § 456.125 Time limits for admission review. Except as required under § 456...

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

PubMed

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

1999-01-01

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

42 CFR 456.520 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.520 Definitions... granted by the Administrator to the Medicaid agency for a specific remote facility to use time periods...

42 CFR 456.522 - Content of request for variance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time..., mental hospital, and ICF located within a 50-mile radius of the facility; (e) The distance and average...

42 CFR 456.508 - Withdrawal of waiver.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Waiver of Requirements § 456.508 Withdrawal of waiver.... (b) If a waiver is withdrawn by the Administrator, each hospital or mental hospital covered by the...

42 CFR 456.522 - Content of request for variance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time... travel time between the remote facility and each facility listed in paragraph (e) of this section; (f...

42 CFR 456.521 - Conditions for granting variance requests.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time... is unable to meet the time requirements for which the variance is requested; and (2) A revised UR...

Responding to Community Needs through Community Follow-Up. Junior College Resource Review.

ERIC Educational Resources Information Center

Mehallis, Mantha Vlahos

This literature review examines the utilization of community needs assessment data in program planning and evaluation efforts at community colleges. The review first defines and looks at the purposes of community needs assessments, noting that while such studies are purported to facilitate the planning and evaluation of credit and non-credit…

42 CFR 456.524 - Notification of Administrator's action and duration of variance.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals Ur Plan: Remote Facility Variances from Time Requirements § 456.524 Notification of Administrator's action and duration of...

42 CFR 456.236 - Continued stay review process.

Code of Federal Regulations, 2012 CFR

2012-10-01

....236 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan... physician members of the committee, one of whom is knowledgeable in the treatment of mental diseases, review...

42 CFR 456.236 - Continued stay review process.

Code of Federal Regulations, 2014 CFR

2014-10-01

....236 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan... physician members of the committee, one of whom is knowledgeable in the treatment of mental diseases, review...

42 CFR 456.236 - Continued stay review process.

Code of Federal Regulations, 2010 CFR

2010-10-01

... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan... each continued stay of a recipient in the mental hospital, the committee, subgroup or designee reviews... committee, subgroup or designee finds that a recipient's continued stay in the mental hospital is needed...

42 CFR 456.500 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Review Plans: FFP, Waivers, and Variances for Hospitals and Mental Hospitals § 456.500 Purpose. For hospitals and mental hospitals, this subpart— (a...

Water Utility Planning for an Emergency Drinking Water Supply

EPA Pesticide Factsheets

Reviews roles and responsibilities among various levels of government regarding emergency water supplies and seeks to encourage collaboration and partnership regarding emergency water supply planning.

The California general plan process and sustainable transportation planning

DOT National Transportation Integrated Search

2001-11-01

This study reviewed the current and potential utility of California's General Plan process as a tool for promoting more sustainable local transportation systems The study used multiple methods to investigate this issue, including: 1. An extensive lit...

Improving utility of evidence synthesis for healthy public policy: the three Rs (relevance, rigor, and readability [and resources]).

PubMed

Thomson, Hilary

2013-08-01

Systematic reviews have the potential to promote knowledge exchange between researchers and decision-makers. Review planning requires engagement with evidence users to ensure preparation of relevant reviews, and well-conducted reviews should provide accessible and reliable synthesis to support decision-making. Yet, systematic reviews are not routinely referred to by decision-makers, and innovative approaches to improve the utility of reviews is needed. Evidence synthesis for healthy public policy is typically complex and methodologically challenging. Although not lessening the value of reviews, these challenges can be overwhelming and threaten their utility. Using the interrelated principles of relevance, rigor, and readability, and in light of available resources, this article considers how utility of evidence synthesis for healthy public policy might be improved.

Improving Utility of Evidence Synthesis for Healthy Public Policy: the Three Rs (Relevance, Rigor, and Readability [and Resources])

PubMed Central

2013-01-01

Systematic reviews have the potential to promote knowledge exchange between researchers and decision-makers. Review planning requires engagement with evidence users to ensure preparation of relevant reviews, and well-conducted reviews should provide accessible and reliable synthesis to support decision-making. Yet, systematic reviews are not routinely referred to by decision-makers, and innovative approaches to improve the utility of reviews is needed. Evidence synthesis for healthy public policy is typically complex and methodologically challenging. Although not lessening the value of reviews, these challenges can be overwhelming and threaten their utility. Using the interrelated principles of relevance, rigor, and readability, and in light of available resources, this article considers how utility of evidence synthesis for healthy public policy might be improved. PMID:23763400

Utilization of Health Research Recommendation in Policy and Planning in Nepal.

PubMed

Dhimal, M; Pandey, A R; Aryal, K K; Budhathoki, C B; Vaidya, D L; Karki, K K; Onta, S

2016-09-01

Over the past decade in Nepal, a large number of studies have been carried in a variety of health areas; however whether evidence derived from these studies has been used to inform health policy has not been explored. This study aims to assess the utilization of recommendations from health research in health policy and plans, and to identify the factors that influence utilization of research findings by policy makers' in Nepal. Qualitative study incorporating literature review and semi-structured interviews was used. Research reports and health related policies were collected from governmental and non-governmental bodies. Documents were reviewed to identify the utilization of research-based recommendations in health policy and plan formulation. In-depth interviews were conducted with key policy makers and researchers to identify factors that hinder the utilization of research recommendations. A total of 83 health related research reports were identified, of which 48 had recommendations. Four policies and three plans, from total 21 identified plans and policies, were found to have incorporated recommendations from research. Of the 48 studies that had recommendations, 35 were found to be used in the policy making process. Lack of appropriate communication mechanisms, and concerns related to the quality of research conducted, were the main factors hindering the translation of evidence into policy. Communication gaps exist between researchers and policy makers, which seem to have impeded the utilization of research-based information and recommendations in decision-making process. Establishing a unit responsible for synthesizing evidences and producing actionable messages for policy makers can improve utilization of research findings.

Technical architecture of ONC-approved plans for statewide health information exchange.

PubMed

Barrows, Randolph C; Ezzard, John

2011-01-01

ONC-approved state plans for HIE were reviewed for descriptions and depictions of statewide HIE technical architecture. Review was complicated by non-standard organizational elements and technical terminology across state plans. Findings were mapped to industry standard, referenced, and defined HIE architecture descriptions and characteristics. Results are preliminary due to the initial subset of ONC-approved plans available, the rapid pace of new ONC-plan approvals, and continuing advancements in standards and technology of HIE, etc. Review of 28 state plans shows virtually all include a direct messaging component, but for participating entities at state-specific levels of granularity (RHIO, enterprise, organization/provider). About ½ of reviewed plans describe a federated architecture, and ¼ of plans utilize a single-vendor "hybrid-federated" architecture. About 1/3 of states plan to leverage new federal and open exchange technologies (DIRECT, CONNECT, etc.). Only one plan describes a centralized architecture for statewide HIE, but others combine central and federated architectural approaches.

Technical Architecture of ONC-Approved Plans For Statewide Health Information Exchange

PubMed Central

Barrows, Randolph C.; Ezzard, John

2011-01-01

ONC-approved state plans for HIE were reviewed for descriptions and depictions of statewide HIE technical architecture. Review was complicated by non-standard organizational elements and technical terminology across state plans. Findings were mapped to industry standard, referenced, and defined HIE architecture descriptions and characteristics. Results are preliminary due to the initial subset of ONC-approved plans available, the rapid pace of new ONC-plan approvals, and continuing advancements in standards and technology of HIE, etc. Review of 28 state plans shows virtually all include a direct messaging component, but for participating entities at state-specific levels of granularity (RHIO, enterprise, organization/provider). About ½ of reviewed plans describe a federated architecture, and ¼ of plans utilize a single-vendor “hybrid-federated” architecture. About 1/3 of states plan to leverage new federal and open exchange technologies (DIRECT, CONNECT, etc.). Only one plan describes a centralized architecture for statewide HIE, but others combine central and federated architectural approaches. PMID:22195059

42 CFR 456.506 - Waiver options for Medicaid agency.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

A review of utility issues for the integration of wind electric generators

NASA Technical Reports Server (NTRS)

Reddoch, T. W.; Barnes, P. R.

1982-01-01

A review of issues and concerns of the electric utility industry for the integration of wind electric generation is offered. The issues have been categorized in three major areas: planning, operations, and dynamic interaction. Representative studies have been chosen for each area to illustrate problems and to alleviate some concerns. The emphasis of this paper is on individual large wind turbines (WTs) and WT arrays for deployment at the bulk level in a utility system.

42 CFR 456.238 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Review of Need for Continued Stay § 456.238 Time limits for...

National Conference on Integrated Resource Planning: Proceedings

NASA Astrophysics Data System (ADS)

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

Integrating MRP (materiel requirements planning) II and JIT to achieve world-class status.

PubMed

Titone, R C

1994-05-01

The concepts and principles of using manufacturing resource planning (MRP II) for planning are not new. Their success has been proven in numerous manufacturing companies in America. The concepts and principles of using just-in-time (JIT) inventory for execution, while more recent, have also been available for some time, and their success in Japan well documented. However, it is the effective integration of these two powerful tools that open the way to achieving world-class manufacturing status. This article will utilize a newly developed world-class manufacturing model, which will review the aspects of planning, beginning with a business plan through the production planning process and culminating with a master schedule that drives a materiel/capacity plan. The importance and interrelationship of these functions are reviewed. The model then illustrates the important aspects of executing these plans beginning with people issues, through total quality control (TQC) and pull systems. We will then utilize this new functional model to demonstrate the relationship between these various functions and the importance of integrating them with a total comprehensive manufacturing strategy that will lead to world-class manufacturing and profits.

Wind energy on the horizon in British Columbia. A review and evaluation of the British Columbia wind energy planning framework

NASA Astrophysics Data System (ADS)

Day, Jason

This study examines the wind energy planning frameworks from ten North American jurisdictions, drawing important lessons that British Columbia could use to build on its current model which has been criticized for its limited scope and restriction of local government powers. This study contributes to similar studies conducted by Kimrey (2006), Longston (2006), and Eriksen (2009). This study concludes that inclusion of wind resource zones delineated through strategic environmental assessment, programme assessment, and conducting research-oriented studies could improve the current British Columbia planning framework. The framework should also strengthen its bat impact assessment practices and incorporate habitat compensation. This research also builds upon Rosenberg's (2008) wind energy planning framework typologies. I conclude that the typology utilized in Texas should be employed in British Columbia in order to facilitate utilizing wind power. The only adaptation needed is the establishment of a cross-jurisdictional review committee for project assessment to address concerns about local involvement and site-specific environmental and social concerns.

Planetary science and resource utilization at a lunar outpost - Chemical analytical facility requirements

NASA Technical Reports Server (NTRS)

Taylor, Lawrence A.

1992-01-01

Unresolved issues of lunar geology are reviewed and the role of a lunar outpost in helping to address them is considered. Plans for in situ resource utilization of lunar materials are examined. Concepts for a lunar outpost are described.

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

Digital Architecture Planning Model

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

Oxstrand, Johanna Helene; Al Rashdan, Ahmad Yahya Mohammad; Bly, Aaron Douglas

As part of the U.S. Department of Energy’s Light Water Reactor Sustainability Program, the Digital Architecture (DA) Project focuses on providing a model that nuclear utilities can refer to when planning deployment of advanced technologies. The digital architecture planning model (DAPM) is the methodology for mapping power plant operational and support activities into a DA that unifies all data sources needed by the utilities to operate their plants. The DA is defined as a collection of information technology capabilities needed to support and integrate a wide spectrum of real-time digital capabilities for performance improvements of nuclear power plants. DA canmore » be thought of as integration of the separate instrumentation and control and information systems already in place in nuclear power plants, which are brought together for the purpose of creating new levels of automation in plant work activities. A major objective in DAPM development was to survey all key areas that needed to be reviewed in order for a utility to make knowledgeable decisions regarding needs and plans to implement a DA at the plant. The development was done in two steps. First, researchers surveyed the nuclear industry in order to learn their near-term plans for adopting new advanced capabilities and implementing a network (i.e., wireless and wire) infrastructure throughout the plant, including the power block. Secondly, a literature review covering regulatory documents, industry standards, and technical research reports and articles was conducted. The objective of the review was to identify key areas to be covered by the DAPM, which included the following: 1. The need for a DA and its benefits to the plant 2. Resources required to implement the DA 3. Challenges that need to be addressed and resolved to implement the DA 4. Roles and responsibilities of the DA implementation plan. The DAPM was developed based on results from the survey and the literature review. Model development, including the survey results and conclusions made about the key areas during the literature review, are described in this report.« less

The peer review system (PRS) for quality assurance and treatment improvement in radiation therapy

NASA Astrophysics Data System (ADS)

Le, Anh H. T.; Kapoor, Rishabh; Palta, Jatinder R.

2012-02-01

Peer reviews are needed across all disciplines of medicine to address complex medical challenges in disease care, medical safety, insurance coverage handling, and public safety. Radiation therapy utilizes technologically advanced imaging for treatment planning, often with excellent efficacy. Since planning data requirements are substantial, patients are at risk for repeat diagnostic procedures or suboptimal therapeutic intervention due to a lack of knowledge regarding previous treatments. The Peer Review System (PRS) will make this critical radiation therapy information readily available on demand via Web technology. The PRS system has been developed with current Web technology, .NET framework, and in-house DICOM library. With the advantages of Web server-client architecture, including IIS web server, SOAP Web Services and Silverlight for the client side, the patient data can be visualized through web browser and distributed across multiple locations by the local area network and Internet. This PRS will significantly improve the quality, safety, and accessibility, of treatment plans in cancer therapy. Furthermore, the secure Web-based PRS with DICOM-RT compliance will provide flexible utilities for organization, sorting, and retrieval of imaging studies and treatment plans to optimize the patient treatment and ultimately improve patient safety and treatment quality.

Addendum to Air Quality: Decision Support Tools, Partner Plans, Working Groups, Committees

NASA Technical Reports Server (NTRS)

Holekamp, Kara; Frisbie, Troy; Estep, Lee

2005-01-01

In the original report dated February 11, 2005, the utility of NASA Earth science data in the air quality activities of other agencies and organizations was assessed by reviewing strategic and mission plans and by conducting personal interviews with agency experts to identify and investigate agencies with the potential for partnership with NASA. The overarching agency strategic plans were reviewed and commonalities such as the desire for partnerships and technology development were noted. This addendum to the original report contains such information about the Tennessee Valley Authority and will be inserted as Section 2.6 of "Air Quality: Decision Support Tools, Partner Plans, Working Groups, Committees."

Addendum to Air Quality: Decision Support Tools, Partner Plans, Working Groups, Committees

NASA Technical Reports Server (NTRS)

Holekamp, Kara; Frisbie, Troy; Estep, Lee

2005-01-01

In the original report dated February 11, 2005, the utility of the NASA Earth science data in the air quality activities of other agencies and organizations was assessed by reviewing strategic and mission plans and by conducting personal interviews with agency experts to identify and investigate agencies with the potential for partnership with NASA. The overarching agency strategic plans were reviewed and commonalities such as the desire for partnerships and technology development were noted. The addendum to the original report contains such information about the Tennessee Valley Authority and will be inserted in Section 2.6 of "Air Quality Decision Support Tools, Partner Plans, Working Groups, Committees".

Integrated payload and mission planning, phase 3. Volume 4: Optimum utilization of Spacelab racks and pallets

NASA Technical Reports Server (NTRS)

Logston, R. G.; Budris, G. D.

1977-01-01

The methodology to optimize the utilization of Spacelab racks and pallets and to apply this methodology to the early STS Spacelab missions was developed. A review was made of Spacelab Program requirements and flow plans, generic flow plans for racks and pallets were examined, and the principal optimization criteria and methodology were established. Interactions between schedule, inventory, and key optimization factors; schedule and cost sensitivity to optional approaches; and the development of tradeoff methodology were addressed. This methodology was then applied to early spacelab missions (1980-1982). Rack and pallet requirements and duty cycles were defined, a utilization assessment was made, and several trade studies performed involving varying degrees of Level IV integration, inventory level, and shared versus dedicated Spacelab racks and pallets.

Creating a Succession-Planning Instrument for Educational Leadership

ERIC Educational Resources Information Center

Parfitt, Christopher M.

2017-01-01

Businesses, non-profit entities, medical units, governmental departments, and other organizations have utilized succession planning for over 30 years, yet the field of education has been slow to adopt models used in other disciplines. Upon review of the literature from various disciplines, themes for developing and assessing quality succession…

Perinatal AIDS: Permanency Planning for the African-American Community.

ERIC Educational Resources Information Center

Taylor-Brown, Susan; And Others

1992-01-01

Conducted a retrospective chart review utilizing Norwood's model on the families of the 83 infants whose cord blood was positive for maternal HIV antibodies or who were congenitally infected with HIV. Discusses implications for permanency planning in the context of their impact on the African-American community. (KS)

Tailoring the Interview Process for More Effective Personnel Selection.

ERIC Educational Resources Information Center

Saville, Anthony

Structuring the initial teacher employment interview adds validity to selection and appropriately utilizes human resources. Five aspects of an effective interview program include: (1) developing a job analysis plan; (2) reviewing the applications; (3) planning for the interview; (4) the interview instrument; and (5) legal implications. An…

42 CFR 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Administrative Requirements § 456.406 Description...; (2) In an ICF that cares primarily for mental patients, at least one individual knowledgeable in the...

42 CFR 456.438 - Time limits for notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Time limits for notification of adverse decision... AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Review of Need for Continued Stay § 456.438 Time limits for notification...

42 CFR 456.438 - Time limits for notification of adverse decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Time limits for notification of adverse decision... AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Review of Need for Continued Stay § 456.438 Time limits for notification...

42 CFR 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

Code of Federal Regulations, 2014 CFR

2014-10-01

...; disqualification from performing UR. 456.406 Section 456.406 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Administrative Requirements § 456.406 Description...

42 CFR 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

Code of Federal Regulations, 2012 CFR

2012-10-01

...; disqualification from performing UR. 456.406 Section 456.406 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Administrative Requirements § 456.406 Description...

42 CFR 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

Code of Federal Regulations, 2011 CFR

2011-10-01

...; disqualification from performing UR. 456.406 Section 456.406 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Administrative Requirements § 456.406 Description...

42 CFR 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

Code of Federal Regulations, 2013 CFR

2013-10-01

...; disqualification from performing UR. 456.406 Section 456.406 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Administrative Requirements § 456.406 Description...

STATE ACID RAIN RESEARCH AND SCREENING SYSTEM - VERSION 1.0 USER'S MANUAL

EPA Science Inventory

The report is a user's manual that describes Version 1.0 of EPA's STate Acid Rain Research and Screening System (STARRSS), developed to assist utility regulatory commissions in reviewing utility acid rain compliance plans. It is a screening tool that is based on scenario analysis...

Geothermal power development in Hawaii. Volume 1. Review and analysis

NASA Astrophysics Data System (ADS)

1982-06-01

The history of geothermal exploration in Hawaii is reviewed briefly. The nature and occurrences of geothermal resources are presented island by island. An overview of geothermal markets is presented. Other topics covered are: potential markets of the identified geothermal areas, well drilling technology, hydrothermal fluid transport, overland and submarine electrical transmission, community aspects of geothermal development, legal and policy issues associated with mineral and land ownership, logistics and infrastructure, legislation and permitting, land use controls, Regulation 8, public utilities commission, political climate and environment, state plans, county plans, geothermal development risks, and business planning guidelines.

Utility interface issues for grid-connected photovoltaic systems

NASA Astrophysics Data System (ADS)

Chu, D.; Key, T.; Fitzer, J.

Photovoltaic (PV) balance-of-system research and development has focused on interconnection with the utility grid as the most promising future application for photovoltaic energy production. These sysems must be compatible with the existing utility grid to be accepted. Compatibility encompasses many technical, economic and institutional issues, from lineman safety to revenue metering and power quality. This paper reviews DOE/PV sponsored research for two of the technical interconnection issues: harmonic injection, and power factor control. Explanations and rationale behind these two issues will be reviewed, and the status of current research and plans for required future work will be presented.

7 CFR 1924.11 - District Director's review of incomplete development.

Code of Federal Regulations, 2010 CFR

2010-01-01

... HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY, DEPARTMENT OF AGRICULTURE PROGRAM REGULATIONS CONSTRUCTION AND REPAIR Planning and Performing Construction...

Group consensus peer review in radiation oncology: commitment to quality.

PubMed

Duggar, W Neil; Bhandari, Rahul; Yang, Chunli Claus; Vijayakumar, Srinivasan

2018-03-27

Peer review, especially prospective peer review, has been supported by professional organizations as an important element in optimal Radiation Oncology practice based on its demonstration of efficacy at detecting and preventing errors prior to patient treatment. Implementation of peer review is not without barriers, but solutions do exist to mitigate or eliminate some of those barriers. Peer review practice at our institution involves three key elements: new patient conference, treatment planning conference, and chart rounds. The treatment planning conference is an adaptation of the group consensus peer review model from radiology which utilizes a group of peers reviewing each treatment plan prior to implementation. The peer group in radiation oncology includes Radiation Oncologists, Physician Residents, Medical Physicists, Dosimetrists, and Therapists. Thus, technical and clinical aspects of each plan are evaluated simultaneously. Though peer review is held in high regard in Radiation Oncology, many barriers commonly exist preventing optimal implementation such as time intensiveness, repetition, and distraction from clinic time with patients. Through the use of automated review tools and commitment by individuals and administration in regards to staffing, scheduling, and responsibilities, these barriers have been mitigated to implement this Group Consensus Peer Review model into a Radiation Oncology Clinic. A Group Consensus Peer Review model has been implemented with strategies to address common barriers to effective and efficient peer review.

Power system restoration - A task force report

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

Adibi, M.; Clelland, P.; Fink, L.

1986-01-01

The IEEE PES System Operation Subcommittee has established the Power System Restoration Task Force to: review operating practices, conduct a literature search, prepare relevant glossaries and bibliographies, and promote information exchange through technical papers. This is the first report of the Task Force. The problem of bulk power system restoration following a complete or partial collapse is practically as old as the electric utility industry itself. Many electric utilities have developed over the years system restoration schemes that meet the needs of their particular systems. These plans provide a great deal of insight into how the restorative process is viewedmore » by operating and planning personnel and what concerns and constraints any plan must operate under. The body of the report consists of notes prepared by members of the Task Force. It should not be interred that a complete reporting on Power System Restoration is undertaken here. The intent is to report upon work of the Task Force to date. The report also reviews several different restoration plans and shows their common concerns and constraints.« less

42 CFR 456.126 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan: Review of Need for Admission 1 § 456.126 Time limits for final... 42 Public Health 4 2011-10-01 2011-10-01 false Time limits for final decision and notification of...

42 CFR 456.137 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan: Review of Need for Continued Stay § 456.137 Time limits for final... 42 Public Health 4 2011-10-01 2011-10-01 false Time limits for final decision and notification of...

42 CFR 456.238 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Review of Need for Continued Stay § 456.238 Time limits for... 42 Public Health 4 2011-10-01 2011-10-01 false Time limits for final decision and notification of...

42 CFR 456.137 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan: Review of Need for Continued Stay § 456.137 Time limits for final... 42 Public Health 4 2010-10-01 2010-10-01 false Time limits for final decision and notification of...

42 CFR 456.126 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan: Review of Need for Admission 1 § 456.126 Time limits for final... 42 Public Health 4 2010-10-01 2010-10-01 false Time limits for final decision and notification of...

Integrated concurrent utilization quality review, Part one.

PubMed

Caterinicchio, R P

1987-01-01

This article is the first of a two-part series which argues for the concurrent management of the appropriateness, necessity, and quality of patient care. Intensifying scrutiny by the credentialing groups, the PROs and all third-party payors underscores the vital need to implement cost-effective information systems which integrate the departmentalized functions of patient-physician profiling, DRG case-mix analyses, length of stay monitoring, pre-admission/admission and continued stay review, discharge planning, risk management, incident reporting and quality review. In the domain of physician performance regarding admitting and practice patterns, the ability to exercise concurrent utilization-quality review means early detection and prevention of events which would otherwise result in denials of payment and/or compromised patient care. Concurrent utilization-quality review must, by definition, be managerially invasive and focused; hence, it is integral to maintaining the integrity of the services and product lines offered by the provider. In fact, if PPO status is a marketing agenda, then the institutional objectives of cost-effectiveness, productivity, value, and competitiveness can only be achieved through concurrent utilization-quality review.

Advanced technology for America's future in space

NASA Technical Reports Server (NTRS)

1990-01-01

In response to Recommendation 8 of the Augustine Committee Report, NASA's Office of Aeronautics, Exploration and Technology (OAET) developed a proposed 'Integrated Technology Plan for the Civil Space Program' that entails substantial changes in the processes, structure and the content of NASA's space research and technology program. The Space Systems and Technology Advisory Committee (SSTAC, a subcommittee of the NASA Advisory Committee) and several other senior, expert, informed advisory groups conducted a review of NASA's proposed Integrated Technology Plan (ITP). This review was in response to the specific request in Recommendation 8 that 'NASA utilize an expert, outside review process, managed from headquarters, to assist in the allocation of technology funds'. This document, the final report from that review, addresses: (1) summary recommendations; (2) mission needs; (3) the integrated technology plan; (4) summary reports of the technical panels; and (5) conclusions and observations.

Social Area Analysis in Program Evaluation and Planning.

ERIC Educational Resources Information Center

Piasecki, Joseph R.; Kamis-Gould, Edna

1981-01-01

Social area analysis (SAA) is defined, and its conceptual roots and principal applications identified. The utility of SAA is assessed by reviewing use of demographic data among several disciplines. Authors review seminal and recent contributions to the field. Ecological fallacies and other problematic facets of SAA are considered. (Author/DWH)

Utility interconnection issues for wind power generation

NASA Technical Reports Server (NTRS)

Herrera, J. I.; Lawler, J. S.; Reddoch, T. W.; Sullivan, R. L.

1986-01-01

This document organizes the total range of utility related issues, reviews wind turbine control and dynamic characteristics, identifies the interaction of wind turbines to electric utility systems, and identifies areas for future research. The material is organized at three levels: the wind turbine, its controls and characteristics; connection strategies as dispersed or WPSs; and the composite issue of planning and operating the electric power system with wind generated electricity.

Defense Infrastructure: Actions Needed to Strengthen Utility Resilience Planning

DTIC Science & Technology

2016-11-01

and design , historical architecture and materials, and overhead; and inflation adjustments. 6We obtained and analyzed records from DOD’s Real...the impacts of those disruptions, and the characteristics of the DOD-owned utility systems, among other things. To inform the design of our survey...managing and operating DOD-owned utility systems. Furthermore, the survey instrument was independently reviewed by a survey design expert within GAO. We

Power system restoration - A task force report

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

Adibi, M.; Clelland, P.; Link, L.

1987-05-01

The IEEE PES System Operation Subcommittee has established the Power System Restoration Task Force to: review operating practices, conduct a literature search, prepare relevant glossaries and bibliographies, and promote information exchange through technical papers. This is the first report of the Task Force. The problem of bulk power system restoration following a complete or partial collapse is practically as old as the electric utility industry itself. Many electric utilities have developed over the years system restoration schemes that meet the needs of their particular systems. These plans provide a great deal of insight into how the restorative process is viewedmore » by operating and planning personnel and what concerns and constraints any plan must operate under.« less

National Transonic Facility: A review of the operational plan

NASA Technical Reports Server (NTRS)

Liepmann, H. W.; Black, R. E.; Dietz, R. O.; Kirchner, M. E.; Sears, W. R.

1980-01-01

The proposed National Transonic Facility (NTF) operational plan is reviewed. The NTF will provide an aerodynamic test capability significantly exceeding that of other transonic regime wind tunnels now available. A limited number of academic research program that might use the NTF are suggested. It is concluded that the NTF operational plan is useful for management, technical, instrumentation, and model building techniques available in the specialized field of aerodynamic analysis and simulation. It is also suggested that NASA hold an annual conference to discuss wind tunnel research results and to report on developments that will further improve the utilization and cost effectiveness of the NTF and other wind tunnels.

Rational decision perspectives on alcohol consumption by youth. Revising the theory of planned behavior.

PubMed

Kuther, Tara L

2002-01-01

Cognitive and developmental approaches have made great strides in describing and predicting alcohol consumption by youth. The present review examines several theories of decision making with regard to alcohol consumption, including subjective expected utility (SEU) theory, the theories of reasoned action and planned behavior, and alcohol-related outcome expectancy theory. In addition, the developmental literature on the contribution of parents and peers to adolescent alcohol consumption is reviewed. A model is proposed, which integrates the theory of planned behavior and alcohol-related outcome expectancy theory with modifications based on findings from the developmental literature. Implications for further research are discussed.

Space transportation system payload status and reimbursement policy

NASA Technical Reports Server (NTRS)

Yardley, J. F.

1977-01-01

The status of the Space Transportation System (STS) is reviewed. The management structure and project planning status are discussed, including considerations of STS utilization, payloads, cost assessments, and pricing policy.

MASS TRANSIT: FTA Could Relieve New Starts Program Funding Constraints

DTIC Science & Technology

2001-08-01

progress through a local or regional review of alternatives, develop preliminary engineering plans , and obtain FTA’s approval for final design.7 TEA-21...and transit programs can also be used to develop, plan , and/or construct these projects. 7The alternatives analysis stage provides information on the...include right-of-way acquisition, utility relocation, and the preparation of final construction plans and cost estimates. Background Page 5 GAO-01-987 New

A systematic review of built environment factors related to physical activity and obesity risk: implications for smart growth urban planning.

PubMed

Durand, C P; Andalib, M; Dunton, G F; Wolch, J; Pentz, M A

2011-05-01

Smart growth is an approach to urban planning that provides a framework for making community development decisions. Despite its growing use, it is not known whether smart growth can impact physical activity. This review utilizes existing built environment research on factors that have been used in smart growth planning to determine whether they are associated with physical activity or body mass. Searching the MEDLINE, Psycinfo and Web-of-Knowledge databases, 204 articles were identified for descriptive review, and 44 for a more in-depth review of studies that evaluated four or more smart growth planning principles. Five smart growth factors (diverse housing types, mixed land use, housing density, compact development patterns and levels of open space) were associated with increased levels of physical activity, primarily walking. Associations with other forms of physical activity were less common. Results varied by gender and method of environmental assessment. Body mass was largely unaffected. This review suggests that several features of the built environment associated with smart growth planning may promote important forms of physical activity. Future smart growth community planning could focus more directly on health, and future research should explore whether combinations or a critical mass of smart growth features is associated with better population health outcomes. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.

The use of routine monitoring and evaluation systems to assess a referral model of family planning and HIV service integration in Nigeria.

PubMed

Chabikuli, Nzapfurundi O; Awi, Dorka D; Chukwujekwu, Ogo; Abubakar, Zubaida; Gwarzo, Usman; Ibrahim, Mohammed; Merrigan, Mike; Hamelmann, Christoph

2009-11-01

To measure changes in service utilization of a model integrating family planning with HIV counselling and testing (HCT), antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) in the Nigerian public health facilities. It is a retrospective survey of attendance and family planning commodity uptake in 71 health facilities in Nigeria that analyzes the preintegration and postintegration periods between March 2007 and January 2009. A prepost retrospective comparison of mean attendance at family planning clinics and couple-years of protection (CYP) compared 6 months preintegration with 9 months postintegration period. An analysis of service ratios was conducted, relating completed referrals at family planning clinics to service utilization at the referring HIV clinics. Mean attendance at family planning clinics increased significantly from 67.6 in preintegration to 87.0 in postintegration. The mean CYP increased significantly from 32.3 preintegration to 38.2 postintegration. Service ratio of referrals from each of the HIV clinics was low but increased in the postintegration period by 4, 34 and 42 per 1000 clients from HCT, ART and PMTCT clinics, respectively. Service ratios were higher in primary healthcare settings than in secondary or tertiary hospitals. Attendance by men at family planning clinics was significantly higher among clients referred from HIV clinics. Family planning-HIV integration using the referral model improved family planning service utilization by clients accessing HIV services, but further improvement is possible. Male utilization of family planning services also improved. The government of Nigeria should review the family planning user fee policy and scale up the integration in primary healthcare facilities.

Planning for pedestrians within the highway environment.

DOT National Transportation Integrated Search

1980-01-01

The guidelines currently utilized to evaluate the need for pedestrian accommodations in suburban areas were reviewed and summarized. Information was obtained from the literature, a mail survey, and personal interviews. Recommendations were developed ...

Idea Bank

ERIC Educational Resources Information Center

Science Teacher, 1978

1978-01-01

Described are methods for making Cartesian divers for explaining atomic models utilizing a city planning analogy, a game for reviewing subject matter, the construction of a cell model, an improved diffusion demonstration, and uses of inexpensive glass cutters. (SL)

Technical Review of Retrieval and Closure Plans for the INEEL INTEC Tank Farm Facility

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

Bamberger, Judith A; Burks, Barry L; Quigley, Keith D

2001-09-28

The purpose of this report is to document the conclusions of a technical review of retrieval and closure plans for the Idaho National Energy and Environmental Laboratory (INEEL) Idaho Nuclear Technology and Engineering Center (INTEC) Tank Farm Facility. In addition to reviewing retrieval and closure plans for these tanks, the review process served as an information exchange mechanism so that staff in the INEEL High Level Waste (HLW) Program could become more familiar with retrieval and closure approaches that have been completed or are planned for underground storage tanks at the Oak Ridge National Laboratory (ORNL) and Hanford sites. Thismore » review focused not only on evaluation of the technical feasibility and appropriateness of the approach selected by INEEL but also on technology gaps that could be addressed through utilization of technologies or performance data available at other DOE sites and in the private sector. The reviewers, Judith Bamberger of Pacific Northwest National Laboratory (PNNL) and Dr. Barry Burks of The Providence Group Applied Technology, have extensive experience in the development and application of tank waste retrieval technologies for nuclear waste remediation.« less

78 FR 13405 - Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-27

...This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state- specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

Patient-reported denials, appeals, and complaints: associations with overall plan ratings.

PubMed

Quigley, Denise D; Haviland, Amelia M; Dembosky, Jacob W; Klein, David J; Elliott, Marc N

2018-03-01

To assess whether Medicare patients' reports of denied care, appeals/complaints, and satisfactory resolution were associated with ratings of their health plan or care. Retrospective analysis of 2010 Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data. Multivariate linear regression of data from 154,766 respondents (61.1% response rate) tested the association of beneficiary ratings of plan and care with beneficiary reports of denied care, appeals, complaints, and complaint resolution, adjusting for beneficiary demographics. Beneficiaries who reported being denied needed care rated their plans and care significantly less positively, by 17.2 points (on a 100-point scale) and 9.1 points, respectively. Filing an appeal was not statistically significantly associated with further lower ratings. Beneficiaries who filed a complaint that was satisfactorily resolved gave slightly lower ratings of plans (-3.4 points) and care (-2.5 points) than those not filing a complaint (P <.001 for all results). Lower ratings from patients reporting complaints and denied care may notably affect the overall 0-10 CAHPS ratings of Medicare Advantage plans. Our results suggest that beneficiaries may attribute the actions that lead to complaints or denials to plans more than to the care they received. Successful complaint resolution and utilization management review might eliminate most deficits associated with complaints and denied care, consistent with the service recovery paradox. High rates of complaints and denied care might identify areas that need improved utilization management review, customer service, and quality improvement. Among those reporting being denied care, filing an appeal was not associated with lower patient ratings of plan or care.

The Future of Electricity Resource Planning

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

Kahrl, Fredrich; Mills, Andrew; Lavin, Luke

Electricity resource planning is the process of identifying longer-term investments to meet electricity reliability requirements and public policy goals at a reasonable cost. Resource planning processes provide a forum for regulators, electric utilities, and electricity industry stakeholders to evaluate the economic, environmental, and social benefits and costs of different investment options. By facilitating a discussion on future goals, challenges and strategies, resource planning processes often play an important role in shaping utility business decisions. Resource planning emerged more than three decades ago in an era of transition, where declining electricity demand and rising costs spurred fundamental changes in electricity industrymore » regulation and structure. Despite significant changes in the industry, resource planning continues to play an important role in supporting investment decision making. Over the next two decades, the electricity industry will again undergo a period of transition, driven by technological change, shifting customer preferences and public policy goals. This transition will bring about a gradual paradigm shift in resource planning, requiring changes in scope, approaches and methods. Even as it changes, resource planning will continue to be a central feature of the electricity industry. Its functions — ensuring the reliability of high voltage (“bulk”) power systems, enabling oversight of regulated utilities and facilitating low-cost compliance with public policy goals — are likely to grow in importance as the electricity industry enters a new period of technological, economic and regulatory change. This report examines the future of electricity resource planning in the context of a changing electricity industry. The report examines emerging issues and evolving practices in five key areas that will shape the future of resource planning: (1) central-scale generation, (2) distributed generation, (3) demand-side resources, (4) transmission and (5) uncertainty and risk management. The analysis draws on a review of recent resource plans for 10 utilities that reflect some of the U.S. electricity industry’s extensive diversity.« less

Towards Designing an Integrated Architecture for NEO Characterization, Mitigation, Scientific Evaluation, and Resource Utilization

NASA Technical Reports Server (NTRS)

Adams, Robert B.; LaPointe, Michael; Wilks, Rod; Allen, Brian

2009-01-01

This poster reviews the planning and design for an integrated architecture for characterization, mitigation, scientific evaluation and resource utilization of near earth objects. This includes tracks to observe and characterize the nature of the threat posed by a NEO, and deflect if a significant threat is posed. The observation stack can also be used for a more complete scientific analysis of the NEO.

Approaches to pharmacy benefit management and the impact of consumer cost sharing.

PubMed

Olson, Bridget M

2003-01-01

Numerous mechanisms have been introduced to deliver prescription drug benefits while controlling pharmaceutical costs. An understanding of the most prominent mechanisms of benefit management is an important step in determining the most effective approach to take in future years. The aims of this review were to illustrate the mechanisms by which managed care has attempted to efficiently and equitably deliver pharmacy benefits and to discuss the impact of such programs, including consumer cost sharing. A review of the literature was conducted using the PreMedline and MEDLINE databases from the years 1966 to 2002, reference lists from relevant articles, and online sources, including news releases, conference materials, and pharmacy benefit management reports. Numerous pharmacy benefit management tools and their impact on utilization, expenditures, and health outcomes are reviewed, including disease state management; utilization management (ie, quantity limitations and prior authorization); drug utilization review; formulary management (ie, open and closed); delivery systems (ie, retail and mail order); and mechanisms for implementing consumer cost sharing (ie, generic incentives, multitiered copayments, and co-insurance). Although there is some evidence to suggest that certain benefit management tools have been successful in reducing health plan expenditures, a more thorough investigation of their potential unintended consequences is needed. Implementing adequate levels of consumer cost sharing is necessary if employers and health plans are to continue offering prescription drug benefits. It is important to remember, however, that quality health care cannot be forfeited for the sake of short-term cost savings.

Developing a UAS Program for Electric Utilities

NASA Astrophysics Data System (ADS)

Keltgen, James

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

In Situ Resource Utilization Technologies for Enhancing and Expanding Mars Scientific and Exploration Missions

NASA Technical Reports Server (NTRS)

Sridhar, K. R.; Finn, J. E.

2000-01-01

The primary objectives of the Mars exploration program are to collect data for planetary science in a quest to answer questions related to Origins, to search for evidence of extinct and extant life, and to expand the human presence in the solar system. The public and political engagement that is critical for support of a Mars exploration program is based on all of these objectives. In order to retain and to build public and political support, it is important for NASA to have an integrated Mars exploration plan, not separate robotic and human plans that exist in parallel or in sequence. The resolutions stemming from the current architectural review and prioritization of payloads may be pivotal in determining whether NASA will have such a unified plan and retain public support. There are several potential scientific and technological links between the robotic-only missions that have been flown and planned to date, and the combined robotic and human missions that will come in the future. Taking advantage of and leveraging those links are central to the idea of a unified Mars exploration plan. One such link is in situ resource utilization (ISRU) as an enabling technology to provide consumables such as fuels, oxygen, sweep and utility gases from the Mars atmosphere.

Theory of reasoned action and theory of planned behavior-based dietary interventions in adolescents and young adults: a systematic review

PubMed Central

Hackman, Christine L; Knowlden, Adam P

2014-01-01

Background Childhood obesity has reached epidemic proportions in many nations around the world. The theory of planned behavior (TPB) and the theory of reasoned action (TRA) have been used to successfully plan and evaluate numerous interventions for many different behaviors. The aim of this study was to systematically review and synthesize TPB and TRA-based dietary behavior interventions targeting adolescents and young adults. Methods The following databases were systematically searched to find articles for this review: Academic Search Premier; Cumulative Index to Nursing and Allied Health (CINAHL); Education Resources Information Center (ERIC); Health Source: Nursing/Academic Edition; Cochrane Central Register of Controlled Trials (CENTRAL); and MEDLINE. Inclusion criteria for articles were: 1) primary or secondary interventions, 2) with any quantitative design, 3) published in the English language, 4) between January 2003 and March 2014, 5) that targeted adolescents or young adults, 6) which included dietary change behavior as the outcome, and 7) utilized TPB or TRA. Results Of the eleven intervention studies evaluated, nine resulted in dietary behavior change that was attributed to the treatment. Additionally, all but one study found there to be a change in at least one construct of TRA or TPB, while one study did not measure constructs. All of the studies utilized some type of quantitative design, with two employing quasi-experimental, and eight employing randomized control trial design. Among the studies, four utilized technology including emails, social media posts, information on school websites, web-based activities, audio messages in classrooms, interactive DVDs, and health-related websites. Two studies incorporated goal setting and four employed persuasive communication. Conclusion Interventions directed toward changing dietary behaviors in adolescents should aim to incorporate multi-faceted, theory-based approaches. Future studies should consider utilizing randomized control trial design and operationalize variables. More research is needed to identify the optimal TPB and TRA modalities to modify dietary behaviors. PMID:24966710

Theory of reasoned action and theory of planned behavior-based dietary interventions in adolescents and young adults: a systematic review.

PubMed

Hackman, Christine L; Knowlden, Adam P

2014-01-01

Childhood obesity has reached epidemic proportions in many nations around the world. The theory of planned behavior (TPB) and the theory of reasoned action (TRA) have been used to successfully plan and evaluate numerous interventions for many different behaviors. The aim of this study was to systematically review and synthesize TPB and TRA-based dietary behavior interventions targeting adolescents and young adults. THE FOLLOWING DATABASES WERE SYSTEMATICALLY SEARCHED TO FIND ARTICLES FOR THIS REVIEW: Academic Search Premier; Cumulative Index to Nursing and Allied Health (CINAHL); Education Resources Information Center (ERIC); Health Source: Nursing/Academic Edition; Cochrane Central Register of Controlled Trials (CENTRAL); and MEDLINE. Inclusion criteria for articles were: 1) primary or secondary interventions, 2) with any quantitative design, 3) published in the English language, 4) between January 2003 and March 2014, 5) that targeted adolescents or young adults, 6) which included dietary change behavior as the outcome, and 7) utilized TPB or TRA. Of the eleven intervention studies evaluated, nine resulted in dietary behavior change that was attributed to the treatment. Additionally, all but one study found there to be a change in at least one construct of TRA or TPB, while one study did not measure constructs. All of the studies utilized some type of quantitative design, with two employing quasi-experimental, and eight employing randomized control trial design. Among the studies, four utilized technology including emails, social media posts, information on school websites, web-based activities, audio messages in classrooms, interactive DVDs, and health-related websites. Two studies incorporated goal setting and four employed persuasive communication. Interventions directed toward changing dietary behaviors in adolescents should aim to incorporate multi-faceted, theory-based approaches. Future studies should consider utilizing randomized control trial design and operationalize variables. More research is needed to identify the optimal TPB and TRA modalities to modify dietary behaviors.

The Olympic and Paralympic Games 2012: literature review of the logistical planning and operational challenges for public health.

PubMed

Enock, K E; Jacobs, J

2008-11-01

To undertake a review of the literature relating to public health planning and interventions at previous summer Olympic and Paralympic Games and other relevant major summer sporting events or mass gatherings, with a focus on official publications and peer-reviewed articles. Literature review. A literature review was undertaken using all biomedical databases and a freetext search using Google to widen the search beyond peer-reviewed publications. Search terms used were: Olympics; Paralympics; mass gatherings; mass gathering medicine; sporting events; weather; planning; and organisation. Citations within articles were searched to identify additional references that would inform this review. This literature review concentrates on the public health aspects of population care at mass gatherings, particularly the Olympic and Paralympic Games which are set over several weeks, focusing on surveillance, prevention and health service quality. The literature identified 10 areas of public health planning: public health command centre and communication; surveillance, assessment and control; environmental health and safety; infectious disease outbreaks; implications of weather conditions; health promotion; travel information; economic assessments; public transport and reduction of asthma events; and preparing athletes for potential allergies. The following themes emerged as crucial factors for the success of any public health interventions at Olympic and Paralympic Games: detailed planning of deliverables; pre-identification of critical success factors; management of risk; detailed contingency planning; and full testing of all plans prior to the event. The 2012 Olympic Games will provide an exciting challenge for public health providers and systems. Preparation requires early detailed planning of policies, procedures and on-site health promotion events, in addition to helping to set up the surveillance and monitoring systems that will capture public health activity alongside medical activity. Learning from the literature review will support the identification of critical success factors and help to formulate recommendations that will allow optimal utilization of public health initiatives. All plans require full costings in advance which are supported by internal and external health-related agencies, voluntary organizations and sponsors. A risk assessment should be undertaken as part of the planning process leading to risk management plans for mitigating identified potential risks. All surveillance and monitoring systems, communication, policies and procedures will require full testing prior to commencement of the Games.

Whither Sex Education? Excellence in Comprehensive Program Development.

ERIC Educational Resources Information Center

Southern, Stephen

A review of recent sex education literature is presented in an attempt to integrate observations and recommendations related to both program development and innovation acceptance. A Developmental Research and Utilization Model is employed to systematically guide planning, implementation, evaluation, advocacy, and institutionalization. Curriculum…

Factors associated with preparedness of the US healthcare system to respond to a pediatric surge during an infectious disease pandemic: Is our nation prepared?

PubMed

Anthony, Christy; Thomas, Tito Joe; Berg, Bridget M; Burke, Rita V; Upperman, Jeffrey S

2017-01-01

Recent incidents have demonstrated that the US health system is unprepared for infectious pandemics resulting in a pediatric surge. Development of efficient plans and a structured and coordinated regional response to pediatric pandemic surge remains an opportunity. To address this gap, we conducted a literature review to assess current efforts, propose a response plan structure, and recommend policy actions. A literature review, utilizing MEDLINE and PubMed, through March 2017 identified articles regarding infectious disease pandemics affecting the US pediatric population. After review of current literature, a proposed response plan structure for a pediatric pandemic surge was designed. Inclusion and exclusion criteria reduced an initial screening of 1,787 articles to 162 articles. Articles ranged in their discussion of pediatric pandemic surge. Review of the articles led to the proposal of organizing the results according to 4 S's; (1) Structure, (2) Staff, (3) Stuff (Resources), and (4) Space. The review has supported the concern that the US health system is unprepared for a pediatric surge induced by infectious disease pandemics. Common themes suggest that response plans should reflect the 4Ss and national guidelines must be translated into regional response systems that account for local nuances.

Applications of Telemedicine and Telecommunications to Disaster Medicine

PubMed Central

Garshnek, Victoria; Burkle, Frederick M.

1999-01-01

Disaster management utilizes diverse technologies to accomplish a complex set of tasks. Despite a decade of experience, few published reports have reviewed application of telemedicine (clinical care at a distance enabled by telecommunication) in disaster situations. Appropriate new telemedicine applications can improve future disaster medicine outcomes, based on lessons learned from a decade of civilian and military disaster (wide-area) telemedicine deployments. This manuscript reviews the history of telemedicine activities in actual disasters and similar scenarios as well as ongoing telemedicine innovations that may be applicable to disaster situations. Emergency care providers must begin to plan effectively to utilize disaster-specific telemedicine applications to improve future outcomes. PMID:9925226

An Overview of ANN Application in the Power Industry

NASA Technical Reports Server (NTRS)

Niebur, D.

1995-01-01

The paper presents a survey on the development and experience with artificial neural net (ANN) applications for electric power systems, with emphasis on operational systems. The organization and constraints of electric utilities are reviewed, motivations for investigating ANN are identified, and a current assessment is given from the experience of 2400 projects using ANN for load forecasting, alarm processing, fault detection, component fault diagnosis, static and dynamic security analysis, system planning, and operation planning.

Langley Research Center Strategic Plan for Education

NASA Technical Reports Server (NTRS)

Proctor, Sandra B.

1994-01-01

Research assignment centered on the preparation of final draft of the NASA Langley Strategic Plan for Education. Primary research activity consisted of data collection, through interviews with LaRC Office of Education and NASA Headquarters staff, university administrators and faculty, and school administrators / teachers; and documentary analysis. Pre-college and university programs were critically reviewed to assure effectiveness, support of NASA and Langley's mission and goals; National Education Goals; and educational reform strategies. In addition to these mandates, pre-college programs were reviewed to address present and future LaRC activities for teacher enhancement and preparation. University programs were reviewed with emphasis on student support and recruitment; faculty development and enhancement; and LaRC's role in promoting the utilization of educational technologies and distance learning. The LaRC Strategic Plan for Education will enable the Office of Education to provide a focused and well planned continuum of education programs for students, teachers and faculty. It will serve to direct and focus present activities and programs while simultaneously offering the flexibility to address new and emerging directions based on changing national, state, and agency trends.

The use of scenarios for long-range planning by investor-owned electric utilities in the Pacific Northwest

NASA Astrophysics Data System (ADS)

Lyons, John V.

Scenario planning is a method of organizing and understanding large amounts of quantitative and qualitative data for leaders to make better strategic decisions. There is a lack of academic research about scenario planning with a subsequent shortage of definitions and theories. This study utilized a case study methodology to analyze scenario planning by investor-owned electric utilities in the Pacific Northwest in their integrated resource planning (IRP) process. The cases include Avista Corporation, Idaho Power, PacifiCorp, Portland General Electric, and Puget Sound Energy. This study sought to determine how scenario planning was used, what scenario approach was used, the scenario outcomes, and the similarities and differences in the scenario planning processes. The literature review of this study covered the development of scenario planning, common definitions and theories, approaches to scenario development, and scenario outcomes. A research methodology was developed to classify the scenario development approach into intuitive, hybrid, or quantitative approaches; and scenario outcomes of changed thinking, stories of plausible futures, improved decision making, and enhanced organizational learning. The study found all three forms of scenario planning in the IRPs. All of the cases used a similar approach to IRP development. All of the cases had at least improved decision making as an outcome of scenario planning. Only one case demonstrated all four scenario outcomes. A critical finding was a correlation between the use of the intuitive approach and the use of all scenario outcomes. Another major finding was the unique use of predetermined elements, which are normally consistent across scenarios, but became critical uncertainties in some of the scenarios in the cases for this study. This finding will need to be confirmed by future research as unique to the industry or an aberration. An unusually high number of scenarios were found for cases using the hybrid approach, which was unexpected based on the literature. This work expanded the methods for studying scenario planning, enhanced the body of scholarly works on scenario planning, and provided a starting point for additional research concerning the use of scenario planning by electric utilities.

Employer health care plan design and its effect on plan costs.

PubMed

Custer, W S

1991-01-01

This study uses claims data from employers in the Houston Area Health Care Coalition (HAHCC) for 1985 through the first half of 1987 to examine the effect of health care plan attributes on health care costs. Plan attributes affect the site of care and the costs of care. Utilization review clearly was effective in reducing the demand for inpatient services, but that reduction was in large measure matched by increases in care in the outpatient setting. Restrictions on mental health benefits also shifted the site of care. In contrast, neither premium sharing nor the plan's deductible had a significant impact on total plan charges. The study results demonstrate the need to have a comprehensive cost management strategy.

INTEGRATION OF SYSTEMS ENGINEERING AND PROCESS INTENSIFICATION IN THE DESIGN OF PROCESSES FOR UTILIZING BIOBASED GLYCEROL

EPA Science Inventory

The expected results include an integrated process and mechanical design including a fabrication plan for the glycerol dehydration reactor, comprehensive heat and material balance, environmental impact assessment and comprehensive safety review. The resulting process design w...

Prospective evaluation of the clinical utility of laryngeal electromyography.

PubMed

Ingle, John W; Young, VyVy N; Smith, Libby J; Munin, Micheal C; Rosen, Clark A

2014-12-01

To prospectively evaluate the clinical utility of laryngeal electromyography (LEMG) STUDY DESIGN: Prospective observational study. The study involved 50 consecutive patients referred for LEMG. Laryngologists initially indicated diagnoses and treatment plans under the assumption of no access to LEMG. Patients then underwent LEMG by blinded examiners. LEMG results were reviewed by each patient's laryngologist. Diagnoses and treatment plans were either maintained or altered based on the LEMG results. The diagnosis changed 10% (5/50) of the time and treatment plans were altered 36% (18/50) of the time based on information provided by LEMG. Observational periods were eliminated in 13/50 patients based on LEMG, moving them to permanent treatment. LEMG allowed the differentiation between joint fixation and bilateral paralysis in three patients. Previously unrecognized superior laryngeal neuropathies were identified in three patients. Laryngeal electromyography often provides clinically useful information that typically leads to a more accurate diagnosis and a more appropriate, expedited treatment plan. 2b. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Combustion Research Aboard the ISS Utilizing the Combustion Integrated Rack and Microgravity Science Glovebox

NASA Technical Reports Server (NTRS)

Sutliff, Thomas J.; Otero, Angel M.; Urban, David L.

2002-01-01

The Physical Sciences Research Program of NASA sponsors a broad suite of peer-reviewed research investigating fundamental combustion phenomena and applied combustion research topics. This research is performed through both ground-based and on-orbit research capabilities. The International Space Station (ISS) and two facilities, the Combustion Integrated Rack and the Microgravity Science Glovebox, are key elements in the execution of microgravity combustion flight research planned for the foreseeable future. This paper reviews the Microgravity Combustion Science research planned for the International Space Station implemented from 2003 through 2012. Examples of selected research topics, expected outcomes, and potential benefits will be provided. This paper also summarizes a multi-user hardware development approach, recapping the progress made in preparing these research hardware systems. Within the description of this approach, an operational strategy is presented that illustrates how utilization of constrained ISS resources may be maximized dynamically to increase science through design decisions made during hardware development.

Resource utilization after introduction of a standardized clinical assessment and management plan.

PubMed

Friedman, Kevin G; Rathod, Rahul H; Farias, Michael; Graham, Dionne; Powell, Andrew J; Fulton, David R; Newburger, Jane W; Colan, Steven D; Jenkins, Kathy J; Lock, James E

2010-01-01

A Standardized Clinical Assessment and Management Plan (SCAMP) is a novel quality improvement initiative that standardizes the assessment and management of all patients who carry a predefined diagnosis. Based on periodic review of systemically collected data the SCAMP is designed to be modified to improve its own algorithm. One of the objectives of a SCAMP is to identify and reduce resource utilization and patient care costs. We retrospectively reviewed resource utilization in the first 93 arterial switch operation (ASO) SCAMP patients and 186 age-matched control ASO patients. We compared diagnostic and laboratory testing obtained at the initial SCAMP clinic visit and control patient visits. To evaluate the effect of the SCAMP over time, the number of clinic visits per patient year and echocardiograms per patient year in historical control ASO patients were compared to the projected rates for ASO SCAMP participants. Cardiac magnetic resonance imaging (MRI), stress echocardiogram, and lipid profile utilization were higher in the initial SCAMP clinic visit group than in age-matched control patients. Total echocardiogram and lung scan usage were similar. Chest X-ray and exercise stress testing were obtained less in SCAMP patients. ASO SCAMP patients are projected to have 0.5 clinic visits and 0.5 echocardiograms per year. Historical control patients had more clinic visits (1.2 vs. 0.5 visits/patient year, P<.01) and a higher echocardiogram rate (0.92 vs. 0.5 echocardiograms/patient year, P<.01) Implementation of a SCAMP may initially lead to increased resource utilization, but over time resource utilization is projected to decrease.

SU-E-T-310: Targeting Safety Improvements Through Analysis of Near-Miss Error Detection Points in An Incident Learning Database

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

Novak, A; Nyflot, M; Sponseller, P

2014-06-01

Purpose: Radiation treatment planning involves a complex workflow that can make safety improvement efforts challenging. This study utilizes an incident reporting system to identify detection points of near-miss errors, in order to guide our departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or their patterns. Methods: 1377 incidents were analyzed from a departmental nearmiss error reporting system from 3/2012–10/2013. All incidents were prospectively reviewed weekly by a multi-disciplinary team, and assigned a near-miss severity score ranging from 0–4 reflecting potential harm (no harm to critical). A 98-step consensus workflow was usedmore » to determine origination and detection points of near-miss errors, categorized into 7 major steps (patient assessment/orders, simulation, contouring/treatment planning, pre-treatment plan checks, therapist/on-treatment review, post-treatment checks, and equipment issues). Categories were compared using ANOVA. Results: In the 7-step workflow, 23% of near-miss errors were detected within the same step in the workflow, while an additional 37% were detected by the next step in the workflow, and 23% were detected two steps downstream. Errors detected further from origination were more severe (p<.001; Figure 1). The most common source of near-miss errors was treatment planning/contouring, with 476 near misses (35%). Of those 476, only 72(15%) were found before leaving treatment planning, 213(45%) were found at physics plan checks, and 191(40%) were caught at the therapist pre-treatment chart review or on portal imaging. Errors that passed through physics plan checks and were detected by therapists were more severe than other errors originating in contouring/treatment planning (1.81 vs 1.33, p<0.001). Conclusion: Errors caught by radiation treatment therapists tend to be more severe than errors caught earlier in the workflow, highlighting the importance of safety checks in dosimetry and physics. We are utilizing our findings to improve manual and automated checklists for dosimetry and physics.« less

Systematic Treatment Selection (STS): A Review and Future Directions

ERIC Educational Resources Information Center

Nguyen, Tam T.; Bertoni, Matteo; Charvat, Mylea; Gheytanchi, Anahita; Beutler, Larry E.

2007-01-01

Systematic Treatment Selection (STS) is a form of technical eclectism that develops and plans treatments using empirically founded principles of psychotherapy. It is a model that provides systematic guidelines for the utilization of different psychotherapeutic strategies based on patient qualities and problem characteristics. Historically, it…

48 CFR 19.705-4 - Reviewing the subcontracting plan.

Code of Federal Regulations, 2014 CFR

2014-10-01

... REGULATION SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS The Small Business Subcontracting Program 19.705-4... involving small business concerns as subcontractors in similar acquisitions; and (3) The relative success of... comply with its obligations under the clause at 52.219-8, Utilization of Small Business Concerns, the...

48 CFR 19.705-4 - Reviewing the subcontracting plan.

Code of Federal Regulations, 2012 CFR

2012-10-01

... REGULATION SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS The Small Business Subcontracting Program 19.705-4... involving small business concerns as subcontractors in similar acquisitions; and (3) The relative success of... comply with its obligations under the clause at 52.219-8, Utilization of Small Business Concerns, the...

48 CFR 19.705-4 - Reviewing the subcontracting plan.

Code of Federal Regulations, 2013 CFR

2013-10-01

... REGULATION SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS The Small Business Subcontracting Program 19.705-4... involving small business concerns as subcontractors in similar acquisitions; and (3) The relative success of... comply with its obligations under the clause at 52.219-8, Utilization of Small Business Concerns, the...

Patient Protection and Affordable Care Act; health insurance market rules. Final rule.

PubMed

2013-02-27

This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS).

Model Development and Process Analysis for Lean Cellular Design Planning in Aerospace Assembly and Manufacturing

NASA Astrophysics Data System (ADS)

Hilburn, Monty D.

Successful lean manufacturing and cellular manufacturing execution relies upon a foundation of leadership commitment and strategic planning built upon solid data and robust analysis. The problem for this study was to create and employ a simple lean transformation planning model and review process that could be used to identify functional support staff resources required to plan and execute lean manufacturing cells within aerospace assembly and manufacturing sites. The lean planning model was developed using available literature for lean manufacturing kaizen best practices and validated through a Delphi panel of lean experts. The resulting model and a standardized review process were used to assess the state of lean transformation planning at five sites of an international aerospace manufacturing and assembly company. The results of the three day, on-site review were compared with baseline plans collected from each of the five sites to determine if there analyzed, with focus on three critical areas of lean planning: the number and type of manufacturing cells identified, the number, type, and duration of planned lean and continuous kaizen events, and the quantity and type of functional staffing resources planned to support the kaizen schedule. Summarized data of the baseline and on-site reviews was analyzed with descriptive statistics. ANOVAs and paired-t tests at 95% significance level were conducted on the means of data sets to determine if null hypotheses related to cell, kaizen event, and support resources could be rejected. The results of the research found significant differences between lean transformation plans developed by site leadership and plans developed utilizing the structured, on-site review process and lean transformation planning model. The null hypothesis that there was no difference between the means of pre-review and on-site cell counts was rejected, as was the null hypothesis that there was no significant difference in kaizen event plans. These factors are critical inputs into the support staffing resources calculation used by the lean planning model. Null hypothesis related to functional support staff resources was rejected for most functional groups, indicating that the baseline site plan inadequately provided for cross-functional staff involvement to support the lean transformation plan. Null hypotheses related to total lean transformation staffing could not be rejected, indicating that while total staffing plans were not significantly different than plans developed during the on-site review and through the use of the lean planning model, the allocation of staffing among various functional groups such as engineering, production, and materials planning was an issue. The on-site review process and simple lean transformation plan developed was determined to be useful in identifying short-comings in lean transformation planning within aerospace manufacturing and assembly sites. It was concluded that the differences uncovered were likely contributing factors affecting the effectiveness of aerospace manufacturing sites' implementation of lean cellular manufacturing.

Decision Support Systems for Research and Management in Advanced Life Support

NASA Technical Reports Server (NTRS)

Rodriquez, Luis F.

2004-01-01

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

76 FR 42590 - Retrospective Review Under E.O. 13563; Improving Common Acreage Reporting Processes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

... solutions to preserve and strengthen the economic stability of America's agricultural producers. RMA..., commodity, credit, conservation, disaster, and emergency assistance programs that help improve the stability... management system. To implement ACRSI in an economical manner, we plan to the extent possible to utilize CIMS...

Contemporary Responses to Violent Attacks on College Campuses

ERIC Educational Resources Information Center

Sulkowski, Michael L.; Lazarus, Philip J.

2011-01-01

In this article, the authors review efforts to increase the availability of crime data to students and parents, utilize security technologies on campus, allow members of campus communities to carry concealed weapons, use criminal or potential shooter profiling, employ threat assessment techniques, and implement emergency response plans to address…

Physician Behavior Modification Using Claims Data: Tetracycline for Upper Respiratory Infection

PubMed Central

McConnell, Thomas S.; Cushing, Alice H.; Bankhurst, Arthur D.; Healy, James L.; McIlvenna, Patricia A.; Skipper, Betty J.

1982-01-01

Professional Standards Review Organization claims data were used in defining, planning, implementing and evaluating an approach to an ambulatory medical care problem utilizing educational intervention. Modification of physicians' tetracycline prescribing behavior was achieved in an actual practice setting by personal visits from peer physicians. PMID:6891147

Shopping for Health Benefits.

ERIC Educational Resources Information Center

Natale, Jo Anna

1992-01-01

Among the ways school districts can obtain the best possible health benefits at the lowest possible cost are the following: (1) reduce the number of full-time employees; (2) set up a utilization review committee; (3) enlist a preferred provider organization; (4) offer wellness programs; (5) develop a self-insurance plan; and (6) consider a…

Health Instruction Packages: Consumer--Birth Control.

ERIC Educational Resources Information Center

Pries, Rose Mary; And Others

Designed for the general public, these three learning modules utilize text, illustrations, and exercises to describe various methods of birth control. The first module, "All about Contraception for the Teenage New Mother" by Rose Mary Pries, discusses the desirability of planned pregnancy and reviews the effectiveness and side effects of…

From Planning to Action: Government Initiatives for Improving School-Level Practice.

ERIC Educational Resources Information Center

Chapman, David W., Ed.; Mahlck, Lars O., Ed.; Smulders, Anna E. M., Ed.

This work examines ways central and regional education ministries can influence practices at the school level. Chapter 1, "Changing What Happens in Schools: Central-Level Initiatives to Improve School Practice," reviews common themes, concerns, problems, and emphases. Chapter 2, "Knowledge Utilization and the Process of Policy…

Assistive Technology and Older Adults in Disasters: Implications for Emergency Management.

PubMed

McSweeney-Feld, Mary Helen

2017-02-01

This article identifies concepts, trends, and policy gaps in the availability and service delivery of assistive technology utilized by older adults in disasters, as well as implications for emergency management planning and shelter administration. Definitions of types of assistive technology, as well as views of older adults using technology as at-risk individuals for emergency management service provision, are provided. An overview of peer-reviewed articles and gray literature is conducted, focusing on publications from 2001 to the present in the United States. Analytical frameworks used by emergency management organizations as well as regulations such as the Americans with Disabilities Act and recent court decisions on emergency shelter accessibility in disasters are reviewed. Research on the use of assistive technology by older adults during disasters is a neglected issue. The current and potential benefits of defining standards for provision and use of assistive technology for older adults during disasters has received limited recognition in emergency management planning. Older adults with disabilities utilize assistive technology to maintain their independence and dignity, and communities as well as emergency services managers need to become more aware of the needs and preferences of these older adults in their planning processes and drills as well as in service delivery during actual events. (Disaster Med Public Health Preparedness. 2017;11:135-139).

Gravity as a factor in the animal environment.

NASA Technical Reports Server (NTRS)

Smith, A. H.

1972-01-01

Review of current knowledge, research, and research planning on the influence of gravity upon living organisms. Discussed factors affecting the adaptability of animals to increased acceleration fields include age, sex, posture, and body size. Affected functions and aspects reviewed cover growth and mature body size, body composition, maintenance feed requirements, and feed utilization efficiency. It is expected that research involving the exposure of animals to altered gravity states will lead to new biological concepts of very broad importance.

Improving equity in the provision of primary health care: lessons from decentralized planning and management in Namibia.

PubMed Central

Bell, Ruth; Ithindi, Taathi; Low, Anne

2002-01-01

This paper draws lessons from a review of primary health care services in Windhoek, the capital of Namibia, undertaken by a regional health management team. The review was carried out because of perceived increases in workload and inadequate staffing levels, arising from the rapid expansion of the city associated with inward migration. A survey of the utilization of government clinics was used to develop a more equitable allocation of primary health care services between localities. The survey revealed disparities between patterns of utilization of the services and the allocation of staff: the poorer localities were relatively underprovided. Decisions made centrally on resource allocation had reinforced the inequities. On the basis of the results of the review, the regional health management team redistributed nursing and medical staff and argued for a shift in the allocation of capital expenditure towards the poorer communities. The review demonstrates the potential for regional and provincial health management teams to make effective assessments of the needs of their populations and to promote the equitable delivery of primary health care services. In order to achieve this they need not only to become effective managers, but also to develop population-based planning skills and the confidence and authority to influence the allocation of resources between and within their regions and provinces. PMID:12219160

Facilities Utilization Program Implementation Handbook

NASA Technical Reports Server (NTRS)

1987-01-01

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

Projects in eastern Canada encounter strong opposition. [Hydroelectric power plants planned

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

Carr, F.H.

1993-09-13

At the end of August, Quebec's provincial utility submitted a long-awaited environmental impact statement on its proposed Great Whale project near Hudson Bay. It faces opposition, as does a big project planned in Labrador. Hydro-Quebec's EIS says its $10-billion, 3,210-Mw project [open quotes]would have impacts that are generally moderate and localized, and that can be mitigated,[close quotes] according to a utility spokeswoman. But environmental and Native American groups opposed to the project say its three powerhouses on the Great Whale River and 600 sq miles of new impoundments would destroy hunting and fishing areas and mar the environment. Five federalmore » and provincial review panels will determine over the next several weeks if the EIS meets their requirements.« less

42 CFR 431.55 - Waiver of other Medicaid requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... restrictions on free choice of providers do not apply to family planning services. (3) No waiver under this..., or State. (2) A locality may use any agency or agent, public or private, profit or nonprofit, to act..., utilization review, medical social services, or administrative services. (B) Any entity described in paragraph...

Research Needs in Fire Safety for the Human Exploration and Utilization of Space: Proceedings and Research Plan

NASA Technical Reports Server (NTRS)

Ruff, Gary A.

2003-01-01

The purpose of the workshop documented in this publication was to bring together personnel responsible for the design and operations of the International Space Station (ISS) and the fire protection research community to review the current knowledge in fire safety relative to spacecraft. From this review, research needs were identified that were then used to formulate a research plan with specific objectives. In this document, I have attempted to capture the very informative and lively discussions that occurred in the plenary sessions and the working groups. I hope that it will be useful to readers and serve as a significant step in assuring fire protection for the crews of current and future spacecraft.

Accelerated testing of space mechanisms

NASA Technical Reports Server (NTRS)

Murray, S. Frank; Heshmat, Hooshang

1995-01-01

This report contains a review of various existing life prediction techniques used for a wide range of space mechanisms. Life prediction techniques utilized in other non-space fields such as turbine engine design are also reviewed for applicability to many space mechanism issues. The development of new concepts on how various tribological processes are involved in the life of the complex mechanisms used for space applications are examined. A 'roadmap' for the complete implementation of a tribological prediction approach for complex mechanical systems including standard procedures for test planning, analytical models for life prediction and experimental verification of the life prediction and accelerated testing techniques are discussed. A plan is presented to demonstrate a method for predicting the life and/or performance of a selected space mechanism mechanical component.

[The effectiveness of continuing care models in patients with chronic diseases: a systematic review].

PubMed

Chen, Hsiao-Mei; Han, Tung-Chen; Chen, Ching-Min

2014-04-01

Population aging has caused significant rises in the prevalence of chronic diseases and the utilization of healthcare services in Taiwan. The current healthcare delivery system is fragmented. Integrating medical services may increase the quality of healthcare, enhance patient and patient family satisfaction with healthcare services, and better contain healthcare costs. This article introduces two continuing care models: discharge planning and case management. Further, the effectiveness and essential components of these two models are analyzed using a systematic review method. Articles included in this systematic review were all original articles on discharge-planning or case-management interventions published between February 1999 and March 2013 in any of 6 electronic databases (Medline, PubMed, Cinahl Plus with full Text, ProQuest, Cochrane Library, CEPS and Center for Chinese Studies electronic databases). Of the 70 articles retrieved, only 7 were randomized controlled trial studies. Three types of continuity-of-care models were identified: discharge planning, case management, and a hybrid of these two. All three models used logical and systematic processes to conduct assessment, planning, implementation, coordination, follow-up, and evaluation activities. Both the discharge planning model and the case management model were positively associated with improved self-care knowledge, reduced length of stay, decreased medical costs, and better quality of life. This study cross-referenced all reviewed articles in terms of target clients, content, intervention schedules, measurements, and outcome indicators. Study results may be referenced in future implementations of continuity-care models and may provide a reference for future research.

Quality assurance of HDR prostate plans: program implementation at a community hospital.

PubMed

Rush, Jennifer B; Thomas, Michael D

2005-01-01

Adenocarcinoma of the prostate is currently the most commonly diagnosed cancer in men in the United States, and the second leading cause of cancer mortality. The utilization of radiation therapy is regarded as the definitive local therapy of choice for intermediate- and high-risk disease, in which there is increased risk for extracapsular extension, seminal vesicle invasion, or regional node involvement. High-dose-rate (HDR) brachytherapy is a logical treatment modality to deliver the boost dose to an external beam radiation therapy (EBRT) treatment to increase local control rates. From a treatment perspective, the utilization of a complicated treatment delivery system, the compressed time frame in which the procedure is performed, and the small number of large dose fractions make the implementation of a comprehensive quality assurance (QA) program imperative. One aspect of this program is the QA of the HDR treatment plan. Review of regulatory and medical physics professional publications shows that substantial general guidance is available. We provide some insight to the implementation of an HDR prostate plan program at a community hospital. One aspect addressed is the utilization of the low-dose-rate (LDR) planning system and the use of existing ultrasound image sets to familiarize the radiation therapy team with respect to acceptable HDR implant geometries. Additionally, the use of the LDR treatment planning system provided a means to prospectively determine the relationship between the treated isodose volume and the product of activity and time for the department's planning protocol prior to the first HDR implant. For the first 12 HDR prostate implants, the root-mean-square (RMS) deviation was 3.05% between the predicted product of activity and time vs. the actual plan values. Retrospective re-evaluation of the actual implant data reduced the RMS deviation to 2.36%.

Planning an organizational wellness initiative at a multi-state social service agency.

PubMed

Miller, J Jay; Grise-Owens, Erlene; Addison, Donia; Marshall, Midaya; Trabue, Donna; Escobar-Ratliff, Laura

2016-06-01

Increasingly, organizations in general, and social service organizations, specifically, are recognizing the importance of planning and evaluating organizational wellness initiatives. Yet, few participatory models for carrying out these aims exist. For this study, researchers utilized concept mapping (CM) to explicate a conceptual framework for planning, and subsequently evaluating, a wellness initiative at a multi-state social service organization. CM is a participatory approach that analyzes qualitative data via multi-dimensional scaling and hierarchical cluster analyses. Outputs include a number of visual depictions that allow researchers to explore complex relationships among sets of the data. Results from this study indicated that participants (N=64), all of whom were employees of the agency, conceptualized organizational wellness via an eight-cluster solution, or Concept Map. Priority areas of this framework, specifically importance and feasibility, were also explored. After a brief review of pertinent literature, this article explicates the CM methodology utilized in this study, describes results, discusses lessons learned, and identifies apt areas for future research. Copyright © 2016 Elsevier Ltd. All rights reserved.

24 CFR 599.507 - Tax incentives utilization plan.

Code of Federal Regulations, 2010 CFR

2010-04-01

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

Harvard Community Health Plan's Mental Health Redesign Project: a managerial and clinical partnership.

PubMed

Abrams, H S

1993-01-01

Harvard Community Health Plan, founded in 1969 as a staff model HMO, is currently a staff and group model HMO with 521,000 members, 19 health centers and 12 independently owned group practices with 26 locations. In 1987, the Plan initiated a review of its mental health benefit and program because its costs were rising, member and clinician dissatisfaction was increasing and many believed the problem was the nature and scope of the benefit. After two years of study, surveys, interviews, cost and utilization analysis, the Plan identified its professional staff as its key asset but recognized many problem areas, including problems with access, variation from site to site, inconsistent service delivery, lack of consistent utilization management and the need for greater diversity along the spectrum of care available to members. From 1989 to 1990, more than 200 clinicians and support staff were engaged in the process of developing a variety of components to the "mental health redesign program." Three simultaneous efforts included developing a method of categorizing patients, restructuring the delivery system and redesigning the benefit. A Mental Health Patient Assessment Tool was created which assists clinicians in performing comprehensive evaluations, administers the benefit, measures progress and supports outcomes research. Delivery system changes included the implementation of self-referral, access standards, intake triage functions by non-clinical staff, program development and an outpatient utilization management function.

Evaluating Management Information Systems, A Protocol for Automated Peer Review Systems

PubMed Central

Black, Gordon C.

1980-01-01

This paper discusses key issues in evaluating an automated Peer Review System. Included are the conceptual base, design, steps in planning structural components, operation parameters, criteria, costs and a detailed outline or protocol for use in the evaluation. At the heart of the Peer Review System is the criteria utilized for measuring quality. Criteria evaluation should embrace, as a minimum, appropriateness, validity and reliability, and completemess or comprehensiveness of content. Such an evaluation is not complete without determining the impact (clinical outcome) of the service system or the patient and the population served.

Physician organization care management capabilities associated with effective inpatient utilization management: a fuzzy set qualitative comparative analysis.

PubMed

Sheehy, Thomas J; Thygeson, N Marcus

2014-12-03

We studied the relationship between physician organization (PO) care management capabilities and inpatient utilization in order to identify PO characteristics or capabilities associated with low inpatient bed-days per thousand. We used fuzzy-set qualitative comparative analysis (fsQCA) to conduct an exploratory comparative case series study. Data about PO capabilities were collected using structured interviews with medical directors at fourteen California POs that are delegated to provide inpatient utilization management (UM) for HMO members of a California health plan. Health plan acute hospital claims from 2011 were extracted from a reporting data warehouse and used to calculate inpatient utilization statistics. Supplementary analyses were conducted using Fisher's Exact Test and Student's T-test. POs with low inpatient bed-days per thousand minimized length of stay and surgical admissions by actively engaging in concurrent review, discharge planning, and surgical prior authorization, and by contracting directly with hospitalists to provide UM-related services. Disease and case management were associated with lower medical admissions and readmissions, respectively, but not lower bed-days per thousand. Care management methods focused on managing length of stay and elective surgical admissions are associated with low bed-days per thousand in high-risk California POs delegated for inpatient UM. Reducing medical admissions alone is insufficient to achieve low bed-days per thousand. California POs with high bed-days per thousand are not applying care management best practices.

An integrative review on coping skills in nursing students: implications for policymaking.

PubMed

Labrague, L J; McEnroe-Petitte, D M; Al Amri, M; Fronda, D C; Obeidat, A A

2018-06-01

This study critically appraised both quantitative and qualitative studies describing coping strategies utilized by nursing students when faced with stress. Stress in nursing students during clinical training is well documented in the nursing literature. The need to utilize positive-coping strategies is necessary to effectively deal with stress and its accompanying stressors. An integrative review method was used in this review. PsycINFO, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE and Scopus were the databases used in searching for relevant literature using the following search terms; 'coping', 'nursing students', clinical training', 'ways of coping' and 'clinical practice'. A total of 27 studies published from 2001 to 2016 were included in this review. Findings demonstrated that nursing students utilized problem-focused coping strategies rather than emotion-focused coping strategies. Specific coping behaviours utilized included problem-solving behaviours, self-confident approaches and seeking of support from family and friends. The review contributes to the growing literature on coping strategies in nursing students and may have implications on nursing education and nursing policy. This review also demonstrated a scarcity of studies that links specific coping strategies to nursing school stressors and examines predictors of coping skills in nursing students. Institutionalization of structured student orientation programme, implementation of well-planned mentoring programmes and establishment of support unit/centres may be helpful in supporting nursing students during their clinical placement. By developing empirically based interventions, nursing faculty can assist nursing students in strengthening their positive-coping skills to effectively deal with various stressors encountered. © 2017 International Council of Nurses.

HTGR technology economic/ business analysis and trade studies impacts. Impacts of HTGR commericialization on the U.S. economy

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

Silady, Fred

The approach to this task was to initially review the 2012 Business Plan and supporting analyses for the above impacts. With that understanding as a base, the Business Plan impacts are updated in terms of the GDP and job creation as a result of additional studies and inputs such as the revised market assessment from Task 1.1. For the impacts on U.S. competitiveness, the NGNP Industry Alliance team members have been utilized to provide inputs on supplier infrastructure development and on vendor capability.

Development of Technologies to Utilize Laser Plasma Radiations Sources for Radiation Effects Sciences

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

Davis, J F

2007-01-31

This final report will cover work performed over the period of November 11, 2005 to September 30, 2006 on the contract to develop technologies using laser sources for radiation effects sciences. The report will discuss four topic areas; the laser source experiments on the Gekko Laser at Osaka, Japan, planning for the Charge State Freeze Out experiments to be performed in calendar year 2007, a review of previous xenon gasbags on the LANL Trident laser to provide planning support to the May-June 2007 HELEN experiments.

24 CFR 599.507 - Tax incentives utilization plan.

Code of Federal Regulations, 2011 CFR

2011-04-01

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

78 FR 65675 - Proposed Collection; 60-Day Comment Request; Multidisciplinary Treatment Planning (MTP) Within...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-01

... summaries of proposed projects to be submitted to the Office of Management and Budget (OMB) for review and..., including the validity of the methodology and assumptions used; (3) Ways to enhance the quality, utility... on multidisciplinary care in cancer. A total of 21 hospitals participating in the NCCCP through June...

77 FR 65390 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

... statement are specifically relevant to the cost plan requirements in section 1876(c)(1)(C) of the Social... utilization data were not reported. This suspension remains in effect and will lead to a reduction in burden... Network Adequacy.'' The suspensions are all due to the fact that equivalent data are already being...

From FBA to Implementation: A Look at What Is Actually Being Delivered

ERIC Educational Resources Information Center

Blood, Erika; Neel, Richard S.

2007-01-01

This study looks at the utilization of assessments on developing behavior intervention plans (BIPs) and their use in designing actual implementation for the children (elementary through high school) labeled EBD in a mid-sized district in eastern Washington. Files were reviewed to determine the types of assessments used, FBA components addressed,…

Psychiatric Inpatient Discharge Planning Practices and Attendance at Aftercare Appointments.

PubMed

Smith, Thomas E; Abraham, Maria; Bolotnikova, Natalia V; Donahue, Sheila A; Essock, Susan M; Olfson, Mark; Shao, Wenjun S; Wall, Melanie M; Radigan, Marleen

2017-01-01

This study examined discharge planning practices by hospital providers for 17,053 psychiatric discharges in New York's statewide Medicaid program. Claims data were linked to information reported to New York State by managed behavioral health care organizations (MBHOs) conducting inpatient utilization reviews. MBHOs documented hospital providers' reports of the presence of three discharge planning practices for each discharge: communicating with an outpatient provider prior to discharge, scheduling an aftercare appointment, and forwarding a discharge summary. Hospital providers reported completing at least one of the three discharge planning practices for 85% of discharges. Individuals who received all three discharge planning practices had a higher likelihood of follow-up and kept their first outpatient follow-up visit at almost twice the speed compared with individuals who received none of the practices (hazard ratio=1.96, p<.001). This study provided baseline information concerning routine discharge planning practices and their relationship to timeliness of care transitions.

Impact of the residential conservation service program on natural gas and electric utilities. Appendix B

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

Not Available

An assessment of the RCS program is provided from the perspective of eleven case study utilities. First, an introduction to the role and value of conservation in utility strategic planning is presented. The interplay of various utility system characteristics is shown to be the primary determinant of the value of conservation efforts from the utility's point of view. Simplified typologies of utilities are developed to aid in the identification of those combinations of the utility characteristics that will favor the adoption of the utility sponsored strategic conservation efforts. The integration of the RCS program with other utility conservation and loadmore » management programs is explored for the eleven case study utilities. Reference is made to the simplified typologies in order to show, through actual program experience, how the strategic position of the utility company affects its adoption of this federal program. Evaluative studies done by the eleven case study utilities of the RCS program are reviewed. Results are presented and the methodologies are critiqued. Conclusions regarding the RCS program from the utility perspective are presented.« less

Japanese plan for SSF utilization

NASA Technical Reports Server (NTRS)

Mizuno, Toshio

1992-01-01

The Japanese Experiment Module (JEM) program has made significant progress. The JEM preliminary design review was completed in July 1992; construction of JEM operation facilities has begun; and the micro-G airplane, drop shaft, and micro-G experiment rocket are all operational. The national policy for JEM utilization was also established. The Space Experiment Laboratory (SEL) opened in June '92 and will function as a user support center. Eight JEM multiuser facilities are in phase B, and scientific requirements are being defined for 17 candidate multiuser facilities. The National Joint Research Program is about to start. Precursor missions and early Space Station utilization activities are being defined. This paper summarizes the program in outline and graphic form.

Risk Assessment Methodology for Water utilities (RAM-W) : the foundation for emergency response planning.

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

Danneels, Jeffrey John

2005-03-01

Concerns about acts of terrorism against critical infrastructures have been on the rise for several years. Critical infrastructures are those physical structures and information systems (including cyber) essential to the minimum operations of the economy and government. The President's Commission on Critical Infrastructure Protection (PCCIP) probed the security of the nation's critical infrastructures. The PCCIP determined the water infrastructure is highly vulnerable to a range of potential attacks. In October 1997, the PCCIP proposed a public/private partnership between the federal government and private industry to improve the protection of the nation's critical infrastructures. In early 2000, the EPA partnered withmore » the Awwa Research Foundation (AwwaRF) and Sandia National Laboratories to create the Risk Assessment Methodology for Water Utilities (RAM-W{trademark}). Soon thereafter, they initiated an effort to create a template and minimum requirements for water utility Emergency Response Plans (ERP). All public water utilities in the US serving populations greater than 3,300 are required to undertaken both a vulnerability assessment and the development of an emergency response plan. This paper explains the initial steps of RAM-W{trademark} and then demonstrates how the security risk assessment is fundamental to the ERP. During the development of RAM-W{trademark}, Sandia performed several security risk assessments at large metropolitan water utilities. As part of the scope of that effort, ERPs at each utility were reviewed to determine how well they addressed significant vulnerabilities uncovered during the risk assessment. The ERP will contain responses to other events as well (e.g. natural disasters) but should address all major findings in the security risk assessment.« less

Scoping study of integrated resource planning needs in the public utility sector

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

Garrick, C J; Garrick, J M; Rue, D R

Integrated resource planning (IRP) is an approach to utility resource planning that integrates the evaluation of supply- and demand-site options for providing energy services at the least cost. Many utilities practice IRP; however, most studies about IRP focus on investor-owned utilities (IOUs). This scoping study investigates the IRP activities and needs of public utilities (not-for-profit utilities, including federal, state, municipal, and cooperative utilities). This study (1) profiles IRP-related characteristics of the public utility sector, (2) articulates the needs of public utilities in understanding and implementing IRP, and (3) identifies strategies to advance IRP principles in public utility planning.

Long term load forecasting accuracy in electric utility integrated resource planning

DOE PAGES

Carvallo, Juan Pablo; Larsen, Peter H.; Sanstad, Alan H.; ...

2018-05-23

Forecasts of electricity consumption and peak demand over time horizons of one or two decades are a key element in electric utilities’ meeting their core objective and obligation to ensure reliable and affordable electricity supplies for their customers while complying with a range of energy and environmental regulations and policies. These forecasts are an important input to integrated resource planning (IRP) processes involving utilities, regulators, and other stake-holders. Despite their importance, however, there has been little analysis of long term utility load forecasting accuracy. We conduct a retrospective analysis of long term load forecasts on twelve Western U. S. electricmore » utilities in the mid-2000s to find that most overestimated both energy consumption and peak demand growth. A key reason for this was the use of assumptions that led to an overestimation of economic growth. We find that the complexity of forecast methods and the accuracy of these forecasts are mildly correlated. In addition, sensitivity and risk analysis of load growth and its implications for capacity expansion were not well integrated with subsequent implementation. As a result, we review changes in the utilities load forecasting methods over the subsequent decade, and discuss the policy implications of long term load forecast inaccuracy and its underlying causes.« less

Long term load forecasting accuracy in electric utility integrated resource planning

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

Carvallo, Juan Pablo; Larsen, Peter H.; Sanstad, Alan H.

Forecasts of electricity consumption and peak demand over time horizons of one or two decades are a key element in electric utilities’ meeting their core objective and obligation to ensure reliable and affordable electricity supplies for their customers while complying with a range of energy and environmental regulations and policies. These forecasts are an important input to integrated resource planning (IRP) processes involving utilities, regulators, and other stake-holders. Despite their importance, however, there has been little analysis of long term utility load forecasting accuracy. We conduct a retrospective analysis of long term load forecasts on twelve Western U. S. electricmore » utilities in the mid-2000s to find that most overestimated both energy consumption and peak demand growth. A key reason for this was the use of assumptions that led to an overestimation of economic growth. We find that the complexity of forecast methods and the accuracy of these forecasts are mildly correlated. In addition, sensitivity and risk analysis of load growth and its implications for capacity expansion were not well integrated with subsequent implementation. As a result, we review changes in the utilities load forecasting methods over the subsequent decade, and discuss the policy implications of long term load forecast inaccuracy and its underlying causes.« less

Assessing quality of care for migraineurs: a model health plan measurement set.

PubMed

Leas, Brian F; Gagne, Joshua J; Goldfarb, Neil I; Rupnow, Marcia F T; Silberstein, Stephen

2008-08-01

Quality of care measures are increasingly important to health plans, purchasers, physicians, and patients. Appropriate measures can be used to assess quality and evaluate improvement and are necessary components of pay-for-performance programs. Despite the broad scope of activity in the development of quality measures, migraine headache has received little attention. Given the enormous costs associated with migraine, especially in terms of lost productivity and preventable health care utilization, health plans could gain from a structured approach to measuring the quality of migraine care their beneficiaries receive. A potential migraine quality measurement set was developed through a review of migraine care literature and guidelines, interviews with leaders in migraine care, health care purchasing, and managed care, and the assembly of an advisory board. The board discussed candidate measures and established consensus on a testable measurement set. Twenty measures were developed, focused primarily on diagnosis and utilization. Areas of utilization include physician visits, emergency department visits, hospitalizations, and imaging. Use of both acute and preventive medications is included. More complex aspects of migraine care are also addressed, including triptan overuse, the relationship between acute and preventive medications, and follow-up after emergency department visits. The measures are currently being tested in health plans to assess their feasibility and value. A compelling case can be made for the development of migraine-specific quality measures for health plans. This effort to develop and test a starter set of measures should lead to new and innovative efforts to assess and improve quality of care for migraineurs.

A scoping review of nursing workforce planning and forecasting research.

PubMed

Squires, Allison; Jylhä, Virpi; Jun, Jin; Ensio, Anneli; Kinnunen, Juha

2017-11-01

This study will critically evaluate forecasting models and their content in workforce planning policies for nursing professionals and to highlight the strengths and the weaknesses of existing approaches. Although macro-level nursing workforce issues may not be the first thing that many nurse managers consider in daily operations, the current and impending nursing shortage in many countries makes nursing specific models for workforce forecasting important. A scoping review was conducted using a directed and summative content analysis approach to capture supply and demand analytic methods of nurse workforce planning and forecasting. The literature on nurse workforce forecasting studies published in peer-reviewed journals as well as in grey literature was included in the scoping review. Thirty six studies met the inclusion criteria, with the majority coming from the USA. Forecasting methods were biased towards service utilization analyses and were not consistent across studies. Current methods for nurse workforce forecasting are inconsistent and have not accounted sufficiently for socioeconomic and political factors that can influence workforce projections. Additional studies examining past trends are needed to improve future modelling. Accurate nursing workforce forecasting can help nurse managers, administrators and policy makers to understand the supply and demand of the workforce to prepare and maintain an adequate and competent current and future workforce. © 2017 John Wiley & Sons Ltd.

Analysis of the value of battery storage with wind and photovoltaic generation to the Sacramento Municipal Utility District

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

Zaininger, H.W.

1998-08-01

This report describes the results of an analysis to determine the economic and operational value of battery storage to wind and photovoltaic (PV) generation technologies to the Sacramento Municipal Utility District (SMUD) system. The analysis approach consisted of performing a benefit-cost economic assessment using established SMUD financial parameters, system expansion plans, and current system operating procedures. This report presents the results of the analysis. Section 2 describes expected wind and PV plant performance. Section 3 describes expected benefits to SMUD associated with employing battery storage. Section 4 presents preliminary benefit-cost results for battery storage added at the Solano wind plantmore » and the Hedge PV plant. Section 5 presents conclusions and recommendations resulting from this analysis. The results of this analysis should be reviewed subject to the following caveat. The assumptions and data used in developing these results were based on reports available from and interaction with appropriate SMUD operating, planning, and design personnel in 1994 and early 1995 and are compatible with financial assumptions and system expansion plans as of that time. Assumptions and SMUD expansion plans have changed since then. In particular, SMUD did not install the additional 45 MW of wind that was planned for 1996. Current SMUD expansion plans and assumptions should be obtained from appropriate SMUD personnel.« less

Utility assessment of a map-based online geo-collaboration tool.

PubMed

Sidlar, Christopher L; Rinner, Claus

2009-05-01

Spatial group decision-making processes often include both informal and analytical components. Discussions among stakeholders or planning experts are an example of an informal component. When participants discuss spatial planning projects they typically express concerns and comments by pointing to places on a map. The Argumentation Map model provides a conceptual basis for collaborative tools that enable explicit linkages of arguments to the places to which they refer. These tools allow for the input of explicitly geo-referenced arguments as well as the visual access to arguments through a map interface. In this paper, we will review previous utility studies in geo-collaboration and evaluate a case study of a Web-based Argumentation Map application. The case study was conducted in the summer of 2005 when student participants discussed planning issues on the University of Toronto St. George campus. During a one-week unmoderated discussion phase, 11 participants wrote 60 comments on issues such as safety, facilities, parking, and building aesthetics. By measuring the participants' use of geographic references, we draw conclusions on how well the software tool supported the potential of the underlying concept. This research aims to contribute to a scientific approach to geo-collaboration in which the engineering of novel spatial decision support methods is complemented by a critical assessment of their utility in controlled, realistic experiments.

Utilization of construction and agricultural waste in Malaysia for development of Green Concrete: A Review

NASA Astrophysics Data System (ADS)

Tambichik, M. A.; Mohamad, N.; Samad, A. A. A.; Bosro, M. Z. M.; Iman, M. A.

2018-04-01

Green Concrete (GC) is defined as a concrete that utilize a waste material for at least one of its component. The production of GC has been increasing due to the drawback of conventional concrete that create many environmental problems. In Malaysia, the amount of waste generates from agricultural and construction industries were increasing every year. Hence, one of the solutions to reduce the impact of conventional concrete and limited landfill spaces due to excessive waste is by utilizing it in concrete. This paper reviews the possible use of construction waste (Recycle Concrete Aggregate) and agricultural waste (Palm Oil Fuel Ash, Rice Husk Ash and Palm Oil Fibre) as partial replacement for the basic material in a concrete to produce an innovative Green Concrete. The optimum replacement level for each type of waste was also been review. Green Concrete also has the potential to reduce environmental pollution and solve the depletion of natural sources. The result from this review shows that the addition of agricultural waste or construction waste in concrete indicate positive and satisfactory strength when compared to normal concrete. Finally, a mass production of Green Concrete can fulfil the Construction Industry Transformation Plan (CITP) 2016-2020 made by CIDB that emphasizes on a construction system which is environmentally sustainable.

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

Code of Federal Regulations, 2011 CFR

2011-10-01

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

TU-AB-201-01: A Comprehensive Planning Comparison Study Between a Novel Direction Modulated Brachytherapy Tandem Applicator and Conventional T&R Applicator for Image Guided Cervical Cancer Brachytherapy

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

Han, D; Liu, Z; University of California, San Diego, La Jolla, CA

2015-06-15

Purpose: To demonstrate that utilization of a novel, intensity modulation capable, direction modulated brachytherapy (DMBT) tandem applicator can improve plan quality compared with conventional T&R applicator during an image guided cervical cancer brachytherapy. Methods: 45 cervical cancer patients treated with PDR brachytherapy were reviewed. Of them, a) 27 were treated using T&R only, b) 9 were treated using T&R with needles attached to the ring, and c) the remaining 9 were treated using T&R with needles attached to the ring (AN) as well as additional free-hand-loaded needles (FN). The DMBT tandem design has 6 peripheral holes of 1.3-mm diameter, groovedmore » along a nonmagnetic tungsten alloy rod, enclosed in a plastic sheath with total 6.0-mm diameter. An in-house-coded inverse planning system was used for planning DMBT and T&R cases. All typical clinical constraints including OAR dose limits, dwell times, and loading patterns were respected. For the DMBT and T&R applicators, the plans were optimized with the same conventional ring in place, but repeatedly planned with and without AN/FN needles. All generated plans were normalized to the same D90 of the clinically treated plans. Results: For the plans in category a), DMBT generally outperformed T&R with average reduction in D2cc of −2.39%, −5.21%, and −2.69% for bladder, rectum, and sigmoid, respectively. For the plans in category b) and c), DMBT generally outperformed T&R if the same needles in AN/FN were utilized in both cases with average reduction in D2cc of −1.82%, −3.40%, and −6.04%, respectively. For the cases where the needles were not utilized for both applicators, an average D2cc reduction of −7.45%, −7.61%, and 17.47% were observed, respectively. Conclusions: Under the same clinical conditions, with/without needles, the DMBT applicator tends to generate more favorable plans compared with the conventional T&R applicator, and hence, is a promising technology.« less

Evidence for the use PET for radiation therapy planning in patients with cervical cancer: a systematic review.

PubMed

Salem, A; Salem, A F; Al-Ibraheem, A; Lataifeh, I; Almousa, A; Jaradat, I

2011-01-01

In recent years, the role of positron emission tomography (PET) in the staging and management of gynecological cancers has been increasing. The aim of this study was to systematically review the role of PET in radiotherapy planning and brachytherapy treatment optimization in patients with cervical cancer. Systematic literature review. Systematic review of relevant literature addressing the utilization of PET and/or PET-computed tomography (CT) in external-beam radiotherapy planning and brachytherapy treatment optimization. We performed an extensive PubMed database search on 20 April 2011. Nineteen studies, including 759 patients, formed the basis of this systematic review. PET/ PET-CT is the most sensitive imaging modality for detecting nodal metastases in patients with cervical cancer and has been shown to impact external-beam radiotherapy planning by modifying the treatment field and customizing the radiation dose. This particularly applies to detection of previously uncovered para-aortic and inguinal nodal metastases. Furthermore, PET/ PET-CT guided intensity-modulated radiation therapy (IMRT) allows delivery of higher doses of radiation to the primary tumor, if brachytherapy is unsuitable, and to grossly involved nodal disease while minimizing treatment-related toxicity. PET/ PET-CT based brachytherapy optimization allows improved tumor-volume dose distribution and detailed 3D dosimetric evaluation of risk organs. Sequential PET/ PET-CT imaging performed during the course of brachytherapy form the basis of “adaptive” brachytherapy in cervical cancer. This review demonstrates the effectiveness of pretreatment PET/ PET-CT in cervical cancer patients treated by radiotherapy. Further prospective studies are required to define the group of patients who would benefit the most from this procedure.

A Review of the Status and Projections for the Dade County Quinmester Extended School Year Program.

ERIC Educational Resources Information Center

Dade County Public Schools, Miami, FL.

This document summarizes the background of the Dade County Quinmester Extended School Year Program involving five high schools in a pilot project. The program resulted from a study of alternative plant utilization plans for the most efficient use of school facilities to reduce the need for capital expenditure during the next five years. Discussed…

Roles of Historical Photography in Waste Site Characterization, Closure, and Remediation

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

Mackey, H.

1998-07-01

Over 40,000 frames of vertical historical photography from 1938 to 1996 and over 10,000 frames of oblique photography from 1981 to 1991 of the 777-square kilometer Savannah River Site in south central South Carolina were reviewed, cataloged, and referenced utilizing ARCView and associated ArcInfo tools. This allows environmental reviews of over 400 potential waste units on the SRS to be conducted in a rapid fashion to support preparation of work plans, characterization, risk assessments, and closure of the waste units in a more cost effective manner.

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

Recent development on computer aided tissue engineering--a review.

PubMed

Sun, Wei; Lal, Pallavi

2002-02-01

The utilization of computer-aided technologies in tissue engineering has evolved in the development of a new field of computer-aided tissue engineering (CATE). This article reviews recent development and application of enabling computer technology, imaging technology, computer-aided design and computer-aided manufacturing (CAD and CAM), and rapid prototyping (RP) technology in tissue engineering, particularly, in computer-aided tissue anatomical modeling, three-dimensional (3-D) anatomy visualization and 3-D reconstruction, CAD-based anatomical modeling, computer-aided tissue classification, computer-aided tissue implantation and prototype modeling assisted surgical planning and reconstruction.

The Space Shuttle - A future space transportation system

NASA Technical Reports Server (NTRS)

Thompson, R. F.

1974-01-01

The objective of the Space Shuttle Program is to achieve an economical space transportation system. This paper provides an introductory review of the considerations which led to the Government decisions to develop the Space Shuttle. The role of a space transportation system is then considered within the context of historical developments in the general field of transportation, followed by a review of the Shuttle system, mission profile, payload categories, and payload accommodations which the Shuttle system will provide, and concludes with a forecast of the systems utilization for space science research and payload planning activity.

MR guided breast interventions: role in biopsy targeting and lumpectomies

PubMed Central

Jagadeesan, Jayender; Richman, Danielle M; Kacher, Daniel F

2015-01-01

Synopsis Contrast enhanced breast MRI is increasingly being used to diagnose breast cancer and to perform biopsy procedures. The American Cancer Society has advised women at high risk for breast cancer to have breast MRI screening as an adjunct to screening mammography. This article places special emphasis on biopsy and operative planning involving MRI and reviews utility of breast MRI in monitoring response to neoadjuvant chemotherapy. We describe peer-reviewed data on currently accepted MR-guided therapeutic methods for addressing benign and malignant breast diseases, including intraoperative imaging. PMID:26499274

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

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-30

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

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

Hardin, M; Harrison, A; Lockamy, V

Purpose: Desire to improve efficiency and throughput inspired a review of our physics chart check procedures. Departmental policy mandates plan checks pre-treatment, after first treatment and weekly every 3–5 days. This study examined the effectiveness of the “after first” check with respect to improving patient safety and clinical efficiency. Type and frequency of variations discovered during this redundant secondary review was examined over seven months. Methods: A community spreadsheet was created to record variations in care discovered during chart review following the first fraction of treatment and before the second fraction (each plan reviewed prior to treatment). Entries were recordedmore » from August 2014 through February 2015, amounting to 43 recorded variations out of 906 reviewed charts. The variations were divided into categories and frequencies were assessed month-to-month. Results: Analysis of recorded variations indicates an overall variation rate of 4.7%. The initial rate was 13.5%; months 2–7 average 3.7%. The majority of variations related to discrepancies in documentation at 46.5%, followed by prescription, plan deficiency, and dose tracking related variations at 25.5%, 12.8%, and 12.8%, respectively. Minor variations (negligible consequence on patient treatment) outweighed major variations 3 to 1. Conclusion: This work indicates that this redundant secondary check is effective. The first month spike in rates could be due to the Hawthorne/observer effect, but the consistent 4% variation rate suggests the need for periodical re-training on variations noted as frequent to improve awareness and quality of the initial chart review process, which may lead to improved treatment quality, patient safety and increased clinical efficiency. Utilizing these results, a continuous quality improvement process following Deming’s Plan-Do-Study-Act (PDSA) methodology was generated. The first iteration of this PDSA was adding a specific dose tracking checklist item in the pre-treatment plan check assessment; the ramification of which will be assessed in future data.« less

Evaluation of nonmetallic thermal protection materials for the manned space shuttle. Volume 1, task 1: Assessment of technical risks associated with utilization of nonmetallic thermal protection system

NASA Technical Reports Server (NTRS)

Wilkinson, W. H.; Kirkhart, F. P.; Kistler, C. W.; Duckworth, W. H.; Ungar, E. W.; Foster, E. L.

1970-01-01

Technical problems of design and flight qualification of the proposed classes of surface insulation materials and leading edge materials were reviewed. A screening test plan, a preliminary design data test plan and a design data test plan were outlined. This program defined the apparent critical differences between the surface insulators and the leading edge materials, structuring specialized screening test plans for each of these two classes of materials. Unique testing techniques were shown to be important in evaluating the structural interaction aspects of the surface insulators and a separate task was defined to validate the test plan. In addition, a compilation was made of available information on proposed material (including metallic TPS), previous shuttle programs, pertinent test procedures, and other national programs of merit. This material was collected and summarized in an informally structured workbook.

Identification and evaluation of educational uses and users for the STS. Educational planning for utilization of space shuttle ED-PLUSS

NASA Technical Reports Server (NTRS)

Engle, H. A.; Christensen, D. L.

1974-01-01

A planning and feasibility study to identify and document a methodology needed to incorporate educational programs into future missions and operations of the space transportation system was conducted. Six tasks were identified and accomplished during the study. The task statements are as follows: (1) potential user identification, (2) a review of space education programs, (3) development of methodology for user involvement, (4) methods to encourage user awareness, (5) compilation of follow-on ideas, and (6) response to NASA questions. Specific recommendations for improving the educational coverage of space activities are provided.

Implementing a research utilization plan for prevention of deep vein thrombosis.

PubMed

Van Wicklin, Sharon A; Ward, Karen S; Cantrell, Shirley W

2006-06-01

Ensuring use of best practices is crucially important in today's health care system. Nurses can identify research results that offer promising new treatment options for their patients and should have a plan for implementing research findings. The perioperative education coordinator at one facility identified the occurrence of deep vein thrombosis as a significant problem. She conducted a literature review, created an education program for nurses, and implemented an evidence-based practice change. This article describes the steps in this process. Now, patients at the facility consistently are assessed for deep vein thrombosis and receive appropriate preventive treatment.

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

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.

Physician-directed software design: the role of utilization statistics and user input in enhancing HELP results review capabilities.

PubMed

Michael, P A

1993-01-01

The M.D. Rounds Report program was developed and implemented in June of 1992 as an adjunct to the HELP System at Rex Hospital. The program facilitates rapid access to information on allergies and current medications, laboratory results, radiology reports and therapist notes for a list of patients without physicians having to make additional menu or submenu selections. In planning for an upgrade of the program, utilization statistics and user feedback provided valuable information in terms of frequency of access, features used and unused, and the value of the program as a reporting tool in comparison to other online results reporting applications. A brief description of the functionality of the M.D. Rounds Report, evaluation of the program audit trail and user feedback, planned enhancements to the program, and a discussion of the prototyping and monitoring experience and the impact on future physician subsystem development will be presented.

MO-B-BRC-00: Prostate HDR Treatment Planning - Considering Different Imaging Modalities

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

NONE

2016-06-15

Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR ismore » U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.« less

Utilizing Wetlands for Phosphorus Reduction in Great Lakes Watersheds: A Review of Available Literature Examining Soil Properties and Phosphorus Removal Efficiency

DTIC Science & Technology

2017-10-01

phosphorus inputs in a variety of agricultural and urban settings. However, maximizing the efficiency and benefits of wetlands for phosphorus reduction...39 Appendix B: Citations Related To P In Agricultural Landscapes...priority areas exhibiting high P export rates associated with agricultural and other land use practices (Figure 2). The GLRI Action Plan recommended

Assessment of Conative Educational Processes and Outcomes: Status Report of Empirical Studies. Project 2.3: Enhancing the Utility of Performance Assessments: Domain-Independent R&D.

ERIC Educational Resources Information Center

Snow, Richard E.; Jackson, Douglas N.

Research planned to improve understanding of conative educational processes and outcomes is described. Over the past year, literature reviews have been conducted aimed at defining categories of assessment of student persistence, freedom from distraction, engagement, and other school-and-work related attitudes and motivations, both as learning…

Biomass cogeneration: A business assessment

NASA Astrophysics Data System (ADS)

Skelton, J. C.

1981-11-01

The biomass cogeneration was reviewed. The business assessment is based in part on discussions with key officials from firms that have adopted biomass cogeneration systems and from organizations such as utilities, state and federal agencies, and banks directly involved in a biomass cogeneration project. The guide is organized into five chapters: biomass cogeneration systems, biomass cogeneration business considerations, biomass cogeneration economics, biomass cogeneration project planning, and case studies.

Operations management: a tool to increase profitability.

PubMed

Mulvehill, M J

2001-03-01

Operations management enables the efficient utilization of the production systems in a business. This paper will address several key elements in the business competency of operations management. Specifically, this discussion will review the components of a material requirement planning system and a "just-in-time" system for inventory control and time management to enable the dentist to monitor a portion of the practice's overhead costs.

Quality and integration of public health information systems: A systematic review focused on immunization and vital records systems.

PubMed

Vest, Joshua R; Kirk, Hilary M; Issel, L Michele

2012-01-01

Public health professionals rely on quantitative data for the daily practice of public health as well as organizational decision making and planning. However, several factors work against effective data sharing among public health agencies in the US. This review characterizes the reported barriers and enablers of effective use of public health IS from an informatics perspective. A systematic review of the English language literature for 2005 to 2011 followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format. The review focused on immunization information systems (IIS) and vital records information systems (VRIS). Systems were described according to the structural aspects of IS integration and data quality. Articles describing IIS documented issues pertaining to the distribution of the system, the autonomy of the data providers, the heterogeneous nature of information sharing as well as the quality of the data. Articles describing VRIS were focused much more heavily on data quality, particularly whether or not the data were free from errors. For state and local practitioners to effectively utilize data, public health IS will have to overcome the challenges posed by a large number of autonomous data providers utilizing a variety of technologies.

Habitat suitability index models: A low effort system for planned coolwater and coldwater reservoirs

USGS Publications Warehouse

McConnell, William J.; Bergersen, Eric P.; Williamson, Kathryn L.

1982-01-01

A novel approach to reservoir habitat evaluation is described and habitat ratings are proposed for five fish species in coolwater and coldwater reservoirs. This approach has the advantages of procedural simplicity and ready availability of input data; consequently, it has potential utility as a screening tool in the early stages of the reservoir planning process.Habitat suitability is determined on the basis of a composite score for five "primary" reservoir attributes (temperature, turbidity, nonliving cover, drawdown, and shallow cove frequency). The va 1ue of each primary reservoi r attribute is determined from one or more "secondary" attributes, which are easily measured variables. Secondary attributes (for example, length of growing season or mean July air temperature) can be directly obtained, prior to construction, from published documents, maps, reservoir plans, and on-site inspections of the proposed reservoir basin.Evaluation criteria and ratings are presented for rainbow trout (Salmo gairdneri), white sucker (Catostomus commersonii), yellow perch (Perca flavescens), common carp (Cyprinus carpio), and black crappie (PomoxTS nigromaculatus). These ratings were derived from literature reviews and from persona 1 experi ence and knowl edge of the authors; however, the system is easily adaptable to change upon further review, differences of opinion by experts, or evaluation of test results under diverse conditions.This technique can be used to evaluate the suitability of a proposed reservoir for different species and to compare the outcomes of alternative construction plans. It could also be expanded to include additional species, which will improve its utility. The system should be useful in determining losses relative to benefits, trade-offs, and potential mitigation measures in reservoir projects.

A review of CDC's Web-based Injury Statistics Query and Reporting System (WISQARS™): Planning for the future of injury surveillance✩

PubMed Central

Ballesteros, Michael F.; Webb, Kevin; McClure, Roderick J.

2017-01-01

Introduction The Centers for Disease Control and Prevention (CDC) developed the Web-based Injury Statistics Query and Reporting System (WISQARSTM) to meet the data needs of injury practitioners. In 2015, CDC completed a Portfolio Review of this system to inform its future development. Methods Evaluation questions addressed utilization, technology and innovation, data sources, and tools and training. Data were collected through environmental scans, a review of peer-reviewed and grey literature, a web search, and stakeholder interviews. Results Review findings led to specific recommendations for each evaluation question. Response CDC reviewed each recommendation and initiated several enhancements that will improve the ability of injury prevention practitioners to leverage these data, better make sense of query results, and incorporate findings and key messages into prevention practices. PMID:28454867

NASA Supportability Engineering Implementation Utilizing DoD Practices and Processes

NASA Technical Reports Server (NTRS)

Smith, David A.; Smith, John V.

2010-01-01

The Ares I design and development program made the determination early in the System Design Review Phase to utilize DoD ILS and LSA approach for supportability engineering as an integral part of the system engineering process. This paper is to provide a review of the overall approach to design Ares-I with an emphasis on a more affordable, supportable, and sustainable launch vehicle. Discussions will include the requirements development, design influence, support concept alternatives, ILS and LSA planning, Logistics support analyses/trades performed, LSA tailoring for NASA Ares Program, support system infrastructure identification, ILS Design Review documentation, Working Group coordination, and overall ILS implementation. At the outset, the Ares I Project initiated the development of the Integrated Logistics Support Plan (ILSP) and a Logistics Support Analysis process to provide a path forward for the management of the Ares-I ILS program and supportability analysis activities. The ILSP provide the initial planning and coordination between the Ares-I Project Elements and Ground Operation Project. The LSA process provided a system engineering approach in the development of the Ares-I supportability requirements; influence the design for supportability and development of alternative support concepts that satisfies the program operability requirements. The LSA planning and analysis results are documented in the Logistics Support Analysis Report. This document was required during the Ares-I System Design Review (SDR) and Preliminary Design Review (PDR) review cycles. To help coordinate the LSA process across the Ares-I project and between programs, the LSA Report is updated and released quarterly. A System Requirement Analysis was performed to determine the supportability requirements and technical performance measurements (TPMs). Two working groups were established to provide support in the management and implement the Ares-I ILS program, the Integrated Logistics Support Working Group (ILSWG) and the Logistics Support Analysis Record Working Group (LSARWG). The Ares I ILSWG is established to assess the requirements and conduct, evaluate analyses and trade studies associated with acquisition logistic and supportability processes and to resolve Ares I integrated logistics and supportability issues. It established a strategic collaborative alliance for coordination of Logistics Support Analysis activates in support of the integrated Ares I vehicle design and development of logistics support infrastructure. A Joint Ares I - Orion LSAR Working Group was established to: 1) Guide the development of Ares-I and Orion LSAR data and serve as a model for future Constellation programs, 2) Develop rules and assumptions that will apply across the Constellation program with regards to the program's LSAR development, and 3) Maintain the Constellation LSAR Style Guide.

Factors associated with the utilization of dental health services by the pediatric population: an integrative review.

PubMed

Curi, Davi Silva Carvalho; Figueiredo, Andreia Cristina Leal; Jamelli, Silvia Regina

2018-05-01

This integrative literature review aimed to analyze studies about factors associated with the utilization of dental health services by the pediatric population between zero and 15 years old, published between 2006 and 2016 and available in Portuguese, English or Spanish. A survey of articles in the Lilacs and Medline databases was carried out, using the search strategy: ("dental care/utilization" OR "dental health services/utilization") AND ("child" OR "child, preschool") AND NOT adult. To analyze the methodological quality, the adapted Critical Appraisal Skill Programme (CASP) and the Agency for Healthcare and Research and Quality (AHRQ) were used. The following predictors of use of dental health services stood out: factors associated with children or adolescents (age, frequency of tooth brushing, chronic conditions), caregivers (schooling, perception of child's dental health, perceived oral health needs), dentists (availability at night and on the weekends) and follow up of oral health by the family health team. These are inherent factors for the planning of oral health policies or programs for the pediatric population. However, these factors vary according to the context, and therefore, a contextual analysis should be conducted.

Evidence-based Peer Review for Radiation Therapy - Updated Review of the Literature with a Focus on Tumour Subsite and Treatment Modality.

PubMed

Huo, M; Gorayski, P; Poulsen, M; Thompson, K; Pinkham, M B

2017-10-01

Technological advances in radiation therapy permit steep dose gradients from the target to spare normal tissue, but increase the risk of geographic miss. Suboptimal target delineation adversely affects clinical outcomes. Prospective peer review is a method for quality assurance of oncologists' radiotherapy plans. Published surveys suggest it is widely implemented. However, it may not be feasible to review every case before commencement of radiation therapy in all departments. The rate of plan changes following peer review of cases without a specific subsite or modality is typically around 10%. Stereotactic body radiation therapy, head and neck, gynaecological, gastrointestinal, haematological and lung cases are associated with higher rates of change of around 25%. These cases could thus be prioritised for peer review. Other factors may limit peer review efficacy including organisational culture, time constraints and the physical environment in which sessions are held. Recommendations for peer review endorsed by the American Society for Radiation Oncology were made available in 2013, but a number of relevant studies have been published since. Here we review and update the literature, and provide an updated suggestion for the implementation of peer review to serve as an adjunct to published guidelines. This may help practitioners evaluate their current processes and maximise the utility and effectiveness of peer review sessions. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Utilizing NX Advanced Simulation for NASA's New Mobile Launcher for Ares-l

NASA Technical Reports Server (NTRS)

Brown, Christopher

2010-01-01

This slide presentation reviews the use of NX to simulate the new Mobile Launcher (ML) for the Ares-I. It includes: a comparison of the sizes of the Saturn 5, the Space Shuttle, the Ares I, and the Ares V, with the height, and payload capability; the loads control plan; drawings of the base framing, the underside of the ML, beam arrangement, and the finished base and the origin of the 3D CAD data. It also reviews the modeling approach, meshing. the assembly Finite Element Modeling, the model summary. and beam improvements.

Ground operation of robotics on Space Station Freedom

NASA Technical Reports Server (NTRS)

Wojcik, Z. Alex; Hunter, David G.; Cantin, Marc R.

1993-01-01

This paper reflects work carried out on Ground Operated Telerobotics (GOT) in 1992 to refine further the ideas, procedures, and technologies needed to test the procedures in a high latency environment, and to integrate GOT into Space Station Freedom operations. Space Station Freedom (SSF) will be in operation for 30 years, and will depend on robots to carry out a significant part of the assembly, maintenance, and utilization workload. Current plans call for on-orbit robotics to be operated by on-board crew members. This approach implies that on-orbit robotics operations use up considerable crew time, and that these operations cannot be carried out when SSF is unmanned. GOT will allow robotic operations to be operated from the ground, with on-orbit crew interventions only when absolutely required. The paper reviews how GOT would be implemented, how GOT operations would be planned and supported, and reviews GOT issues, critical success factors, and benefits.

Ground operation of robotics on Space Station Freedom

NASA Astrophysics Data System (ADS)

Wojcik, Z. Alex; Hunter, David G.; Cantin, Marc R.

1993-03-01

This paper reflects work carried out on Ground Operated Telerobotics (GOT) in 1992 to refine further the ideas, procedures, and technologies needed to test the procedures in a high latency environment, and to integrate GOT into Space Station Freedom operations. Space Station Freedom (SSF) will be in operation for 30 years, and will depend on robots to carry out a significant part of the assembly, maintenance, and utilization workload. Current plans call for on-orbit robotics to be operated by on-board crew members. This approach implies that on-orbit robotics operations use up considerable crew time, and that these operations cannot be carried out when SSF is unmanned. GOT will allow robotic operations to be operated from the ground, with on-orbit crew interventions only when absolutely required. The paper reviews how GOT would be implemented, how GOT operations would be planned and supported, and reviews GOT issues, critical success factors, and benefits.

Space Station RT and E Utilization Study

NASA Technical Reports Server (NTRS)

Wunsch, P. K.; Anderson, P. H.

1989-01-01

Descriptive information on a set of 241 mission concepts was reviewed to establish preliminary Space Station outfitting needs for technology development missions. The missions studied covered the full range of in-space technology development activities envisioned for early Space Station operations and included both pressurized volume and attached payload requirements. Equipment needs were compared with outfitting plans for the life sciences and microgravity user communities, and a number of potential outfitting additions were identified. Outfitting implementation was addressed by selecting a strawman mission complement for each of seven technical themes, by organizing the missions into flight scenarios, and by assessing the associated outfitting buildup for planning impacts.

Orbital design strategy for domestic communication satellite systems.

NASA Technical Reports Server (NTRS)

Ramji, S.; Sawitz, P.

1973-01-01

Review of some of the considerations pertinent to efficient orbit utilization in the design of domestic communications satellite systems. A strategy is developed to efficiently locate a heterogeneous system of satellites within the available arc and provide room for future growth. A practical design is illustrated, using a computer simulation model, for the placement of 25 satellites within 73% of the available arc employing frequency and polarization coordination techniques. A number of widely variable factors that influence satellite spacing are examined. These factors include such critical system elements as telephony and television interference noise limits, frequency plan coordination, polarization plan coordination, ground antenna diameter, signal protection ratio, and satellite station keeping.

CBCT in orthodontics: assessment of treatment outcomes and indications for its use

PubMed Central

Nervina, J M

2015-01-01

Since its introduction into dentistry in 1998, CBCT has become increasingly utilized for orthodontic diagnosis, treatment planning and research. The utilization of CBCT for these purposes has been facilitated by the relative advantages of three-dimensional (3D) over two-dimensional radiography. Despite many suggested indications of CBCT, scientific evidence that its utilization improves diagnosis and treatment plans or outcomes has only recently begun to emerge for some of these applications. This article provides a comprehensive and current review of key studies on the applications of CBCT in orthodontic therapy and for research to decipher treatment outcomes and 3D craniofacial anatomy. The current diagnostic and treatment planning indications for CBCT include impacted teeth, cleft lip and palate and skeletal discrepancies requiring surgical intervention. The use of CBCT in these and other situations such as root resorption, supernumerary teeth, temporomandibular joint (TMJ) pathology, asymmetries and alveolar boundary conditions should be justified on the basis of the merits relative to risks of imaging. CBCT has also been used to assess 3D craniofacial anatomy in health and disease and of treatment outcomes including that of root morphology and angulation; alveolar boundary conditions; maxillary transverse dimensions and maxillary expansion; airway morphology, vertical malocclusion and obstructive sleep apnoea; TMJ morphology and pathology contributing to malocclusion; and temporary anchorage devices. Finally, this article utilizes findings of these studies and current voids in knowledge to provide ideas for future research that could be beneficial for further optimizing the use of CBCT in research and the clinical practice of orthodontics. PMID:25358833

State Performance-Based Regulation Using Multiyear Rate Plans for U.S. Electric Utilities

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

Lowry, Mark Newton; Makos, Matt; Deason, Jeff

Electric utilities today must contain costs at a time when many need to modernize aging systems and all face major changes in technologies, customer preferences and competitive pressures.Most U.S. electric utility facilities are investor-owned, subject to rate and service regulation by state public utility commissions. Regulatory systems under which these utilities operate affect their performance and ability to meet these challenges. In this business environment, multiyear rate plans have some advantages over traditional rate regulation.The report focuses on key design issues and provides case studies of the multiyear rate plan approach, applicable to both vertically integrated and restructured states. Markmore » Newton Lowry and Matt Makos of Pacific Energy Group Research and Jeff Deason of Berkeley Lab authored the report; Lisa Schwartz, Berkeley Lab, was project manager and technical editor.The report is aimed primarily at state utility regulators and stakeholders in the state regulatory process. The multiyear rate approach also provides ideas on how to streamline oversight of public power utilities and rural electric cooperatives for their governing boards.Two key provisions of multiyear rate plans strengthen cost containment incentives and streamline regulation: 1. Reducing frequency of rate cases, typically to every four or five years 2. Using an attrition relief mechanism to escalate rates or revenue between rate cases to address cost pressures such as inflation and growth in number of customers, independently of the utility’s own cost Better utility performance can be achieved under well-designed multiyear rate plans while achieving lower regulatory costs. Benefits can be shared between utilities and their customers. But plans can be complex and involve significant changes in the regulatory system. Designing plans that stimulate utility performance without undue risk and share benefits fairly can be challenging.This report discusses the rationale for multiyear rate plans and their usefulness under modern business conditions. It then explains critical plan design issues and challenges and presents results from numerical research that considers the extra incentive power achieved under different plan provisions. Next, the report presents several case studies of utilities that have operated under formal multiyear rate plans or, for various reasons, have stayed out of rate cases for more than a decade. These studies consider the effect of multiyear rate plans and rate case frequency on utility cost, reliability and other performance dimensions.« less

The utility of ultrasound in the assessment of traumatic peripheral nerve lesions: report of 4 cases.

PubMed

Zeidenberg, Joshua; Burks, S Shelby; Jose, Jean; Subhawong, Ty K; Levi, Allan D

2015-09-01

Ultrasound technology continues to improve with better image resolution and availability. Its use in evaluating peripheral nerve lesions is increasing. The current review focuses on the utility of ultrasound in traumatic injuries. In this report, the authors present 4 illustrative cases in which high-resolution ultrasound dramatically enhanced the anatomical understanding and surgical planning of traumatic peripheral nerve lesions. Cases include a lacerating injury of the sciatic nerve at the popliteal fossa, a femoral nerve injury from a pseudoaneurysm, an ulnar nerve neuroma after attempted repair with a conduit, and, finally, a spinal accessory nerve injury after biopsy of a supraclavicular fossa lesion. Preoperative ultrasound images and intraoperative pictures are presented with a focus on how ultrasound aided with surgical decision making. These cases are set into context with a review of the literature on peripheral nerve ultrasound and a comparison between ultrasound and MRI modalities.

Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods.

PubMed

Bender, Donna S; Morey, Leslie C; Skodol, Andrew E

2011-07-01

Personality disorders are associated with fundamental disturbances of self and interpersonal relations, problems that vary in severity within and across disorders. This review surveyed clinician-rated measures of personality psychopathology that focus on self-other dimensions to explore the feasibility and utility of constructing a scale of severity of impairment in personality functioning for DSM-5. Robust elements of the instruments were considered in creating a continuum of personality functioning based on aspects of identity, self-direction, empathy, and intimacy. Building on preliminary findings (Morey et al., 2011 /this issue), the proposed Levels of Personality Functioning will be subjected to extensive empirical testing in the DSM-5 field trials and elsewhere. The resulting version of this severity measure is expected to have clinical utility in identifying personality psychopathology, planning treatment, building the therapeutic alliance, and studying treatment course and outcome.

Liquid metal magnetohydrodynamics (LMMHD) technology transfer feasibility study. Volume 1: Summary

NASA Technical Reports Server (NTRS)

Phen, R. L.; Hays, L. G.; Alper, M. E.

1973-01-01

The potential application of liquid metal magnetohydrodynamics (LMMHD) to central station utility power generation through the period to 1990 is examined. Included are: (1) a description of LMMHD and a review of its development status, (2) LMMHD preliminary design for application to central station utility power generation, (3) evaluation of LMMHD in comparison with conventional and other advanced power generation systems and (4) a technology development plan. One of the major conclusions found is that the most economic and technically feasible application of LMMHD is a topping cycle to a steam plant, taking advantage of high temperatures available but not usable by the steam cycle.

Some potential research applications of GOES/VAS data in meteorology

NASA Technical Reports Server (NTRS)

Wilson, G. S.

1983-01-01

The understanding and utilization of radiance data from the VAS instrument for meteorological purposes which requires an extensive and organized research plan whose ultimate goal is to provide quantitative measurements of the structure/dynamics of the atmosphere is outlined. The unique multispectral VAS data are potentially useful in almost all aspects of meteorology but have immediate applications in the mesoscale and severe storm research area since measurements are available over regional areas at time intervals of less than 1 hour. The higher priority research applications of VAS data pertaining to the interpretation and utilization of the passive VAS radiance measurements for mesoscale and severe-storm research are reviewed.

Airline flight planning: The weather connection

NASA Technical Reports Server (NTRS)

Steinberg, R.

1981-01-01

Airline flight planning has shown little improvement in accuracy since the introduction of computerized techniques in 1964. This has primarily been, because both the type of weather product utilized by the carriers and the way they have employed it has remained unchanged over the past 15 years. The airlines now have an opportunity to make a significant advance in this area with attendant benefits in fuel savings. Most the technological ingredients are in place, but it will take increased cooperation between government and the private sector if cost effective improvements are to be made on a reasonable time scale. This paper reviews the meteorological basis for the present method of flight planning and analyzes its impact on current flight operations. A new approach is suggested for developing a weather data base, for flight planning, which has the potential of providing a fuel savings of between 2 and 3 percent on long distance flights.

Plan of research for integrated soil moisture studies. Recommendations of the Soil Moisture Working Group

NASA Technical Reports Server (NTRS)

1980-01-01

Soil moisture information is a potentially powerful tool for applications in agriculture, water resources, and climate. At present, it is difficult for users of this information to clearly define their needs in terms of accuracy, resolution and frequency because of the current sparsity of data. A plan is described for defining and conducting an integrated and coordinated research effort to develop and refine remote sensing techniques which will determine spatial and temporal variations of soil moisture and to utilize soil moisture information in support of agricultural, water resources, and climate applications. The soil moisture requirements of these three different application areas were reviewed in relation to each other so that one plan covering the three areas could be formulated. Four subgroups were established to write and compile the plan, namely models, ground-based studies, aircraft experiments, and spacecraft missions.

Final Environmental Assessment for Munitions Storage Area at Langley Air Force Base, Virginia

DTIC Science & Technology

2004-08-01

Existing Conditions LAND USE Land uses on Langley AFB are grouped by function in distinct geographic areas. For example, aircraft operations and...1998a) is used to coordinate natural resource management. Langley’s Urban Forest Inventory Review and Management Plan (Davey Resource Group 1997...following data to develop noise contours: aircraft types, runway utilization patterns, engine power settings, airspeeds, altitude profiles , flight track

L-325 Sagebrush Habitat Mitigation Project: FY2008 Compensation Area Monitoring Report

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

Durham, Robin E.; Sackschewsky, Michael R.

2008-09-30

This document provides a review and status of activities conducted in support of the Fluor Daniel Hanford Company (Fluor) Mitigation Action Plan (MAP) for Project L-325, Electrical Utility Upgrades. It includes time-zero monitoring results for planting activities conducted in January 2008, annual survival monitoring for all planting years (2007 and 2008), and recommendations for the successful completion of DOE habitat mitigation commitments for this project.

Strategic environmental assessment in China: motivations, politics, and effectiveness.

PubMed

Zhu, Da; Ru, Jiang

2008-09-01

This paper examines how strategic environmental assessment has been practiced at the national level in China through 2005 and why it has been practiced in the manner observed. Based on literature reviews and interviews carried out in 2005 and 2006, we find that bureaucratic politics between environmental and nonenvironmental ministries has limited the legislation and implementation of strategic environmental assessment to environmental assessment (EA) for a set of government plans defined in the 2003 Environmental Impact Assessment Law. Interviewees from environmental and nonenvironmental ministries and key research institutes have reported that few planning EAs have been performed at the sectoral level. Nonenvironmental ministries have either evaded the 2003 Environmental Impact Assessment Law and have not undertaken required planning EA or have organized planning EA on their own without participation by the State Environmental Protection Administration. The rising tension between the environmental and nonenvironmental ministries has limited the role of planning EA as a participatory decision-making tool. In addition to bureaucratic politics, we find that weak public participation and underemphasis on social analysis in planning EA may have further compromised the utility of planning EA.

In-Situ Resource Utilization (ISRU) Development Program

NASA Technical Reports Server (NTRS)

Sanders, Jerry

1998-01-01

The question "Why In-Situ Resource Utilization (ISRU)?" is addressed in this presentation. The reasons given concentrate on Cost reduction, Mass reduction, Risk reduction, the expansion of human exploration and presence and the enabling of industrial exploitation. A review of the Martian and Lunar resources available for ISRU is presented. Other ISRU concepts (i.e., In-Situ Consumable production (ISCP) and In-Situ Propellant Production (ISPP)) are introduced and further explained. The objectives of a Mars ISRU System Technology (MIST) include (1) the characterization of technology and subsystem performance for mission modeling and technology funding planning, (2) reduce risk and concerns arising from sample return and human missions utilizing ISRU, and (3) demonstrate the environmental suitability of ISRU components/processes and systems. A proof of concept demonstration schedule and a facility overview for MIST is presented.

A Novel Evaluation Model for the Vehicle Navigation Device Market Using Hybrid MCDM Techniques

NASA Astrophysics Data System (ADS)

Lin, Chia-Li; Hsieh, Meng-Shu; Tzeng, Gwo-Hshiung

The developing strategy of ND is also presented to initiate the product roadmap. Criteria for evaluation are constructed via reviewing papers, interviewing experts and brain-storming. The ISM (interpretive structural modeling) method was used to construct the relationship between each criterion. The existing NDs were sampled to benchmark the gap between the consumer’s aspired/desired utilities with respect to the utilities of existing/developing NDs. The VIKOR method was applied to rank the sampled NDs. This paper will propose the key driving criteria of purchasing new ND and compare the consumer behavior of various characters. Those conclusions can be served as a reference for ND producers for improving existing functions or planning further utilities in the next e-era ND generation.

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

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

Schweitzer, M.

1991-01-01

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

Intersectoral planning for city health development.

PubMed

Green, Geoff

2012-04-01

The article reviews the evolution and process of city health development planning (CHDP) in municipalities participating in the European Network of Healthy Cities organized by the European Region of the World Health Organization. The concept of CHDP combines elements from three theoretical domains: (a) health development, (b) city governance, and (c) urban planning. The setting was the 77 cities which participated in Phase IV (2003-2008) of the network. Evidence was gathered principally from a general evaluation questionnaire sent to all network cities. CHDPs are strategic documents giving direction to municipalities and partner agencies. Analysis revealed a trend away from "classic" CHDPs with a primary focus on health development towards ensuring a health dimension to other sector plans, and into the overarching strategies of city governments. Linked to the Phase IV priority themes of Healthy aging and healthy urban planning, cities further developed the concept and application of human-centered sustainability. More work is required to utilize cost-benefit analysis and health impact assessment to unmask the synergies between health and economic prosperity.

Research priorities and plans for the International Space Station-results of the 'REMAP' Task Force

NASA Technical Reports Server (NTRS)

Kicza, M.; Erickson, K.; Trinh, E.

2003-01-01

Recent events in the International Space Station (ISS) Program have resulted in the necessity to re-examine the research priorities and research plans for future years. Due to both technical and fiscal resource constraints expected on the International Space Station, it is imperative that research priorities be carefully reviewed and clearly articulated. In consultation with OSTP and the Office of Management and budget (OMB), NASA's Office of Biological and Physical Research (OBPR) assembled an ad-hoc external advisory committee, the Biological and Physical Research Maximization and Prioritization (REMAP) Task Force. This paper describes the outcome of the Task Force and how it is being used to define a roadmap for near and long-term Biological and Physical Research objectives that supports NASA's Vision and Mission. Additionally, the paper discusses further prioritizations that were necessitated by budget and ISS resource constraints in order to maximize utilization of the International Space Station. Finally, a process has been developed to integrate the requirements for this prioritized research with other agency requirements to develop an integrated ISS assembly and utilization plan that maximizes scientific output. c2003 American Institute of Aeronautics and Astronautics. Published by Elsevier Science Ltd. All rights reserved.

[Development of human resources and the Plan of Action].

PubMed

Vidal, C

1984-01-01

This article (whose first part was published in the previous issue of Educación Médica y Salud) concludes an exhaustive review of manpower development in the Americas. This part considers the specific measures in this field enunciated in the Plan of Action; these measures pertain to four main areas: planning and programming of human resources, training in priority areas, utilization of human resources, and educational technology. The author discusses the present and future possibilities and obstacles of each of these activities and the steps to be taken to bring needs into line with real situations. It is of paramount importance that the national health authorities clearly spell out their policies for the development of human resources in the health field within the framework of general development policies. Another point to be insisted upon is the multiprofessional and multidisciplinary training of the health team and the importance of the education-service-supervision function, which usually results in permanent and continuing education, which in turn optimizes the utilization of personnel. However, none of this will be possible without an appropriate education technology with which to innovate, analyze and refine the entire education process and so meet the needs of both society and the health services.

Breast Imaging Second Opinions Impact Surgical Management.

PubMed

Spivey, Tara Lynn; Carlson, Kjirsten Ayn; Janssen, Imke; Witt, Thomas R; Jokich, Peter; Madrigrano, Andrea

2015-07-01

Breast surgeons often see women for second opinions for abnormalities found on breast imaging. For second opinions, these images are submitted for review and interpretation by dedicated breast imagers. This study evaluated the conformity of results among interpretation of imaging submitted from outside hospitals both from tertiary care centers, as well as community programs, in an attempt to evaluate the utility of this practice for the sake of clinical management and resource utilization. A retrospective chart review was conducted on all breast patients that submitted outside imaging films for the years 2011 to 2013 at Rush University Medical Center (RUMC). The radiologic diagnosis and each patient's proposed management plan was collected and evaluated for concordance between the outside institutions and RUMC. A total of 380 patients who presented for second opinions with an interpretation of outside exams were evaluated. In 47.4 % [95 % confidence interval (CI) 42.4-52.4] of cases there was distinct variance in radiologic impression. For 53.5 % (95 % CI 48.4-58.5) of patients, there was a change in recommended management plan, which included recommendations for either additional imaging or need for additional biopsy. In total, this changed the overall surgical management in 27.1 % (95 % CI 22.8-31.9) of cases. In six patients, the reinterpretation of outside imaging detected new malignancies not previously identified. Overall, 83.7 % (95 % CI 79.7-87.1) of patients who submitted imaging from outside institutions chose to complete the remainder of their treatment at RUMC. The practice of second opinion review changed overall definitive management at our specialty center in more than one in four cases. In addition, the review identified six previously unrecognized malignancies. Given this data, the practice of second opinions and interpretation of outside exams should continue despite the additional resources required.

Assessing validity of observational intervention studies - the Benchmarking Controlled Trials.

PubMed

Malmivaara, Antti

2016-09-01

Benchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations. To create and pilot test a checklist for appraising methodological validity of a BCT. The checklist was created by extracting the most essential elements from the comprehensive set of criteria in the previous paper on BCTs. Also checklists and scientific papers on observational studies and respective systematic reviews were utilized. Ten BCTs published in the Lancet and in the New England Journal of Medicine were used to assess feasibility of the created checklist. The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies. The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies. However, the piloted checklist should be validated in further studies. Key messages Benchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations. This paper presents a checklist for appraising methodological validity of BCTs and pilot-tests the checklist with ten BCTs published in leading medical journals. The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies. The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies.

Physician-directed software design: the role of utilization statistics and user input in enhancing HELP results review capabilities.

PubMed Central

Michael, P. A.

1993-01-01

The M.D. Rounds Report program was developed and implemented in June of 1992 as an adjunct to the HELP System at Rex Hospital. The program facilitates rapid access to information on allergies and current medications, laboratory results, radiology reports and therapist notes for a list of patients without physicians having to make additional menu or submenu selections. In planning for an upgrade of the program, utilization statistics and user feedback provided valuable information in terms of frequency of access, features used and unused, and the value of the program as a reporting tool in comparison to other online results reporting applications. A brief description of the functionality of the M.D. Rounds Report, evaluation of the program audit trail and user feedback, planned enhancements to the program, and a discussion of the prototyping and monitoring experience and the impact on future physician subsystem development will be presented. PMID:8130443

Attention Demands of Spoken Word Planning: A Review

PubMed Central

Roelofs, Ardi; Piai, Vitória

2011-01-01

Attention and language are among the most intensively researched abilities in the cognitive neurosciences, but the relation between these abilities has largely been neglected. There is increasing evidence, however, that linguistic processes, such as those underlying the planning of words, cannot proceed without paying some form of attention. Here, we review evidence that word planning requires some but not full attention. The evidence comes from chronometric studies of word planning in picture naming and word reading under divided attention conditions. It is generally assumed that the central attention demands of a process are indexed by the extent that the process delays the performance of a concurrent unrelated task. The studies measured the speed and accuracy of linguistic and non-linguistic responding as well as eye gaze durations reflecting the allocation of attention. First, empirical evidence indicates that in several task situations, processes up to and including phonological encoding in word planning delay, or are delayed by, the performance of concurrent unrelated non-linguistic tasks. These findings suggest that word planning requires central attention. Second, empirical evidence indicates that conflicts in word planning may be resolved while concurrently performing an unrelated non-linguistic task, making a task decision, or making a go/no-go decision. These findings suggest that word planning does not require full central attention. We outline a computationally implemented theory of attention and word planning, and describe at various points the outcomes of computer simulations that demonstrate the utility of the theory in accounting for the key findings. Finally, we indicate how attention deficits may contribute to impaired language performance, such as in individuals with specific language impairment. PMID:22069393

Quality and integration of public health information systems: A systematic review focused on immunization and vital records systems

PubMed Central

Vest, Joshua R; Kirk, Hilary M; Issel, L Michele

2012-01-01

Objectives: Public health professionals rely on quantitative data for the daily practice of public health as well as organizational decision making and planning. However, several factors work against effective data sharing among public health agencies in the US. This review characterizes the reported barriers and enablers of effective use of public health IS from an informatics perspective. Methods: A systematic review of the English language literature for 2005 to 2011 followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format. The review focused on immunization information systems (IIS) and vital records information systems (VRIS). Systems were described according to the structural aspects of IS integration and data quality. Results: Articles describing IIS documented issues pertaining to the distribution of the system, the autonomy of the data providers, the heterogeneous nature of information sharing as well as the quality of the data. Articles describing VRIS were focused much more heavily on data quality, particularly whether or not the data were free from errors. Conclusions: For state and local practitioners to effectively utilize data, public health IS will have to overcome the challenges posed by a large number of autonomous data providers utilizing a variety of technologies. PMID:23569634

Behavioral healthcare services use in health savings accounts versus traditional health plans.

PubMed

Hardie, Nancy A; Lo Sasso, Anthony T; Shah, Mona; Levin, Regina A

2010-12-01

Numerous studies have examined behavioral health services via employer-sponsored health insurance cost-sharing measures. Their results clearly indicate that health plan design matters a great deal with respect to behavioral health utilization. It is also clear that there remain a number of unresolved issues, particularly with respect to the effects of a switch from traditional plan designs to high deductible, consumer-driven policies. Health Savings Accounts (HSA) have been well described in the literature with some comparisons to traditional healthcare plans, however no reports have been made about their use for behavioral health treatment. We sought to estimate the impact switching to a consumer driven health plan (CDHP) with a health savings account had upon the utilization of behavioral health care. Utilization of behavioral health services were reviewed from claims data over three years (2005 through 2007). Comparisons were made between members who switched from traditional health plans to consumer driven health plans in 2007 with health savings accounts and members who remained in traditional health plans. A pre-post study design was applied to two cohorts, stayers and switchers. The stayer cohort consisted of traditional health plan members enrolled from 2005 through 2007. Stayers were offered a health savings account in 2006 and 2007, but opted to remain in traditional health plans. The switcher cohort consisted of members enrolled in traditional plans in 2005 who opted to switch to a health savings account for two years thereafter (2006 and 2007). The use and intensity of behavioral health services in each study year were generated from claims data. Logistic and OLS regression analyses were applied to behavioral health services use and outpatient intensity measures respectively with independent variables post years, cohort and their interaction terms. Both analyses controlled for demographic variables. Additional behavioral disorder variables were added to the intensity regression. Members who switched to a health savings account plan were slightly less likely to initiate behavioral health services in each post year relative to members who stayed in traditional health plans. Of those who sought outpatient behavioral services, there was no difference between cohorts in the intensity of behavioral health services they received. Our results suggest enrollment in CDHPs moderately affects the use of behavioral health services but do not affect the intensity of outpatient behavioral health services conditioned on initiating these services. These finding are somewhat limited in that specific information about benefits were not included in the study. These results are also subject to self-selection bias. Members who switched to CDHP may be influenced to do so by other unknown factors that bear on their behavioral health. Recent growth in the number of health savings accounts and current attention to mental health legislation warrant answers about behavioral health spending and efficacious utilization of behavioral health services. Further studies which include behavioral health services outcomes and quality of care gleaned from claims data can answer questions about the efficiency of health savings accounts.

The Austrian Space Plan

NASA Astrophysics Data System (ADS)

Pseiner, K.; Balogh, W.

2002-01-01

After several years of preparation and discussion among the involved players, the Austrian Space Plan was approved for implementation in November 2001. Based on careful benchmarking and analysis of the capabilities of the Austrian space sector it aims to create excellent conditions for the sector's further development. The new space strategy embraces Austria's participation in the mandatory and optional programmes of the European Space Agency and establishes a National Space Programme supported by separate funding opportunities. A set of clearly-defined indicators ensures that the progress in implementing the Space Plan can be objectively judged through independent, annual reviews. The National Space Programme promotes international cooperation in space research and space activities with the aim to strengthen the role of space science and to better prepare Austrian space industry for the commercial space market. In the framework of the Space Plan the Austrian Space Agency has been tasked with integrating the industry's growing involvement in aeronautics activities to better utilize synergies with the space sector. This paper reviews the various steps leading to the approval of the new space strategy and discusses the hurdles mastered in this process. It reports on the Space Plan's first results, specifically taking into account projects involving international cooperation. For the first the Austria aerospace-sector can rely on an integrated strategy for aeronautics- and space activities which is firmly rooted in the efforts to enhance the country's R&D activities. It may also act as a useful example for other small space- using countries planning to enhance their involvement in space activities.

A New, Integrated Approach to Army Operational Testing and Evaluation

DTIC Science & Technology

1977-11-04

simulation should be reviewed to determine if there are areas that may or could produce data to support OT. During the Validation Phase the operational...II must provide the data for a valid estimate of the system’s military utility, operational effectiveness and operational suitability (including...the necessity of planning to acquire supplementary data . This data may be derived by analysis or obtained in tests (contractor, development and/or

Mental Health Manpower, Volume I: An Annotated Bibliography and Commentary, and Volume II: Recruitment, Training and Utilization - A Compilation of Articles, Surveys, and a Review of Applicable Literature.

ERIC Educational Resources Information Center

Klutch, Murray

The study was designed to provide a base for mental health manpower planning. The first and principal section of Volume I is an annotated bibliography of applicable articles and books. An index lists items included in the bibliography according to subject and profession. A discussion of two conceptual approaches to alleviating the manpower…

Liability for managed care decisions: the Employee Retirement Income Security Act (ERISA) and the uneven playing field.

PubMed

Mariner, W K

1996-06-01

As managed care organizations expand their programs of quality assurance and physician evaluation, more medical malpractice lawsuits may be brought against managed care organizations on the ground that, like hospitals, they are legally responsible for negligent corporate acts that injure patients. However, the federal Employee Retirement Income Security Act (ERISA) shields managed care organizations from liability when they are part of an employee group health plan governed by ERISA. Unlike patients with other types of insurance, patients in ERISA health plans do not have a malpractice remedy for a managed care organization's negligence. A few federal appeals courts recently recognized that ERISA plans can be vicariously liable for their physicians' medical malpractice, but only if the physician is the plan's employee or agent. Yet ERISA still prohibits negligence claims against ERISA health plans for injuries resulting from denial of plan benefits, failure to use qualified physicians, utilization review, or improper plan administration. Current managed care operations do not neatly distinguish between administering benefits and controlling quality of care. Neither should the law. ERISA should be amended to provide employees with the same remedies that patients in non-ERISA plans enjoy.

Liability for managed care decisions: the Employee Retirement Income Security Act (ERISA) and the uneven playing field.

PubMed Central

Mariner, W K

1996-01-01

As managed care organizations expand their programs of quality assurance and physician evaluation, more medical malpractice lawsuits may be brought against managed care organizations on the ground that, like hospitals, they are legally responsible for negligent corporate acts that injure patients. However, the federal Employee Retirement Income Security Act (ERISA) shields managed care organizations from liability when they are part of an employee group health plan governed by ERISA. Unlike patients with other types of insurance, patients in ERISA health plans do not have a malpractice remedy for a managed care organization's negligence. A few federal appeals courts recently recognized that ERISA plans can be vicariously liable for their physicians' medical malpractice, but only if the physician is the plan's employee or agent. Yet ERISA still prohibits negligence claims against ERISA health plans for injuries resulting from denial of plan benefits, failure to use qualified physicians, utilization review, or improper plan administration. Current managed care operations do not neatly distinguish between administering benefits and controlling quality of care. Neither should the law. ERISA should be amended to provide employees with the same remedies that patients in non-ERISA plans enjoy. PMID:8659664

Methodological Issues in Economic Evaluations Submitted to the Pan-Canadian Oncology Drug Review (pCODR).

PubMed

Masucci, Lisa; Beca, Jaclyn; Sabharwal, Mona; Hoch, Jeffrey S

2017-12-01

Public drug plans are faced with increasingly difficult funding decisions. In Canada, the pan-Canadian Oncology Drug Review (pCODR) makes funding recommendations to the provincial and territorial drug plans responsible for cancer drugs. Assessments of the economic models submitted by pharmaceutical manufacturers are publicly reported. The main objective of this research was to identify recurring methodological issues in economic models submitted to pCODR for funding reviews. The secondary objective was to explore whether there exists any observed relationships between reported methodological issues and funding recommendations made by pCODR's expert review committee. Publicly available Economic Guidance Reports from July 2011 (inception) until June 2014 for drug reviews with a final funding recommendation (N = 34) were independently examined by two authors. Major methodological issues from each review were abstracted and grouped into nine main categories. Each issue was also categorized based on perception of the reviewer's actions to manage it. The most commonly reported issues involved costing (59% of reviews), time horizon (56%), and model structure (36%). Several types of issues were identified that usually could not be resolved, such as quality of clinical data or uncertainty with indirect comparisons. Issues with costing or choice of utility estimates could usually be addressed or explored by reviewers. No statistically significant relationship was found between any methodological issue and funding recommendations from the expert review committee. The findings provide insights that can be used by parties who submit or review economic evidence for continuous improvement and consistency in economic modeling, reporting, and decision making.

3D Printing in Liver Surgery: A Systematic Review.

PubMed

Witowski, Jan Sylwester; Coles-Black, Jasamine; Zuzak, Tomasz Zbigniew; Pędziwiatr, Michał; Chuen, Jason; Major, Piotr; Budzyński, Andrzej

2017-12-01

Rapid growth of three-dimensional (3D) printing in recent years has led to new applications of this technology across all medical fields. This review article presents a broad range of examples on how 3D printing is facilitating liver surgery, including models for preoperative planning, education, and simulation. We have performed an extensive search of the medical databases Ovid/MEDLINE and PubMed/EMBASE and screened articles fitting the scope of review, following previously established exclusion criteria. Articles deemed suitable were analyzed and data on the 3D-printed models-including both technical properties and desirable application-and their impact on clinical proceedings were extracted. Fourteen articles, presenting unique utilizations of 3D models, were found suitable for data analysis. A great majority of articles (93%) discussed models used for preoperative planning and intraoperative guidance. PolyJet was the most common (43%) and, at the same time, most expensive 3D printing technology used in the development process. Many authors of reviewed articles reported that models were accurate (71%) and allowed them to understand patient's complex anatomy and its spatial relationships. Although the technology is still in its early stages, presented models are considered useful in preoperative planning and patient and student education. There are multiple factors limiting the use of 3D printing in everyday healthcare, the most important being high costs and the time-consuming process of development. Promising early results need to be verified in larger randomized trials, which will provide more statistically significant results.

The use of the transition cost accounting system in health services research

PubMed Central

Azoulay, Arik; Doris, Nadine M; Filion, Kristian B; Caron, Joanna; Pilote, Louise; Eisenberg, Mark J

2007-01-01

The Transition cost accounting system integrates clinical, resource utilization, and financial information and is currently being used by several hospitals in Canada and the United States to calculate the costs of patient care. Our objectives were to review the use of hospital-based cost accounting systems to measure costs of treatment and discuss potential use of the Transition cost accounting system in health services research. Such systems provide internal reports to administrators for formulating major policies and strategic plans for future activities. Our review suggests that the Transition cost accounting information system may useful for estimating in-hospital costs of treatment. PMID:17686148

The use of the transition cost accounting system in health services research.

PubMed

Azoulay, Arik; Doris, Nadine M; Filion, Kristian B; Caron, Joanna; Pilote, Louise; Eisenberg, Mark J

2007-08-08

The Transition cost accounting system integrates clinical, resource utilization, and financial information and is currently being used by several hospitals in Canada and the United States to calculate the costs of patient care. Our objectives were to review the use of hospital-based cost accounting systems to measure costs of treatment and discuss potential use of the Transition cost accounting system in health services research. Such systems provide internal reports to administrators for formulating major policies and strategic plans for future activities. Our review suggests that the Transition cost accounting information system may useful for estimating in-hospital costs of treatment.

Treatment Fidelity Among Family Health Promoters Delivering a Physical Activity and Nutrition Intervention to Immigrant and Refugee Families.

PubMed

Bronars, Carrie A; Hanza, Marcelo M; Meiers, Sonja J; Patten, Christi A; Clark, Matthew M; Nigon, Julie A; Weis, Jennifer A; Wieland, Mark L; Sia, Irene G

2017-04-01

Lack of treatment fidelity can be an important source of variation affecting the credibility and utility of outcomes from behavioral intervention research. Development and implementation of a well-designed treatment fidelity plan, especially with research involving underserved populations, requires careful conceptualization of study needs in conjunction with what is feasible in the population. The purpose of this article is to review a fidelity-monitoring plan consistent with the National Institutes of Health Behavior Change Consortium guidelines (e.g., design, training, delivery, receipt, and enactment) for an intervention trial designed to improve physical activity and nutrition among immigrant and refugee families. Description of the fidelity monitoring plan is provided and challenges related to monitoring treatment fidelity in a community-based participatory intervention for immigrant and refugee families are discussed.

A study of the potential impacts of space utilization

NASA Technical Reports Server (NTRS)

Cheston, T. S.; Chafer, C. M.; Chafer, S. B.; Webb, D. C.; Stadd, C. A.

1979-01-01

Because the demand for comprehensive impact analysis of space technologies will increase with the use of space shuttles, the academic social sciences/humanities community was surveyed in order to determine their interests in space utilization, to develop a list of current and planned courses, and to generate a preliminary matrix of relevant social sciences. The academic scope/focus of a proposed social science space-related journal was identified including the disciplines which should be represented in the editorial board/reviewer system. The time and funding necessary to develop a self-sustaining journal were assessed. Cost income, general organizational structure, marking/distribution and funding sources were analyzed. Recommendations based on the survey are included.

Combustion Research aboard the ISS Utilizing the Combustion Integrated Rack and Microgravity Science Glovebox

NASA Astrophysics Data System (ADS)

Sutliff, T. J.; Otero, A. M.; Urban, D. L.

2002-01-01

The Physical Sciences Research Program of NASA has chartered a broad suite of peer-reviewed research investigating both fundamental combustion phenomena and applied combustion research topics. Fundamental research provides insights to develop accurate simulations of complex combustion processes and allows developers to improve the efficiency of combustion devices, to reduce the production of harmful emissions, and to reduce the incidence of accidental uncontrolled combustion (fires, explosions). The applied research benefit humans living and working in space through its fire safety program. The Combustion Science Discipline is implementing a structured flight research program utilizing the International Space Station (ISS) and two of its premier facilities, the Combustion Integrated Rack of the Fluids and Combustion Facility and the Microgravity Science Glovebox to conduct this space-based research. This paper reviews the current vision of Combustion Science research planned for International Space Station implementation from 2003 through 2012. A variety of research efforts in droplets and sprays, solid-fuels combustion, and gaseous combustion have been independently selected and critiqued through a series of peer-review processes. During this period, while both the ISS carrier and its research facilities are under development, the Combustion Science Discipline has synergistically combined research efforts into sub-topical areas. To conduct this research aboard ISS in the most cost effective and resource efficient manner, the sub-topic research areas are implemented via a multi-user hardware approach. This paper also summarizes the multi-user hardware approach and recaps the progress made in developing these research hardware systems. A balanced program content has been developed to maximize the production of fundamental and applied combustion research results within the current budgetary and ISS operational resource constraints. Decisions on utilizing the Combustion Integrated Rack and the Microgravity Science Glovebox are made based on facility capabilities and research requirements. To maximize research potential, additional research objectives are specified as desires a priori during the research design phase. These expanded research goals, which are designed to be achievable even with late addition of operational resources, allow additional research of a known, peer-endorsed scope to be conducted at marginal cost. Additional operational resources such as upmass, crewtime, data downlink bandwidth, and stowage volume may be presented by the ISS planners late in the research mission planning process. The Combustion Discipline has put in place plans to be prepared to take full advantage of such opportunities.

Recent progress in utilization planning for Space Station Freedom

NASA Technical Reports Server (NTRS)

Bartoe, John-David F.; Thiringer, Peter S.

1991-01-01

The progress made in utilization planning for the redesigned Space Station Freedom (SSF) concept is described. Consideration is given to the SSF user capabilities, the strategic planning process, the strategic planning organizations, and the Consolidated Operations and Utilization Plan (COUP, which will be released in January 1993) as well as to the COUP development process and implementation. The process by which the COUP will be produced was exercised in the international Multilateral Strategic and Tactical Integration Process (MUSTIP) simulation. The paper describes the MUSTIP simulation and its activities along with MUSTIP findings and recommendations.

42 CFR 456.180 - Individual written plan of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Plan of Care § 456.180 Individual written plan of care. (a) Before admission to a mental hospital or...

SU-F-T-252: An Investigation of Gamma Knife Frame Definition Error When Using a Pre-Planning Workflow

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

Johnson, P

Purpose: To determine causal factors related to high frame definition error when treating GK patients using a pre-planning workflow. Methods: 160 cases were retrospectively reviewed. All patients received treatment using a pre-planning workflow whereby stereotactic coordinates are determined from a CT scan acquired after framing using a fiducial box. The planning software automatically detects the fiducials and compares their location to expected values based on the rigid design of the fiducial system. Any difference is reported as mean and maximum frame definition error. The manufacturer recommends these values be less than 1.0 mm and 1.5 mm. In this study, framemore » definition error was analyzed in comparison with a variety of factors including which neurosurgeon/oncologist/physicist was involved with the procedure, number of post used during framing (3 or 4), type of lesion, and which CT scanner was utilized for acquisition. An analysis of variance (ANOVA) approach was used to statistically evaluate the data and determine causal factors related to instances of high frame definition error. Results: Two factors were identified as significant: number of post (p=0.0003) and CT scanner (p=0.0001). Further analysis showed that one of the four scanners was significantly different than the others. This diagnostic scanner was identified as an older model with localization lasers not tightly calibrated. The average value for maximum frame definition error using this scanner was 1.48 mm (4 posts) and 1.75 mm (3 posts). For the other scanners this value was 1.13 mm (4 posts) and 1.40 mm (3 posts). Conclusion: In utilizing a pre-planning workflow the choice of CT scanner matters. Any scanner utilized for GK should undergo routine QA at a level appropriate for radiation oncology. In terms of 3 vs 4 post, it is hypothesized that three posts provide less stability during CT acquisition. This will be tested in future work.« less

Improving client and nurse satisfaction through the utilization of bedside report.

PubMed

Vines, Mary M; Dupler, Alice E; Van Son, Catherine R; Guido, Ginny W

2014-01-01

Bedside reporting improves client safety and trust and facilitates nursing teamwork and accountability; however, many nurses do not consider it best practice when caring for their clients. A literature review was conducted to determine whether bedside report is an essential shift handover process that promotes both client and nursing satisfaction. Implications for nurses in professional development are discussed, and strategies for developing and implementing bedside report using Lewin's theory of planned change are provided.

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

Zoberi, J.

Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR ismore » U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.« less

Resource Allocation Planning Helper (RALPH): Lessons learned

NASA Technical Reports Server (NTRS)

Durham, Ralph; Reilly, Norman B.; Springer, Joe B.

1990-01-01

The current task of Resource Allocation Process includes the planning and apportionment of JPL's Ground Data System composed of the Deep Space Network and Mission Control and Computing Center facilities. The addition of the data driven, rule based planning system, RALPH, has expanded the planning horizon from 8 weeks to 10 years and has resulted in large labor savings. Use of the system has also resulted in important improvements in science return through enhanced resource utilization. In addition, RALPH has been instrumental in supporting rapid turn around for an increased volume of special what if studies. The status of RALPH is briefly reviewed and important lessons learned from the creation of an highly functional design team are focused on through an evolutionary design and implementation period in which an AI shell was selected, prototyped, and ultimately abandoned, and through the fundamental changes to the very process that spawned the tool kit. Principal topics include proper integration of software tools within the planning environment, transition from prototype to delivered to delivered software, changes in the planning methodology as a result of evolving software capabilities and creation of the ability to develop and process generic requirements to allow planning flexibility.

Estimating Health-State Utility for Economic Models in Clinical Studies: An ISPOR Good Research Practices Task Force Report.

PubMed

Wolowacz, Sorrel E; Briggs, Andrew; Belozeroff, Vasily; Clarke, Philip; Doward, Lynda; Goeree, Ron; Lloyd, Andrew; Norman, Richard

Cost-utility models are increasingly used in many countries to establish whether the cost of a new intervention can be justified in terms of health benefits. Health-state utility (HSU) estimates (the preference for a given state of health on a cardinal scale where 0 represents dead and 1 represents full health) are typically among the most important and uncertain data inputs in cost-utility models. Clinical trials represent an important opportunity for the collection of health-utility data. However, trials designed primarily to evaluate efficacy and safety often present challenges to the optimal collection of HSU estimates for economic models. Careful planning is needed to determine which of the HSU estimates may be measured in planned trials; to establish the optimal methodology; and to plan any additional studies needed. This report aimed to provide a framework for researchers to plan the collection of health-utility data in clinical studies to provide high-quality HSU estimates for economic modeling. Recommendations are made for early planning of health-utility data collection within a research and development program; design of health-utility data collection during protocol development for a planned clinical trial; design of prospective and cross-sectional observational studies and alternative study types; and statistical analyses and reporting. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Light Water Reactor Sustainability Program A Reference Plan for Control Room Modernization: Planning and Analysis Phase

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

Jacques Hugo; Ronald Boring; Lew Hanes

2013-09-01

The U.S. Department of Energy’s Light Water Reactor Sustainability (LWRS) program is collaborating with a U.S. nuclear utility to bring about a systematic fleet-wide control room modernization. To facilitate this upgrade, a new distributed control system (DCS) is being introduced into the control rooms of these plants. The DCS will upgrade the legacy plant process computer and emergency response facility information system. In addition, the DCS will replace an existing analog turbine control system with a display-based system. With technology upgrades comes the opportunity to improve the overall human-system interaction between the operators and the control room. To optimize operatormore » performance, the LWRS Control Room Modernization research team followed a human-centered approach published by the U.S. Nuclear Regulatory Commission. NUREG-0711, Rev. 3, Human Factors Engineering Program Review Model (O’Hara et al., 2012), prescribes four phases for human factors engineering. This report provides examples of the first phase, Planning and Analysis. The three elements of Planning and Analysis in NUREG-0711 that are most crucial to initiating control room upgrades are: • Operating Experience Review: Identifies opportunities for improvement in the existing system and provides lessons learned from implemented systems. • Function Analysis and Allocation: Identifies which functions at the plant may be optimally handled by the DCS vs. the operators. • Task Analysis: Identifies how tasks might be optimized for the operators. Each of these elements is covered in a separate chapter. Examples are drawn from workshops with reactor operators that were conducted at the LWRS Human System Simulation Laboratory HSSL and at the respective plants. The findings in this report represent generalized accounts of more detailed proprietary reports produced for the utility for each plant. The goal of this LWRS report is to disseminate the technique and provide examples sufficient to serve as a template for other utilities’ projects for control room modernization.« less

Effects of the West Africa Ebola Virus Disease on Health-Care Utilization – A Systematic Review

PubMed Central

Brolin Ribacke, Kim J.; Saulnier, Dell D.; Eriksson, Anneli; von Schreeb, Johan

2016-01-01

Significant efforts were invested in halting the recent Ebola virus disease outbreak in West Africa. Now, studies are emerging on the magnitude of the indirect health effects of the outbreak in the affected countries, and the aim of this study is to systematically assess the results of these publications. The methodology for this review adhered to the Prisma guidelines for systematic reviews. A total of 3354 articles were identified for screening, and while 117 articles were read in full, 22 studies were included in the final review. Utilization of maternal health services decreased during the outbreak. The number of cesarean sections and facility-based deliveries declined and followed a similar pattern in Guinea, Liberia, and Sierra Leone. A change in the utilization of antenatal and postnatal care and family planning services was also seen, as well as a drop in utilization of children’s health services, especially in terms of vaccination coverage. In addition, the uptake of HIV/AIDS and malaria services, general hospital admissions, and major surgeries decreased as well. Interestingly, it was the uptake of health service provision by the population that decreased, rather than the volume of health service provision. Estimates from the various studies suggest that non-Ebola morbidity and mortality have increased after the onset of the outbreak in Sierra Leone, Guinea, and Liberia. Reproductive, maternal, and child health services were especially affected, and the decrease in facility deliveries, cesarean sections, and volume of antenatal and postnatal care visits might have significant adverse effects on maternal and newborn health. The impact of Ebola stretches far beyond Ebola cases and deaths. This review indicates that indirect health service effects are substantial and both short and long term, and highlights the importance of support to maintain routine health service delivery and the maintenance of vaccination programs as well as preventative and curative malaria programs, both in general but especially in times of a disaster. PMID:27777926

Assessing validity of observational intervention studies – the Benchmarking Controlled Trials

PubMed Central

Malmivaara, Antti

2016-01-01

Abstract Background: Benchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations. Aims: To create and pilot test a checklist for appraising methodological validity of a BCT. Methods: The checklist was created by extracting the most essential elements from the comprehensive set of criteria in the previous paper on BCTs. Also checklists and scientific papers on observational studies and respective systematic reviews were utilized. Ten BCTs published in the Lancet and in the New England Journal of Medicine were used to assess feasibility of the created checklist. Results: The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies. Conclusions: The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies. However, the piloted checklist should be validated in further studies.Key messagesBenchmarking Controlled Trial (BCT) is a concept which covers all observational studies aiming to assess impact of interventions or health care system features to patients and populations.This paper presents a checklist for appraising methodological validity of BCTs and pilot-tests the checklist with ten BCTs published in leading medical journals. The appraised studies seem to have several methodological limitations, some of which could be avoided in planning, conducting and reporting phases of the studies.The checklist can be used for planning, conducting, reporting, reviewing, and critical reading of observational intervention studies. PMID:27238631

Development of a Rural Health Framework: Implications for Program Service Planning and Delivery

PubMed Central

White, Deanna

2013-01-01

Purpose: To describe the development and application of an evidence-based Rural Health Framework to guide rural health program, policy and service planning. Methods: A literature review of rural health programs, focusing on health promotion, chronic disease prevention and population health, was conducted using several bibliographic databases. Findings: Thirty papers met the criteria for review, describing chronic disease interventions and public health policies in rural settings. Twenty-one papers demonstrated effective intervention programs and highlighted potential good practices for rural health programs, which were used to define key elements of a Rural Health Framework. Conclusions: The Rural Health Framework was applied to an influenza immunization program to demonstrate its utility in assisting public health providers to increase uptake of the vaccine. This Rural Health Framework provides an opportunity for program planners to reflect on the key issues facing rural communities to ensure the development of policies and strategies that will prudently and effectively meet population health needs. PMID:23968625

A descriptive review of the methodologies used in household surveys on medicine utilization.

PubMed

Bertoldi, Andréa D; Barros, Aluísio J D; Wagner, Anita; Ross-Degnan, Dennis; Hallal, Pedro C

2008-10-31

Studies carried out in the community enable researchers to understand access to medicines, affordability, and barriers to use from the consumer's point of view, and may stimulate the development of adequate medicines policies. The aim of the present article was to describe methodological and analytical aspects of quantitative studies on medicine utilization carried out at the household level. Systematic review of original papers with data collected in studies in which the household was a sampling unit, published between 1995 and 2008. The electronic review was carried out in Medline/Pubmed, Scielo and Lilacs. The reference lists of the papers identified were examined, as well as other publications by their authors. Studies on the utilization of specific pharmacological groups, or those including only respondents with a given disease were excluded. Out of 4852 papers initially identified in the literature search, 61 fulfilled our inclusion criteria. Most studies were carried out in Europe and North America and used a cross-sectional approach. More than 80% used face-to-face interviews for data collection, and the most frequently used recall period for assessing medicine utilization was 14-15 days. In 59% of the studies, interviewers were trained to request the packaging of the medicines reported by the subjects; medical prescriptions were requested less frequently (15% of the studies). These data will be useful for updating researchers on what methods their peers are currently using. Such information may help overcome challenges in the planning and analyses of future studies. Moreover, this publication may contribute to the improvement of the quality of medicine use data obtained in household surveys.

25 CFR 1000.69 - How can a Tribe/Consortium obtain comments or selection documents received or utilized after OSG...

Code of Federal Regulations, 2010 CFR

2010-04-01

...-DETERMINATION AND EDUCATION ACT Other Financial Assistance for Planning and Negotiation Grants for Non-BIA... documents received or utilized after OSG has made a decision on a planning grant application? 1000.69... selection documents received or utilized after OSG has made a decision on a planning grant application? A...

42 CFR 456.80 - Individual written plan of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Individual written plan of care. 456.80 Section 456... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Plan of Care § 456.80 Individual written plan of care. (a) Before admission to a hospital or before authorization for...

Utilizing semantic networks to database and retrieve generalized stochastic colored Petri nets

NASA Technical Reports Server (NTRS)

Farah, Jeffrey J.; Kelley, Robert B.

1992-01-01

Previous work has introduced the Planning Coordinator (PCOORD), a coordinator functioning within the hierarchy of the Intelligent Machine Mode. Within the structure of the Planning Coordinator resides the Primitive Structure Database (PSDB) functioning to provide the primitive structures utilized by the Planning Coordinator in the establishing of error recovery or on-line path plans. This report further explores the Primitive Structure Database and establishes the potential of utilizing semantic networks as a means of efficiently storing and retrieving the Generalized Stochastic Colored Petri Nets from which the error recovery plans are derived.

The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies.

PubMed

Kohrt, Brandon A; Asher, Laura; Bhardwaj, Anvita; Fazel, Mina; Jordans, Mark J D; Mutamba, Byamah B; Nadkarni, Abhijit; Pedersen, Gloria A; Singla, Daisy R; Patel, Vikram

2018-06-16

Community-based mental health services are emphasized in the World Health Organization’s Mental Health Action Plan , the World Bank’s Disease Control Priorities , and the Action Plan of the World Psychiatric Association. There is increasing evidence for effectiveness of mental health interventions delivered by non-specialists in community platforms in low- and middle-income countries (LMIC). However, the role of community components has yet to be summarized. Our objective was to map community interventions in LMIC, identify competencies for community-based providers, and highlight research gaps. Using a review-of-reviews strategy, we identified 23 reviews for the narrative synthesis. Motivations to employ community components included greater accessibility and acceptability compared to healthcare facilities, greater clinical effectiveness through ongoing contact and use of trusted local providers, family involvement, and economic benefits. Locations included homes, schools, and refugee camps, as well as technology-aided delivery. Activities included awareness raising, psychoeducation, skills training, rehabilitation, and psychological treatments. There was substantial variation in the degree to which community components were integrated with primary care services. Addressing gaps in current practice will require assuring collaboration with service users, utilizing implementation science methods, creating tools to facilitate community services and evaluate competencies of providers, and developing standardized reporting for community-based programs.

Pawnee Nation Energy Option Analyses

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

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

2009-07-31

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

Hospital utilization by health maintenance organizations. Separating apples from oranges.

PubMed

Mott, P D

1986-05-01

The hospitalization rate of HMOs is reported to be 444 bed days per 1,000 enrollees per year. It is often forgotten that there is also out-of-plan utilization. A review of previous studies and a survey of reporting practices by three HMOs illustrate many problems with HMO utilization data. HMO rates, like those of other insurers, reflect only the hospital admissions that the plans know about and pay for, not the total hospital experience of their enrollees. While only a thorough tracking of subscriber utilization of all insurers and institutions will provide estimates of the magnitude of unreported admissions and their impact on utilization rates, this report enumerates the ways in which patients may receive inpatient care without the HMO having a record of the admissions and/or having to pay for them. It was found that admissions can be unreported when another insurer or institution pays (e.g., Medicare, No Fault, Workmen's Compensation, duplicate coverage, school health and liability insurance or VA, military, municipal, and state hospitals); when the HMO does not cover benefits (e.g., cosmetic and oral surgery, experimental procedures, long-term psychiatric, chronic, or rehabilitation stays); and when HMO coverage is denied for procedural reasons (e.g., catastrophic stays covered by reinsurance, newborns, voluntary "leakage," or improper following of HMO procedures). True HMO rates are unknown but are estimated by some authors to be 7-37% higher than the reported figure, depending on which types of unreported use are estimated. There is a need for future analyses to quantify true hospitalization rates of enrollees of HMOs and other insurers.

Review of water demand and water utilization studies for the Provo River drainage basin, and review of a study of the effects of the proposed Jordanelle Reservoir on seepage to underground mines, Bonneville unit of the central Utah project

USGS Publications Warehouse

Waddell, K.M.; Freethey, G.W.; Susong, D.D.; Pyper, G.E.

1991-01-01

Problem: Questions have been raised concerning the adequacy of available water to fulfill the needs of storage, exchanges, diversions, and instream flows, pursuant to existing water rights in the Provo River drainage basin part of the Bonneville Unit. Also, concern has been expressed about the potential for seepage of water from Jordanelle Reservoir to underground mines. The Utah Congressional Delegation requested that the U.S. Geological Survey (USGS) review the results of analyses performed by and for the USBR.Purpose and Scope: The purpose of this report is to present the results of the USGS review of (1) the hydrologic data, techniques, and model used by the USBR in their hydrologic analyses of the Provo River drainage basin and (2) the results of a study of the potential for seepage from the Jordanelle Reservoir to nearby underground mines.The USGS reviewed USBR-supplied water demands, water utilization studies, and models of seepage from Jordanelle Reservoir. The USBR estimated that about 90 percent of the water supply for Jordanelle Reservoir will be water from Strawberry Reservoir exchanged for water from the Provo River stored in Utah Lake. If the Utah State Engineer allows the USBR to claim an estimated 19,700 acre-feet of return flows from the CUP, only about 77 percent of the supply would be derived from exchange of existing water rights in Utah Lake. The USGS assumed that planned importations of water from the Uinta Basin will be available and deliverable to fulfill the proposed exchanges.Water rights and demands are important for determining water availability. The USGS did not conduct an independent review of water rights and demands. The USSR and Utah Division of Water Rights use different methods in some areas for determining stress on the system based on past records. The USSR used "historical observed diversions" and the Utah Division of Water Rights use "diversion entitlements", which may not be equal to the historical diversions. The USGS based its review upon water demands used by the USSR. The Utah Division of Water Rights has responsibility for granting and enforcing water rights, and the final decisions on how the rights will be adjudicated lies with the Utah Division of Water Rights and with the courts. The USGS review did not consider the draft water distribution plan for the Utah Lake drainage basin proposed by the Utah State Engineer (written commun., October 15,1991). This plan, when finalized, may have an effect on water availability to the CUP.

Insights into managed care--operational, legal and actuarial.

PubMed

Melek, S P; Johnson, B A; Schryver, D

1997-01-01

Understanding the operational, legal and actuarial dimensions of managed care is essential to developing managed care contracts between managed care organizations and individual health care providers or groups such as provider-sponsored organizations or independent practice associations. Operationally, it is important to understand managed care and its trends, emphasizing business issues, knowing your practice and defining acceptable levels of reimbursement and risk. Legally, there are a number of common themes or issues relevant to all managed care contracts, including primary care vs. specialist contracts, services offered, program policies and procedures, utilization review, physician reimbursement and compensation, payment schedule, terms and conditions, term and termination, continuation of care requirements, indemnification, amendment of contract and program policies, and stop-loss insurance. Actuarial issues include membership, geography, age-gender distribution, degree of health care management, local managed care utilization levels, historical utilization levels, health plan benefit design, among others.

Modeling the Dynamic Interrelations between Mobility, Utility, and Land Asking Price

NASA Astrophysics Data System (ADS)

Hidayat, E.; Rudiarto, I.; Siegert, F.; Vries, W. D.

2018-02-01

Limited and insufficient information about the dynamic interrelation among mobility, utility, and land price is the main reason to conduct this research. Several studies, with several approaches, and several variables have been conducted so far in order to model the land price. However, most of these models appear to generate primarily static land prices. Thus, a research is required to compare, design, and validate different models which calculate and/or compare the inter-relational changes of mobility, utility, and land price. The applied method is a combination of analysis of literature review, expert interview, and statistical analysis. The result is newly improved mathematical model which have been validated and is suitable for the case study location. This improved model consists of 12 appropriate variables. This model can be implemented in the Salatiga city as the case study location in order to arrange better land use planning to mitigate the uncontrolled urban growth.

Contingency Planning for Planetary Rovers

NASA Technical Reports Server (NTRS)

Dearden, Richard; Meuleau, Nicolas; Ramakrishnan, Sailesh; Smith, David; Washington, Rich; Clancy, Daniel (Technical Monitor)

2002-01-01

There has been considerable work in AI on planning under uncertainty. But this work generally assumes an extremely simple model of action that does not consider continuous time and resources. These assumptions are not reasonable for a Mars rover, which must cope with uncertainty about the duration of tasks, the power required, the data storage necessary, along with its position and orientation. In this paper, we outline an approach to generating contingency plans when the sources of uncertainty involve continuous quantities such as time and resources. The approach involves first constructing a "seed" plan, and then incrementally adding contingent branches to this plan in order to improve utility. The challenge is to figure out the best places to insert contingency branches. This requires an estimate of how much utility could be gained by building a contingent branch at any given place in the seed plan. Computing this utility exactly is intractable, but we outline an approximation method that back propagates utility distributions through a graph structure similar to that of a plan graph.

Incremental Contingency Planning

NASA Technical Reports Server (NTRS)

Dearden, Richard; Meuleau, Nicolas; Ramakrishnan, Sailesh; Smith, David E.; Washington, Rich

2003-01-01

There has been considerable work in AI on planning under uncertainty. However, this work generally assumes an extremely simple model of action that does not consider continuous time and resources. These assumptions are not reasonable for a Mars rover, which must cope with uncertainty about the duration of tasks, the energy required, the data storage necessary, and its current position and orientation. In this paper, we outline an approach to generating contingency plans when the sources of uncertainty involve continuous quantities such as time and resources. The approach involves first constructing a "seed" plan, and then incrementally adding contingent branches to this plan in order to improve utility. The challenge is to figure out the best places to insert contingency branches. This requires an estimate of how much utility could be gained by building a contingent branch at any given place in the seed plan. Computing this utility exactly is intractable, but we outline an approximation method that back propagates utility distributions through a graph structure similar to that of a plan graph.

Medical talent management: a model for physician deployment.

PubMed

Brightman, Baird

2007-01-01

This article aims to provide a focused cost-effective method for triaging physicians into appropriate non-clinical roles to benefit both doctors and healthcare organizations. Reviews a validated career-planning process and customize it for medical talent management. A structured career assessment can differentiate between different physician work styles and direct medical talent into best-fit positions. This allows healthcare organizations to create a more finely tuned career ladder than the familiar "in or out" binary choice. PRACTICAL IMPLICATIONS--Healthcare organizations can invest in cost-effective processes for the optimal utilization of their medical talent. Provides a new use for a well-validated career assessment and planning system. The actual value of this approach should be studied using best-practices in ROI research.

Inpatient imaging utilization: trends of the past decade.

PubMed

Shinagare, Atul B; Ip, Ivan K; Abbett, Sarah K; Hanson, Richard; Seltzer, Steven E; Khorasani, Ramin

2014-03-01

We have previously reported inpatient imaging utilization trends at our institution from fiscal year (FY) 1984 through FY 2002. In this study, we assessed the trends in imaging utilization for inpatients from FY 2003 through FY 2012. In this institutional review board-approved retrospective study performed at a 793-bed tertiary care academic institution, we reviewed imaging utilization in adult inpatients from October 1, 2002, through September 30, 2012 (FY 2003 through FY 2012), and recorded the gross number of imaging studies coded by modality (conventional [radiography and fluoroscopy], ultrasound, nuclear medicine, CT, and MRI) and associated relative value units (RVUs). We used linear regression to assess trends in number of imaging studies and RVUs per case-mix-adjusted admission (CMAA). The total number of imaging studies, as well as the number of CT, nuclear medicine, and conventional studies adjusted for case mix, decreased (p=0.02, p=0.0006, p=0.0008, and p=0.001, respectively); CT per CMAA increased until FY 2009 and then decreased through FY 2012. Utilization of ultrasound and MRI did not change significantly (p=0.15 and p=0.22, respectively). Unadjusted global RVUs increased until FY 2009 and then showed a slight decrease through FY 2012 (p=0.04), whereas RVUs per CMAA did not change significantly (p=0.18). After decades of continued rise, imaging utilization for inpatients significantly decreased by most measures between FY 2009 and FY 2012. Future studies to evaluate the contribution of various factors to this decline, including efforts to reduce inappropriate use of imaging and concerns about potential harms of radiation exposure, may be helpful in optimizing imaging utilization and resource planning.

GPS test range mission planning

NASA Astrophysics Data System (ADS)

Roberts, Iris P.; Hancock, Thomas P.

The principal features of the Test Range User Mission Planner (TRUMP), a PC-resident tool designed to aid in deploying and utilizing GPS-based test range assets, are reviewed. TRUMP features time history plots of time-space-position information (TSPI); performance based on a dynamic GPS/inertial system simulation; time history plots of TSPI data link connectivity; digital terrain elevation data maps with user-defined cultural features; and two-dimensional coverage plots of ground-based test range assets. Some functions to be added during the next development phase are discussed.

Statement by Dr. Raul A. Deju to the Subcommittee on Radioactive Waste, Energy and Utilities Committee, Washington State Senate, Richland, Washington, October 21, 1982

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

Deju, R.A.

1982-10-01

The Basalt Waste Isolation Project's mission is to assess whether or not a nuclear waste repository can be sited in the basalts beneath the Hanford Site. Dr. Deju summarizes the results of the siting studies, the activities connected with waste package development, and ongoing engineering studies. In addition, he gives a glimpse of past technical reviews of the project and comments on major technical activities planned in the near future.

Design of RCSS

PubMed Central

Strum, David P.; Vargas, Luis G.; May, Jerrold H.

1997-01-01

Abstract The plans for Resource Coordination for Surgical Services system (RCSS) incorporate a distributed objectbase with a coordinating server. User-centered information screens are customized for each geographic location in surgical services. User interfaces are designed to mimic paper lists and worksheets used by health care providers. Patient-specific and site-specific data will be entered and maintained by providers at each geographic location, but also rebroadcast and displayed for all providers. Although RCSS is primarily a communications system, it will also support review of surgical utilization and operative scheduling. PMID:9067878

Plants and their microbial assistants: Nature's answer to Earth's environmental pollution problems

NASA Technical Reports Server (NTRS)

Wolverton, B. C.

1990-01-01

The utilization of higher plants and their associated microorganisms to solve environmental pollution problems on Earth and in future space applications is briefly reviewed. If man is sealed inside closed facilities, he becomes a polluter of the environment. It is also common knowledge to most people that man cannot survive on Earth without green photosynthesizing plants and microorganisms. Therefore, it is vitally important to have a better understanding of the interactions of man with plants and microorganisms. Biosphere 2 and other related studies presently being conducted or planned, hopefully, will supply data that will help save planet Earth from impending environmental disaster. The development of means to utilize both air and water pollution as a nutrient source for growing green plants is examined.

A systematic review of cost-sharing strategies used within publicly-funded drug plans in member countries of the organisation for economic co-operation and development.

PubMed

Barnieh, Lianne; Clement, Fiona; Harris, Anthony; Blom, Marja; Donaldson, Cam; Klarenbach, Scott; Husereau, Don; Lorenzetti, Diane; Manns, Braden

2014-01-01

Publicly-funded drug plans vary in strategies used and policies employed to reduce continually increasing pharmaceutical expenditures. We systematically reviewed the utilization of cost-sharing strategies and physician-directed prescribing regulations in publicly-funded formularies within member nations of the Organization of Economic Cooperation and Development (OECD). Using the OECD nations as the sampling frame, a search for cost-sharing strategies and physician-directed prescribing regulations was done using published and grey literature. Collected data was verified by a system expert within the prescription drug insurance plan in each country, to ensure the accuracy of key data elements across plans. Significant variation in the use of cost-sharing mechanisms was seen. Copayments were the most commonly used cost-containment measure, though their use and amount varied for those with certain conditions, most often chronic diseases (in 17 countries), and by socio-economic status (either income or employment status), or with age (in 15 countries). Caps and deductibles were only used by five systems. Drug cost-containment strategies targeting physicians were also identified in 24 countries, including guideline-based prescribing, prescription monitoring and incentive structures. There was variable use of cost-containment strategies to limit pharmaceutical expenditures in publicly funded formularies within OECD countries. Further research is needed to determine the best approach to constrain costs while maintaining access to pharmaceutical drugs.

Energy aspects of solid waste management: Proceedings

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

Not Available

1990-01-01

The Eighteenth Annual Illinois Energy Conference entitled Energy Aspects of Solid Waste Management'' was held in Chicago, Illinois on October 29--30, 1990. The conference program was developed by a planning committee that drew upon Illinois energy and environmental specialists from the major sectors including energy industries, environmental organizations, research universities, utility companies, federal, state and local government agencies, and public interest groups. Within this framework, the committee identified a number of key topic areas surrounding solid waste management in Illinois which were the focus of the conference. These issues included: review of the main components of the solid waste cyclemore » in the Midwest and what the relative impact of waste reduction, recycling, incineration and land disposal might be on Illinois' and the Midwest's solid waste management program. Investigation of special programs in the Midwest dealing with sewage sludge, combustion residuals and medical/infectious wastes. Review of the status of existing landfills in Illinois and the Midwest and an examination of the current plans for siting of new land disposal systems. Review of the status of incinerators and waste-to-energy systems in Illinois and the Midwest, as well as an update on activities to maximize methane production from landfills in the Midwest.« less

COMPLEAT (Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies): A planning tool for publicly owned electric utilities. [Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies (Compleat)

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

Not Available

1990-09-01

COMPLEAT takes its name, as an acronym, from Community-Oriented Model for Planning Least-Cost Energy Alternatives and Technologies. It is an electric utility planning model designed for use principally by publicly owned electric utilities and agencies serving such utilities. As a model, COMPLEAT is significantly more full-featured and complex than called out in APPA's original plan and proposal to DOE. The additional complexity grew out of a series of discussions early in the development schedule, in which it became clear to APPA staff and advisors that the simplicity characterizing the original plan, while highly desirable in terms of utility applications, wasmore » not achievable if practical utility problems were to be addressed. The project teams settled on Energy 20/20, an existing model developed by Dr. George Backus of Policy Assessment Associates, as the best candidate for the kinds of modifications and extensions that would be required. The remainder of the project effort was devoted to designing specific input data files, output files, and user screens and to writing and testing the compute programs that would properly implement the desired features around Energy 20/20 as a core program. This report presents in outline form, the features and user interface of COMPLEAT.« less

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.

An audit of imaging test utilization for the management of lymphoma in an oncology hospital: implications for resource planning?

PubMed

Schwartz, A; Gospodarowicz, M K; Khalili, K; Pintilie, M; Goddard, S; Keller, A; Tsang, R W

2006-02-01

The purpose of this study was to assist with resource planning by examining the pattern of physician utilization of imaging procedures for lymphoma patients in a dedicated oncology hospital. The proportion of imaging tests ordered for routine follow up with no specific clinical indication was quantified, with specific attention to CT scans. A 3-month audit was performed. The reasons for ordering all imaging procedures (X-rays, CT scans, ultrasound, nuclear scan and MRI) were determined through a retrospective chart review. 411 lymphoma patients had 686 assessments (sets of imaging tests) and 981 procedures (individual imaging tests). Most procedures were CT scans (52%) and chest radiographs (30%). The most common reasons for ordering imaging were assessing response (23%), and investigating new symptoms (19%). Routine follow up constituted 21% of the assessments (142/686), and of these, 82% were chest radiographs (116/142), while 24% (34/142) were CT scans. With analysis restricted to CT scans (296 assessments in 248 patients), the most common reason for ordering CT scans were response evaluation (40%), and suspicion of recurrence and/or new symptom (23%). Follow-up CT scans done with no clinical indication comprised 8% (25/296) of all CT assessments. Staging CT scans were under-represented at 6% of all assessments. Imaging with CT scans for follow up of asymptomatic patients is infrequent. However, scans done for staging new lymphoma patients were unexpectedly low in frequency, due to scans done elsewhere prior to referral. This analysis uncovered utilization patterns, helped resource planning and provided data to reduce unnecessary imaging procedures.

Utilizing codes of ethics in health professions education.

PubMed

Dahnke, Michael D

2014-10-01

Codes of ethics abound in health care, the aims and purposes of which are multiple and varied, from operating as a decision making tool to acting as a standard of practice that can be operational in a legal context to providing a sense of elevated seriousness and professionalism within a field of practice. There is some doubt and controversy, however, regarding the value and use of these codes both in professional practice and in the education of healthcare professionals. I intend to review and analyze the various aims and purposes of ethics codes particularly within the study and practice of healthcare in light of various criticisms of codes of ethics. After weighing the strength and import of these criticisms, I plan to explore effective means for utilizing such codes as part of the ethics education of healthcare professionals. While noting significant limitations of this tool, both in practice and in education, I plan to demonstrate its potential usefulness as well, in both generating critical thinking within the study of ethics and as a guide for practice for the professional.

Seizure Action Plans Do Not Reduce Health Care Utilization in Pediatric Epilepsy Patients.

PubMed

Roundy, Lindsi M; Filloux, Francis M; Kerr, Lynne; Rimer, Alyssa; Bonkowsky, Joshua L

2016-03-01

Management of pediatric epilepsy requires complex coordination of care. We hypothesized that an improved seizure management care plan would reduce health care utilization and improve outcomes. The authors conducted a cohort study with historical controls of 120 epilepsy patients before and after implementation of a "Seizure Action Plan." The authors evaluated for differences in health care utilization including emergency department visits, hospitalizations, clinic visits, telephone calls, and the percentage of emergency department visits that resulted in hospitalization in patients who did or did not have a Seizure Action Plan. The authors found that there was no decrease in these measures of health care utilization, and in fact the number of follow-up clinic visits was increased in the group with Seizure Action Plans (4.2 vs 3.3, P = .006). However, the study was underpowered to detect smaller differences. This study suggests that pediatric epilepsy quality improvement measures may require alternative approaches to reduce health care utilization and improve outcomes. © The Author(s) 2015.

Seizure Action Plans Do Not Reduce Health Care Utilization in Pediatric Epilepsy Patients

PubMed Central

Roundy, Lindsi M.; Filloux, Francis M.; Kerr, Lynne; Rimer, Alyssa; Bonkowsky, Joshua L.

2015-01-01

Management of pediatric epilepsy requires complex coordination of care. We hypothesized that an improved seizure management care plan would reduce healthcare utilization and improve outcomes. We conducted a cohort study with historical controls of 120 epilepsy patients before and after implementation of a “Seizure Action Plan.” We evaluated for differences in healthcare utilization including emergency department visits, hospitalizations, clinic visits, telephone calls, and the percentage of emergency department visits that resulted in hospitalization in patients who did or did not have a Seizure Action Plan. We found that there was no decrease in these measures of healthcare utilization, and in fact the number of follow-up clinic visits was increased in the group with Seizure Action Plans (4.2 versus 3.3, p 0.006). However, the study was underpowered to detect smaller differences. Our study suggests that pediatric epilepsy quality improvement measures may require alternative approaches to reduce healthcare utilization and improve outcomes. PMID:26245799

Integrating market processes into utility resource planning

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

Kahn, E.P.

1992-11-01

Integrated resource planning has resulted in an abundance of alternatives for meeting existing and new demand for electricity services: (1) utility demand-side management (DSM) programs, (2) DSM bidding, (3) competitive bidding for private power supplies, (4) utility re-powering, and (5) new utility construction. Each alternative relies on a different degree of planning for implementation and, therefore, each alternative relies on markets to a greater or lesser degree. This paper shows how the interaction of planning processes and market forces results in resource allocations among the alternatives. The discussion focuses on three phenomena that are driving forces behind the unanticipated consequences'more » of contemporary integrated resource planning efforts. These forces are: (1) large-scale DSM efforts, (2) customer bypass, and (3) large-scale independent power projects. 22 refs., 3 figs., 2 tabs.« less

Discharge Planning in Chronic Conditions

PubMed Central

McMartin, K

2013-01-01

Background Chronically ill people experience frequent changes in health status accompanied by multiple transitions between care settings and care providers. Discharge planning provides support services, follow-up activities, and other interventions that span pre-hospital discharge to post-hospital settings. Objective To determine if discharge planning is effective at reducing health resource utilization and improving patient outcomes compared with standard care alone. Data Sources A standard systematic literature search was conducted for studies published from January 1, 2004, until December 13, 2011. Review Methods Reports, randomized controlled trials, systematic reviews, and meta-analyses with 1 month or more of follow-up and limited to specified chronic conditions were examined. Outcomes included mortality/survival, readmissions and emergency department (ED) visits, hospital length of stay (LOS), health-related quality of life (HRQOL), and patient satisfaction. Results One meta-analysis compared individualized discharge planning to usual care and found a significant reduction in readmissions favouring individualized discharge planning. A second meta-analysis compared comprehensive discharge planning with postdischarge support to usual care. There was a significant reduction in readmissions favouring discharge planning with postdischarge support. However, there was significant statistical heterogeneity. For both meta-analyses there was a nonsignificant reduction in mortality between the study arms. Limitations There was difficulty in distinguishing the relative contribution of each element within the terms “discharge planning” and “postdischarge support.” For most studies, “usual care” was not explicitly described. Conclusions Compared with usual care, there was moderate quality evidence that individualized discharge planning is more effective at reducing readmissions or hospital LOS but not mortality, and very low quality evidence that it is more effective at improving HRQOL or patient satisfaction. Compared with usual care, there was low quality evidence that the discharge planning plus postdischarge support is more effective at reducing readmissions but not more effective at reducing hospital LOS or mortality. There was very low quality evidence that it is more effective at improving HRQOL or patient satisfaction. Plain Language Summary Chronically ill people experience frequent changes in their health status and multiple transitions between care settings and care providers (e.g., hospital to home). Discharge planning provides support services, follow-up activities and other interventions that span pre-hospital discharge to post-hospital settings. A review of the effects of different discharge plans was conducted. After searching for relevant studies, 11 studies were found that compared discharge planning with routine discharge care. This review indicates that: Individualized discharge planning reduces initial hospital length of stay and subsequent readmission to hospital but does not reduce mortality. The effect on health-related quality of life (HRQOL) or patient satisfaction is uncertain. Discharge planning plus postdischarge support reduces readmissions but does not reduce the initial hospital length of stay or mortality after discharge. The effect on HRQOL or patient satisfaction is uncertain. PMID:24167538

PLANNING GUIDELINES FOR CONSTRUCTION OF FACILITIES AT THE STATE-SUPPORTED COLLEGES AND UNIVERSITIES IN COLORADO.

ERIC Educational Resources Information Center

Colorado Association of State Institutions of Higher Education, Denver.

GUIDELINES ARE PRESENTED TO INSURE UNIFORM PLANNING AT THE EIGHT STATE-SUPPORTED INSTITUTIONS OF HIGHER LEARNING IN COLORADO. TWO PLANNING CONSULTANT FIRMS SUBMITTED UTILIZATION CRITERIA AND SQUARE FOOTAGE CRITERIA WHICH WERE USED TO DEVELOP STANDARDS FOR PLANNING IN THE STATE INSTITUTIONS. STANDARDS WERE SET FOR (1) CLASSROOM UTILIZATION, (2)…

Planning satellite communication services and spectrum-orbit utilization

NASA Technical Reports Server (NTRS)

Sawitz, P. H.

1982-01-01

The relationship between approaches to planning satellite communication services and spectrum-orbit utilization is considered, with emphasis on the fixed-satellite and the broadcasting-satellite services. It is noted that there are several possible approaches to planning space services, differing principally in the rigidity with which technical parameters are prescribed, in the time for which a plan remains in force, and in the procedures adopted for implementation and modifications. With some planning approaches, spectrum-orbit utilization is fixed at the time the plan is made. Others provide for greater flexibility by making it possible to postpone some decisions on technical parameters. In addition, the two political questions of what is equitable access and how it can be guaranteed in practice play an important role.

Expected Utility Distributions for Flexible, Contingent Execution

NASA Technical Reports Server (NTRS)

Bresina, John L.; Washington, Richard

2000-01-01

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

Impact of a Value-based Formulary on Medication Utilization, Health Services Utilization, and Expenditures.

PubMed

Yeung, Kai; Basu, Anirban; Hansen, Ryan N; Watkins, John B; Sullivan, Sean D

2017-02-01

Value-based benefit design has been suggested as an effective approach to managing the high cost of pharmaceuticals in health insurance markets. Premera Blue Cross, a large regional health plan, implemented a value-based formulary (VBF) for pharmaceuticals in 2010 that explicitly used cost-effectiveness analysis (CEA) to inform medication copayments. The objective of the study was to determine the impact of the VBF. Interrupted time series of employer-sponsored plans from 2006 to 2013. Intervention group: 5235 beneficiaries exposed to the VBF. 11,171 beneficiaries in plans without any changes in pharmacy benefits. The VBF-assigned medications with lower value (estimated by CEA) to higher copayment tiers and assigned medications with higher value to lower copayment tiers. Primary outcome was medication expenditures from member, health plan, and member plus health plan perspectives. Secondary outcomes were medication utilization, emergency department visits, hospitalizations, office visits, and nonmedication expenditures. In the intervention group after VBF implementation, member medication expenditures increased by $2 per member per month (PMPM) [95% confidence interval (CI), $1-$3] or 9%, whereas health plan medication expenditures decreased by $10 PMPM (CI, $18-$2) or 16%, resulting in a net decrease of $8 PMPM (CI, $15-$2) or 10%, which translates to a net savings of $1.1 million. Utilization of medications moved into lower copayment tiers increased by 1.95 days' supply (CI, 1.29-2.62) or 17%. Total medication utilization, health services utilization, and nonmedication expenditures did not change. Cost-sharing informed by CEA reduced overall medication expenditures without negatively impacting medication utilization, health services utilization, or nonmedication expenditures.

Impact of High-Deductible Health Plans on Health Care Utilization and Costs

PubMed Central

Waters, Teresa M; Chang, Cyril F; Cecil, William T; Kasteridis, Panagiotis; Mirvis, David

2011-01-01

Background High-deductible health plans (HDHPs) are of high interest to employers, policy makers, and insurers because of potential benefits and risks of this fundamentally new coverage model. Objective To investigate the impact of HDHPs on health care utilization and costs in a heterogeneous group of enrollees from a variety of individual and employer-based health plans. Data Claims and member data from a major insurer and zip code-level census data. Study Design Retrospective difference-in-differences analyses were used to examine the impact of HDHP plans. This analytical approach compared changes in utilization and expenditures over time (2007 versus 2005) across the two comparison groups (HDHP switchers versus matched PPO controls). Results In two-part models, HDHP enrollment was associated with reduced emergency room use, increases in prescription medication use, and no change in overall outpatient expenditures. The impact of HDHPs on utilization differed by subgroup. Chronically ill enrollees and those who clearly had a choice of plans were more likely to increase utilization in specific categories after switching to an HDHP plan. Conclusions Whether HDHPs are associated with lower costs is far from settled. Various subgroups of enrollees may choose HDHPs for different reasons and react differently to plan incentives. PMID:21029087

Strategic plan for infrastructure optimization

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

Donley, C.D.

This document represents Fluor Daniel Hanford`s and DynCorp`s Tri-Cities Strategic Plan for Fiscal Years 1998--2002, the road map that will guide them into the next century and their sixth year of providing safe and cost effective infrastructure services and support to the Department of Energy (DOE) and the Hanford Site. The Plan responds directly to the issues raised in the FDH/DOE Critical Self Assessment specifically: (1) a strategy in place to give DOE the management (systems) and physical infrastructure for the future; (2) dealing with the barriers that exist to making change; and (3) a plan to right-size the infrastructuremore » and services, and reduce the cost of providing services. The Plan incorporates initiatives from several studies conducted in Fiscal Year 1997 to include: the Systems Functional Analysis, 200 Area Water Commercial Practices Plan, $ million Originated Cost Budget Achievement Plan, the 1OO Area Vacate Plan, the Railroad Shutdown Plan, as well as recommendations from the recently completed Review of Hanford Electrical Utility. These and other initiatives identified over the next five years will result in significant improvements in efficiency, allowing a greater portion of the infrastructure budget to be applied to Site cleanup. The Plan outlines a planning and management process that defines infrastructure services and structure by linking site technical base line data and customer requirements to work scope and resources. The Plan also provides a vision of where Site infrastructure is going and specific initiatives to get there.« less

78 FR 9016 - Approval and Promulgation of Air Quality Implementation Plans; Massachusetts; Revisions to Fossil...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-07

... Promulgation of Air Quality Implementation Plans; Massachusetts; Revisions to Fossil Fuel Utilization and..., inspection, maintenance and testing requirements for certain fossil fuel utilization facilities, rename and... fossil fuel utilization facility regulation, source registration regulation, and new industrial...

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

Code of Federal Regulations, 2011 CFR

2011-10-01

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

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

Dynamics of a Successful Planned Giving Program Utilizing Shared Leadership at Historically Black Colleges and Universities (HBCUs)

ERIC Educational Resources Information Center

Baldwin, Robin Lynn Brunty

2013-01-01

The purpose of this study was to evaluate the dynamics of a successful planned giving program utilizing shared leadership at Historically Black Colleges and Universities (HBCUs). This information will assist the leadership in determining if and how a successful planned giving program can be established for HBCUs. It is possible for planned gifts…

MO-B-BRC-01: Introduction [Brachytherapy

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

Prisciandaro, J.

2016-06-15

Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR ismore » U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.« less

Baseline Evaluations to Support Control Room Modernization at Nuclear Power Plants

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

Boring, Ronald L.; Joe, Jeffrey C.

2015-02-01

For any major control room modernization activity at a commercial nuclear power plant (NPP) in the U.S., a utility should carefully follow the four phases prescribed by the U.S. Nuclear Regulatory Commission in NUREG-0711, Human Factors Engineering Program Review Model. These four phases include Planning and Analysis, Design, Verification and Validation, and Implementation and Operation. While NUREG-0711 is a useful guideline, it is written primarily from the perspective of regulatory review, and it therefore does not provide a nuanced account of many of the steps the utility might undertake as part of control room modernization. The guideline is largely summative—intendedmore » to catalog final products—rather than formative—intended to guide the overall modernization process. In this paper, we highlight two crucial formative sub-elements of the Planning and Analysis phase specific to control room modernization that are not covered in NUREG-0711. These two sub-elements are the usability and ergonomics baseline evaluations. A baseline evaluation entails evaluating the system as-built and currently in use. The usability baseline evaluation provides key insights into operator performance using the control system currently in place. The ergonomics baseline evaluation identifies possible deficiencies in the physical configuration of the control system. Both baseline evaluations feed into the design of the replacement system and subsequent summative benchmarking activities that help ensure that control room modernization represents a successful evolution of the control system.« less

MO-B-BRC-04: MRI-Based Prostate HDR

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

Mourtada, F.

2016-06-15

Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR ismore » U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.« less

MO-B-BRC-02: Ultrasound Based Prostate HDR

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

Chang, Z.

2016-06-15

Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR ismore » U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.« less

Portal Vein Embolization Utilizing N-Butyl Cyanoacrylate for Contralateral Lobe Hypertrophy Prior to Liver Resection: A Systematic Review and Meta-Analysis.

PubMed

Wajswol, Ethan; Jazmati, Tarek; Contractor, Sohail; Kumar, Abhishek

2018-04-23

To evaluate the safety and effectiveness of n-butyl cyanoacrylate (NBCA) for portal vein embolization (PVE) when used to induce contralateral future liver remnant (FLR) hypertrophy in patients undergoing planned hepatic resection for hepatic malignancy. The PubMed database (including articles indexed by MEDLINE) was searched for articles published from 1970 to 2018 describing patients treated with PVE utilizing NBCA to induce hypertrophy of the FLR prior to contralateral hepatic lobe resection. Demographic data, embolization technique, complications of embolization, resultant FLR hypertrophy, and surgical outcomes were obtained when available. A meta-analysis was performed to determine the cumulative relative hypertrophy rate of the FLR following PVE with NBCA. The literature search yielded 18 relevant articles. Six hundred and seven patients (383 men, 220 women; mean age 60.7 years) with procedures describing PVE utilizing NBCA were reviewed. The most common underlying hepatic malignancies were colorectal metastases (n = 348), followed by cholangiocarcinomas (n = 92), and hepatocellular carcinomas (n = 89). Technical success was reportedly achieved in 603/607 patients, for a success rate of 99.3%. Fixed effects meta-analysis of the relative hypertrophy rate of the FLR among studies resulted in an aggregate rate of 49.4 ± 1.3%. Of the patients who underwent attempted PVE, 461/607 (75.9%) eventually underwent surgical resection. Major complications following PVE occurred in 19 patients (3.13%), while minor complications following PVE occurred in 38 patients (6.26%). PVE utilizing NBCA to induce hypertrophy of the FLR prior to contralateral lobe resection in the setting of hepatic malignancy is safe and effective. Level IIa-Systematic review of cohort studies.

Using Multiattribute Utility Theory as a Priority-Setting Tool in Human Services Planning.

ERIC Educational Resources Information Center

Camasso, Michael J.; Dick, Janet

1993-01-01

The feasibility of applying multiattribute utility theory to the needs assessment and priority-setting activities of human services planning councils was studied in Essex County (New Jersey). Decision-making and information filtering processes are explored in the context of community planning. (SLD)

42 CFR 456.380 - Individual written plan of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before...) Activities; (v) Therapies; (vi) Social services; (vii) Diet; and (viii) Special procedures designed to meet...

42 CFR 456.380 - Individual written plan of care.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before...) Activities; (v) Therapies; (vi) Social services; (vii) Diet; and (viii) Special procedures designed to meet...

NASA science utilization plans for the Space Station.

PubMed

Reeves, E M; Cressy, P J

1995-10-01

The Mir-1 and International Space Station Alpha capabilities present the science community with unique long duration platforms to conduct a wide range of scientific research in the microgravity and life sciences as well as in the observational sciences, NASA is developing plans to use the capabilities of Mir and Space Station as they emerge during the development of the orbital program. In both cases the planned science utilization programs take advantage of the volume, crew, power, microgravity and logistics resupply unique to each phase. The paper will present these utilization plans in the context of an evolving scientific program.

Report: Survey Results on Information Used by Water Utilities to Conduct Vulnerability Assessments

EPA Pesticide Factsheets

Report #2004-M-0001, November 21, 2003. EPA developed a Strategic Plan for Homeland Security (Plan), dated Sept 2002, which states that EPA will work with the States, tribes, drinking water utilities, and others to enhance the security of water utilities.

76 FR 59066 - Notice of Regulatory Review Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-23

... [No. 2011-N-10] Notice of Regulatory Review Plan AGENCY: Federal Housing Finance Agency. ACTION... of and requesting comments on the FHFA interim regulatory review plan for review of existing... comments on all aspects of the interim regulatory review plan, including legal and policy considerations...

Multilateral initiative on malaria: justification, evolution, achievements, challenges, opportunities, and future plans.

PubMed

Rugemalila, Joas B; Ogundahunsi, Olumide A T; Stedman, Timothy T; Kilama, Wen L

2007-12-01

Malaria is a major public health problem; about half of the world's populations live under exposure. The problem is increasing in magnitude and complexity because it is entwined with low socio-economic status, which makes African women and children particularly vulnerable. Combating malaria therefore requires concerted international efforts with an emphasis on Africa. The Multilateral Initiative on Malaria (MIM) was founded in 1997 to meet that need through strengthening research capacity in Africa, increasing international cooperation and communication, and utilization of research findings to inform malaria prevention, treatment, and control. The review undertaken in 2002 showed that through improved communication and science-focused institutional networks, MIM had brought African scientists together, opened up communication among malaria stakeholders, and provided Internet access to literature. The achievements were made through four autonomous constituents including the coordinating Secretariat being hosted for the first time in Africa by the African Malaria Network Trust (AMANET) for the period 2006-2010. The other constituents are the MIM TDR providing funding for peer-reviewed research; MIMCom facilitating Internet connectivity, access to medical literature, and communication between scientists inside and outside of Africa; and MR4 providing scientists access to research tools, standardized reagents, and protocols. Future plans will mostly consolidate the gains made under the MIM Strategic Plan for the period 2003-2005.

Fossil fuels in a sustainable energy future

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

Bechtel, T.F.

1995-12-01

The coal industry in the United States has become a world leader in safety, productivity, and environmental protection in the mining of coal. The {open_quotes}pick-and-shovel{close_quotes} miner with mangled limbs and black lung disease has been replaced by the highly skilled technicians that lead the world in tons per man-hour. The gob piles, polluted streams, and scared land are a thing of the past. The complementary efforts of the DOE and EPRI-funded programs in coal utilization R&D and the Clean Coal Technology Program commercial demonstrations, have positioned the power generation industry to utilize coal in a way that doesn`t pollute themore » air or water, keeps electrical power costs low, and avoids the mountains of waste material. This paper reviews the potential for advanced coal utilization technologies in new power generation applications as well as the repowering of existing plants to increase their output, raise their efficiency, and reduce pollution. It demonstrates the potential for these advanced coal-fueled plants to play a complementary role in future planning with the natural gas and oil fired units currently favored in the market place. The status of the US program to demonstrate these technologies at commercial scale is reviewed in some detail.« less

42 CFR 456.242 - UR plan requirements for medical care evaluation studies.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Medical Care Evaluation Studies § 456.242 UR plan requirements for medical care... evaluation studies in the mental hospital; (2) Documents for each study— (i) Its results; and (ii) How the...

75 FR 62023 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-07

...] Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities September 29... (75 FR 37884) proposing to amend the transmission planning and cost allocation requirements... transmission needs driven by public policy requirements established by state or federal laws or regulations...

40 CFR 72.43 - Phase I reduced utilization plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) PERMITS REGULATION Acid Rain Compliance Plan and Compliance Options § 72.43 Phase I reduced... any Acid Rain emissions limitation or emissions reduction requirements during Phase I; and (ii) Meets... this section shall include in the Acid Rain permit application for the unit a reduced utilization plan...

40 CFR 72.43 - Phase I reduced utilization plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) PERMITS REGULATION Acid Rain Compliance Plan and Compliance Options § 72.43 Phase I reduced... any Acid Rain emissions limitation or emissions reduction requirements during Phase I; and (ii) Meets... this section shall include in the Acid Rain permit application for the unit a reduced utilization plan...

40 CFR 72.43 - Phase I reduced utilization plans.

Code of Federal Regulations, 2014 CFR

2014-07-01

... (CONTINUED) PERMITS REGULATION Acid Rain Compliance Plan and Compliance Options § 72.43 Phase I reduced... any Acid Rain emissions limitation or emissions reduction requirements during Phase I; and (ii) Meets... this section shall include in the Acid Rain permit application for the unit a reduced utilization plan...

40 CFR 72.43 - Phase I reduced utilization plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) PERMITS REGULATION Acid Rain Compliance Plan and Compliance Options § 72.43 Phase I reduced... any Acid Rain emissions limitation or emissions reduction requirements during Phase I; and (ii) Meets... this section shall include in the Acid Rain permit application for the unit a reduced utilization plan...

40 CFR 72.43 - Phase I reduced utilization plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) PERMITS REGULATION Acid Rain Compliance Plan and Compliance Options § 72.43 Phase I reduced... any Acid Rain emissions limitation or emissions reduction requirements during Phase I; and (ii) Meets... this section shall include in the Acid Rain permit application for the unit a reduced utilization plan...

Customer satisfaction planning and industrial engineering move hospital towards in-house stockless program.

PubMed

Burton, R; Mauk, D

1993-03-01

By integrating customer satisfaction planning and industrial engineering techniques when examining internal costs and efficiencies, materiel managers are able to better realize what concepts will best meet their customers' needs. Defining your customer(s), applying industrial engineering techniques, completing work sampling studies, itemizing recommendations and benefits to each alternative, performing feasibility and cost-analysis matrixes and utilizing resources through productivity monitoring will get you on the right path toward selecting concepts to use. This article reviews the above procedures as they applied to one hospital's decision-making process to determine whether to incorporate a stockless inventory program. Through an analysis of customer demand, the hospital realized that stockless was the way to go, but not by outsourcing the function--the hospital incorporated an in-house stockless inventory program.

Printing Technologies for Medical Applications.

PubMed

Shafiee, Ashkan; Atala, Anthony

2016-03-01

Over the past 15 years, printers have been increasingly utilized for biomedical applications in various areas of medicine and tissue engineering. This review discusses the current and future applications of 3D bioprinting. Several 3D printing tools with broad applications from surgical planning to 3D models are being created, such as liver replicas and intermediate splints. Numerous researchers are exploring this technique to pattern cells or fabricate several different tissues and organs, such as blood vessels or cardiac patches. Current investigations in bioprinting applications are yielding further advances. As one of the fastest areas of industry expansion, 3D additive manufacturing will change techniques across biomedical applications, from research and testing models to surgical planning, device manufacturing, and tissue or organ replacement. Copyright © 2016. Published by Elsevier Ltd.

Overcoming barriers to the use of osteopathic manipulation techniques in the emergency department.

PubMed

Roberge, Raymond J; Roberge, Marc R

2009-08-01

Osteopathic Manipulation Techniques (OMT) have been shown to be effective therapeutic modalities in various clinical settings, but appear to be underutilized in the emergency department (ED) setting. To examine barriers to the use of OMT in the ED and provide suggestions to ameliorate these barriers. Literature review While the medical literature cites numerous obstacles to the use of OMT in the ED setting, most can be positively addressed through education, careful planning, and ongoing research into use of these techniques. Recent prospective clinical trials of OMT have demonstrated the utility of these modalities. Osteopathic Manipulation Techniques are useful therapeutic modalities that could be utilized to a greater degree in the ED. As the number of osteopathic emergency physicians increases, the opportunity to employ these techniques should increase.

WE-E-BRB-11: Riview a Web-Based Viewer for Radiotherapy.

PubMed

Apte, A; Wang, Y; Deasy, J

2012-06-01

Collaborations involving radiotherapy data collection, such as the recently proposed international radiogenomics consortium, require robust, web-based tools to facilitate reviewing treatment planning information. We present the architecture and prototype characteristics for a web-based radiotherapy viewer. The web-based environment developed in this work consists of the following components: 1) Import of DICOM/RTOG data: CERR was leveraged to import DICOM/RTOG data and to convert to database friendly RT objects. 2) Extraction and Storage of RT objects: The scan and dose distributions were stored as .png files per slice and view plane. The file locations were written to the MySQL database. Structure contours and DVH curves were written to the database as numeric data. 3) Web interfaces to query, retrieve and visualize the RT objects: The Web application was developed using HTML 5 and Ruby on Rails (RoR) technology following the MVC philosophy. The open source ImageMagick library was utilized to overlay scan, dose and structures. The application allows users to (i) QA the treatment plans associated with a study, (ii) Query and Retrieve patients matching anonymized ID and study, (iii) Review up to 4 plans simultaneously in 4 window panes (iv) Plot DVH curves for the selected structures and dose distributions. A subset of data for lung cancer patients was used to prototype the system. Five user accounts were created to have access to this study. The scans, doses, structures and DVHs for 10 patients were made available via the web application. A web-based system to facilitate QA, and support Query, Retrieve and the Visualization of RT data was prototyped. The RIVIEW system was developed using open source and free technology like MySQL and RoR. We plan to extend the RIVIEW system further to be useful in clinical trial data collection, outcomes research, cohort plan review and evaluation. © 2012 American Association of Physicists in Medicine.

Strategies and Exemplars for Public Outreach Events: Planning, Implementation, Evaluation

NASA Astrophysics Data System (ADS)

Cobb, W. H.; Buxner, S.; Shipp, S. S.; Shebby, S.

2015-12-01

IntroductionEach year the National Aeronautics and Space Administration (NASA) sponsors a variety of public outreach events to share information with educators, students, and the general public. These events are designed to increase interest in and awareness of the mission and goals of NASA. Planning and implementation best practices gleaned from the NASA SMD Education's review of large-scale events, "Best Practices in Outreach Events" will be shared. Outcomes from an event, i C Ceres, celebrating the Dawn mission's arrival at dwarf planet Ceres that utilized these strategies will be shared. Best practices included can be pertinent for all event organizers and evaluators regardless of event size. BackgroundThe literature review focused on identifying evaluations of large-scale public outreach events—and, within these evaluations, identifying best practices. The following criteria for identifying journal articles and reports to potentially include: Public, science-related events open to adults and children. Events with more than 1,000 attendees. Events that occurred during the last 5 years. Evaluations that included information on data collected from visitors and/or volunteers. Evaluations that specified the type of data collected, methodology, and associated results. Planning and Implementation Best PracticesThe literature review revealed key considerations for planning and of large-scale events implementing events. A summary of related best practices is presented below. 1) Advertise the event 2) Use and advertise access to scientists 3) Recruit scientists using these findings 4) Ensure that the event is group and particularly child friendly 5) Target specific event outcomes Best Practices Informing Real-world Planning, Implementation and EvaluationDawn mission's collaborative design of a series of events, i C Ceres, including in-person, interactive events geared to families and live presentations will be shared. Outcomes and lessons learned will be imparted rising from these events and their evaluation. There will be a focus on the family event, in particular the evidence that scientist participation was a particular driver for the event's impact and success.

Ethical Guidance for Disaster Response, Specifically Around Crisis Standards of Care: A Systematic Review.

PubMed

Leider, Jonathon P; DeBruin, Debra; Reynolds, Nicole; Koch, Angelica; Seaberg, Judy

2017-09-01

Terrorism, disease outbreaks, and other natural disasters and mass casualty events have pushed health care and public health systems to identify and refine emergency preparedness protocols for disaster response. Ethical guidance, alongside legal and medical frameworks, are increasingly common components of disaster response plans. To systematically review the prevalence and content of ethical guidance offered for disaster response, specifically around crisis standards of care (CSCs). We systematically indexed academic literature from PubMed, Google Scholar, and ISI Web of Science from 2012 to 2016. We searched for peer-reviewed articles that substantively engaged in discussion of ethical guidance for CSCs. Researchers screened potential articles for identification and discussion of ethical issues in CSC planning. We categorized and cataloged ethical concepts and principles. Of 580 peer-reviewed articles mentioning ethics and CSCs or disaster planning, 38 (6%) met selection criteria. The systematic review of the CSC ethics literature since 2012 showed that authors were primarily focused on the ethical justifications for CSC (n = 20) as well as a need for ethics guidelines for implementing CSCs; the ethical justifications for triage (n = 19), both as to which criteria to use and the appropriate processes by which to employ triage; and international issues (n = 17). In addition to these areas of focus, the scholarly literature included discussion of a number of other ethical issues, including duty to care (n = 11), concepts of a duty to plan (n = 8), utilitarianism (n = 5), moral distress (n = 4), professional norms (n = 3), reciprocity (n = 2), allocation criteria (n = 4), equity (n = 4), research ethics (n = 2), duty to steward resources (n = 2), social utility and social worth (n = 2), and a number of others (n = 20). Although public health preparedness efforts have paid increasing attention to CSCs in recent years, CSC plans have rarely been implemented within the United States to date, although some components are common (e.g., triage is used in US emergency departments regularly). Conversely, countries outside the United States more commonly implement CSCs within a natural disaster or humanitarian crisis response, and may offer significant insight into ethics and disaster response for US-based practitioners. This systematic review identifies the most oft-used and -discussed ethical concepts and principles used in disaster planning around CSCs. Although discussion of more nuanced issues (e.g., health equity) are present, the majority of items substantively engaging in ethical discussion around disaster planning do so regarding triage and why ethics is needed in disaster response generally. Public health implications. A significant evolution in disaster planning has occurred within the past decade; ethical theories and frameworks have been put to work. For ethical guidance to be useful, it must be practical and implementable. Although high-level, abstract frameworks were once prevalent in disaster planning-especially in the early days of pandemic planning-concerns about the ethically difficult concept of CSCs pervade scholarly articles. Ethical norms must be clearly stated and justified and practical guidelines ought to follow from them. Ethical frameworks should guide clinical protocols, but this requires that ethical analysis clarifies what strategies to use to honor ethical commitments and achieve ethical objectives. Such implementation issues must be considered well ahead of a disaster. As governments and health care systems plan for mass casualty events, ethical guidance that is theoretically sound and practically useful can-and should-form an important foundation from which to build practical guidance for responding to disasters with morally appropriate means.

Barriers to Advance Care Planning at the End of Life: An Explanatory Systematic Review of Implementation Studies

PubMed Central

Lund, Susi; Richardson, Alison; May, Carl

2015-01-01

Context Advance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges. Objective To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice. Design An explanatory systematic review of qualitative implementation studies. Data sources Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched. Methods Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes. Results 13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations. Conclusions This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows. PMID:25679395

WASTE ANALYSIS PLAN REVIEW ADVISOR - AN INTELLIGENT DATABASE TO ASSIST RCRA PERMIT REVIEWERS

EPA Science Inventory

The Waste Analysis Plan Review Advisor (WAPRA) system assists in the review of the Waste Analysis Plan Section of RCRA Part B facility permit applications. Specifically, this program automates two functions of the waste analysis plan review. First, the system checks all wastes wh...

78 FR 48504 - Proposed Revisions to Maintenance Rule Standard Review Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-08

... Review Plan AGENCY: Nuclear Regulatory Commission. ACTION: Standard review plan-draft section revision... Review Plan for the Review of Safety Analysis Reports for Nuclear Power Plants: LWR Edition,'' Section 17... and Management System (ADAMS): You may access publicly available documents online in the NRC Library...

Impact of a Value-Based Formulary on Medication Utilization, Health Services Utilization, and Expenditures

PubMed Central

Yeung, Kai; Basu, Anirban; Hansen, Ryan N.; Watkins, John B.; Sullivan, Sean D.

2016-01-01

Background Value-based benefit design has been suggested as an effective approach to managing the high cost of pharmaceuticals in health insurance markets. Premera Blue Cross, a large regional health plan, implemented a Value-Based Formulary (VBF) for pharmaceuticals in 2010 that explicitly used cost-effectiveness analysis (CEA) to inform medication copayments. Objective To determine the impact of the VBF. Design Interrupted time-series of employer-sponsored plans from 2006 to 2013. Subjects Intervention group: 5,235 beneficiaries exposed to the VBF. Control group: 11,171 beneficiaries in plans without any changes in pharmacy benefits. Intervention The VBF assigned medications with lower value (estimated by CEA) to higher copayment tiers and assigned medications with higher value to lower copayment tiers. Measures Primary outcome was medication expenditures from member, health plan, and member plus health plan perspectives. Secondary outcomes were medication utilization, emergency department visits, hospitalizations, office visits, and non-medication expenditures. Results In the intervention group after VBF implementation, member medication expenditures increased by $2 per member per month (PMPM) (95% CI, $1 to $3) or 9%, while health plan medication expenditures decreased by $10 PMPM (CI, $18 to $2) or 16%, resulting in a net decrease of $8 PMPM (CI, $15 to $2) or 10%, which translates to a net savings of $1.1 million. Utilization of medications moved into lower copayment tiers increased by 1.95 days’ supply (CI, 1.29 to 2.62) or 17%. Total medication utilization, health services utilization and non-medication expenditures did not change. Conclusions Cost-sharing informed by CEA reduced overall medication expenditures without negatively impacting medication utilization, health services utilization or non-medication expenditures. PMID:27579915

The impact of functional imaging on radiation medicine.

PubMed

Sharma, Nidhi; Neumann, Donald; Macklis, Roger

2008-09-15

Radiation medicine has previously utilized planning methods based primarily on anatomic and volumetric imaging technologies such as CT (Computerized Tomography), ultrasound, and MRI (Magnetic Resonance Imaging). In recent years, it has become apparent that a new dimension of non-invasive imaging studies may hold great promise for expanding the utility and effectiveness of the treatment planning process. Functional imaging such as PET (Positron Emission Tomography) studies and other nuclear medicine based assays are beginning to occupy a larger place in the oncology imaging world. Unlike the previously mentioned anatomic imaging methodologies, functional imaging allows differentiation between metabolically dead and dying cells and those which are actively metabolizing. The ability of functional imaging to reproducibly select viable and active cell populations in a non-invasive manner is now undergoing validation for many types of tumor cells. Many histologic subtypes appear amenable to this approach, with impressive sensitivity and selectivity reported. For clinical radiation medicine, the ability to differentiate between different levels and types of metabolic activity allows the possibility of risk based focal treatments in which the radiation doses and fields are more tightly connected to the perceived risk of recurrence or progression at each location. This review will summarize many of the basic principles involved in the field of functional PET imaging for radiation oncology planning and describe some of the major relevant published data behind this expanding trend.

Air Force Research Laboratory space technology strategic investment model: analysis and outcomes for warfighter capabilities

NASA Astrophysics Data System (ADS)

Preiss, Bruce; Greene, Lloyd; Kriebel, Jamie; Wasson, Robert

2006-05-01

The Air Force Research Laboratory utilizes a value model as a primary input for space technology planning and budgeting. The Space Sector at AFRL headquarters manages space technology investment across all the geographically disparate technical directorates and ensures that integrated planning is achieved across the space community. The space investment portfolio must ultimately balance near, mid, and far-term investments across all the critical space mission areas. Investment levels and growth areas can always be identified by a typical capability analysis or gap analysis, but the value model approach goes one step deeper and helps identify the potential payoff of technology investments by linking the technology directly to an existing or potential concept. The value of the technology is then viewed from the enabling performance perspective of the concept that ultimately fulfills the Air Force mission. The process of linking space technologies to future concepts and technology roadmaps will be reviewed in this paper, along with representative results from this planning cycle. The initial assumptions in this process will be identified along with the strengths and weaknesses of this planning methodology.

Planned Improvements for the WB-57F Aircraft

NASA Astrophysics Data System (ADS)

Baccus, S.; Roberts, A.; Ross, M.

2003-12-01

NASA WB-57F aircraft have supported the atmospheric science community for over 30 years. Recent attention has focused on the chemistry and dynamics of the UTLS region of the atmosphere and several NASA sponsored field campaigns (ACCENT, CRYSTAL-FACE) have made critical use of the WB-57F's unique ability to carry large (3 ton) payloads during extended cruise at all altitudes from the lower troposphere to the lower stratosphere (20 km ceiling). In addition, the WB-57F's robust structure permits a large number and variety of instruments to be carried at inlet-favorable locations on the aircraft. In order to further improve the WB-57F's performance and unique utility to the atmospheric research and spacecraft validation communities, NASA is planning several upgrades to the WB-57F including state-of-the-art avionics and autopilot, landing gear replacement, maximum gross weight increase, engine replacement, and ultrapod installation. We will review the present WB-57F performance, plans for upcoming science campaigns, and plans for increased WB-57F payload, range, endurance, and ceiling resulting from the upgrades.

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

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

Barbose, Galen; Wiser, Ryan; Phadke, Amol

2008-02-01

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

Current and future role of voluntary surgical contraception in increasing access to and utilization of family planning services in Africa.

PubMed

Gaym, Asheber

2012-10-01

Voluntary surgical contraception is the most widely utilized method of contraception in the world. High effectiveness, low complication rates and reduced cost in the long term make them the ideal contraceptive choice to diverse group of clients including clients from low resource settings. To assess the current status of utilization and effectiveness of voluntary surgical contraception in Africa and suggest possible future roles in contraceptive method choice. A review of available literature on voluntary surgical contraception and synthesis of information under relevant headings. Despite very high total fertility rates in most countries of Africa, surgical contraceptives still contribute to a very small proportion ofcontraceptive method choice in the continent. Client profile and acceptability studies indicate a large unmet need for permanent contraception in the continent. Lack of information, misconceptions and weak health systems (particularly surgical care) are the major impediments to increasing availability of surgical contraception. Lack of knowledge and low levels of motivation among health care providers may also be significant barriers to access. Ihcreasing availability of information on the safety and effectiveness of these methods to both health care providers and the general population can increase demand and acceptability. Delegating service provision to appropriately trained non-physician providers at primary care settings can assist in increasing accessibility of these important family planning methods.

Operator-assisted planning and execution of proximity operations subject to operational constraints

NASA Technical Reports Server (NTRS)

Grunwald, Arthur J.; Ellis, Stephen R.

1991-01-01

Future multi-vehicle operations will involve multiple scenarios that will require a planning tool for the rapid, interactive creation of fuel-efficient trajectories. The planning process must deal with higher-order, non-linear processes involving dynamics that are often counter-intuitive. The optimization of resulting trajectories can be difficult to envision. An interaction proximity operations planning system is being developed to provide the operator with easily interpreted visual feedback of trajectories and constraints. This system is hosted on an IRIS 4D graphics platform and utilizes the Clohessy-Wiltshire equations. An inverse dynamics algorithm is used to remove non-linearities while the trajectory maneuvers are decoupled and separated in a geometric spreadsheet. The operator has direct control of the position and time of trajectory waypoints to achieve the desired end conditions. Graphics provide the operator with visualization of satisfying operational constraints such as structural clearance, plume impingement, approach velocity limits, and arrival or departure corridors. Primer vector theory is combined with graphical presentation to improve operator understanding of suggested automated system solutions and to allow the operator to review, edit, or provide corrective action to the trajectory plan.

Intercoder Reliability of Mapping Between Pharmaceutical Dose Forms in the German Medication Plan and EDQM Standard Terms.

PubMed

Sass, Julian; Becker, Kim; Ludmann, Dominik; Pantazoglou, Elisabeth; Dewenter, Heike; Thun, Sylvia

2018-01-01

A nationally uniform medication plan has recently been part of German legislation. The specification for the German medication plan was developed in cooperation between various stakeholders of the healthcare system. Its' goal is to enhance usability and interoperability while also providing patients and physicians with the necessary information they require for a safe and high-quality therapy. Within the research and development project named Medication Plan PLUS, the specification of the medication plan was tested and reviewed for semantic interoperability in particular. In this study, the list of pharmaceutical dose forms provided in the specification was mapped to the standard terms of the European Directorate for the Quality of Medicines & HealthCare by different coders. The level of agreement between coders was calculated using Cohen's Kappa (κ). Results show that less than half of the dose forms could be coded with EDQM standard terms. In addition to that Kappa was found to be moderate, which means rather unconvincing agreement among coders. In conclusion, there is still vast room for improvement in utilization of standardized international vocabulary and unused potential considering cross-border eHealth implementations in the future.

Identifying Pathways toward Sustainable Electricity Supply and Demand Using an Integrated Resource Strategic Planning Model for Saudi Arabia

NASA Astrophysics Data System (ADS)

Alabbas, Nabeel H.

Despite holding 16% of proved oil reserves in the world, Saudi Arabia might be on an unsustainable path to become a net oil importer by the 2030s. Decades of domestic energy subsidies accompanied by a high population growth rate have encouraged inefficient production and high domestic consumption of fossil fuel energy, which has resulted in environmental degradation, and significant social and economic consequences. In addition, the government's dependence on oil as a main source of revenue (89%) to finance its development programs cannot be sustained due to oil's exhaustible nature and rapidly increasing domestic consumption. The electricity and water sectors consume more energy than other sectors. The literature review revealed that electricity use in Saudi Arabia is following an unsustainable path (7-8% annual growth over the last decade). The water sector is another major energy consumer due to an unprecedented demand for water in the Kingdom (18% of world's total desalinated water output with per capita consumption is twice the world average). Multiple entities have been involved in fragmented planning activities on the supply-side as well as to a certain extent on the demand-side; moreover, comprehensive integrated resource strategic plans have been lacking at the national level. This dissertation established an integrated resource strategic planning (IRSP) model for Saudi Arabia's electricity and water sectors. The IRSP can clearly determine the Kingdom's future vision of its utility sector, including goals, policies, programs, and an execution timetable, taking into consideration economic, environmental and social benefits. Also, a weather-based hybrid end-use econometric demand forecasting model was developed to project electricity demand until 2040. The analytical economic efficiency and technical assessments reveal that Saudi Arabia can supply almost 75% of its electricity from renewable energy sources with a significant achievable potential for saving 26% of peak demand by 2040. However, the development of sustainable energy systems in the country's utility sector will not occur automatically. Thus, several actions are proposed for developing the sustainable energy roadmap, strategies, and policies for Saudi Arabia's utility sector, supporting its position as a new vehicle of growth that facilitates national and socio-economic development and economic diversification plan.

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

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

Morgan, R.

1980-07-01

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

NASA Microgravity Combustion Science Research Plans for the ISS

NASA Technical Reports Server (NTRS)

Sutliff, Thomas J.

2003-01-01

A peer-reviewed research program in Microgravity Combustion Science has been chartered by the Physical Sciences Research Division of the NASA Office of Biological and Physical Research. The scope of these investigations address both fundamental combustion phenomena and applied combustion research topics of interest to NASA. From this pool of research, flight investigations are selected which benefit from access to a microgravity environment. Fundamental research provides insights to develop accurate simulations of complex combustion processes and allows developers to improve the efficiency of combustion devices, to reduce the production of harmful emissions, and to reduce the incidence of accidental uncontrolled combustion (fires, explosions). Through its spacecraft fire safety program, applied research is conducted to decrease risks to humans living and working in space. The Microgravity Combustion Science program implements a structured flight research process utilizing the International Space Station (ISS) and two of its premier facilities- the Combustion Integrated Rack of the Fluids and Combustion Facility and the Microgravity Science Glovebox - to conduct space-based research investigations. This paper reviews the current plans for Microgravity Combustion Science research on the International Space Station from 2003 through 2012.

A Systematic Review of Cost-Sharing Strategies Used within Publicly-Funded Drug Plans in Member Countries of the Organisation for Economic Co-Operation and Development

PubMed Central

Barnieh, Lianne; Clement, Fiona; Harris, Anthony; Blom, Marja; Donaldson, Cam; Klarenbach, Scott; Husereau, Don; Lorenzetti, Diane; Manns, Braden

2014-01-01

Background Publicly-funded drug plans vary in strategies used and policies employed to reduce continually increasing pharmaceutical expenditures. We systematically reviewed the utilization of cost-sharing strategies and physician-directed prescribing regulations in publicly-funded formularies within member nations of the Organization of Economic Cooperation and Development (OECD). Methods & Findings Using the OECD nations as the sampling frame, a search for cost-sharing strategies and physician-directed prescribing regulations was done using published and grey literature. Collected data was verified by a system expert within the prescription drug insurance plan in each country, to ensure the accuracy of key data elements across plans. Significant variation in the use of cost-sharing mechanisms was seen. Copayments were the most commonly used cost-containment measure, though their use and amount varied for those with certain conditions, most often chronic diseases (in 17 countries), and by socio-economic status (either income or employment status), or with age (in 15 countries). Caps and deductibles were only used by five systems. Drug cost-containment strategies targeting physicians were also identified in 24 countries, including guideline-based prescribing, prescription monitoring and incentive structures. Conclusions There was variable use of cost-containment strategies to limit pharmaceutical expenditures in publicly funded formularies within OECD countries. Further research is needed to determine the best approach to constrain costs while maintaining access to pharmaceutical drugs. PMID:24618721

38 CFR 21.96 - Review of the plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... reaching the goals of the plan will be reviewed and evaluated as scheduled in the plan by the case manager and the veteran. (b) Comprehensive review required. The case manager and the veteran will review all... such review the veteran and the case manager will agree whether the plan should be: (1) Retained in its...

Odor Control Test Report of the Urine Containment Bag (UCB) for Orion Utilization

NASA Technical Reports Server (NTRS)

Casper, Stephanie; Williams, Nichole M. M.

2010-01-01

The purpose of this report is to summarize the conclusions for the odor control test of the Urine Containment Bag (UCB), P/N SDD46107234-306 in an environment simulating a space craft capsule. JSC 65891, Odor Control Test Plan of the Urine Containment Bag (UCB) for Orion Utilization, documents the test plan. The details of the test set-up and data reduction are detailed in the WSTF test report for this test WSTF #10-44500, Odor Control Test Plan of the Urine Containment Bag (UCB) for Orion Utilization,. This document outlines the project conclusions and forward plans with regard to trash containment for Constellation.

Review of Reports on Lake Erie-Lake Ontario Waterway, New York. Appendix E. Impact Assessment and Environment Plan.

DTIC Science & Technology

1973-10-01

estate 4.0 1.I 3.5 8.7 Transportation 6. 0 1.8 5.4 .3 (: ommunication and public utilities .).2 1.4 2. 3.5 Services 10. -1.7 10.1 16.1 Government 17.7...tourist directed. Tourism is reduced, in part, because "the poor environmental quality of the waterfront and the lack of comprehensibility and focus in...varied facilities also serve local and regional recreation functions. In addition to the park lands, an extensive private commercial tourism sector

Application of remote sensors in coastal zone observations

NASA Technical Reports Server (NTRS)

Caillat, J. M.; Elachi, C.; Brown, W. E., Jr.

1975-01-01

A review of processes taking place along coastlines and their biological consideration led to the determination of the elements which are required in the study of coastal structures and which are needed for better utilization of the resources from the oceans. The processes considered include waves, currents, and their influence on the erosion of coastal structures. Biological considerations include coastal fisheries, estuaries, and tidal marshes. Various remote sensors were analyzed for the information which they can provide and sites were proposed where a general ocean-observation plan could be tested.

Alternative energy sources II; Proceedings of the Second Miami International Conference, Miami Beach, Fla., December 10-13, 1979. Volume 9 - Conservation, economics, and policy; Index

NASA Astrophysics Data System (ADS)

Veziroglu, T. N.

The book examines the topics of waste utilization, conservation, and energy economics and policy. Energy supply and demand, energy economics and planning, and energy strategies and policies are reviewed. Papers are presented on the contributions to the energy supply of the industrialized countries from nuclear energy and regenerative energy flows, a method for estimating escalation and interest during construction, and a comparison of the incentives used to stimulate energy production between the United States and Japan.

An Economic Approach to Setting Contribution Limits in Qualified State-Sponsored Tuition Savings Plans.

ERIC Educational Resources Information Center

Ma, Jennifer; Warshawsky, Mark J.; Ameriks, John; Blohm, Julia A.

This study used an expected utility framework with a mean-lower partial moment specification for investor utility to determine the asset allocation and the allowable contribution limits for qualified state-sponsored tuition savings plans. Given the assumptions about state policymakers' perceptions of investor utility, the study determined the…

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

DTIC Science & Technology

2014-05-01

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

10 CFR 436.107 - Review of plan.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Operations Plans § 436.107 Review of plan. (a) Each plan or revision of a plan shall be submitted to DOE and... general operations plan under the guidelines will be evaluated with respect to: (1) Adequacy of... 10 Energy 3 2010-01-01 2010-01-01 false Review of plan. 436.107 Section 436.107 Energy DEPARTMENT...

NOx SOx Secondary NAAQS: Integrated Review Plan ...

EPA Pesticide Factsheets

The NOx SOx Secondary NAAQS Integrated Review Plan is the first document generated as part of the National Ambient Air Quality Standards (NAAQS) review process. The Plan presents background information, the schedule for the review, the process to be used in conducting the review, and the key policy-relevant science issues that will guide the review. The integrated review plan also discusses the frameworks for the various assessment documents to be prepared by the EPA as part of the review, including an Integrated Science Assessment (ISA), and as warranted, a Risk/Exposure Assessment (REA), and a Policy Assessment (PA). The primary purpose of the NOx SOx Secondary NAAQS Integrated Review Plan is to highlight the key policy-relevant issues to be considered in the Review of the Oxides of Nitrogen and Oxides of Sulfur Secondary NAAQS. A draft of the integrated review plan will be the subject of an advisory review with the Clean Air Scientific Advisory Committee (CASAC) and made available to the public for review and comment.

SU-F-T-231: Improving the Efficiency of a Radiotherapy Peer-Review System for Quality Assurance

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

Hsu, S; Basavatia, A; Garg, M

Purpose: To improve the efficiency of a radiotherapy peer-review system using a commercially available software application for plan quality evaluation and documentation. Methods: A commercial application, FullAccess (Radialogica LLC, Version 1.4.4), was implemented in a Citrix platform for peer-review process and patient documentation. This application can display images, isodose lines, and dose-volume histograms and create plan reports for peer-review process. Dose metrics in the report can also be benchmarked for plan quality evaluation. Site-specific templates were generated based on departmental treatment planning policies and procedures for each disease site, which generally follow RTOG protocols as well as published prospective clinicalmore » trial data, including both conventional fractionation and hypo-fractionation schema. Once a plan is ready for review, the planner exports the plan to FullAccess, applies the site-specific template, and presents the report for plan review. The plan is still reviewed in the treatment planning system, as that is the legal record. Upon physician’s approval of a plan, the plan is packaged for peer review with the plan report and dose metrics are saved to the database. Results: The reports show dose metrics of PTVs and critical organs for the plans and also indicate whether or not the metrics are within tolerance. Graphical results with green, yellow, and red lights are displayed of whether planning objectives have been met. In addition, benchmarking statistics are collected to see where the current plan falls compared to all historical plans on each metric. All physicians in peer review can easily verify constraints by these reports. Conclusion: We have demonstrated the improvement in a radiotherapy peer-review system, which allows physicians to easily verify planning constraints for different disease sites and fractionation schema, allows for standardization in the clinic to ensure that departmental policies are maintained, and builds a comprehensive database for potential clinical outcome evaluation.« less

Energy aspects of solid waste management: Proceedings

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

Not Available

1990-12-31

The Eighteenth Annual Illinois Energy Conference entitled ``Energy Aspects of Solid Waste Management`` was held in Chicago, Illinois on October 29--30, 1990. The conference program was developed by a planning committee that drew upon Illinois energy and environmental specialists from the major sectors including energy industries, environmental organizations, research universities, utility companies, federal, state and local government agencies, and public interest groups. Within this framework, the committee identified a number of key topic areas surrounding solid waste management in Illinois which were the focus of the conference. These issues included: review of the main components of the solid waste cyclemore » in the Midwest and what the relative impact of waste reduction, recycling, incineration and land disposal might be on Illinois` and the Midwest`s solid waste management program. Investigation of special programs in the Midwest dealing with sewage sludge, combustion residuals and medical/infectious wastes. Review of the status of existing landfills in Illinois and the Midwest and an examination of the current plans for siting of new land disposal systems. Review of the status of incinerators and waste-to-energy systems in Illinois and the Midwest, as well as an update on activities to maximize methane production from landfills in the Midwest.« less

Assessment of cost sharing in the Pima County Marketplace.

PubMed

Jennings, Nicholas B; Eng, Howard J

2017-01-01

The Patient Protection and Affordable Care Act established health insurance marketplaces to allow consumers to make educated decisions about their health care coverage. During the first open enrollment period in 2013, the federally facilitated marketplace in Pima County, Arizona listed 119 plans, making it one of the most competitive markets in the country. This study compares these plans based on differences in consumer cost sharing, including deductibles, co-pays and premiums. Consumer costs were reviewed using specific cases including a normal delivery pregnancy, the management of Type II Diabetes, and the utilization of specialty drugs to treat Hepatitis C. Total cost of care was calculated as the cost of managing the condition or event plus the cost of monthly premiums, evaluated as a single individual age 27. Evaluating a plan on premium alone is not sufficient as cost sharing can dramatically raise the cost of care. A rating system and better cost transparency tools could provider easier access to pertinent information for consumers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review.

PubMed

Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

2017-09-01

Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: "Healthcare and Knowledge Management"; "Knowledge Management Tools in Healthcare" and "Community of Practices in healthcare". It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning. Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.

12 CFR 563b.115 - How will OTS review my business plan?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false How will OTS review my business plan? 563b.115... business plan? (a) OTS will review your business plan to determine that it demonstrates a safe and sound... will be determinative. OTS will review every case on its merits. (b) You must file your business plan...

K-12 education sector desk reference. Final report

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

NONE

1998-01-01

K-12 schools are a major energy customer. To help utility managers better analyze their business relationships with this important market segment, this reference provides background information, statistics, and other useful information. This is a reference. It is a compilation of figures, charts, and tables taken from many existing sources representing some of the best information available about K-12 schools. Analysts reviews over 2,500 pages of government and private sector documents (listed in Appendix A) to select the 100 pages included here. They made every effort to select documents likely to be useful to utility planning staff and program managers. Wherevermore » possible, specific state data have been included to help utility staff compute impacts within a service territory. Both a phone number and e-mail address have been included wherever available for each document listed in Appendix A. The report includes data on the following: energy use; federal mandates; deferred maintenance; indoor air quality; and technology in education. 21 figs., 49 tabs.« less

Audit of the Functioning of the Elective Neurosurgical Operation Theater in India: A Prospective Study and Review of Literature.

PubMed

Saikia, Amrit Kumar; Sriganesh, Kamath; Ranjan, Manish; Claire, Marie; Mittal, Mohit; Pandey, Paritosh

2015-08-01

Knowledge about the utilization of the operation theater (OT) is essential to improve its efficiency. This study evaluated the neurosurgical operation theater utilization in a neurosciences teaching hospital. Data collected included OT start time, delay in start, anesthesia induction time, surgical preparation time, anesthesia recovery time, operating time, time between cases, and theater closing time. Five hundred thirty-seven surgeries were performed during the study period. The percentage of time used for anesthesia induction, actual surgical procedure, recovery from anesthesia, and theater preparation between the two cases were 8%, 70%, 6% and 5%, respectively. Fourteen percent of scheduled cases were cancelled. On 220 occasions (70.51%), theater was over-run. Late start contributed to loss of 8370 minutes (140 hours) of theater time. This study identified the proportion of time spent on each activity in the neurosurgical OT. This knowledge is likely to facilitate better planning of neurosurgical theater schedule and result in optimal utilization. Copyright © 2015 Elsevier Inc. All rights reserved.

49 CFR 194.121 - Response plan review and update procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 3 2011-10-01 2011-10-01 false Response plan review and update procedures. 194... SAFETY RESPONSE PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.121 Response plan review and update procedures. (a) Each operator shall update its response plan to address new or different operating conditions...

49 CFR 194.121 - Response plan review and update procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 3 2013-10-01 2013-10-01 false Response plan review and update procedures. 194... SAFETY RESPONSE PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.121 Response plan review and update procedures. (a) Each operator shall update its response plan to address new or different operating conditions...

49 CFR 194.121 - Response plan review and update procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 3 2014-10-01 2014-10-01 false Response plan review and update procedures. 194... SAFETY RESPONSE PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.121 Response plan review and update procedures. (a) Each operator shall update its response plan to address new or different operating conditions...

49 CFR 194.121 - Response plan review and update procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 3 2012-10-01 2012-10-01 false Response plan review and update procedures. 194... SAFETY RESPONSE PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.121 Response plan review and update procedures. (a) Each operator shall update its response plan to address new or different operating conditions...

49 CFR 194.121 - Response plan review and update procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 3 2010-10-01 2010-10-01 false Response plan review and update procedures. 194... SAFETY RESPONSE PLANS FOR ONSHORE OIL PIPELINES Response Plans § 194.121 Response plan review and update procedures. (a) Each operator shall update its response plan to address new or different operating conditions...

Effect of insurance parity on substance abuse treatment.

PubMed

Azzone, Vanessa; Frank, Richard G; Normand, Sharon-Lise T; Burnam, M Audrey

2011-02-01

This study examined the impact of insurance parity on the use, cost, and quality of substance abuse treatment. The authors compared substance abuse treatment spending and utilization from 1999 to 2002 for continuously enrolled beneficiaries covered by Federal Employees Health Benefit (FEHB) plans, which require parity coverage of mental health and substance use disorders, with spending and utilization among beneficiaries in a matched set of health plans without parity coverage. Logistic regression models estimated the probability of any substance abuse service use. Conditional on use, linear models estimated total and out-of-pocket spending. Logistic regression models for three quality indicators for substance abuse treatment were also estimated: identification of adult enrollees with a new substance abuse diagnosis, treatment initiation, and treatment engagement. Difference-in-difference estimates were computed as (postparity - preparity) differences in outcomes in plans without parity subtracted from those in FEHB plans. There were no significant differences between FEHB and non-FEHB plans in rates of change in average utilization of substance abuse services. Conditional on service utilization, the rate of substance abuse treatment out-of-pocket spending declined significantly in the FEHB plans compared with the non-FEHB plans (mean difference=-$101.09, 95% confidence interval [CI]=-$198.06 to -$4.12), whereas changes in total plan spending per user did not differ significantly. With parity, more patients had new diagnoses of a substance use disorder (difference-in-difference risk=.10%, CI=.02% to .19%). No statistically significant differences were found for rates of initiation and engagement in substance abuse treatment. Findings suggest that for continuously enrolled populations, providing parity of substance abuse treatment coverage improved insurance protection but had little impact on utilization, costs for plans, or quality of care.

Optimizing the Long-Term Operating Plan of Railway Marshalling Station for Capacity Utilization Analysis

PubMed Central

Zhou, Wenliang; Yang, Xia; Deng, Lianbo

2014-01-01

Not only is the operating plan the basis of organizing marshalling station's operation, but it is also used to analyze in detail the capacity utilization of each facility in marshalling station. In this paper, a long-term operating plan is optimized mainly for capacity utilization analysis. Firstly, a model is developed to minimize railcars' average staying time with the constraints of minimum time intervals, marshalling track capacity, and so forth. Secondly, an algorithm is designed to solve this model based on genetic algorithm (GA) and simulation method. It divides the plan of whole planning horizon into many subplans, and optimizes them with GA one by one in order to obtain a satisfactory plan with less computing time. Finally, some numeric examples are constructed to analyze (1) the convergence of the algorithm, (2) the effect of some algorithm parameters, and (3) the influence of arrival train flow on the algorithm. PMID:25525614

Cardiovascular disease prevention in low resource settings: lessons from the Heartfile experience in Pakistan.

PubMed

Nishtar, Sania

2003-01-01

This paper outlines activities of the Heartfile Program in Pakistan (http://heartfile.org). The program focuses on cardiovascular disease prevention and health promotion, and includes several initiatives that encompass building policy, reorienting health services, and developing community interventions that utilize the print and electronic media and outreach at the grass-root level to incorporate social marketing approaches. Initiated by the nonprofit private sector, the program now links with major public sector primary healthcare programs, and is currently spearheading formulation of the National Action Plan on Noncommunicable Disease Prevention and Control in Pakistan. In addition, the program is being refined, validated, and packaged as a replicable model for other developing countries and in low resource settings, utilizing appropriate principles of franchising with inbuilt components sensitive to cultural and social adaptations. A review of the planning process, implementation strategy, and fund-raising experience is presented. Strategies unique to low resource settings, such as the development of cost- and time-efficient strategic alliances and partnerships, have also been highlighted. In addition, specific caveats are identified as being helpful to private sector development of chronic disease prevention programs in resource-constrained settings, and a road map to a sustainable public-private sector partnership is provided.

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.

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

DTIC Science & Technology

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

ISRU Technologies for Mars Life Support

NASA Technical Reports Server (NTRS)

Finn, John E.; Sridhar, K. R.

2000-01-01

The primary objectives of the Mars Exploration program are to collect data for planetary science in a quest to answer questions related to Origins, to search for evidence of extinct and extant life, and to expand the human presence in the solar system. The public and political engagement that is critical for support of a Mars exploration program is based on all of these objectives. In order to retain and to build public and political support, it is important for NASA to have an integrated Mars exploration plan, not separate robotic and human plans that exist in parallel or in sequence. The resolution stemming from the current architectural review and prioritization of payloads may be pivotal in determining whether NASA will have such a unified plan and retain public support. There are several potential scientific and technological links between the robotic-only missions that have been flown and planned to date, and the robotic + human missions that will come in the future. Taking advantage of and leveraging those links are central to the idea of a unified Mars exploration plan. One such link is in situ resource utilization (ISRU) as an enabling technology to provide consumables such as fuels, oxygen, sweep and utility gases from the Mars atmosphere. ISRU for propellant production and for generation of life support consumables is a key element of human exploration mission plans because of the tremendous savings that can be realized in terms of launch costs and reduction in overall risk to the mission. The Human Exploration and Development of Space (HEDS) Enterprise has supported ISRU technology development for several years, and is funding the MIP and PROMISE payloads that will serve as the first demonstrations of ISRU technology for Mars. In our discussion and presentation at the workshop, we will highlight how the PROMISE ISRU experiment that has been selected by HEDS for a future Mars flight opportunity can extend and enhance the science experiments on board.

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

Herrington, J; Price, M; Brindle, J

Purpose: To evaluate the equivalence of spine SBRT treatment plans created in Eclipse for the TrueBeam STx (Varian Medical System, Palo Alto, CA) compared to plans using CyberKnife and MultiPlan (Accuray, Sunnyvale, CA). Methods: CT data and contours for 23 spine SBRT patients previously treated using CyberKnife (CK) were exported from MultiPlan treatment planning system into Eclipse where they were planned using static IMRT 6MV coplanar beams. Plans were created according to the original prescription dose and fractionation schedule while limiting spinal dose according to the RTOG 0631 protocol and maintaining target coverage comparable to the original CK plans. Plansmore » were evaluated using new conformity index (nCI), homogeneity index (HI), dose-volume histogram data, number of MU, and estimated treatment time. To ensure all Eclipse plans were deliverable, standard clinical IMRT QA was performed. The plan results were matched with their complimentary CK plans for paired statistical analysis. Results: Plans generated in Eclipse demonstrated statistically significant (p<0.01) improvements compared to complimentary CK plans in median values of maximum spinal cord dose (17.39 vs. 18.12 Gy), RTOG spinal cord constraint dose (14.50 vs. 16.93 Gy), nCI (1.28 vs. 1.54), HI (1.13 vs. 1.27), MU (3918 vs. 36416), and estimated treatment time (8 vs. 48 min). All Eclipse generated plans passed our clinically used protocols for IMRT QA. Conclusion: CK spine SBRT replanned utilizing Eclipse for LINAC delivery demonstrated dosimetric advantages. We propose improvements in plan quality metrics reviewed in this study may be attributed to dynamic MLCs that facilitate treatment of complicated geometries as well as posterior beams ideal for centrally located and/or posterior targets afforded by gantry-based RT delivery.« less

75 FR 6413 - Office of New Reactors; Proposed Revision to Standard Review Plan, Section 14.3.12 on Physical...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-09

... Standard Review Plan, Section 14.3.12 on Physical Security Hardware Inspections, Tests, Analyses, and.... SUMMARY: The NRC is soliciting public comment on NUREG-0800, ``Standard Review Plan for the Review of Safety Analysis Reports for Nuclear Power Plants,'' on a proposed Revision 1 to Standard Review Plan (SRP...

75 FR 36125 - Office of New Reactors; Proposed Revision to Standard Review Plan, Section 13.6.2, Revision 1 on...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-24

... Standard Review Plan, Section 13.6.2, Revision 1 on Physical Security--Design Certification AGENCY: Nuclear... comment on NUREG-0800, ``Standard Review Plan for the Review of Safety Analysis Reports for Nuclear Power Plants,'' on a proposed Revision 1 to Standard Review Plan (SRP), Section 13.6.2 on ``Physical Security...

77 FR 73060 - Standard Review Plan for Review of Fuel Cycle Facility License Applications

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

... NUCLEAR REGULATORY COMMISSION [NRC-2012-0220] Standard Review Plan for Review of Fuel Cycle... 1, ``Standard Review Plan (SRP) for the Review of a License Application for a Fuel Cycle Facility... for a fuel cycle facility (NUREG-1520) provides NRC staff guidance for reviewing and evaluating the...

The business case for payer support of a community-based health information exchange: a humana pilot evaluating its effectiveness in cost control for plan members seeking emergency department care.

PubMed

Tzeel, Albert; Lawnicki, Victor; Pemble, Kim R

2011-07-01

As emergency department utilization continues to increase, health plans must limit their cost exposure, which may be driven by duplicate testing and a lack of medical history at the point of care. Based on previous studies, health information exchanges (HIEs) can potentially provide health plans with the ability to address this need. To assess the effectiveness of a community-based HIE in controlling plan costs arising from emergency department care for a health plan's members. Albert Tzeel. The study design was observational, with an eligible population (N = 1482) of fully insured plan members who sought emergency department care on at least 2 occasions during the study period, from December 2008 through March 2010. Cost and utilization data, obtained from member claims, were matched to a list of persons utilizing the emergency department where HIE querying could have occurred. Eligible members underwent propensity score matching to create a test group (N = 326) in which the HIE database was queried in all emergency department visits, and a control group (N = 325) in which the HIE database was not queried in any emergency department visit. Post-propensity matching analysis showed that the test group achieved an average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost-savings. When clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decrease. Although many factors can play a role in this finding, it is likely that HIEs obviate unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care.

Systematic reviews: guidance relevant for studies of older people

PubMed Central

Wilkinson, Tim; Dodds, Richard M.; Ioannidis, John P. A.

2017-01-01

Abstract Systematic reviews and meta-analyses are increasingly common. This article aims to provide guidance for people conducting systematic reviews relevant to the healthcare of older people. An awareness of these issues will also help people reading systematic reviews to determine whether the results will influence their clinical practice. It is essential that systematic reviews are performed by a team which includes the required technical and clinical expertise. Those performing reviews for the first time should ensure they have appropriate training and support. They must be planned and performed in a transparent and methodologically robust way: guidelines are available. The protocol should be written—and if possible published—before starting the review. Geriatricians will be interested in a table of baseline characteristics, which will help to determine if the studied samples or populations are similar to their patients. Reviews of studies of older people should consider how they will manage issues such as different age cut-offs; non-specific presentations; multiple predictors and outcomes; potential biases and confounders. Systematic reviews and meta-analyses may provide evidence to improve older people's care, or determine where new evidence is required. Newer methodologies, such as meta-analyses of individual level data, network meta-analyses and umbrella reviews, and realist synthesis, may improve the reliability and clinical utility of systematic reviews. PMID:28655142

Cross-cultural assessment of HIV-associated cognitive impairment using the Kaufman assessment battery for children: a systematic review.

PubMed

van Wyhe, Kaylee S; van de Water, Tanya; Boivin, Michael J; Cotton, Mark F; Thomas, Kevin Gf

2017-06-14

Despite improved efficacy of, and access to, combination antiretroviral therapy (cART), HIV-associated cognitive impairments remain prevalent in both children and adults. Neuropsychological tests that detect such impairment can help clinicians formulate effective treatment plans. The Kaufman Assessment Battery for Children (KABC), although developed and standardized in the United States, is used frequently in many different countries and cultural contexts to assess paediatric performance across various cognitive domains. This systematic review investigated the cross-cultural utility of the original KABC, and its 2nd edition (KABC-II), in detecting HIV-associated cognitive impairment in children and adolescents. We entered relevant keywords and MeSH terms into the PubMed, PsycInfo, EBSCOHost, ProQuest, and Scopus databases, with search limits set from 1983-2017. Two independent reviewers evaluated the retrieved abstracts and manuscripts. Studies eligible for inclusion in the review were those that (a) used the KABC/KABC-II to assess cognitive function in children/adolescents aged 2-18 years, (b) featured a definition of cognitive impairment (e.g. >2 SD below the mean) or compared the performance of HIV-infected and uninfected control groups, and (c) used a sample excluded from population on which the instruments were normed. We identified nine studies (eight conducted in African countries, and one in the United Kingdom) to comprise the review's sample. All studies detected cognitive impairment in HIV-infected children, including those who were cART-naïve or who were cART treated and clinically stable. KABC/KABC-II subtests assessing simultaneous processing appeared most sensitive. Evaluation of the methodological quality of the selected studies by two independent reviews suggested that shortcomings included reporting and selection biases. This systematic review provides evidence for the cross-cultural utility of the KABC/KABC-II, particularly the simultaneous processing subtests, in detecting cognitive impairment in HIV-infected children (including those who are clinically stable). Although the current results suggest there is justification for using the KABC/KABC-II primarily in East Africa, further investigation is required to explore the instrument's utility in other HIV-prevalent regions of the globe.

HONDA'S IDEA ABOUT THE UTILIZATION OF NATURAL SCENERY ON "THE USE OF SCENIC LANDSCAPES"

NASA Astrophysics Data System (ADS)

Ogawa, Toru; Sanada, Junko

Essentially, natural scenery area plan must include scenery conservation and utilization as well as natural conservation, actually however, it is said that natural scenery area plan leans much toward natural conservation. So this study aims to focus on Seiroku Honda who has a major thinking about "utilization of scenery" in the Japanese national park's formation stage and clarify Honda's idea about the utilization of natural scenery by analyzing his "the Use of Scenic Landscapes". As a result, following three points are clarified. 1) Honda has four ideas in the base of each plans. 2) scenic landscape as resources in Honda's own ideas. 3) there was some conflict between modification ways and landscape resources.

Interdisciplinary Care Planning and the Written Care Plan in Nursing Homes: A Critical Review

ERIC Educational Resources Information Center

Dellefield, Mary Ellen

2006-01-01

Purpose: This article is a critical review of the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. Design and Methods: We reviewed educational and empirical literature. Results: Interdisciplinary care planning and the written care plan are…

Nitrogen Oxides (NOx) Primary NAAQS REVIEW: Integrated ...

EPA Pesticide Factsheets

The NOx Integrated Review Plan is the first document generated as part of the National Ambient Air Quality Standards (NAAQS) review process. The Plan presents background information, the schedule for the review, the process to be used in conducting the review, and the key policy-relevant science issues that will guide the review. The integrated review plan also discusses the frameworks for the various assessment documents to be prepared by the EPA as part of the review, including an Integrated Science Assessment (ISA), and as warranted, a Risk/Exposure Assessment (REA), and a Policy Assessment (PA). The primary purpose of the NOx Integrated Review Plan is to highlight the key policy-relevant issues to be considered in the Review of the NO2 primary NAAQS. A draft of the integrated review plan will be the subject of an advisory review with the Clean Air Scientific Advisory Committee (CASAC) and made available to the public for review and comment.

Sulfur Dioxide (SO2) Primary NAAQS Review: Integrated Review Plan - Advisory with CASAC

EPA Science Inventory

The SO2 Integrated Review Plan is the first document generated as part of the National Ambient Air Quality Standards (NAAQS) review process. The Plan presents background information, the schedule for the review, the process to be used in conducting the review, and the key policy-...

75 FR 36126 - Office of New Reactors; Proposed Revision to Standard Review Plan Section 13.6.3, Revision 1 on...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-24

... Standard Review Plan Section 13.6.3, Revision 1 on Physical Security--Early Site Permit AGENCY: Nuclear... comment on NUREG-0800, ``Standard Review Plan for the Review of Safety Analysis Reports for Nuclear Power Plants,'' on a proposed Revision 1 to Standard Review Plan (SRP), Section 13.6.3 on ``Physical Security...

Handbook on Planning for Sustainability for Water and Wastewater Utilities

EPA Pesticide Factsheets

The handbook details steps utilities can undertake to enhance their existing planning processes to ensure that water infrastructure investments are cost-effective over their life-cycle, resource efficient and support other relevant community goals.

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

Code of Federal Regulations, 2013 CFR

2013-10-01

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

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

Code of Federal Regulations, 2014 CFR

2014-10-01

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

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

Code of Federal Regulations, 2011 CFR

2011-10-01

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

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

Code of Federal Regulations, 2010 CFR

2010-10-01

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

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

Code of Federal Regulations, 2012 CFR

2012-10-01

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

Energy-Efficiency Retrofits in Small-Scale Multifamily Rental Housing: A Business Model

NASA Astrophysics Data System (ADS)

DeChambeau, Brian

The goal of this thesis to develop a real estate investment model that creates a financial incentive for property owners to perform energy efficiency retrofits in small multifamily rental housing in southern New England. The medium for this argument is a business plan that is backed by a review of the literature and input from industry experts. In addition to industry expertise, the research covers four main areas: the context of green building, efficient building technologies, precedent programs, and the Providence, RI real estate market for the business plan. The thesis concludes that the model proposed can improve the profitability of real estate investment in small multifamily rental properties, though the extent to which this is possible depends partially on utility-run incentive programs and the capital available to invest in retrofit measures.

Orofacial pain: a guide for the headache physician.

PubMed

Shephard, Martina K; Macgregor, E Anne; Zakrzewska, Joanna M

2014-01-01

Orofacial pain represents a significant burden in terms of morbidity and health service utilization. It includes very common disorders such as toothache and temporomandibular disorders, as well as rare orofacial pain syndromes. Many orofacial pain conditions have overlapping presentations, and diagnostic uncertainty is frequently encountered in clinical practice. This review provides a clinically orientated overview of common and uncommon orofacial pain presentations and diagnoses, with an emphasis on conditions that may be unfamiliar to the headache physician. A holistic approach to orofacial pain management is important, and the social, cultural, psychological and cognitive context of each patient needs to be considered in the process of diagnostic formulation, as well as in the development of a pain management plan according to the biopsychosocial model. Recognition of psychological comorbidities will assist in diagnosis and management planning. © 2013 American Headache Society.

Conceptual definition of a technology development mission for advanced solar dynamic power systems

NASA Technical Reports Server (NTRS)

Migra, R. P.

1986-01-01

An initial conceptual definition of a technology development mission for advanced solar dynamic power systems is provided, utilizing a space station to provide a dedicated test facility. The advanced power systems considered included Brayton, Stirling, and liquid metal Rankine systems operating in the temperature range of 1040 to 1400 K. The critical technologies for advanced systems were identified by reviewing the current state of the art of solar dynamic power systems. The experimental requirements were determined by planning a system test of a 20 kWe solar dynamic power system on the space station test facility. These requirements were documented via the Mission Requirements Working Group (MRWG) and Technology Development Advocacy Group (TDAG) forms. Various concepts or considerations of advanced concepts are discussed. A preliminary evolutionary plan for this technology development mission was prepared.

A review of selection-based tests of abiotic surrogates for species representation.

PubMed

Beier, Paul; Sutcliffe, Patricia; Hjort, Jan; Faith, Daniel P; Pressey, Robert L; Albuquerque, Fabio

2015-06-01

Because conservation planners typically lack data on where species occur, environmental surrogates--including geophysical settings and climate types--have been used to prioritize sites within a planning area. We reviewed 622 evaluations of the effectiveness of abiotic surrogates in representing species in 19 study areas. Sites selected using abiotic surrogates represented more species than an equal number of randomly selected sites in 43% of tests (55% for plants) and on average improved on random selection of sites by about 8% (21% for plants). Environmental diversity (ED) (42% median improvement on random selection) and biotically informed clusters showed promising results and merit additional testing. We suggest 4 ways to improve performance of abiotic surrogates. First, analysts should consider a broad spectrum of candidate variables to define surrogates, including rarely used variables related to geographic separation, distance from coast, hydrology, and within-site abiotic diversity. Second, abiotic surrogates should be defined at fine thematic resolution. Third, sites (the landscape units prioritized within a planning area) should be small enough to ensure that surrogates reflect species' environments and to produce prioritizations that match the spatial resolution of conservation decisions. Fourth, if species inventories are available for some planning units, planners should define surrogates based on the abiotic variables that most influence species turnover in the planning area. Although species inventories increase the cost of using abiotic surrogates, a modest number of inventories could provide the data needed to select variables and evaluate surrogates. Additional tests of nonclimate abiotic surrogates are needed to evaluate the utility of conserving nature's stage as a strategy for conservation planning in the face of climate change. © 2015 Society for Conservation Biology.

Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department

PubMed Central

Roberge, Raymond J.; Roberge, Marc R.

2009-01-01

Background: Osteopathic Manipulation Techniques (OMT) have been shown to be effective therapeutic modalities in various clinical settings, but appear to be underutilized in the emergency department (ED) setting. Objective: To examine barriers to the use of OMT in the ED and provide suggestions to ameliorate these barriers. Methods: Literature review Results: While the medical literature cites numerous obstacles to the use of OMT in the ED setting, most can be positively addressed through education, careful planning, and ongoing research into use of these techniques. Recent prospective clinical trials of OMT have demonstrated the utility of these modalities. Conclusion: Osteopathic Manipulation Techniques are useful therapeutic modalities that could be utilized to a greater degree in the ED. As the number of osteopathic emergency physicians increases, the opportunity to employ these techniques should increase. PMID:19718381

Advanced system demonstration for utilization of biomass as an energy source. Environmental report

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

McCollom, M.

1979-01-01

The conclusions and findings of extensive analyses undertaken to assess the environmental impacts and effects of the proposal to assist in an Advanced System Demonstration for Utilization of Biomass as an Energy Source by means of a wood-fueled power plant. Included are a description of the proposed project, a discussion of the existing environment that the project would affect, a summary of the project's impacts on the natural and human environments, a discussion of the project's relationships to other government policies and plans, and an extensive review of the alternatives which were considered in evaluating the proposed action. All findingsmore » of the research undertaken are discussed. More extensive presentations of the methods of analysis used to arrive at the various conclusions are available in ten topical technical appendices.« less

Sulfur Dioxide (SO2) Primary NAAQS Review: Integrated ...

EPA Pesticide Factsheets

The SO2 Integrated Review Plan is the first document generated as part of the National Ambient Air Quality Standards (NAAQS) review process. The Plan presents background information, the schedule for the review, the process to be used in conducting the review, and the key policy-relevant science issues that will guide the review. The integrated review plan also discusses the frameworks for the various assessment documents to be prepared by the EPA as part of the review, including an Integrated Science Assessment (ISA), and as warranted, a Risk/Exposure Assessment (REA), and a Policy Assessment (PA). The primary purpose of the SO2 Integrated Review Plan is to highlight the key policy-relevant issues to be considered in the Review of the SO2 primary NAAQS. A draft of the integrated review plan will be the subject of an advisory with the Clean Air Scientific Advisory Committee (CASAC) and made available to the public for review and comment.

77 FR 22691 - Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-17

... statute provides that the Institute will not develop a dollars-per-quality-life-year estimate as a... have practical utility; How the quality, utility, and clarity of the information to be collected may be... plan sponsors of calculating the average number of lives covered for the applicable policy year or plan...

Family Planning Visits by Teenagers: United States, 1978. Data on Health Resources Utilization Series 13, No. 58.

ERIC Educational Resources Information Center

Foster, Jean; Eckard, Eugenia

Teenagers' utilization of family planning services is of major concern in view of the estimated 4.1 million adolescent females at risk, defined as fertile, sexually active teenagers who are not pregnant and who are not seeking to become pregnant. To obtain information regarding teenagers' use of medical family planning services in clinical…

STS/Spacelab payload utilization planning study: Executive summary

NASA Technical Reports Server (NTRS)

1976-01-01

The planning process recommended to meet the orbital flight requirements for the Space Transportation System and payload development, procurement, operations, and support leading to authorization and funding of STS and payload project activities is described. The rationale and rp primary products of STS utilization planning are summarized along with the implementation of the system. Major recommendations of the study are included.

Utilizing grassroots workers in family planning programs in India: prospects and problems.

PubMed

Mani, S B

1991-01-01

In order to rapidly expand the network of delivery systems and speed up the process of acceptance of family planning messages and methods, a shift took place in the Indian family planning program from the bureaucratic "clinical" approach to the people oriented "extension" approach. As a result, there is an increasing emphasis on moving the family planning efforts closer to the grassroots level. A key methodological issue centers on the proper selection, cultural acceptability, and the effectiveness of the grassroots workers who are to be trained and through whom family planning motivational messages and methods are to be introduced. The Indian government, from time to time, has trained and utilized different groups of grassroots workers in its family planning promotional efforts. Anthropological field studies were conducted in two different regions in India to examine the potential and actual roles of two groups of grassroots workers--opinion leaders and traditional birth attendants--in the delivery of family planning services in the rural areas. These studies revealed that while the traditional birth attendants can be trained and utilized to a limited extent in promoting family planning efforts, especially to the eligible female clients, the role of the opinion leaders in such efforts is at best questionable. Based on these field studies, cultural and technical (including bureaucratic) problems in training and utilizing opinion leaders and traditional birth attendants are explored in detail. Modifications in the training program strategies are suggested to improve and expand the family planning delivery system in rural India.

Are prescription drug insurance choices consistent with expected utility theory?

PubMed

Bundorf, M Kate; Mata, Rui; Schoenbaum, Michael; Bhattacharya, Jay

2013-09-01

To determine the extent to which people make choices inconsistent with expected utility theory when choosing among prescription drug insurance plans and whether tabular or graphical presentation format influences the consistency of their choices. Members of an Internet-enabled panel chose between two Medicare prescription drug plans. The "low variance" plan required higher out-of-pocket payments for the drugs respondents usually took but lower out-of-pocket payments for the drugs they might need if they developed a new health condition than the "high variance" plan. The probability of a change in health varied within subjects and the presentation format (text vs. graphical) and the affective salience of the clinical condition (abstract vs. risk related to specific clinical condition) varied between subjects. Respondents were classified based on whether they consistently chose either the low or high variance plan. Logistic regression models were estimated to examine the relationship between decision outcomes and task characteristics. The majority of respondents consistently chose either the low or high variance plan, consistent with expected utility theory. Half of respondents consistently chose the low variance plan. Respondents were less likely to make discrepant choices when information was presented in graphical format. Many people, although not all, make choices consistent with expected utility theory when they have information on differences among plans in the variance of out-of-pocket spending. Medicare beneficiaries would benefit from information on the extent to which prescription drug plans provide risk protection. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Peer Review of Radiotherapy Planning: Quantifying Outcomes and a Proposal for Prospective Data Collection.

PubMed

Mackenzie, J; Graham, G; Olivotto, I A

2016-12-01

The Canadian Partnership for Quality Radiotherapy quality assurance guidelines recommend that radiation oncologist peer review of curative radiotherapy plans takes place ideally before the first fraction of treatment is delivered. This study documented and evaluated the outcomes of weekly, disease site-specific, radiotherapy peer review, quality assurance rounds at the Tom Baker Cancer Centre in Calgary, Canada with a view to making recommendations about the optimal timing and documentation of peer review during the radiotherapy planning processes. Outcomes of each case reviewed at (i) breast, (ii) head and neck (including thyroid and cutaneous cases) and (iii) lung team quality assurance rounds from 6 January to 5 May 2015 were recorded prospectively. Each radiotherapy plan was assigned an outcome: A for plans with no suggested changes; B for satisfactory, but where issues were raised to consider for future patients; or C when a change was recommended before the first or next fraction. The B outcomes were further subdivided into B1 for a case-specific concern and B2 for a policy gap. Plans were assessed after contour definition and before the plan was formulated (post-contouring reviews) and/or assessed when the plan was complete (post-planning reviews). 209 radiotherapy plans prescribed by 20 radiation oncologists were peer reviewed at 43 quality assurance meetings. 93% were curative-intent and 7% were palliative. 83% of plans were reviewed before delivery of the first treatment fraction. There were a total of 257 case reviews: 60 at the post-contouring stage, 197 at the post-planning stage, including 46 patients reviewed at both time points. Overall rates of A, B1, B2 and C outcomes were 78%, 9%, 4% and 9%, respectively. The most common reason for a B or C outcome was related to target volume definition. Only 56% of C outcomes at the post-planning stage would have been detected at the post-contouring stage. Results varied between tumour site groups. 9% of radiotherapy plans reviewed had changes suggested before delivery to the patient. Review at the post-planning stage after plan completion was necessary to detect all suggested changes, but for head and neck cases, all C outcomes could have been detected at the post-contouring stage. More widespread implementation of radiotherapy peer review in the UK is recommended. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

NOx SOx Secondary NAAQS: Integrated Review Plan - CASAC Advisory

EPA Science Inventory

The NOx SOx Secondary NAAQS Integrated Review Plan is the first document generated as part of the National Ambient Air Quality Standards (NAAQS) review process. The Plan presents background information, the schedule for the review, the process to be used in conducting the review,...

Moving toward integrated value-based planning: The issues

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

Chamberlin, J.H.; Braithwait, C.L.

1988-07-01

Integrated Value-Based Planning (IVP) is a promising new planning approach that uses value, as well as cost, as the common denominator for evaluating supply and demand resource options. Planning based on value yields an ''apples to apples'' comparison of utility and customer options. The IVP approach can form the cornerstone of a successful market-driven utility planning strategy. This conference will raise questions, discuss issues, and further the exchange of information regarding the tools, concepts, and techniques needed to put IVP into the utility planner's toolbox. This proceedings is more than a compendium of papers. It is designed to let bothmore » participants and non-participants exchange information. To this end, listings and cross-listings of papers, speakers and participant interest areas, along with the ever-invaluable phone number have been included.« less

Future directions: Integrated resource planning

NASA Astrophysics Data System (ADS)

Bauer, D. C.; Eto, J.

Integrated resource planning or IRP is the process for integrating supply- and demand-side resources to provide energy services at a cost that balances the interests of all stakeholders. It now is the resource planning process used by electric utilities in over 30 states. The goals of IRP have evolved from least cost planning and encouragement of demand-side management to broader, more complex issues including core competitive business activity, risk management and sharing, accounting for externalities, and fuel switching between gas and electricity. IRP processes are being extended to other interior regions of the country, to non-investor owned utilities, and to regional (rather than individual utility) planning bases, and to other fuels (natural gas). The comprehensive, multi-valued, and public reasoning characteristics of IRP could be extended to applications beyond energy, e.g., transportation, surface water management, and health care in ways suggested.

The effectiveness of pretreatment physics plan review for detecting errors in radiation therapy

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

Gopan, Olga; Zeng, Jing; Novak, Avrey

Purpose: The pretreatment physics plan review is a standard tool for ensuring treatment quality. Studies have shown that the majority of errors in radiation oncology originate in treatment planning, which underscores the importance of the pretreatment physics plan review. This quality assurance measure is fundamentally important and central to the safety of patients and the quality of care that they receive. However, little is known about its effectiveness. The purpose of this study was to analyze reported incidents to quantify the effectiveness of the pretreatment physics plan review with the goal of improving it. Methods: This study analyzed 522 potentiallymore » severe or critical near-miss events within an institutional incident learning system collected over a three-year period. Of these 522 events, 356 originated at a workflow point that was prior to the pretreatment physics plan review. The remaining 166 events originated after the pretreatment physics plan review and were not considered in the study. The applicable 356 events were classified into one of the three categories: (1) events detected by the pretreatment physics plan review, (2) events not detected but “potentially detectable” by the physics review, and (3) events “not detectable” by the physics review. Potentially detectable events were further classified by which specific checks performed during the pretreatment physics plan review detected or could have detected the event. For these events, the associated specific check was also evaluated as to the possibility of automating that check given current data structures. For comparison, a similar analysis was carried out on 81 events from the international SAFRON radiation oncology incident learning system. Results: Of the 356 applicable events from the institutional database, 180/356 (51%) were detected or could have been detected by the pretreatment physics plan review. Of these events, 125 actually passed through the physics review; however, only 38% (47/125) were actually detected at the review. Of the 81 events from the SAFRON database, 66/81 (81%) were potentially detectable by the pretreatment physics plan review. From the institutional database, three specific physics checks were particularly effective at detecting events (combined effectiveness of 38%): verifying the isocenter (39/180), verifying DRRs (17/180), and verifying that the plan matched the prescription (12/180). The most effective checks from the SAFRON database were verifying that the plan matched the prescription (13/66) and verifying the field parameters in the record and verify system against those in the plan (23/66). Software-based plan checking systems, if available, would have potential effectiveness of 29% and 64% at detecting events from the institutional and SAFRON databases, respectively. Conclusions: Pretreatment physics plan review is a key safety measure and can detect a high percentage of errors. However, the majority of errors that potentially could have been detected were not detected in this study, indicating the need to improve the pretreatment physics plan review performance. Suggestions for improvement include the automation of specific physics checks performed during the pretreatment physics plan review and the standardization of the review process.« less

The effectiveness of pretreatment physics plan review for detecting errors in radiation therapy.

PubMed

Gopan, Olga; Zeng, Jing; Novak, Avrey; Nyflot, Matthew; Ford, Eric

2016-09-01

The pretreatment physics plan review is a standard tool for ensuring treatment quality. Studies have shown that the majority of errors in radiation oncology originate in treatment planning, which underscores the importance of the pretreatment physics plan review. This quality assurance measure is fundamentally important and central to the safety of patients and the quality of care that they receive. However, little is known about its effectiveness. The purpose of this study was to analyze reported incidents to quantify the effectiveness of the pretreatment physics plan review with the goal of improving it. This study analyzed 522 potentially severe or critical near-miss events within an institutional incident learning system collected over a three-year period. Of these 522 events, 356 originated at a workflow point that was prior to the pretreatment physics plan review. The remaining 166 events originated after the pretreatment physics plan review and were not considered in the study. The applicable 356 events were classified into one of the three categories: (1) events detected by the pretreatment physics plan review, (2) events not detected but "potentially detectable" by the physics review, and (3) events "not detectable" by the physics review. Potentially detectable events were further classified by which specific checks performed during the pretreatment physics plan review detected or could have detected the event. For these events, the associated specific check was also evaluated as to the possibility of automating that check given current data structures. For comparison, a similar analysis was carried out on 81 events from the international SAFRON radiation oncology incident learning system. Of the 356 applicable events from the institutional database, 180/356 (51%) were detected or could have been detected by the pretreatment physics plan review. Of these events, 125 actually passed through the physics review; however, only 38% (47/125) were actually detected at the review. Of the 81 events from the SAFRON database, 66/81 (81%) were potentially detectable by the pretreatment physics plan review. From the institutional database, three specific physics checks were particularly effective at detecting events (combined effectiveness of 38%): verifying the isocenter (39/180), verifying DRRs (17/180), and verifying that the plan matched the prescription (12/180). The most effective checks from the SAFRON database were verifying that the plan matched the prescription (13/66) and verifying the field parameters in the record and verify system against those in the plan (23/66). Software-based plan checking systems, if available, would have potential effectiveness of 29% and 64% at detecting events from the institutional and SAFRON databases, respectively. Pretreatment physics plan review is a key safety measure and can detect a high percentage of errors. However, the majority of errors that potentially could have been detected were not detected in this study, indicating the need to improve the pretreatment physics plan review performance. Suggestions for improvement include the automation of specific physics checks performed during the pretreatment physics plan review and the standardization of the review process.

Using task performance to inform treatment planning for youth with ADHD: A systematic review.

PubMed

Molitor, Stephen J; Langberg, Joshua M

2017-12-01

The role that neuropsychological task performance plays in the assessment of Attention-Deficit/Hyperactivity Disorder (ADHD) is currently ambiguous, and findings are mixed regarding whether tasks have validity for diagnosing the disorder. Irrespective of their validity for diagnosing ADHD, neuropsychological tasks could provide valuable information to mental health professionals if they can inform recommendations for treatment targets and modalities. Therefore, this review sought to synthesize the available evidence related to the use of neuropsychological task performance as a tool for informing treatment planning for youth with ADHD. Reviewed studies focused on examinations of associations between task performance and academic, social, and health outcomes, as well as response to treatment. Twenty-five relevant studies using samples of youth diagnosed with ADHD in clinical, community, and school settings were identified. Review of the evidence suggests that task performance may be useful in identifying individuals with ADHD at risk for academic impairment. However, the evidence is less compelling for identifying youth at risk for impaired social functioning or poor health outcomes. The review also found that task performance is likely useful for predicting response to treatment with methylphenidate. Across studies, evidence indicated that interpreting task performance in an integrated manner, such as a factor score or mean score, was more consistently useful for predicting outcomes of interest than interpreting performance from a single task. Implications for the use of tasks in ADHD assessments are discussed, and future directions are outlined for further examining the clinical utility of task performance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Renewable energy in electric utility capacity planning: a decomposition approach with application to a Mexican utility

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

Staschus, K.

1985-01-01

In this dissertation, efficient algorithms for electric-utility capacity expansion planning with renewable energy are developed. The algorithms include a deterministic phase that quickly finds a near-optimal expansion plan using derating and a linearized approximation to the time-dependent availability of nondispatchable energy sources. A probabilistic second phase needs comparatively few computer-time consuming probabilistic simulation iterations to modify this solution towards the optimal expansion plan. For the deterministic first phase, two algorithms, based on a Lagrangian Dual decomposition and a Generalized Benders Decomposition, are developed. The probabilistic second phase uses a Generalized Benders Decomposition approach. Extensive computational tests of the algorithms aremore » reported. Among the deterministic algorithms, the one based on Lagrangian Duality proves fastest. The two-phase approach is shown to save up to 80% in computing time as compared to a purely probabilistic algorithm. The algorithms are applied to determine the optimal expansion plan for the Tijuana-Mexicali subsystem of the Mexican electric utility system. A strong recommendation to push conservation programs in the desert city of Mexicali results from this implementation.« less

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

NASA Technical Reports Server (NTRS)

Choo, Y. K.

1983-01-01

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

13. Site D57 & 58C, Layout and Utility Plan, U.S. ...

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

13. Site D-57 & 58-C, Layout and Utility Plan, U.S. Army Corps of Engineers, 1 March 1957. - Newport NIKE Missile Battery D-57/58, Integrated Fire Control Area, Newport Road, Carleton, Monroe County, MI

Plan characteristics and SSI enrollees' access to and quality of care in four TennCare MCOs.

PubMed

Hill, Steven C; Wooldridge, Judith

2002-10-01

To assess hypotheses about which managed care organization (MCO) characteristics affect access to care and quality of care--including access to specialists, providers' knowledge about disability, and coordination of care--for people with disabilities. Survey of blind/disabled Supplemental Security Income (SSI) enrollees in four MCOs serving TennCare, Tennessee's Medicaid managed care program, in Memphis, conducted from 1998 through spring 1999. We compared enrollee reports of access and quality across the four MCOs using regression methods, and we use case study methods to assess whether patterns both within and across MCOs are consistent with the hypotheses. We conducted computer-assisted telephone surveys and used regression analysis to compare access and quality controlling for enrollee characteristics. Although the four MCOs' characteristics varied, access to providers, coordination of care, and access to some services were generally similar across MCOs. Enrollees in one plan, the only MCO with a larger provider network and that paid physicians on a fee-for-service basis, reported their providers were more knowledgeable, and they had more secondary preventive care visits. Differences found in access to specialists and delays in approving care appear to be unrelated to characteristics reported by the MCOs, but instead may be related to how tightly utilization is reviewed. Plan networks, financial incentives, utilization management methods, and state requirements are important areas for further study, and, in the meantime, ongoing monitoring of SSI enrollees in each MCO may be important for detecting problems and successes.

An analysis of hospital capital planning and financing in three European countries: Using the principal-agent approach to identify the potential for economic problems.

PubMed

Thompson, Ceri R; McKee, Martin

2011-02-01

To explore differences in national approaches to hospital capital planning and financing in three European countries and to understand the roles and positions of the actors involved. Case studies of major new hospital developments were undertaken in each of the study countries (France, Sweden and England), based on a review of documents related to each development and the national framework within which they took place, as well as interviews with key informants. The principal-agent model was used, focusing on identification of differing utilities and information asymmetries. There are substantial differences between countries, for example in relation to the role of the hospital in its own redevelopment, the organisational distance between actors, the institutional level at which decision rights for major investments are exercised, and how principals control the agents. These differences have implications for the processes involved and the nature of economic and health care problems that can arise. There is evidence of, and opportunity for economic problems in all systems but these seems to be greater in France and England where the hospital leads the process, where there is limited involvement by the regional bodies, and informational differences appear greater. We conclude that hospital planning processes should be informed by an explicit understanding of the powerful groups involved and their divergent preferences and utilities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Electrical load management at the Goldstone DSN Complex

NASA Technical Reports Server (NTRS)

Rayburn, J. C.

1981-01-01

A Power Load Management Plan was deveoped which utilizes the unique power generating capabilities of the stations to reduce the stress on the local utility's reserve capacity and reduce the cost of electrical power at the stations. The plan has greatly reduced the cost of Goldstone electrical power by completely eliminating the use of commercial power during the local utility's high usage periods each day.

33 CFR 103.510 - Area Maritime Security (AMS) Plan review and approval.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Area Maritime Security (AMS) Plan review and approval. 103.510 Section 103.510 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF...) Plan § 103.510 Area Maritime Security (AMS) Plan review and approval. Each AMS Plan will be submitted...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2010 CFR

2010-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2011 CFR

2011-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2012 CFR

2012-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2013 CFR

2013-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... of this part must be submitted. (c) Revisions or amendments to an approved response plan must be...

75 FR 29588 - Office of New Reactors: Proposed NUREG-0800; Standard Review Plan Section 13.6.6, Draft Revision...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-26

... NUCLEAR REGULATORY COMMISSION [NRC-2010-0184] Office of New Reactors: Proposed NUREG-0800; Standard Review Plan Section 13.6.6, Draft Revision 0 on Cyber Security Plan AGENCY: Nuclear Regulatory... Plants,'' on a proposed Standard Review Plan (SRP) Section 13.6.6 on ``Cyber Security Plan'' (Agencywide...

From reaching every district to reaching every community: analysis and response to the challenge of equity in immunization in Cambodia.

PubMed

Chan Soeung, Sann; Grundy, John; Duncan, Richard; Thor, Rasoka; Bilous, Julian B

2013-08-01

BACKGROUND An international review of the Cambodian Expanded Programme on Immunization (EPI) in 2010 and other data show that despite immunization coverage increases and vaccine preventable diseases incidence reductions, inequities in access to immunization services exist. Utilizing immunization and health systems literature, analysis of global health databases and the EPI review findings, this paper examines the characteristics of immunization access and outcome inequities, and describes proposed longer-term strategic and operational responses to these problems. Findings The national programme has evolved from earlier central and provincial level planning to strengthening routine immunization coverage through the District level 'Reaching Every District Strategy'. However, despite remarkable improvements, the review found over 20% of children surveyed were not fully immunized, primarily from communities where inequities of both access and impact persist. These inequities relate mainly to socio-economic exposures including wealth and education level, population mobility and ethnicity. To address these problems, a shift in strategic and operational response is proposed that will include (a) a re-focus of planning on facility level to detect disadvantaged communities, (b) establishment of monitoring systems to provide detailed information on community access and utilization, (c) development of communication strategies and health networks that enable providers to adjust service delivery according to the needs of vulnerable populations, and (d) securing financial, management and political commitment for 'reaching every community'. CONCLUSIONS For Cambodia to achieve its immunization equity objectives and disease reduction goals, a shift of emphasis to health centre and community is needed. This approach will maximize the benefits of new vaccine introduction in the coming 'Decade of Vaccines', plus potentially extend the reach of other life-saving maternal and child health interventions to the socially disadvantaged, both in Cambodia and in other countries with a similar level of development.

42 CFR 457.150 - CMS review of State plan material.

Code of Federal Regulations, 2013 CFR

2013-10-01

... State plan material. (a) Basis for action. CMS reviews each State plan and plan amendment to determine... on complete plan. CMS approves or disapproves the State plan or plan amendment only in its entirety... disapprove the State plan or plan amendment, or to determine that previously approved material no longer...

Implant Utilization and Time to Prosthetic Rehabilitation in Conventional and Advanced Fibular Free Flap Reconstruction of the Maxilla and Mandible.

PubMed

Chuka, Richelle; Abdullah, Wael; Rieger, Jana; Nayar, Suresh; Seikaly, Hadi; Osswald, Martin; Wolfaardt, Johan

Precisely designed jaw reconstruction rehabilitation (JRR) is important to the integrity of the jaw structure and oral functions. Advanced three-dimensional (3D) digital surgical design and simulation (SDS) techniques have the potential to reduce time to reconstructive and dental treatment completion, thereby promoting early functional oral rehabilitation. This study investigated the use of SDS in JRR procedures. A retrospective chart review was conducted on adult head and neck tumor (HNT) participants who completed JRR treatment with a fibular free flap (FFF) reconstruction. Two treatment approaches, advanced 3D SDS technique (with-SDS) and conventional, nondigitally planned technique (without-SDS), included the use of osseointegrated implants. Data were collected from adult patients treated between January 2000 and March 2014 at the Institute for Reconstructive Sciences in Medicine (iRSM). Participants were excluded if they underwent a bone-containing augmentation to the FFF reconstruction. The without-SDS group underwent a conventional, nonguided FFF reconstruction followed by nonguided implant placement. The with-SDS group underwent a guided FFF reconstruction with guided implant placement during the reconstructive surgery. The outcome measures included implant utilization (ratio of implants placed to connected) and time to prosthetic connection after FFF reconstruction. Mann-Whitney U test was used to analyze the data. The digital SDS technique (with-SDS) group completed prosthetic treatment with a significantly higher utilization of implants as well as a significantly shorter time to prosthetic delivery. SDS allows an interdisciplinary treatment team to work together to create a virtual plan that leads to greater efficiency in patient treatment time and utilization of dental implants.

Engineering aspects of geothermal development with emphasis on the Imperial Valley of California

NASA Technical Reports Server (NTRS)

Goldsmith, M.

1978-01-01

This review was prepared in support of a geothermal planning activity of the County of Imperial. Engineering features of potential geothermal development are outlined. Acreage requirements for drilling and powerplants are estimated, as are the costs for wells, fluid transmission pipes, and generating stations. Rough scaling relationships are developed for cost factors as a function of reservoir temperature. Estimates are made for cooling water requirements, and possible sources of cooling water are discussed. Availability and suitability of agricultural wastewater for cooling are emphasized. The utility of geothermal resources for fresh water production in the Imperial Valley is considered.

Space Station Freedom - Optimized to support microgravity research and earth observations

NASA Technical Reports Server (NTRS)

Bilardo, Vincent J., Jr.; Herman, Daniel J.

1990-01-01

The Space Station Freedom Program is reviewed, with particular attention given to the Space Station configuration, program elements description, and utilization accommodation. Since plans call for the assembly of the initial SSF configuration over a 3-year time span, it is NASA's intention to perform useful research on it during the assembly process. The research will include microgravity experiments and observational sciences. The specific attributes supporting these attempts are described, such as maintainance of a very low microgravity level and continuous orientation of the vehicle to maintain a stable, accurate local-vertical/local-horizontal attitude.

SAGA: A project to automate the management of software production systems

NASA Technical Reports Server (NTRS)

Campbell, R. H.

1983-01-01

The current work in progress for the SAGA project are described. The highlights of this research are: a parser independent SAGA editor, design for the screen editing facilities of the editor, delivery to NASA of release 1 of Olorin, the SAGA parser generator, personal workstation environment research, release 1 of the SAGA symbol table manager, delta generation in SAGA, requirements for a proof management system, documentation for and testing of the cyber pascal make prototype, a prototype cyber-based slicing facility, a June 1984 demonstration plan, SAGA utility programs, summary of UNIX software engineering support, and theorem prover review.

A systematic, multimodality approach to emergency elbow imaging.

PubMed

Singer, Adam D; Hanna, Tarek; Jose, Jean; Datir, Abhijit

2016-01-01

The elbow is a complex synovial hinge joint that is frequently involved in both athletic and nonathletic injuries. A thorough understanding of the normal anatomy and various injury patterns is essential when utilizing diagnostic imaging to identify damaged structures and to assist in surgical planning. In this review, the elbow anatomy will be scrutinized in a systematic approach. This will be followed by a comprehensive presentation of elbow injuries that are commonly seen in the emergency department accompanied by multimodality imaging findings. A short discussion regarding pitfalls in elbow imaging is also included. Copyright © 2015 Elsevier Inc. All rights reserved.

Magnetic Resonance Imaging and Arthroscopic Correlation in Shoulder Instability.

PubMed

Knapik, Derrick M; Voos, James E

2017-12-01

The shoulder is the most inherently unstable joint in the body, prone to high rates of anterior dislocations with subsequent injuries to soft tissue and bony stabilizing structures, resulting in recurrent shoulder instability. Advanced imaging utilizing magnetic resonance (MR) imaging and MR arthrography allows for thorough evaluation of lesions present in the unstable shoulder and is critical for preoperative planning. Arthroscopic shoulder stabilization in the appropriately selected patient can help restore stability and function. This review highlights correlations between MR imaging and arthroscopy of the most commonly reported soft tissue and bony injuries present in patients with shoulder instability.

The NASA automation and robotics technology program

NASA Technical Reports Server (NTRS)

Holcomb, Lee B.; Montemerlo, Melvin D.

1986-01-01

The development and objectives of the NASA automation and robotics technology program are reviewed. The objectives of the program are to utilize AI and robotics to increase the probability of mission success; decrease the cost of ground control; and increase the capability and flexibility of space operations. There is a need for real-time computational capability; an effective man-machine interface; and techniques to validate automated systems. Current programs in the areas of sensing and perception, task planning and reasoning, control execution, operator interface, and system architecture and integration are described. Programs aimed at demonstrating the capabilities of telerobotics and system autonomy are discussed.

Status and future of Quantitative Microbiological Risk Assessment in China

PubMed Central

Dong, Q.L.; Barker, G.C.; Gorris, L.G.M.; Tian, M.S.; Song, X.Y.; Malakar, P.K.

2015-01-01

Since the implementation of the Food Safety Law of the People's Republic of China in 2009 use of Quantitative Microbiological Risk Assessment (QMRA) has increased. QMRA is used to assess the risk posed to consumers by pathogenic bacteria which cause the majority of foodborne outbreaks in China. This review analyses the progress of QMRA research in China from 2000 to 2013 and discusses 3 possible improvements for the future. These improvements include planning and scoping to initiate QMRA, effectiveness of microbial risk assessment utility for risk management decision making, and application of QMRA to establish appropriate Food Safety Objectives. PMID:26089594

Prevalence of self-medication and associated factors in an elderly population: a systematic review.

PubMed

Jerez-Roig, Javier; Medeiros, Lucas F B; Silva, Victor A B; Bezerra, Camila L P A M; Cavalcante, Leandro A R; Piuvezam, Grasiela; Souza, Dyego L B

2014-12-01

The aging of the world populat ion together with changes in the epidemiological profile of diseases have led to increases in both the consumption of medicines and health expenses. In this context, self-medication has gained importance as a rapid treatment that bypasses bureaucracy and, in some instances, delays in obtaining medical assistance. Verification of self-medication prevalence and associated factors in the elderly, as well as identification of the main categories of non-prescription drugs utilized. The following databases were utilized: Cochrane, PubMed, Scopus, LILACS, SciELO, PAHO, MedCarib and WHOLIS. Studies on the prevalence of self-medication in community-dwelling elderly were included. Review studies were excluded, as well as MSc dissertations, PhD theses and research with convenience sampling. Community-dwelling individuals aged 60 years or over. A systematic review of population-based articles published up until September 1, 2014, is presented. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Statement was applied for critical assessment of the articles, and those with a minimum score of 60% were selected for inclusion in the review. Thirty-six articles were selected, of which 28 were included after critical reading. The prevalence of self-medication varied between 4 and 87%, and the majority of studies reported values between 20 and 60%. The mean prevalence reported in the articles was 38%, but several criteria were utilized to measure self-medication. The most commonly utilized non-prescription drugs were analgesics and antipyretics, followed by non-hormonal anti-inflammatories, cardiovascular agents, dietary complements and alternative medicine components. The variables that presented positive associations with self-medication were female sex, visits to pharmacists, depression, functional dependency, recent hospitalization, oral pain, restriction of activities and physical inactivity. The variables with negative associations were medical appointments, married status, use of health services, satisfaction with living arrangements, living in institutional settings and private health plans. Different definitions of self-medication were employed in the identified articles, which hindered the comparison between studies and meta-analysis. Only 15 studies analysed associated factors and a minority carried out multivariate data analysis. Self-medication is frequent among the elderly, with different prevalence values found in the selected studies, probably because of heterogeneity in definitions and samples. Future studies are necessary, utilizing a standard self-medication criterion to facilitate comparison and elucidate the factors associated with this behaviour.

Factors associated with utilization of long-acting and permanent contraceptive methods among women who have decided not to have more children in Gondar city.

PubMed

Zenebe, Chernet Baye; Adefris, Mulat; Yenit, Melaku Kindie; Gelaw, Yalemzewod Assefa

2017-09-06

Despite the fact that long acting family planning methods reduce population growth and improve maternal health, their utilization remains poor. Therefore, this study assessed the prevalence of long acting and permanent family planning method utilization and associated factors among women in reproductive age groups who have decided not to have more children in Gondar city, northwest Ethiopia. An institution based cross-sectional study was conducted from August to October, 2015. Three hundred seventeen women who have decided not to have more children were selected consecutively into the study. A structured and pretested questionnaire was used to collect data. Both bivariate and multi-variable logistic regressions analyses were used to identify factors associated with utilization of long acting and permanent family planning methods. The multi-variable logistic regression analysis was used to investigate factors associated with the utilization of long acting and permanent family planning methods. The Adjusted Odds Ratio (AOR) with the corresponding 95% Confidence Interval (CI) was used to show the strength of associations, and variables with a P-value of <0.05 were considered statistically significant. In this study, the overall prevalence of long acting and permanent contraceptive (LAPCM) method utilization was 34.7% (95% CI: 29.5-39.9). According to the multi-variable logistic regression analysis, utilization of long acting and permanent contraceptive methods was significantly associated with women who had secondary school, (AOR: 2279, 95% CI: 1.17, 4.44), college, and above education (AOR: 2.91, 95% CI: 1.36, 6.24), history of previous utilization (AOR: 3.02, 95% CI: 1.69, 5.38), and information about LAPCM (AOR: 8.85, 95% CI: 2.04, 38.41). In this study the prevalence of long acting and permanent family planning method utilization among women who have decided not to have more children was high compared with previous studies conducted elsewhere. Advanced educational status, previous utilization of LAPCM, and information on LAPCM were significantly associated with the utilization of LAPCM. As a result, strengthening behavioral change communication channels to make information accessible is highly recommended.

Planning Electric Transmission Lines: A Review of Recent Regional Transmission Plans

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

Eto, Joseph H.

The first Quadrennial Energy Review (QER) recommends that the U.S. Department of Energy (DOE) conduct a national review of transmission plans and assess the barriers and incentives to their implementation. DOE tasked Lawrence Berkeley National Laboratory (LBNL) to prepare two reports to support the agency’s response to this recommendation. This report reviews regional transmission plans and regional transmission planning processes that have been directed by Federal Energy Regulatory Commission (FERC) Order Nos. 890 and 1000. We focus on the most recent regional transmission plans (those issued in 2015 and through approximately mid-year 2016) and current regional transmission planning processes. Amore » companion report focuses on non-plan-related factors that affect transmission projects.« less

Directly Improving the Quality of Radiation Treatment Through Peer Review: A Cross-sectional Analysis of Cancer Centers Across a Provincial Cancer Program.

PubMed

Rouette, Julie; Gutierrez, Eric; O'Donnell, Jennifer; Reddeman, Lindsay; Hart, Margaret; Foxcroft, Sophie; Mitera, Gunita; Warde, Padraig; Brundage, Michael D

2017-07-01

To describe the outcomes of peer review across all 14 cancer centers in Ontario. We identified all peer-reviewed, curative treatment plans delivered in Ontario within a 3-month study period from 2013 to 2014 using a provincial cancer treatment database and collected additional data on the peer-review outcomes. Considerable variation was found in the proportion of peer-reviewed plans across the centers (average 70.2%, range 40.8%-99.2%). During the study period, 5561 curative plans underwent peer review. Of those, 184 plans (3.3%) had changes recommended. Of the 184 plans, the changes were major (defined as requiring repeat planning or having a major effect on planning or clinical outcomes, or both) in 40.2% and minor in 47.8%. For the remaining 12.0%, data were missing. The proportions of recommended changes varied among disease sites (0.0%-7.0%). The disease sites with the most recommended changes to treatment plans after peer review and with the greatest potential for benefit were the esophagus (7.0%), uterus (6.7%), upper limb (6.3%), cervix and lower limb (both 6.0%), head and neck and bilateral lung (both 5.9%), right supraclavicular lymph nodes (5.7%), rectum (5.3%), and spine (5.0%). Although the heart is an organ at risk in left-sided breast treatment plans, the proportions of recommended changes did not significantly differ between the left breast treatment plans (3.0%, 95% confidence interval 2.0%-4.5%) and right breast treatment plans (2.4%, 95% confidence interval 1.5%-3.8%). The recommended changes were more frequently made when peer review occurred before radiation therapy (3.8%) than during treatment (1.4%-2.8%; P=.0048). The proportion of plans with recommended changes was not significantly associated with patient volume (P=.23), peer-review performance (P=.36), or center academic status (P=.75). Peer review of treatment plans directly affects the quality of care by identifying important clinical and planning changes. Provincial strategies are underway to optimize its conduct in radiation oncology. Copyright © 2016. Published by Elsevier Inc.

Efficiency improvements of offline metrology job creation

NASA Astrophysics Data System (ADS)

Zuniga, Victor J.; Carlson, Alan; Podlesny, John C.; Knutrud, Paul C.

1999-06-01

Progress of the first lot of a new design through the production line is watched very closely. All performance metrics, cycle-time, in-line measurement results and final electrical performance are critical. Rapid movement of this lot through the line has serious time-to-market implications. Having this material waiting at a metrology operation for an engineer to create a measurement job plan wastes valuable turnaround time. Further, efficient use of a metrology system is compromised by the time required to create and maintain these measurement job plans. Thus, having a method to develop metrology job plans prior to the actual running of the material through the manufacture area can significantly improve both cycle time and overall equipment efficiency. Motorola and Schlumberger have worked together to develop and test such a system. The Remote Job Generator (RJG) created job plans for new device sin a manufacturing process from an NT host or workstation, offline. This increases available system tim effort making production measurements, decreases turnaround time on job plan creation and editing, and improves consistency across job plans. Most importantly this allows job plans for new devices to be available before the first wafers of the device arrive at the tool for measurement. The software also includes a database manager which allows updates of existing job plans to incorporate measurement changes required by process changes or measurement optimization. This paper will review the result of productivity enhancements through the increased metrology utilization and decreased cycle time associated with the use of RJG. Finally, improvements in process control through better control of Job Plans across different devices and layers will be discussed.

3D Printing: current use in facial plastic and reconstructive surgery.

PubMed

Hsieh, Tsung-Yen; Dedhia, Raj; Cervenka, Brian; Tollefson, Travis T

2017-08-01

To review the use of three-dimensional (3D) printing in facial plastic and reconstructive surgery, with a focus on current uses in surgical training, surgical planning, clinical outcomes, and biomedical research. To evaluate the limitations and future implications of 3D printing in facial plastic and reconstructive surgery. Studies reviewed demonstrated 3D printing applications in surgical planning including accurate anatomic biomodels, surgical cutting guides in reconstruction, and patient-specific implants fabrication. 3D printing technology also offers access to well tolerated, reproducible, and high-fidelity/patient-specific models for surgical training. Emerging research in 3D biomaterial printing have led to the development of biocompatible scaffolds with potential for tissue regeneration in reconstruction cases involving significant tissue absence or loss. Major limitations of utilizing 3D printing technology include time and cost, which may be offset by decreased operating times and collaboration between departments to diffuse in-house printing costs SUMMARY: The current state of the literature shows promising results, but has not yet been validated by large studies or randomized controlled trials. Ultimately, further research and advancements in 3D printing technology should be supported as there is potential to improve resident training, patient care, and surgical outcomes.

Review of crisis resource management (CRM) principles in the setting of intraoperative malignant hyperthermia.

PubMed

Isaak, Robert Scott; Stiegler, Marjorie Podraza

2016-04-01

The practice of medicine is characterized by routine and typical cases whose management usually goes according to plan. However, the occasional case does arise which involves rare catastrophic emergencies, such as intraoperative malignant hyperthermia (MH), which require a comprehensive, coordinated, and resource-intensive treatment plan. Physicians are expected to provide expert quality care for routine, typical cases, but is it reasonable to expect the same standard of expertise and comprehensive management when the emergency involves a rare entity? Although physicians would like to say yes to this question, the reality is that no physician will ever amass the amount of experience in patient care needed to truly qualify as an expert in the management of a rare emergency entity, such as MH. However, physicians can become expert in the global process of managing emergencies by using the principles of crisis resource management (CRM). In this article, we review the key concepts of CRM, using a real life example of a team who utilized CRM principles to successfully manage an intraoperative MH crisis, despite there being no one on the team who had ever previously encountered a true MH crisis.

Multimodal neuroimaging in presurgical evaluation of drug-resistant epilepsy☆

PubMed Central

Zhang, Jing; Liu, Weifang; Chen, Hui; Xia, Hong; Zhou, Zhen; Mei, Shanshan; Liu, Qingzhu; Li, Yunlin

2013-01-01

Intracranial EEG (icEEG) monitoring is critical in epilepsy surgical planning, but it has limitations. The advances of neuroimaging have made it possible to reveal epileptic abnormalities that could not be identified previously and improve the localization of the seizure focus and the vital cortex. A frequently asked question in the field is whether non-invasive neuroimaging could replace invasive icEEG or reduce the need for icEEG in presurgical evaluation. This review considers promising neuroimaging techniques in epilepsy presurgical assessment in order to address this question. In addition, due to large variations in the accuracies of neuroimaging across epilepsy centers, multicenter neuroimaging studies are reviewed, and there is much need for randomized controlled trials (RCTs) to better reveal the utility of presurgical neuroimaging. The results of multiple studies indicate that non-invasive neuroimaging could not replace invasive icEEG in surgical planning especially in non-lesional or extratemporal lobe epilepsies, but it could reduce the need for icEEG in certain cases. With technical advances, multimodal neuroimaging may play a greater role in presurgical evaluation to reduce the costs and risks of epilepsy surgery, and provide surgical options for more patients with drug-resistant epilepsy. PMID:24282678

Creating an outpatient center of excellence in CT.

PubMed

Itri, Jason N; Bakow, Eric; Woods, Jordan

2014-12-01

CT examinations represent a substantial portion of the workload for many radiology departments, and optimizing service delivery is a critical function to ensure customer satisfaction. This article describes how the Six Sigma methodology was used in the radiology department at a large academic hospital to improve the patient experience and increase CT capacity while reducing waste and improving staff satisfaction. The 5 distinct phases of Six Sigma are reviewed as they apply to our CT Center of Excellence project: define, measure, analyze, improve, and control. Process metrics used in this project include the percentage of outpatient CT exams started within 5 minutes of the scheduled appointment time, and the number of studies with protocols selected >48 hours before the CT exam is performed. Outcome metrics include monthly department expense per scan and CT Press Ganey "standard test and treatment" mean scores. An approach to developing interventions is described based on identifying critical sources of variation, ranking these by creating risk prioritization numbers, performing root cause analysis, and utilizing the failure mode and effects analysis tool to prioritize possible solutions. Finally, the key features of action plans and a control plan are reviewed. Copyright © 2014 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Concurrent planning and execution for a walking robot

NASA Astrophysics Data System (ADS)

Simmons, Reid

1990-07-01

The Planetary Rover project is developing the Ambler, a novel legged robot, and an autonomous software system for walking the Ambler over rough terrain. As part of the project, we have developed a system that integrates perception, planning, and real-time control to navigate a single leg of the robot through complex obstacle courses. The system is integrated using the Task Control Architecture (TCA), a general-purpose set of utilities for building and controlling distributed mobile robot systems. The walking system, as originally implemented, utilized a sequential sense-plan-act control cycle. This report describes efforts to improve the performance of the system by concurrently planning and executing steps. Concurrency was achieved by modifying the existing sequential system to utilize TCA features such as resource management, monitors, temporal constraints, and hierarchical task trees. Performance was increased in excess of 30 percent with only a relatively modest effort to convert and test the system. The results lend support to the utility of using TCA to develop complex mobile robot systems.

Who does workforce planning well? Workforce review team rapid review summary.

PubMed

Curson, J A; Dell, M E; Wilson, R A; Bosworth, D L; Baldauf, B

2010-01-01

This paper sets out to disseminate new knowledge about workforce planning, a crucial health sector issue. The Health Select Committee criticised NHS England's failure to develop and apply effective workforce planning. The Workforce Review Team (WRT) commissioned the Institute for Employment Research, Warwick University, to undertake a "rapid review" of global literature to identify good practice. A workforce planning overview, its theoretical principles, good practice exemplars are provided before discussing their application to healthcare. The literature review, undertaken September-November 2007, determined the current workforce planning evidence within and outside health service provision and any consensus on successful workforce planning. Much of the literature was descriptive and there was a lack of comparative or evaluative research-based evidence to inform U.K. healthcare workforce planning. Workforce planning practices were similar in other countries. There was no evidence to challenge current WRT approaches to NHS England workforce planning. There are a number of indications about how this might be extended and improved, given additional resources. The evidence-base for workforce planning would be strengthened by robust and authoritative studies. Systematic workforce planning is a key healthcare quality management element. This review highlights useful information that can be turned into knowledge by informed application to the NHS. Best practice in other sectors and other countries appears to warrant exploration.

The Business Case for Payer Support of a Community-Based Health Information Exchange: A Humana Pilot Evaluating Its Effectiveness in Cost Control for Plan Members Seeking Emergency Department Care

PubMed Central

Tzeel, Albert; Lawnicki, Victor; Pemble, Kim R.

2011-01-01

Background As emergency department utilization continues to increase, health plans must limit their cost exposure, which may be driven by duplicate testing and a lack of medical history at the point of care. Based on previous studies, health information exchanges (HIEs) can potentially provide health plans with the ability to address this need. Objective To assess the effectiveness of a community-based HIE in controlling plan costs arising from emergency department care for a health plan's members. Albert Tzeel Methods The study design was observational, with an eligible population (N = 1482) of fully insured plan members who sought emergency department care on at least 2 occasions during the study period, from December 2008 through March 2010. Cost and utilization data, obtained from member claims, were matched to a list of persons utilizing the emergency department where HIE querying could have occurred. Eligible members underwent propensity score matching to create a test group (N = 326) in which the HIE database was queried in all emergency department visits, and a control group (N = 325) in which the HIE database was not queried in any emergency department visit. Results Post–propensity matching analysis showed that the test group achieved an average savings of $29 per emergency department visit compared with the control group. Decreased utilization of imaging procedures and diagnostic tests drove this cost-savings. Conclusions When clinicians utilize HIE in the care of patients who present to the emergency department, the costs borne by a health plan providing coverage for these patients decrease. Although many factors can play a role in this finding, it is likely that HIEs obviate unnecessary service utilization through provision of historical medical information regarding specific patients at the point of care. PMID:25126351

Actual and potential use of population viability analyses in recovery of plant species listed under the US endangered species act.

PubMed

Zeigler, Sara L; Che-Castaldo, Judy P; Neel, Maile C

2013-12-01

Use of population viability analyses (PVAs) in endangered species recovery planning has been met with both support and criticism. Previous reviews promote use of PVA for setting scientifically based, measurable, and objective recovery criteria and recommend improvements to increase the framework's utility. However, others have questioned the value of PVA models for setting recovery criteria and assert that PVAs are more appropriate for understanding relative trade-offs between alternative management actions. We reviewed 258 final recovery plans for 642 plants listed under the U.S. Endangered Species Act to determine the number of plans that used or recommended PVA in recovery planning. We also reviewed 223 publications that describe plant PVAs to assess how these models were designed and whether those designs reflected previous recommendations for improvement of PVAs. Twenty-four percent of listed species had recovery plans that used or recommended PVA. In publications, the typical model was a matrix population model parameterized with ≤5 years of demographic data that did not consider stochasticity, genetics, density dependence, seed banks, vegetative reproduction, dormancy, threats, or management strategies. Population growth rates for different populations of the same species or for the same population at different points in time were often statistically different or varied by >10%. Therefore, PVAs parameterized with underlying vital rates that vary to this degree may not accurately predict recovery objectives across a species' entire distribution or over longer time scales. We assert that PVA, although an important tool as part of an adaptive-management program, can help to determine quantitative recovery criteria only if more long-term data sets that capture spatiotemporal variability in vital rates become available. Lacking this, there is a strong need for viable and comprehensive methods for determining quantitative, science-based recovery criteria for endangered species with minimal data availability. Uso Actual y Potencial del Análisis de Viabilidad Poblacional para la Recuperación de Especies de Plantas Enlistadas en el Acta de Especies En Peligro de E.U.A. © 2013 Society for Conservation Biology.

Study of research and development requirements of small gas-turbine combustors

NASA Technical Reports Server (NTRS)

Demetri, E. P.; Topping, R. F.; Wilson, R. P., Jr.

1980-01-01

A survey is presented of the major small-engine manufacturers and governmental users. A consensus was undertaken regarding small-combustor requirements. The results presented are based on an evaluation of the information obtained in the course of the study. The current status of small-combustor technology is reviewed. The principal problems lie in liner cooling, fuel injection, part-power performance, and ignition. Projections of future engine requirements and their effect on the combustor are discussed. The major changes anticipated are significant increases in operating pressure and temperature levels and greater capability of using heavier alternative fuels. All aspects of combustor design are affected, but the principal impact is on liner durability. An R&D plan which addresses the critical combustor needs is described. The plan consists of 15 recommended programs for achieving necessary advances in the areas of liner thermal design, primary-zone performance, fuel injection, dilution, analytical modeling, and alternative-fuel utilization.

Designing insurance to promote use of childhood obesity prevention services.

PubMed

Rask, Kimberly J; Gazmararian, Julie A; Kohler, Susan S; Hawley, Jonathan N; Bogard, Jenny; Brown, Victoria A

2013-01-01

Childhood obesity is a recognized public health crisis. This paper reviews the lessons learned from a voluntary initiative to expand insurance coverage for childhood obesity prevention and treatment services in the United States. In-depth telephone interviews were conducted with key informants from 16 participating health plans and employers in 2010-11. Key informants reported difficulty ensuring that both providers and families were aware of the available services. Participating health plans and employers are beginning new tactics including removing enrollment requirements, piloting enhanced outreach to selected physician practices, and educating providers on effective care coordination and use of obesity-specific billing codes through professional organizations. The voluntary initiative successfully increased private health insurance coverage for obesity services, but the interviews described variability in implementation with both best practices and barriers identified. Increasing utilization of obesity-related health services in the long term will require both family- and provider-focused interventions in partnership with improved health insurance coverage.

Quality control and quality assurance plan for bridge channel-stability assessments in Massachusetts

USGS Publications Warehouse

Parker, Gene W.; Pinson, Harlow

1993-01-01

A quality control and quality assurance plan has been implemented as part of the Massachusetts bridge scour and channel-stability assessment program. This program is being conducted by the U.S. Geological Survey, Massachusetts-Rhode Island District, in cooperation with the Massachusetts Highway Department. Project personnel training, data-integrity verification, and new data-management technologies are being utilized in the channel-stability assessment process to improve current data-collection and management techniques. An automated data-collection procedure has been implemented to standardize channel-stability assessments on a regular basis within the State. An object-oriented data structure and new image management tools are used to produce a data base enabling management of multiple data object classes. Data will be reviewed by assessors and data base managers before being merged into a master bridge-scour data base, which includes automated data-verification routines.

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.

Contractor and government - Teamwork and commitment

NASA Technical Reports Server (NTRS)

Griffin, G. D.

1985-01-01

Procedures being implemented at NASA to improve cooperation with contractors and increase productivity are reviewed from the NASA point of view. The goals of the U.S. space program for the coming 25 years are listed, and the importance of the commercial utilization of space in these plans is stressed. Consideration is given to the ongoing American Productivity Center White-Collar Productivity-Improvement Project, the implementation of the recommendations of the 1984 NASA/Contractor Conferences in present and future contracts, and the use of incentive contracts to create situations in which both NASA and the contractor benefit from increased productivity. Future plans call for increased industry responsibility in managing and operating the STS; steamlining of Shuttle operations; advanced design-to-cost procedures, increased commonality, better NASA-contractor communications, and more use of CAD/CAM and robotics for the Space Station; and accommodation of greatly expanded private investment and exploitation of space.

PSNs: a new model for Medicare risk contracting.

PubMed

Prescott, F M

1997-03-01

The 1995 Republican House Medicare reform proposal introduced the provider services network (PSN) concept as a new healthcare delivery model for accepting and administering Medicare risk contracts. A PSN operates much like an HMO, but is not subject to the reserve requirements established for HMOs. Providers that want to enter the Medicare risk contracting arena and exercise more control over the delivery of healthcare services may consider forming a PSN. To form a PSN, providers must be sufficiently capitalized to compete with HMOs, create a formal legal organization, and develop a financial plan. To ensure that its goals are met, the PSN must develop a sales promotion plan, enroll members, control and monitor financial resources and clinical outcomes, and implement a management information system. Other crucial capabilities that a PSN must develop include establishing mechanisms for utilization review, membership information maintenance, claims adjudication, physician credentialing, quality assurance, and member grievance procedures.

The development of a program analysis environment for Ada

NASA Technical Reports Server (NTRS)

Brown, David B.; Carlisle, Homer W.; Chang, Kai-Hsiung; Cross, James H.; Deason, William H.; Haga, Kevin D.; Huggins, John R.; Keleher, William R. A.; Starke, Benjamin B.; Weyrich, Orville R.

1989-01-01

A unit level, Ada software module testing system, called Query Utility Environment for Software Testing of Ada (QUEST/Ada), is described. The project calls for the design and development of a prototype system. QUEST/Ada design began with a definition of the overall system structure and a description of component dependencies. The project team was divided into three groups to resolve the preliminary designs of the parser/scanner: the test data generator, and the test coverage analyzer. The Phase 1 report is a working document from which the system documentation will evolve. It provides history, a guide to report sections, a literature review, the definition of the system structure and high level interfaces, descriptions of the prototype scope, the three major components, and the plan for the remainder of the project. The appendices include specifications, statistics, two papers derived from the current research, a preliminary users' manual, and the proposal and work plan for Phase 2.

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

Medicare Part D Roulette: Potential Implications of Random Assignment and Plan Restrictions

PubMed Central

Patel, Rajul A.; Walberg, Mark P.; Woelfel, Joseph A.; Amaral, Michelle M.; Varu, Paresh

2013-01-01

Background Dual-eligible (Medicare/Medicaid) beneficiaries are randomly assigned to a benchmark plan, which provides prescription drug coverage under the Part D benefit without consideration of their prescription drug profile. To date, the potential for beneficiary assignment to a plan with poor formulary coverage has been minimally studied and the resultant financial impact to beneficiaries unknown. Objective We sought to determine cost variability and drug use restrictions under each available 2010 California benchmark plan. Methods Dual-eligible beneficiaries were provided Part D plan assistance during the 2010 annual election period. The Medicare Web site was used to determine benchmark plan costs and prescription utilization restrictions for each of the six California benchmark plans available for random assignment in 2010. A standardized survey was used to record all de-identified beneficiary demographic and plan specific data. For each low-income subsidy-recipient (n = 113), cost, rank, number of non-formulary medications, and prescription utilization restrictions were recorded for each available 2010 California benchmark plan. Formulary matching rates (percent of beneficiary's medications on plan formulary) were calculated for each benchmark plan. Results Auto-assigned beneficiaries had only a 34% chance of being assigned to the lowest cost plan; the remainder faced potentially significant avoidable out-of-pocket costs. Wide variations between benchmark plans were observed for plan cost, formulary coverage, formulary matching rates, and prescription utilization restrictions. Conclusions Beneficiaries had a 66% chance of being assigned to a sub-optimal plan; thereby, they faced significant avoidable out-of-pocket costs. Alternative methods of beneficiary assignment could decrease beneficiary and Medicare costs while also reducing medication non-compliance. PMID:24753963

Comments in reply: new directions in migration research.

PubMed

Shaw, R P

1986-01-01

The author comments on a review of his recent book NEW DIRECTIONS IN MIGRATION RESEARCH and reflects on theory and model specification, problems of estimation and statistical inference, realities of temporal and spatial heterogeneity, choices of explanatory variables, and the importance of broader political issues in migration studies. A core hypothesis is that market forces have declined as influences on internal migration in Canada over the last 30 years. Theoretical underpinnings include declining relevance of wage considerations in the decision to migrate on the assumption that marginal utility of money diminishes and marginal utility of leisure increases as society becomes wealthier. The author perceives the human capital model to have limitations and is especially troubled by the "as if" clause--that all migrants behave "as if" they calculate benefits and risks with equal rigor. The author has "shadowed" and not quantified the costs involved. He implies that normative frameworks for future migration research and planning should be established.

Wind - Prototypes on the landscape

NASA Astrophysics Data System (ADS)

Smith, M. L.

1981-12-01

Large wind turbines are shown to be attractive to utilities because of the potential for decreasing gas and oil consumption, the relatively low costs for entry into the field, and the wide distribution of wind energy. The total generating capacity can be increased in incremental steps, experience in construction and operation of large turbines have been gained from the NASA Mod O, OA, 1, and 2 models, and advances in manufacturing processes will make the large turbines competitive as replacement power for oil and gas burning utility generators. The 300 ft rotor Mod 2 machines are described, along with designs for the Mod 5A and Mod 5B wind turbines, with 400 and 422 ft, 6.2 and 7.2 MW rotors and outputs, respectively. Current plans for multi-MW windfarms are reviewed, and the option of using the land around large wind turbines for other purposes is stressed.

Solid-State 2-Micron Laser Transmitter Advancement for Wind and Carbon Dioxide Measurements From Ground, Airborne, and Space-Based Lidar Systems

NASA Technical Reports Server (NTRS)

Singh, Upendra N.; Kavaya, Michael J.; Koch, Grady; Yu, Jirong; Ismail, Syed

2008-01-01

NASA Langley Research Center has been developing 2-micron lidar technologies over a decade for wind measurements, utilizing coherent Doppler wind lidar technique and carbon dioxide measurements, utilizing Differential Absorption Lidar (DIAL) technique. Significant advancements have been made towards developing state-of-the-art technologies towards laser transmitters, detectors, and receiver systems. These efforts have led to the development of solid-state lasers with high pulse energy, tunablility, wavelength-stability, and double-pulsed operation. This paper will present a review of these technological developments along with examples of high resolution wind and high precision CO2 DIAL measurements in the atmosphere. Plans for the development of compact high power lasers for applications in airborne and future space platforms for wind and regional to global scale measurement of atmospheric CO2 will also be discussed.

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.

The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Specialty Behavioral Health Care Utilization and Spending Among Carve-In Enrollees.

PubMed

Harwood, Jessica M; Azocar, Francisca; Thalmayer, Amber; Xu, Haiyong; Ong, Michael K; Tseng, Chi-Hong; Wells, Kenneth B; Friedman, Sarah; Ettner, Susan L

2017-02-01

The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA's impact on BH expenditures and utilization among "carve-in" enrollees. We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008-2009), during (2010), and after (2011-2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits, medication management, individual and family psychotherapy); intermediate care utilization (structured outpatient, day treatment, residential); and inpatient utilization. MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits [respective immediate increases of: $1.05 (P=0.02); $0.88 (P=0.04); 0.00045 visits (P=0.00)], and individual psychotherapy visits [immediate increase of 0.00578 visits (P=0.00) and additional increases of 0.00017 visits/mo (P=0.03)]. MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; for example, in July 2012 predicted per-enrollee plan spending was $4.92 without MHPAEA and $6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act's inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets.

Systematic reviews: guidance relevant for studies of older people.

PubMed

Shenkin, Susan D; Harrison, Jennifer K; Wilkinson, Tim; Dodds, Richard M; Ioannidis, John P A

2017-09-01

Systematic reviews and meta-analyses are increasingly common. This article aims to provide guidance for people conducting systematic reviews relevant to the healthcare of older people. An awareness of these issues will also help people reading systematic reviews to determine whether the results will influence their clinical practice. It is essential that systematic reviews are performed by a team which includes the required technical and clinical expertise. Those performing reviews for the first time should ensure they have appropriate training and support. They must be planned and performed in a transparent and methodologically robust way: guidelines are available. The protocol should be written-and if possible published-before starting the review. Geriatricians will be interested in a table of baseline characteristics, which will help to determine if the studied samples or populations are similar to their patients. Reviews of studies of older people should consider how they will manage issues such as different age cut-offs; non-specific presentations; multiple predictors and outcomes; potential biases and confounders. Systematic reviews and meta-analyses may provide evidence to improve older people's care, or determine where new evidence is required. Newer methodologies, such as meta-analyses of individual level data, network meta-analyses and umbrella reviews, and realist synthesis, may improve the reliability and clinical utility of systematic reviews. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.

"Life without nuclear power": A nuclear plant retirement formulation model and guide based on economics. San Onofre Nuclear Generating Station case: Economic impacts and reliability considerations leading to plant retirement

NASA Astrophysics Data System (ADS)

Wasko, Frank

Traditionally, electric utilities have been slow to change and very bureaucratic in nature. This culture, in and of itself, has now contributed to a high percentage of United States electric utilities operating uneconomical nuclear plants (Crooks, 2014). The economic picture behind owning and operating United States nuclear plants is less than favorable for many reasons including rising fuel, capital and operating costs (EUCG, 2012). This doctoral dissertation is specifically focused on life without nuclear power. The purpose of this dissertation is to create a model and guide that will provide electric utilities who currently operate or will operate uneconomical nuclear plants the opportunity to economically assess whether or not their nuclear plant should be retired. This economic assessment and stakeholder analysis will provide local government, academia and communities the opportunity to understand how Southern California Edison (SCE) embraced system upgrade import and "voltage support" opportunities to replace "base load" generation from San Onofre Nuclear Generating Station (SONGS) versus building new replacement generation facilities. This model and guide will help eliminate the need to build large replacement generation units as demonstrated in the SONGS case analysis. The application of The Nuclear Power Retirement Model and Guide will provide electric utilities with economic assessment parameters and an evaluation assessment progression needed to better evaluate when an uneconomical nuclear plant should be retired. It will provide electric utilities the opportunity to utilize sound policy, planning and development skill sets when making this difficult decision. There are currently 62 nuclear power plants (with 100 nuclear reactors) operating in the United States (EIA, 2014). From this group, 38 are at risk of early retirement based on the work of Cooper (2013). As demonstrated in my model, 35 of the 38 nuclear power plants qualify to move to the economic assessment review and then on to the stakeholder cost benefit analysis (if model qualifications are met) leading to a final plant retirement decision. This application via the model and guide, in turn, will lead electric utilities to explore system upgrade import opportunities and mitigation measures versus building new replacement generation facilities. United States nuclear reactors are licensed for 40 years with a 20 year extension available prior to the expiration date (EIA, 2013). Since late 2012, electric power companies have announced the early retirement of four uneconomical nuclear power plants while other studies have indicated that as many as 70 percent of United States nuclear power plants are potentially at risk for early retirement (Crooks, 2014 and Cooper, 2013). A high percentage of these aforementioned nuclear plants have operating licenses that will not expire until 2030 and beyond. Thus, for the most part, replacement power contingency planning has not been initiated for these plants or is still in preliminary stages. The recent nuclear plant retirements are the first since 1998 (EIA, 2013). Decisions to retire the plants involved concerns over maintenance and repair costs as well as declining profitability (EIA, 2013). In addition, the Energy Information Administration (2010-2012) released data that demonstrated that the worst 25 percent of United States nuclear plants are far more expensive to operate and generate electricity than new gas plants. It is equally important to understand and explain the economic and power replacement implications to both ratepayers and end-users. A SONGS case study analysis will review the economic, operational and political challenges that SCE faced leading to the retirement decision of SONGS. As preface to the case study, replacement steam generators (RSGs) were installed in Unit 2 in 2009 and in Unit 3 in 2010. In January 2012, while Unit 2 was down for routine maintenance, a small leak was discovered inside a steam generator in Unit 3. Because of the situation, both units remained shut down to evaluate the cause of the leakage and to make repairs. SCE submitted plans to the Nuclear Regulatory Commission (NRC) to re-start Unit 2 at reduced power. However, concerns over the length of the review process and the high costs associated with steam generator repairs led SCE to retire both reactors (SCE SONGS Fact Sheets, 2012-2013). Finally, collaborative resource power replacement planning is needed more than ever as nuclear facilities in the United States are now being retired for economic related reasons (Crooks, 2014). This collaborative power replacement process and implementation must encompass all relevant stakeholders including state grid operators, ratepayers, shareholders and the electric utility company.

77 FR 77117 - Proposed Revision 0 on Access Authorization-Operational Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-31

...--Operational Program AGENCY: Nuclear Regulatory Commission. ACTION: Standard review plan-draft section revision... public comment on NUREG-0800, ``Standard Review Plan for the Review of Safety Analysis Reports for... seeks comments on the new Section 13.6.4 of the Standard Review Plan (SRP) concerning implementation of...

12 CFR 933.3 - Independent review of capital plan.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 7 2011-01-01 2011-01-01 false Independent review of capital plan. 933.3 Section 933.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS BANK CAPITAL STRUCTURE PLANS § 933.3 Independent review of capital plan. Prior to...

Temporal and Resource Reasoning for Planning, Scheduling and Execution in Autonomous Agents

NASA Technical Reports Server (NTRS)

Muscettola, Nicola; Hunsberger, Luke; Tsamardinos, Ioannis

2005-01-01

This viewgraph slide tutorial reviews methods for planning and scheduling events. The presentation reviews several methods and uses several examples of scheduling events for the successful and timely completion of the overall plan. Using constraint based models the presentation reviews planning with time, time representations in problem solving and resource reasoning.

77 FR 35114 - Agency Information Collection (NCA PreNeed Burial Planning) Activity Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-12

...Need Burial Planning) Activity Under OMB Review AGENCY: National Cemetery Administration, Department of... PreNeed Burial Planning, VA Form 40-10007. OMB Control Number: 2900--New. Type of Review: New... members, and their eligible family members with planning for burial in a VA national cemetery. This...

Use of multiple-site performance-contingent SEMG reward programming in pediatric rehabilitation: a retrospective review.

PubMed

Bolek, Jeffrey E

2006-09-01

We completed a retrospective review of the effectiveness of multi-site, performance-contingent reward programming on functional change in motor performance of 16 treatment resistant children. Patients were previously treated in physical or occupational therapy for head control, standing balance training, sitting and upper extremity use (brachial plexus injury). They then participated in a program that utilized multiple surface electromyography sites the use of which was rewarded with videos for performing the correct constellation of recruitment pattern (e.g., contracting some muscles while relaxing others). Onset of reward was calibrated for each patient and transfer of skill to outside the clinic was encouraged by linking a verbal cue to the correct motor plan. Fourteen of the 16 patients improved. The implications of the use of this technique in the treatment of motor dysfunction is discussed.

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.

Planning for a Distributed Disruption: Innovative Practices for Incorporating Distributed Solar into Utility Planning

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

Mills, Andrew D.; Barbose, Galen L.; Seel, Joachim

The rapid growth of distributed solar photovoltaics (DPV) has critical implications for U.S. utility planning processes. This report informs utility planning through a comparative analysis of roughly 30 recent utility integrated resource plans or other generation planning studies, transmission planning studies, and distribution system plans. It reveals a spectrum of approaches to incorporating DPV across nine key planning areas, and it identifies areas where even the best current practices might be enhanced. (1) Forecasting DPV deployment: Because it explicitly captures several predictive factors, customer-adoption modeling is the most comprehensive forecasting approach. It could be combined with other forecasting methods tomore » generate a range of potential futures. (2) Ensuring robustness of decisions to uncertain DPV quantities: using a capacity-expansion model to develop least-cost plans for various scenarios accounts for changes in net load and the generation portfolio; an innovative variation of this approach combines multiple per-scenario plans with trigger events, which indicate when conditions have changed sufficiently from the expected to trigger modifications in resource-acquisition strategy. (3) Characterizing DPV as a resource option: Today's most comprehensive plans account for all of DPV's monetary costs and benefits. An enhanced approach would address non-monetary and societal impacts as well. (4) Incorporating the non-dispatchability of DPV into planning: Rather than having a distinct innovative practice, innovation in this area is represented by evolving methods for capturing this important aspect of DPV. (5) Accounting for DPV's location-specific factors: The innovative propensity-to-adopt method employs several factors to predict future DPV locations. Another emerging utility innovation is locating DPV strategically to enhance its benefits. (6) Estimating DPV's impact on transmission and distribution investments: Innovative practices are being implemented to evaluate system needs, hosting capacities, and system investments needed to accommodate DPV deployment. (7) Estimating avoided losses associated with DPV: A time-differentiated marginal loss rate provides the most comprehensive estimate of avoided losses due to DPV, but no studies appear to use it. (8) Considering changes in DPV's value with higher solar penetration: Innovative methods for addressing the value changes at high solar penetrations are lacking among the studies we evaluate. (9) Integrating DPV in planning across generation, transmission, and distribution: A few states and regions have started to develop more comprehensive processes that link planning forums, but there are still many issues to address.« less

Planning for a Distributed Disruption: Innovative Practices for Incorporating Distributed Solar into Utility Planning

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

Mill, Andrew; Barbose, Galen; Seel, Joachim

The rapid growth of distributed solar photovoltaics (DPV) has critical implications for U.S. utility planning processes. This report informs utility planning through a comparative analysis of roughly 30 recent utility integrated resource plans or other generation planning studies, transmission planning studies, and distribution system plans. It reveals a spectrum of approaches to incorporating DPV across nine key planning areas, and it identifies areas where even the best current practices might be enhanced. 1) Forecasting DPV deployment: Because it explicitly captures several predictive factors, customer-adoption modeling is the most comprehensive forecasting approach. It could be combined with other forecasting methods tomore » generate a range of potential futures. 2) Ensuring robustness of decisions to uncertain DPV quantities: using a capacity-expansion model to develop least-cost plans for various scenarios accounts for changes in net load and the generation portfolio; an innovative variation of this approach combines multiple per-scenario plans with trigger events, which indicate when conditions have changed sufficiently from the expected to trigger modifications in resource-acquisition strategy. 3) Characterizing DPV as a resource option: Today’s most comprehensive plans account for all of DPV’s monetary costs and benefits. An enhanced approach would address non-monetary and societal impacts as well. 4) Incorporating the non-dispatchability of DPV into planning: Rather than having a distinct innovative practice, innovation in this area is represented by evolving methods for capturing this important aspect of DPV. 5) Accounting for DPV’s location-specific factors: The innovative propensity-to-adopt method employs several factors to predict future DPV locations. Another emerging utility innovation is locating DPV strategically to enhance its benefits. 6) Estimating DPV’s impact on transmission and distribution investments: Innovative practices are being implemented to evaluate system needs, hosting capacities, and system investments needed to accommodate DPV deployment. 7) Estimating avoided losses associated with DPV: A time-differentiated marginal loss rate provides the most comprehensive estimate of avoided losses due to DPV, but no studies appear to use it. 8) Considering changes in DPV’s value with higher solar penetration: Innovative methods for addressing the value changes at high solar penetrations are lacking among the studies we evaluate. 9) Integrating DPV in planning across generation, transmission, and distribution: A few states and regions have started to develop more comprehensive processes that link planning forums, but there are still many issues to address.« less

Engineering Technical Review Planning Briefing

NASA Technical Reports Server (NTRS)

Gardner, Terrie

2012-01-01

The general topics covered in the engineering technical planning briefing are 1) overviews of NASA, Marshall Space Flight Center (MSFC), and Engineering, 2) the NASA Systems Engineering(SE) Engine and its implementation , 3) the NASA Project Life Cycle, 4) MSFC Technical Management Branch Services in relation to the SE Engine and the Project Life Cycle , 5) Technical Reviews, 6) NASA Human Factor Design Guidance , and 7) the MSFC Human Factors Team. The engineering technical review portion of the presentation is the primary focus of the overall presentation and will address the definition of a design review, execution guidance, the essential stages of a technical review, and the overall review planning life cycle. Examples of a technical review plan content, review approaches, review schedules, and the review process will be provided and discussed. The human factors portion of the presentation will focus on the NASA guidance for human factors. Human factors definition, categories, design guidance, and human factor specialist roles will be addressed. In addition, the NASA Systems Engineering Engine description, definition, and application will be reviewed as background leading into the NASA Project Life Cycle Overview and technical review planning discussion.

Derby district redevelopment in Colorado: case study on the health impact assessment process.

PubMed

Maclennan, Carol F; Ghosh, Tista S; Juliusson, Lara; Vogt, Richard L; Boehmer, Tegan K

2012-01-01

Health Impact Assessment (HIA) is a tool that is increasingly utilized in the U.S. to shape policies that may impact the public's health. Domestic examples of HIAs and the process by which they were conducted, however, are rarely documented in the peer-reviewed literature. Through an existing relationship with the planning department in Commerce City, Colorado, Tri-County Health Department (TCHD) was able to identify a proposed redevelopment plan as a candidate for an HIA. The HIA focused on potential effects of the proposed redevelopment of Commerce City's historic Derby District on residents' physical activity and nutrition-related behaviors. This article describes the HIA process used by TCHD. Several sources of data were used, including participatory community input on walkability and safety, local health behavior data, and maps of health-influencing environmental characteristics. Using a variety of information sources including community input and local health behavior data can be useful in conducting HIAs and impacting policies. Local health departments should consider cultivating ongoing collaborative partnerships with municipal planning departments and community groups to conduct HIAs and to implement recommendations.

Operational Planning for Multiple Heterogeneous Unmanned Aerial Vehicles in Three Dimensions

DTIC Science & Technology

2009-06-01

human input in the planning process. Two solution methods are presented: (1) a mixed-integer program, and (2) an algorithm that utilizes a metaheuristic ...and (2) an algorithm that utilizes a metaheuristic to generate composite variables for a linear program, called the Composite Operations Planning...that represent a path and an associated type of UAV. The reformulation is incorporated into an algorithm that uses a metaheuristic to generate the

Operations research for resource planning and -use in radiotherapy: a literature review.

PubMed

Vieira, Bruno; Hans, Erwin W; van Vliet-Vroegindeweij, Corine; van de Kamer, Jeroen; van Harten, Wim

2016-11-25

The delivery of radiotherapy (RT) involves the use of rather expensive resources and multi-disciplinary staff. As the number of cancer patients receiving RT increases, timely delivery becomes increasingly difficult due to the complexities related to, among others, variable patient inflow, complex patient routing, and the joint planning of multiple resources. Operations research (OR) methods have been successfully applied to solve many logistics problems through the development of advanced analytical models for improved decision making. This paper presents the state of the art in the application of OR methods for logistics optimization in RT, at various managerial levels. A literature search was performed in six databases covering several disciplines, from the medical to the technical field. Papers included in the review were published in peer-reviewed journals from 2000 to 2015. Data extraction includes the subject of research, the OR methods used in the study, the extent of implementation according to a six-stage model and the (potential) impact of the results in practice. From the 33 papers included in the review, 18 addressed problems related to patient scheduling (of which 12 focus on scheduling patients on linear accelerators), 8 focus on strategic decision making, 5 on resource capacity planning, and 2 on patient prioritization. Although calculating promising results, none of the papers reported a full implementation of the model with at least a thorough pre-post performance evaluation, indicating that, apart from possible reporting bias, implementation rates of OR models in RT are probably low. The literature on OR applications in RT covers a wide range of approaches from strategic capacity management to operational scheduling levels, and shows that considerable benefits in terms of both waiting times and resource utilization are likely to be achieved. Various fields can be further developed, for instance optimizing the coordination between the available capacity of different imaging devices or developing scheduling models that consider the RT chain of operations as a whole rather than the treatment machines alone.

[Nurse-Led Care Models in the Context of Community Elders With Chronic Disease Management: A Systematic Review].

PubMed

Hsieh, Pei-Lun; Chen, Ching-Min

2016-08-01

Longer average life expectancies have caused the rapid growth of the elderly as a percentage of Taiwan's population and, as a result of the number of elders with chronic diseases and disability. Providing continuing-care services in community settings for elderly with multiple chronic conditions has become an urgent need. To review the nurse-led care models that are currently practiced among elders with chronic disease in the community and to further examine the effectiveness and essential components of these models using a systematic review method. Twelve original articles on chronic disease-care planning for the elderly or on nurse-led care management interventions that were published between 2000 and 2015 in any of five electronic databases: MEDLINE, PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus with Full Text, Cochrane Library, and CEPS (Chinese Electronic Periodicals Service）were selected and analyzed systematically. Four types of nurse-led community care models, including primary healthcare, secondary prevention care, cross-boundary models, and case management, were identified. Chronic disease-care planning, case management, and disease self-management were found to be the essential components of the services that were provided. The care models used systematic processes to conduct assessment, planning, implementation, coordination, and follow-up activities as well as to deliver services and to evaluate disease status. The results revealed that providing continuing-care services through the nurse-led community chronic disease-care model and cross-boundary model enhanced the ability of the elderly to self-manage their chronic diseases, improved healthcare referrals, provided holistic care, and maximized resource utilization efficacy. The present study cross-referenced all reviewed articles in terms of target clients, content, intervention, measurements, and outcome indicators. Study results may be referenced in future implementations of nurse-led community care models as well as in future research.

Utilization of Negotiated Tuition Aid Benefits. A Summary of the Study "Where Are the Women? A Study of the Underutilization of Tuition Aid Plans."

ERIC Educational Resources Information Center

Abramovitz, Mimi

A chapter from the forthcoming book, "Practitioners' Guide to Education for Working Adults," describes a year-long study to explore the low utilization of tuition aid plans in three unionized companies. The research has shown that the use of tuition aid programs is in inverse ratio to need. Workers who tend to utilize tuition aid are those who…

Biological phenotypes associated with individuals at high risk for developing alcohol-related disorders: Part 1.

PubMed

Hill, S Y

2000-01-01

This article reviews the results of studies concerning particular classes of biological phenotypes that may have relevance for alcohol dependence. Broadly defined, these classes include brain neurotransmitter systems and neuroelectric potentials. Evidence is presented concerning genotypic variation in alcoholics and high-risk relatives suggesting that the etiology of alcoholism and other addictive diseases is mediated in part through suboptimal neurotransmitter functioning. Research opportunities are offered with respect to specific candidate genes that have been cloned from these neurotransmitter systems that could be most fully utilized in family-based genetic analyses. Additional evidence is offered, suggesting that characteristics of particular neuroelectric potentials (e.g. the amplitude of the P300 component of the event-related potential) may provide another dimension of potential markers that could be used to identify children at risk. Finally, methodological considerations specific to high risk studies are discussed. Among these are the need to include a plan for studying more severe cases of alcohol dependence that are relatively uncomplicated by other major psychiatric disorders. Plans for long-term follow-up of children at highest risk for developing the disorder should also be included. Multiple domains of inquiry should not be viewed as "unfocused" but rather as an economical means for utilizing highly characterized samples of individuals meeting rigorous research criteria.

Multigenerational challenges in academic medicine: UCDavis's responses.

PubMed

Howell, Lydia Pleotis; Servis, Gregg; Bonham, Ann

2005-06-01

Academic medicine is a unique work environment, one of the few where members of four different generations regularly interact and where multigenerational teams are key to fulfilling its missions, particularly education. This can lead to increased creativity, but also to intergenerational conflict, since each generation has different values and expectations. The authors describe multigenerational challenges confronted at the University of California, Davis, School of Medicine, and that school's responses to them. These challenges include issues related to work hours, workload, compensation, evaluation for advancement, recruitment and retention, and attendance at required meetings. Awareness of the different generational qualities and values allowed the school of medicine to identify the multigenerational origin of many of these ongoing issues and challenges and to plan appropriate solutions within the Office of Academic Affairs. These include policy changes related to work-life balance, utilizing multiple faculty tracks with different roles, allowing part-time faculty appointments, creating a variety of faculty development programs geared toward different generational needs (which utilize flexible modules, menus of options, and alternative technologies for presentation), defining appropriate reward and incentives through compensations plans, and creating peer-reviewed awards. The authors conclude that these efforts mitigate conflict, promote diversity, and allow multigenerational teams to function more effectively and creatively in education, research, and clinical care. Ongoing evaluation will further refine this approach.

The utility of the functional independence measure (FIM) in discharge planning for burn patients.

PubMed

Choo, Benji; Umraw, Nisha; Gomez, Manuel; Cartotto, Robert; Fish, Joel S

2006-02-01

Determining burn patients' need for inpatient rehabilitation at discharge is difficult and an objective clinical indicator might aid in this decision. The functional independence measure (FIM) is a validated outcome measure that predicts the need for rehabilitation services. This study evaluated the utility of the FIM score for discharge planning in burn patients. A retrospective chart review and FIM score determination was performed on all major burn patients discharged from a regional adult burn centre between July 1, 1999 and June 30, 2000. From 164 adult burn patients discharged, 37 met the American Burn Association criteria for major burns. One patient had insufficient data. Therefore, 36 patients were studied (mean age 47.3 +/- 17.4 years, and mean body area burned 27.4 +/- 12.9%). All 17 patients with FIM scores greater than 110 were discharged home, and patients with FIM score of 110 or lower were discharged to another institution (rehabilitation hospital n = 14, other acute care hospital n = 4, or a nursing home n = 1) p < 0.0001. A discharge FIM score of 110 or lower was strongly associated with the need for inpatient rehabilitation, while a FIM score greater than 110 indicates the patient is independent enough to manage at home. Further prospective studies will be necessary to validate these findings.

Evidence for Healthy Cities: reflections on practice, method and theory.

PubMed

de Leeuw, Evelyne

2009-11-01

The European Healthy Cities project can be characterized as a social movement that employs an extremely wide range of political, social and behavioural interventions for the development and sustenance of urban population health. At all of these levels, the movement is inspired by ideological, theoretical and evidence-based perspectives. The result of this stance is a dynamic, complex and diverse landscape of initiatives, plans, programmes and actions. In quantitative terms (the number of WHO designated cities and associated cities and communities through national networks), 'Healthy Cities' can be regarded as an extraordinary accomplishment and a credit for both WHO and cities in the movement. In qualitative terms, however, critics of the movement have maintained that little evidence on its success and effectiveness has been generated. This critique finds its foundations in the mere perceptions of evidence, the politics of science and urban governance, and perspectives on the preferred or professed utilities of evidence-based health notions. The article reviews the nature of evidence and its interface with politics and governance. Applying a conceptual framework combining insights from knowledge utilization theory, theoretical perspectives on (health) policy development, theory-based evaluations and planned intervention approaches, it demonstrates that, although the evidence is overwhelming, there are barriers to the implementation of such evidence that should be further addressed by 'Healthy Cities'.

Concerns about dose and underutilization of twelve-step programs: models, scales, and theory that inform treatment planning.

PubMed

Cloud, Richard N; Kingree, J B

2008-01-01

Researchers have observed that a majority of addicted persons who are encouraged and facilitated by treatment providers to attend twelve-step (TS) programs either drop out or sporadically use twelve-step programs following treatment. This is troubling given considerable evidence of TS program benefits associated with regular weekly attendance and ubiquitous reliance by treatment professionals on these programs to provide important support services. This chapter reviews and advances theory of TS utilization and dose that is supported by prior research, multivariate models, and scales that predict risk of TS meeting underutilization. Advancing theory should organize and clarify the process of initial utilization, guide intervention development, and improve adherence of TS program referrals, all of which should lead to improved treatment planning and better outcomes. Three theories are integrated to explain processes that may influence TS program dose: the health belief model, self-determination theory (motivational theory), and a person-in-organization cultural fit theory. Four multidimensional scales developed specifically to predict participation are described. Implications for practice and future research are considered in a final discussion. Information contained in this chapter raises awareness of the need for TS-focused treatments to focus on achieving weekly attendance during and after treatment.

The utility of magnetic resonance imaging in the diagnosis and management of pediatric benign ovarian lesions.

PubMed

Emil, Sherif; Youssef, Fouad; Arbash, Ghaidaa; Baird, Robert; Laberge, Jean-Martin; Puligandla, Pramod; Albuquerque, Pedro

2018-01-31

The utility of magnetic resonance imaging (MRI) in the diagnosis and management of pediatric ovarian lesions has not been well defined. A retrospective review of all girls who underwent MRI evaluation of ovarian masses during the period 2009-2015 was performed. The accuracy of MRI was evaluated by comparing results with surgical findings, pathology reports, and subsequent imaging. The influence of the MRI on the treatment plan was specifically explored. Eighteen girls, 12-17years of age, underwent 27 MRIs, subsequent to ultrasound identification of ovarian lesions. Of 9 neoplastic lesions diagnosed on MRI, 8 (89%) were confirmed by surgical and pathological findings. Of 18 functional lesions, 17 (94.4%) were confirmed pathologically or by resolution on subsequent imaging. Twenty MRI exams (74%) directly influenced the treatment plan, by leading to appropriate operative intervention in 9 and appropriate observation in 11. The extent of ovarian resection was guided by MRI findings in 8 of 9 (89%) neoplastic lesions. For characterizing lesions as neoplastic, the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of MRI were 89%, 94%, 94%, 89%, and 93% respectively. MRI can differentiate functional from neoplastic pediatric ovarian masses, and guide ovarian resection in appropriate cases. II. Copyright © 2018. Published by Elsevier Inc.

Image Guided Radiation Therapy (IGRT) Practice Patterns and IGRT's Impact on Workflow and Treatment Planning: Results From a National Survey of American Society for Radiation Oncology Members

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

Nabavizadeh, Nima, E-mail: nabaviza@ohsu.edu; Elliott, David A.; Chen, Yiyi

Purpose: To survey image guided radiation therapy (IGRT) practice patterns, as well as IGRT's impact on clinical workflow and planning treatment volumes (PTVs). Methods and Materials: A sample of 5979 treatment site–specific surveys was e-mailed to the membership of the American Society for Radiation Oncology (ASTRO), with questions pertaining to IGRT modality/frequency, PTV expansions, method of image verification, and perceived utility/value of IGRT. On-line image verification was defined as images obtained and reviewed by the physician before treatment. Off-line image verification was defined as images obtained before treatment and then reviewed by the physician before the next treatment. Results: Of 601 evaluablemore » responses, 95% reported IGRT capabilities other than portal imaging. The majority (92%) used volumetric imaging (cone-beam CT [CBCT] or megavoltage CT), with volumetric imaging being the most commonly used modality for all sites except breast. The majority of respondents obtained daily CBCTs for head and neck intensity modulated radiation therapy (IMRT), lung 3-dimensional conformal radiation therapy or IMRT, anus or pelvis IMRT, prostate IMRT, and prostatic fossa IMRT. For all sites, on-line image verification was most frequently performed during the first few fractions only. No association was seen between IGRT frequency or CBCT utilization and clinical treatment volume to PTV expansions. Of the 208 academic radiation oncologists who reported working with residents, only 41% reported trainee involvement in IGRT verification processes. Conclusion: Consensus guidelines, further evidence-based approaches for PTV margin selection, and greater resident involvement are needed for standardized use of IGRT practices.« less

Image Guided Radiation Therapy (IGRT) Practice Patterns and IGRT's Impact on Workflow and Treatment Planning: Results From a National Survey of American Society for Radiation Oncology Members.

PubMed

Nabavizadeh, Nima; Elliott, David A; Chen, Yiyi; Kusano, Aaron S; Mitin, Timur; Thomas, Charles R; Holland, John M

2016-03-15

To survey image guided radiation therapy (IGRT) practice patterns, as well as IGRT's impact on clinical workflow and planning treatment volumes (PTVs). A sample of 5979 treatment site-specific surveys was e-mailed to the membership of the American Society for Radiation Oncology (ASTRO), with questions pertaining to IGRT modality/frequency, PTV expansions, method of image verification, and perceived utility/value of IGRT. On-line image verification was defined as images obtained and reviewed by the physician before treatment. Off-line image verification was defined as images obtained before treatment and then reviewed by the physician before the next treatment. Of 601 evaluable responses, 95% reported IGRT capabilities other than portal imaging. The majority (92%) used volumetric imaging (cone-beam CT [CBCT] or megavoltage CT), with volumetric imaging being the most commonly used modality for all sites except breast. The majority of respondents obtained daily CBCTs for head and neck intensity modulated radiation therapy (IMRT), lung 3-dimensional conformal radiation therapy or IMRT, anus or pelvis IMRT, prostate IMRT, and prostatic fossa IMRT. For all sites, on-line image verification was most frequently performed during the first few fractions only. No association was seen between IGRT frequency or CBCT utilization and clinical treatment volume to PTV expansions. Of the 208 academic radiation oncologists who reported working with residents, only 41% reported trainee involvement in IGRT verification processes. Consensus guidelines, further evidence-based approaches for PTV margin selection, and greater resident involvement are needed for standardized use of IGRT practices. Copyright © 2016 Elsevier Inc. All rights reserved.

Utilizing HDTV as Data for Space Flight

NASA Technical Reports Server (NTRS)

Grubbs, Rodney; Lindblom, Walt

2006-01-01

In the aftermath of the Space Shuttle Columbia accident February 1, 2003, the Columbia Accident Investigation Board recognized the need for better video data from launch, on-orbit, and landing to assess the status and safety of the shuttle orbiter fleet. The board called on NASA to improve its imagery assets and update the Agency s methods for analyzing video. This paper will feature details of several projects implemented prior to the return to flight of the Space Shuttle, including an airborne HDTV imaging system called the WB-57 Ascent Video Experiment, use of true 60 Hz progressive scan HDTV for ground and airborne HDTV camera systems, and the decision to utilize a wavelet compression system for recording. This paper will include results of compression testing, imagery from the launch of STS-114, and details of how commercial components were utilized to image the shuttle launch from an aircraft flying at 400 knots at 60,000 feet altitude. The paper will conclude with a review of future plans to expand on the upgrades made prior to return to flight.

Impact of axillary ultrasound and core needle biopsy on the utility of intraoperative frozen section analysis and treatment decision making in women with invasive breast cancer.

PubMed

Caretta-Weyer, Holly; Sisney, Gale A; Beckman, Catherine; Burnside, Elizabeth S; Salkowsi, Lonie R; Strigel, Roberta M; Wilke, Lee G; Neuman, Heather B

2012-09-01

Our objective was to evaluate the impact of preoperative axillary ultrasound and core needle biopsy (CNB) on breast cancer treatment decision making. A secondary aim was to evaluate the impact on the utility of intraoperative sentinel lymph node (SLN) frozen section. A review of 84 patients with clinically negative axilla who underwent axillary ultrasound was performed. Sensitivity, specificity, and positive/negative predictive value for axillary ultrasound with CNB was calculated. Thirty-one (37%) had suspicious nodes. Of 27 amenable to CNB, 12 (14%) were malignant, changing treatment plans. The sensitivity of ultrasound and CNB was 54% and specificity 100%; the positive and negative predictive values were 100% and 80%, respectively. In 41 patients with normal ultrasounds who underwent SLN frozen section, 10 (24%) were positive. Preoperative axillary ultrasound impacts treatment decision making in 14%. With a sensitivity of 54%, it is a useful adjunct to, but not replacement for, SLN biopsy. Frozen section remains of utility even after a negative axillary ultrasound. Copyright © 2012 Elsevier Inc. All rights reserved.

SU-E-T-106: An Institutional Review of Using Commercially Available Software to Evaluate Treatment Plan Quality for Various Treatment Sites and Beam Deliveries

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

Esquivel, C; Patton, L; Walker, S

Purpose: Use Sun Nuclear Quality Reports™ with PlanIQ™ to evaluate different treatment delivery techniques for various treatment sites. Methods: Fifteen random patients with different treatment sites were evaluated. These include the Head/Neck, prostate, pelvis, lung, esophagus, axilla, bladder and abdomen. Initially, these sites were planned on the Pinnacle {sup 3} V9.6 treatment planning system and utilized nine 6MV step-n-shoot IMRT fields. The RT plan, dose and structure sets were sent to Quality Reports™ where a DVH was recreated and the plans were compared to a unique Plan Algorithm for each treatment site. Each algorithm has its own plan quality metricsmore » and objectives, which include the PTV coverage, PTV maximum dose, the prescription dose outside the target, doses to the critical structures, and the global maximum dose and its location. Each plan was scored base on meeting each objective. Plans may have been reoptimized and reevaluated with Quality Reports™ based on the initial score. PlanIQ™ was used to evaluate if any objective not met was achievable or difficult to obtain. A second plan using VMAT delivery was created for each patient and scored with Quality Reports™. Results: There were a wide range of scores for the different treatment sites with some scoring better for IMRT plans and some better for the VMAT deliveries. The variation in the scores could be attributed to the treatment site, location, and shape of the target. Most deliveries were chosen for the VMAT due to the short treatment times and quick patient throughput with acceptable plan scores. Conclusion: The tools are provided for both physician and dosimetrist to objectively evaluate the use of VMAT delivery versus the step-n-shoot IMRT delivery for various sites. PlanIQ validates if objectives can be met. For the physicist, a concise pass/fail report is created for plan evaluation.« less

3D printing in neurosurgery: A systematic review

PubMed Central

Randazzo, Michael; Pisapia, Jared M.; Singh, Nickpreet; Thawani, Jayesh P.

2016-01-01

Background: The recent expansion of three-dimensional (3D) printing technology into the field of neurosurgery has prompted a widespread investigation of its utility. In this article, we review the current body of literature describing rapid prototyping techniques with applications to the practice of neurosurgery. Methods: An extensive and systematic search of the Compendex, Scopus, and PubMed medical databases was conducted using keywords relating to 3D printing and neurosurgery. Results were manually screened for relevance to applications within the field. Results: Of the search results, 36 articles were identified and included in this review. The articles spanned the various subspecialties of the field including cerebrovascular, neuro-oncologic, spinal, functional, and endoscopic neurosurgery. Conclusions: We conclude that 3D printing techniques are practical and anatomically accurate methods of producing patient-specific models for surgical planning, simulation and training, tissue-engineered implants, and secondary devices. Expansion of this technology may, therefore, contribute to advancing the neurosurgical field from several standpoints. PMID:27920940

Report of health and environmental effects of increased coal utilization by the Committee on Health and Environmental Effects of Increased Coal Utilization.

PubMed

1980-06-01

The National Energy Plan announced by President Carter on April 29, 1977 proposed a significant increase in the utilization of the vast domestic deposits of coal to replace the dwindling supplies of oil and natural gas, and increasingly expensive oil from foreign sources, to meet national energy needs. At the same time, in recognition of possible adverse health and ecological consequences of increased coal production and use, the President announced that a special committee would be formed to study this aspect of the National Energy Plan. The Committee held a series of public meetings during November and December 1977 to review a number of special papers on particular problems associated with increased coal utilization. These papers, which were prepared by scientists of the US Environmental Protection Agency; the Department of Energy; the HEW National Institute for Occupational Safety and Health, and the National Institute of Environmental Health Sciences; New York University; and Vanderbilt University; provided essential background information for the deliberations of the Committee and were published in EHP Vol. 33, pp. 127-314, 1979. One paper by A. P. Altschuler et al. is published in this volume of EHP. The Committee's basic finding was that it is safe to proceed with plans to increase the utilization of coal if the following environmental and safety policies are adhered to:* Compliance with Federal and State air, water, and solid waste regulations* Universal adoption and successful operation of best available control technology on new facilities* Compliance with reclamation standards* Compliance with mine health and safety standards* Judicious siting of coal-fired facilitiesThe Committee concluded that, even with the best mitigation policies, there will be some adverse health and environmental effects from the dramatic increase in coal use. However, these will not impact all regions and individuals uniformly. The Committee identified six major areas of uncertainty and concern requiring further investigation if the nation is to minimize undesirable consequences of increased coal utilization now, and in the future. Two critical health issues of concern are air pollution health effects and coal mine worker health and safety. Two critical environmental issues are global effects of carbon dioxide in the atmosphere and acid fallout. Two additional important issues of concern are trace elements in the environment and reclamation of arid land.Finally, because of the inadequate data and methodology used in the study of these matters, the Committee strongly recommended the establishment of an improved national environmental data collection, modeling and monitoring system.

42 CFR 456.181 - Reports of evaluations and plans of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Reports of evaluations and plans of care. 456.181 Section 456.181 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals...

IET area plot and utilities plan. Includes drainage. Ralph M. ...

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

IET area plot and utilities plan. Includes drainage. Ralph M. Parsons 902-4-ANP-U-310. Date: February 1954. Approved by INEEL Classification Office for public release. INEEL code no. 035-0100-00-693-106898 - Idaho National Engineering Laboratory, Test Area North, Scoville, Butte County, ID

47 CFR 54.313 - Annual reporting requirements for high-cost recipients.

Code of Federal Regulations, 2012 CFR

2012-10-01

... planning with a focus on Tribal community anchor institutions; (ii) Feasibility and sustainability planning... annual report, any ETC that files annual financial reports with the Rural Utilities Service may instead file a copy of its report to the Rural Utilities Service. (g) Areas with No Terrestrial Backhaul...

76 FR 53450 - Transmission Planning and Cost Allocation by Transmission Owning and Operating Public Utilities...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-26

... Planning and Cost Allocation by Transmission Owning and Operating Public Utilities; Notice of Staff Informational Conferences Take notice that Commission staff will convene three informational conferences to discuss the requirements of Order No. 1000.\\1\\ The Commission directed its staff to hold the informational...

The impact of national health insurance on the utilization of health care services by pregnant women: the case in Taiwan.

PubMed

Chen, L M; Wen, S W; Li, C Y

2001-03-01

Substantially increased funding for health care services occurred in Taiwan after the implementation of a national health insurance plan in 1995. This study attempts to examine the impact of this national health insurance plan on the utilization of prenatal and intrapartum care services. Nationally representative surveys of all pregnant women in Taiwan in 1989 (1,662 participants) and in 1996 (3,626 participants) were included in the analysis. We first compared the distribution of birth characteristics between the two surveys. We then calculated the rate of utilization of various prenatal and intrapartum care services in the two surveys in the overall sample and in subsamples, stratified by maternal education, age, and parity. The utilization of most prenatal and intrapartum care services, especially the complicated laboratory tests, increased in 1996 compared to 1989. For example, the proportion of women who received amniocentesis increased from 1.62% in 1989 to 5.60% in 1996 and German measles testing increased from 5.96% to 27.11%. By contrast, the proportion of women who received consultation services was stable over time, or for family planning, consultation declined from 33.21% to 27.00%. These changes in utilization over time were consistently observed across different maternal education, age, and parity groups. The utilization of prenatal and intrapartum care services, especially for the more expensive services, has substantially increased in Taiwan since the implementation of the national health insurance. For countries considering similar national health insurance plan, it may be helpful to consider cost-containing measures before the implementation of such a plan.

IPEM: An Integrated Planning, Effectiveness Model.

ERIC Educational Resources Information Center

Donsky, Aaron P.

While historically higher education has utilized many different planning paradigms and elements, two concepts (strategic planning and operational planning) can be presented as the major planning concepts into which the various paradigms can be placed. Starting in fall 1991, Seminole Community College developed a planning model which integrated…

Outcomes associated with a negotiated asthma treatment plan.

PubMed

Clark, Noreen M; Ko, Yi-An; Gong, Z Molly; Johnson, Timothy R

2012-08-01

Negotiated treatment plans are increasingly recommended in asthma clinical care. However, limited data are available to indicate whether this more patient-engaged process results in improved health outcomes. The aim of this study was to determine the associations between the presence of a negotiated treatment plan and the outcomes related to adherence to the medical regimen, symptom control, and health care use. The focus of the study was on women, the subgroup of adult patients, who are most vulnerable for negative asthma outcomes. Data were collected by telephone interview and medical record review from 808 women diagnosed with asthma at baseline, first year, and second year follow-up. Associations were examined between the presence of a negotiated treatment plan at baseline and subsequent asthma outcomes. Women with a negotiated treatment plan reported more adherent to prescribed asthma medicines (odds ratio (OR) = 2.41, 95% confidence interval (CI) = (1.82, 3.19)) and those with a plan and using oral steroids at baseline had less oral steroid use at follow-up (OR = 0.21, 95% CI = (0.05, 0.93)). Women with a negotiated plan also had more days (17%, 95% CI = (8, 27)) and nights (31%, 95% CI = (16, 48)) with symptoms than those without such a plan. No differences in hospitalizations, emergency department visits, or urgent physician office visits were noted between the groups. Patients with higher education levels were more likely to have a negotiated treatment plan. Negotiated treatment plans appear to have achieved greater adherence to prescribed asthma medicines and less need for oral steroids but were not related to fewer symptoms of asthma or reductions in urgent health care use. Additional strategies may be needed to reduce symptom and health services utilization outcomes.

The 2002 review of Florida's twenty-five long range transportation plans

DOT National Transportation Integrated Search

2002-08-01

Florida's 25 metropolitan planning organization (MPO) long range transportation plans (LRTPs) were reviewed. Each MPO had completed at least one update cycle since the initial review in 1997. Additionally, federal transportation legislation added a f...

Evaluation of site plan review procedures.

DOT National Transportation Integrated Search

1988-01-01

The site plan review procedures of the Virginia Department of Transportation (VDOT) were evaluated. The objectives of the evaluation were to recommend (1) a set of site plan review procedures including a checklist, (2) definitions of the roles and re...

12 CFR 563b.110 - Who must review my business plan?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Who must review my business plan? 563b.110... business plan? (a) Your chief executive officer and members of the board of directors must review, and at least two-thirds of your board of directors must approve, the business plan. (b) Your chief executive...

Multi-Level Linking of Teaching and Extra-Curricular Activity with Professional Planning Research: The Case of the Lincoln Planning Review

ERIC Educational Resources Information Center

Rennie, Hamish G.

2010-01-01

The experience in developing a student-led academic journal, the Lincoln Planning Review, to provide experiential learning that links undergraduates in a small professional planning programme directly to research publication is described. A combination of circumstances, including an impending review of the programme by the external professional…

33 CFR 155.1070 - Procedures for plan review, revision, amendment, and appeal.

Code of Federal Regulations, 2014 CFR

2014-07-01

... REGULATIONS FOR VESSELS Tank Vessel Response Plans for Oil § 155.1070 Procedures for plan review, revision, amendment, and appeal. (a) A vessel response plan must be reviewed annually by the owner or operator. (1... “Application for Approval/Revision of Vessel Pollution Response Plans” (CG-6083) located at: http://www.uscg...

Sci—Sat AM: Stereo — 02: Implementation of a VMAT class solution for kidney SBRT

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

Sonier, M; Lalani, N; Korol, R

An emerging treatment option for inoperable primary renal cell carcinoma and oligometastatic adrenal lesions is stereotactic body radiation therapy (SBRT). At our center, kidney SBRT treatments were originally planned with IMRT. The goal was to plan future patients using VMAT to improve treatment delivery efficiency. The purpose of this work was twofold: 1) to develop a VMAT class solution for the treatment of kidney SBRT; and, 2) to assess VMAT plan quality when compared to IMRT plans. Five patients treated with IMRT for kidney SBRT were reviewed and replanned in Pinnacle using a single VMAT arc with a 15° collimatormore » rotation, constrained leaf motion and 4° gantry spacing. In comparison, IMRT plans utilized 7–9 6MV beams, with various collimator rotations and up to 2 non-coplanar beams for maximum organ-at-risk (OAR) sparing. Comparisons were made concerning target volume conformity, homogeneity, dose to OARs, treatment time and monitor units (MUs). There was no difference in MUs; however, VMAT reduced the treatment time from 13.0±2.6min, for IMRT, to 4.0±0.9min. The collection of target and OAR constraints and SmartArc parameters, produced a class solution that generated VMAT plans with increased target homogeneity and improved 95% conformity index calculated at < 1.2. In general, the VMAT plans displayed a reduced maximum point dose to nearby OARs with increased intermediate dose to distant OARs. Overall, the introduction of a VMAT class solution for kidney SBRT improves efficiency by reducing treatment planning and delivery time.« less

Planning magnetic resonance imaging for prostate cancer intensity-modulated radiation therapy: Impact on target volumes, radiotherapy dose and androgen deprivation administration.

PubMed

Horsley, Patrick J; Aherne, Noel J; Edwards, Grace V; Benjamin, Linus C; Wilcox, Shea W; McLachlan, Craig S; Assareh, Hassan; Welshman, Richard; McKay, Michael J; Shakespeare, Thomas P

2015-03-01

Magnetic resonance imaging (MRI) scans are increasingly utilized for radiotherapy planning to contour the primary tumors of patients undergoing intensity-modulated radiation therapy (IMRT). These scans may also demonstrate cancer extent and may affect the treatment plan. We assessed the impact of planning MRI detection of extracapsular extension, seminal vesicle invasion, or adjacent organ invasion on the staging, target volume delineation, doses, and hormonal therapy of patients with prostate cancer undergoing IMRT. The records of 509 consecutive patients with planning MRI scans being treated with IMRT for prostate cancer between January 2010 and July 2012 were retrospectively reviewed. Tumor staging and treatment plans before and after MRI were compared. Of the 509 patients, 103 (20%) were upstaged and 44 (9%) were migrated to a higher risk category as a result of findings at MRI. In 94 of 509 patients (18%), the MRI findings altered management. Ninety-four of 509 patients (18%) had a change to their clinical target volume (CTV) or treatment technique, and in 41 of 509 patients (8%) the duration of hormone therapy was changed because of MRI findings. The use of radiotherapy planning MRI altered CTV design, dose and/or duration of androgen deprivation in 18% of patients in this large, single institution series of men planned for dose-escalated prostate IMRT. This has substantial implications for radiotherapy target volumes and doses, as well as duration of androgen deprivation. Further research is required to investigate whether newer MRI techniques can simultaneously fulfill staging and radiotherapy contouring roles. © 2014 Wiley Publishing Asia Pty Ltd.

Solar thermal power plants in small utilities - An economic impact analysis

NASA Technical Reports Server (NTRS)

Bluhm, S. A.; Ferber, R. R.; Mayo, L. G.

1979-01-01

A study was performed to assess the potential economic impact of small solar thermal electric power systems in statistically representative synthetic small utilities of the Southwestern United States. Power supply expansion plans were compared on the basis of present worth of future revenue requirements for 1980-2000 with and without solar thermal plants. Coal-fired and oil-fired municipal utility expansion plans with 5 percent solar penetration were 0.5 percent and 2.25 percent less expensive, respectively, than the corresponding conventional plan. At $969/kWe, which assumes the same low cost solar equipment but no improvement in site development costs, solar penetration of 5 percent in the oil-fired municipal reduced revenue requirements 0.88 percent. The paper concludes that some solar thermal plants are potentially economic in small community utilities of the Southwest.

People, planning, predictions pull DP&L to pinnacle

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

Beaty, W.; Warkentin, D.

Dayton Power and Light was chosen as the 26th utility to receive Electric Light and Power`s annual Utility of the Year award for investor-owned electric utilities. The award not only recognizes management for having guided the company to a high level of achievement, but to each employee for their contribution to the company`s success. Using its formula of three Ps to success - people, planning, and predict and prevent - this West Central Ohio utility plans on using its current plain vanilla approach to business to carve out its own pattern for the years ahead. DP&L`s employees have gone abovemore » and beyond the call of duty to serve its customers and shareholders. The utility`s operations are epitomized by the excellent fuel efficiency of its generating plants. DP&L has been in Electric Light & Power`s top 10 heat rate rankings for nine out of the past 10 years. Investor earnings per share increased from $1.15 in 1991 to $1.34 in 1992, with earnings per share rising by 6% to $1.42 in 1993.« less

Where's the evidence? a systematic review of economic analyses of residential aged care infrastructure.

PubMed

Easton, Tiffany; Milte, Rachel; Crotty, Maria; Ratcliffe, Julie

2017-03-21

Residential care infrastructure, in terms of the characteristics of the organisation (such as proprietary status, size, and location) and the physical environment, have been found to directly influence resident outcomes. This review aimed to summarise the existing literature of economic evaluations of residential care infrastructure. A systematic review of English language articles using AgeLine, CINAHL, Econlit, Informit (databases in Health; Business and Law; Social Sciences), Medline, ProQuest, Scopus, and Web of Science with retrieval up to 14 December 2015. The search strategy combined terms relating to nursing homes, economics, and older people. Full economic evaluations, partial economic evaluations, and randomised trials reporting more limited economic information, such as estimates of resource use or costs of interventions were included. Data was extracted using predefined data fields and synthesized in a narrative summary to address the stated review objective. Fourteen studies containing an economic component were identified. None of the identified studies attempted to systematically link costs and outcomes in the form of a cost-benefit, cost-effectiveness, or cost-utility analysis. There was a wide variation in approaches taken for valuing the outcomes associated with differential residential care infrastructures: 8 studies utilized various clinical outcomes as proxies for the quality of care provided, and 2 focused on resident outcomes including agitation, quality of life, and the quality of care interactions. Only 2 studies included residents living with dementia. Robust economic evidence is needed to inform aged care facility design. Future research should focus on identifying appropriate and meaningful outcome measures that can be used at a service planning level, as well as the broader health benefits and cost-saving potential of different organisational and environmental characteristics in residential care. International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42015015977 .

14 CFR 77.2 - Definition of terms.

Code of Federal Regulations, 2010 CFR

2010-01-01

... planning document or military service military airport planning document. Precision instrument runway means... military airport layout plan; any other FAA planning document, or military service military airport planning document. Utility runway means a runway that is constructed for and intended to be used by...

Strategic planning for the International Space Station

NASA Technical Reports Server (NTRS)

Griner, Carolyn S.

1990-01-01

The concept for utilization and operations planning for the International Space Station Freedom was developed in a NASA Space Station Operations Task Force in 1986. Since that time the concept has been further refined to definitize the process and products required to integrate the needs of the international user community with the operational capabilities of the Station in its evolving configuration. The keystone to the process is the development of individual plans by the partners, with the parameters and formats common to the degree that electronic communications techniques can be effectively utilized, while maintaining the proper level and location of configuration control. The integration, evaluation, and verification of the integrated plan, called the Consolidated Operations and Utilization Plan (COUP), is being tested in a multilateral environment to prove out the parameters, interfaces, and process details necessary to produce the first COUP for Space Station in 1991. This paper will describe the concept, process, and the status of the multilateral test case.

Will the Needs-Based Planning of Health Human Resources Currently Undertaken in Several Countries Lead to Excess Supply and Inefficiency?

PubMed

Basu, Kisalaya; Pak, Maxwell

2016-01-01

Recently, the emphasis on health human resources (HHR) planning has shifted away from a utilization-based approach toward a needs-based one in which planning is based on the projected health needs of the population. However, needs-based models that are currently in use rely on a definition of 'needs' that include only the medical circumstances of individuals and not personal preferences or other socio-economic factors. We examine whether planning based on such a narrow definition will maximize social welfare. We show that, in a publicly funded healthcare system, if the planner seeks to meet the aggregate need without taking utilization into consideration, then oversupply of HHR is likely because 'needs' do not necessarily translate into 'usage.' Our result suggests that HHR planning should track the healthcare system as access gradually improves because, even if health care is fully accessible, individuals may not fully utilize it to the degree prescribed by their medical circumstances. Copyright © 2014 John Wiley & Sons, Ltd.

48 CFR 307.7104 - Review and certification.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Review and certification. 307.7104 Section 307.7104 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES COMPETITION AND ACQUISITION PLANNING ACQUISITION PLANNING Acquisition Plan 307.7104 Review and certification...

48 CFR 307.7104 - Review and certification.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 4 2014-10-01 2014-10-01 false Review and certification. 307.7104 Section 307.7104 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES COMPETITION AND ACQUISITION PLANNING ACQUISITION PLANNING Acquisition Plan 307.7104 Review and certification...

48 CFR 307.7104 - Review and certification.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 4 2013-10-01 2013-10-01 false Review and certification. 307.7104 Section 307.7104 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES COMPETITION AND ACQUISITION PLANNING ACQUISITION PLANNING Acquisition Plan 307.7104 Review and certification...

48 CFR 307.7104 - Review and certification.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Review and certification. 307.7104 Section 307.7104 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES COMPETITION AND ACQUISITION PLANNING ACQUISITION PLANNING Acquisition Plan 307.7104 Review and certification...

48 CFR 307.7104 - Review and certification.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 4 2012-10-01 2012-10-01 false Review and certification. 307.7104 Section 307.7104 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES COMPETITION AND ACQUISITION PLANNING ACQUISITION PLANNING Acquisition Plan 307.7104 Review and certification...

Manpower Planning for the Wastewater Treatment Workforce of Texas: An Emerging Function. Presented at the Annual Meeting of the Texas Water Utilities Association (58th, College Station, Texas, March, 1976).

ERIC Educational Resources Information Center

Jackson, Tom

This paper, presented at the 58th annual meeting of the Texas Water Utilities Association, attempts to point out the need for manpower planning for the wastewater treatment workforce of Texas. As reasons for manpower planning, this document discloses estimates of 1400-1500 new jobs, 1300 of which will be in wastewater treatment facilities of 1 MGD…

45 CFR 309.35 - What are the procedures for review of a Tribal IV-D program application, plan or plan amendment?

Code of Federal Regulations, 2014 CFR

2014-10-01

...) The effective date of a plan or plan amendment may not be earlier than the first day of the fiscal... program application, plan or plan amendment? 309.35 Section 309.35 Public Welfare Regulations Relating to... of a Tribal IV-D program application, plan or plan amendment? (a) The Secretary will promptly review...

42 CFR 488.64 - Remote facility variances for utilization review requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Remote facility variances for utilization review... PROCEDURES Special Requirements § 488.64 Remote facility variances for utilization review requirements. (a... such facility or direct responsibility for the care of the patients being reviewed or, in the case of a...

78 FR 26810 - Adequacy of Design Features and Functional Capabilities Identified and Described for Withstanding...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-08

.... ACTION: Standard review plan section; issuance. SUMMARY: The U.S. Nuclear Regulatory Commission (NRC) is issuing a new section of NUREG-0800, ``Standard Review Plan for the Review of Safety Analysis Reports for... impacts.'' DATES: The effective date of this Standard Review Plan (SRP) update is June 7, 2013. ADDRESSES...

Biomarker-Guided Adaptive Trial Designs in Phase II and Phase III: A Methodological Review

PubMed Central

Antoniou, Miranta; Jorgensen, Andrea L; Kolamunnage-Dona, Ruwanthi

2016-01-01

Background Personalized medicine is a growing area of research which aims to tailor the treatment given to a patient according to one or more personal characteristics. These characteristics can be demographic such as age or gender, or biological such as a genetic or other biomarker. Prior to utilizing a patient’s biomarker information in clinical practice, robust testing in terms of analytical validity, clinical validity and clinical utility is necessary. A number of clinical trial designs have been proposed for testing a biomarker’s clinical utility, including Phase II and Phase III clinical trials which aim to test the effectiveness of a biomarker-guided approach to treatment; these designs can be broadly classified into adaptive and non-adaptive. While adaptive designs allow planned modifications based on accumulating information during a trial, non-adaptive designs are typically simpler but less flexible. Methods and Findings We have undertaken a comprehensive review of biomarker-guided adaptive trial designs proposed in the past decade. We have identified eight distinct biomarker-guided adaptive designs and nine variations from 107 studies. Substantial variability has been observed in terms of how trial designs are described and particularly in the terminology used by different authors. We have graphically displayed the current biomarker-guided adaptive trial designs and summarised the characteristics of each design. Conclusions Our in-depth overview provides future researchers with clarity in definition, methodology and terminology for biomarker-guided adaptive trial designs. PMID:26910238

Monitoring outcomes for the Medicare Advantage program: methods and application of the VR-12 for evaluation of plans.

PubMed

Kazis, Lewis E; Selim, Alfredo J; Rogers, William; Qian, Shirley X; Brazier, John

2012-01-01

The Veterans RAND 12-Item Health Survey (VR-12) is one of the major patient-reported outcomes for ranking the Medicare Advantage (MA) plans in the Health Outcomes Survey (HOS). Approaches for scoring physical and mental health are given using contemporary norms and regression estimators. A new metric approach for the VR-12 called the "VR-6D" is presented with case-mix adjustments for monitoring plans that combine utilities and mortality. Results show that the models for ranking health outcomes of the plans are robust and credible. Future directions include the use of utilities for evaluating and ranking of MA plans.

A comparison of mail-service and retail community pharmacy claims in 5 prescription benefit plans.

PubMed

Clark, Bartholomew E; Siracuse, Mark V; Garis, Robert I

2009-06-01

Little evidence has been presented to date that would either support or refute a widely held belief that mail-service pharmacy utilization routinely produces savings in drug benefit costs for prescription benefit plan sponsors. To present a comparative analysis of mail-service and community pharmacy service drug benefit costs for 5 employer-sponsored prescription drug benefit plans. A cross-sectional comparison of 17,725 matched transaction pairs of community and mail-service prescriptions from a data set comprised 484,987 prescription claims from a convenience sample of 5 employer-sponsored prescription benefit plans. Differences between community pharmacy and mail-service prescription transactions were examined at the per-unit level of analysis for drug ingredient costs, dispensing fees, co-payments, dollar amounts paid by plan sponsor, and total dollar amounts. Overall, the total cost of prescriptions was lower through mail-service pharmacies for all 5 plans studied. Two of 5 plans had co-payment incentives to use mail-service, yet plan sponsors paid more for mail-service drugs; respectively, 4.5% and 8.3% more overall, 25.0% and 21.4% more for generic medications; and 3.0% and 7.0% more for brand name medications. Mail-service co-payments were 48.9% and 51.7% lower. Mail-service utilization rates were 15.2% and 31.5% of the total number of prescriptions dispensed in the period studied. Three of 5 plans had no co-payment incentive to use mail-service and paid less for mail-service drugs; respectively, 18.7%, 6.6%, and 15.7% less overall; 17.4%, 15.6%, and 7.9% less for generic medications; and 18.8%, 5.2%, and 16.6% less for brand name medications. Mail-service co-payments were 10.5% more, 5.2% less, and 1.8% more than community pharmacy co-payments, respectively. Mail-service utilization rates were 0.8%, 1.2%, and 4.4%. Co-payment incentives to use mail-service pharmacies instead of community pharmacies were associated with higher mail-service utilization rates and with higher costs to plan sponsors. Absence of a co-payment incentive to use mail-service pharmacies was associated with lower mail-service utilization rates and with lower costs to plan sponsors.

A novel approach for documenting naming errors induced by navigated transcranial magnetic stimulation.

PubMed

Lioumis, Pantelis; Zhdanov, Andrey; Mäkelä, Niko; Lehtinen, Henri; Wilenius, Juha; Neuvonen, Tuomas; Hannula, Henri; Deletis, Vedran; Picht, Thomas; Mäkelä, Jyrki P

2012-03-15

Transcranial magnetic stimulation (TMS) is widely used both in basic research and in clinical practice. TMS has been utilized in studies of functional organization of speech in healthy volunteers. Navigated TMS (nTMS) allows preoperative mapping of the motor cortex for surgical planning. Recording behavioral responses to nTMS in the speech-related cortical network in a manner that allows off-line review of performance might increase utility of nTMS both for scientific and clinical purposes, e.g., for a careful preoperative planning. Four subjects participated in the study. The subjects named pictures of objects presented every 2-3s on a computer screen. One-second trains of 5 pulses were applied by nTMS 300ms after the presentation of pictures. The nTMS and stimulus presentation screens were cloned. A commercial digital camera was utilized to record the subject's performance and the screen clones. Delays between presentation, audio and video signals were eliminated by carefully tested combination of displays and camera. An experienced neuropsychologist studied the videos and classified the errors evoked by nTMS during the object naming. Complete anomias, semantic, phonological and performance errors were observed during nTMS of left fronto-parieto-temporal cortical regions. Several errors were detected only in the video classification. nTMS combined with synchronized video recording provides an accurate monitoring tool of behavioral TMS experiments. This experimental setup can be particularly useful for high-quality cognitive paradigms and for clinical purposes. Copyright © 2011 Elsevier B.V. All rights reserved.

Referral patterns and service utilization in a pediatric hospital-wide intimate partner violence program.

PubMed

Cruz, Mario; Cruz, Patricia B; Weirich, Christine; McGorty, Ryan; McColgan, Maria D

2013-08-01

To describe the referral patterns and utilization of on-site intimate partner violence (IPV) services in both inpatient and outpatient settings at a large urban children's hospital. Retrospective review of case records from IPV victims referred to an on-site IPV counselor between September 2005 and February 2010. Descriptive statistics were used to examine IPV victim demographics, number of referrals per hospital department, referral source (type of staff member), time spent by IPV counselor for initial consultation, and services provided to IPV victims. A total of 453 unique referrals were made to the IPV counselor: 81% were identified by universal screening and 19% by risk-based screening. Thirty-six percent of IPV victims were referred from primary care clinics; 26% from inpatient units; 13% from outpatient subspecialty clinics; 12.5% from the emergency department; 5% from the Child Protection Program; and 4% were employee self-referrals. Social workers generated the most referrals (55%), followed by attending physicians (17%), residents (13%), nurses (7%), and other individuals (self-referrals) (4%). The median initial IPV intervention required 42 minutes. Supportive counseling and safety planning were the services most often utilized by IPV victims. IPV screening can be successfully integrated in both inpatient and outpatient settings by a multidisciplinary group of hospital staff. Most referrals were generated by universal screening outside of the primary care setting. IPV victims generally desired supportive counseling and safety planning over immediate housing relocation. Many IPV screening opportunities were missed by using verbal screening alone. Copyright © 2013 Elsevier Ltd. All rights reserved.