Effects of HMO market penetration on physicians' work effort and satisfaction.

Science.gov (United States)

Hadley, J; Mitchell, J M

1997-01-01

We investigate whether geographic variations in health maintenance organization (HMO) market penetration are associated with three aspects of physicians' practices: number of hours worked per year, number of patients seen per week, and satisfaction with the current practice. Based on multivariate regression analysis of data for 4,373 patient care physicians (under age forty-five) from a national random sample surveyed in 1991, we estimate that a doubling of the average level of HMO penetration is associated with statistically significant differences of 4 percent fewer annual hours, 13.7 percent fewer patients seen per week, and a 20 percent greater likelihood of not being very satisfied with one's current practice.

The health maintenance organization strategy: a corporate takeover of health services delivery.

Science.gov (United States)

Salmon, J W

1975-01-01

This paper presents a political economic framework for viewing the social organization of the delivery of health care servies and predicting a qualitatively different institutional configuration involving the health maintenance organization. The principal forces impacting American capitalism today are leading to a fundamental restructuring for increased social efficiency of the entire social welfare sector, including the health services industry. The method to achieve this restructuring involves health policy directed at raising the contribution to the social surplus from the delivery of health care services and eventual corporate domination. The health maintenance organization conceptualization is examined with suggestions as to how the HMO strategy promoted by the state leads to this corporate takeover. The mechanism and extent of the present corporate involvement are examined and implications of health services as a social control mechanism are presented.

Competition among hospitals for HMO business: effect of price and nonprice attributes.

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Young, Gary J; Burgess, James E; Valley, Danielle

2002-10-01

To investigate patterns of competition among hospitals for the business of health maintenance organizations (HMOs). The study focused on the relative importance of hospital price and nonprice attributes in the competition for HMO business. The study capitalized on hospital cost reports from Florida that are unique in their inclusion of financial data regarding HMO business activity. The time frame was 1992 to 1997. The study was designed as an observational investigation of acute care hospitals. Results indicated that a hospital's share of HMO business was related to both its price and nonprice attributes. However, the importance of both price and nonprice attributes diminished as the number of HMOs in a market increased. Hospitals that were market share leaders in terms of HMO business (i.e., 30 percent or more market share) were superior, on average, to their competitors on both price and nonprice attributes. Study results indicate that competition among hospitals for HMO business involves a complex set of price and nonprice attributes. The HMOs do not appear to focus on price alone. Hospitals likely to be the most attractive to HMOs are those that can differentiate themselves on the basis of nonprice attributes while being competitive on price as well.

A physician role typology: colleague and client dependence in an HMO.

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Barr, J K; Steinberg, M K

1985-01-01

This paper reports on physicians' role definitions in one prepaid group practice, a health maintenance organization (HMO). Colleague and client dependence are reviewed and analyzed as separable dimensions of physician role definitions. Data are derived from documents, interviews, and staff questionnaires collected in 1979-1980. The evidence reported suggests widespread colleague dependence in the HMO. Physicians consulted with one another about patient care and engaged in informal referral and review, developing practice standards; and some of these physicians relied on colleagues for handling their patient visits when needed. In relation to their patients, some physicians viewed themselves as bureaucratic officials relatively dependent on client approval in carrying out their health care activities, while others saw themselves as trusted medical experts in a setting free of nonmedical constraints in patient care. The relationship of organizational structure to these different role definitions is discussed. Classifying these HMO physicians according to a fourfold typology of professional dependence shows that most are Organizational Physicians (Type I), who are both colleague and client dependent. Collegial Physicians (Type II) are colleague dependent and, at the same time, do not perceive clients as demanding. Implications for quality of care and physician satisfaction and turnover are considered.

Financial risk sharing with providers in health maintenance organizations, 1999.

Science.gov (United States)

Gold, Marsha R; Lake, Timothy; Hurley, Robert; Sinclair, Michael

2002-01-01

The transfer of financial risk from health maintenance organizations (HMOs) to providers is controversial. To provide timely national data on these practices, we conducted a telephone survey in 1999 of a multi-staged probability sample of HMOs in 20 of the nation's 60 largest markets, accounting for 86% of all HMO enrollees nationally. Among those sampled, 82% responded. We found that HMOs' provider networks with physicians, hospitals, skilled nursing homes, and home health agencies are complex and multi-tiered Seventy-six percent of HMOs in our study use contracts for their HMO products that involve global, professional services, or hospital risk capitation to intermediate entities. These arrangements account for between 24.5 million and 27.4 million of the 55.9 million commercial and Medicare HMO enrollees in the 60 largest markets. While capitation arrangements are particularly common in California, they are more common elsewhere than many assume. The complex layering of risk sharing and delegation of care management responsibility raise questions about accountability and administrative costs in managed care. Do complex structures provide a way to involve providers more directly in managed care, or do they diffuse authority and add to administrative costs?

HMO innovations. Video-enhanced medical advice; senior zoo walkers; Group Health Resource Line; enhancing health education programs through desktop publishing; home health beat; innovative school health partnership.

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Paperny, D M; Maeser, J D; Artz, K; Stroh, M J; Jackson, L; Cohen, K; Lancaster, M S; Heyer, A L; Clevenson, D S

1991-01-01

The editors of HMO PRACTICE asked clinicians and health educators in HMOs across the country to submit reports on their unique, successful patient education programs. The following HMO Innovations testify to the wide range of new technologies, enterprising partnerships, and creative ideas that are shaping health education in HMOs today.

The effect of practitioner compensation on HMO consumer satisfaction.

Science.gov (United States)

Scoggins, John F

2002-04-01

To test the hypothesis that a health maintenance organization (HMO) consumer's satisfaction depends on the way his or her health plan compensates practitioners. Consumer Assessment of Health Plans (CAHPS) survey data from 1999 and 2000 were provided by the Office of Public Insurance Counsel for the state of Texas. These data were combined with the Health Plan Employer Data and Information Set (HEDIS) quality measures of managed care health plans in Texas published by the Texas Health Care Information Council. The study fitted the CAHPS survey data to an ordered-probit model. The dependent variable was customer satisfaction with the health plan, using a rating scale from 0-10. The independent variables included the percentage of health plan practitioners compensated with capitated fees, the percentage compensated with a bonus or withholding incentive, and other health plan and consumer characteristics. Consumer satisfaction with HMOs is negatively correlated with the percentage of practitioners who are compensated on a capitated-fee basis and positively correlated with the percentage of practitioners compensated with a fee-withholding incentive (e.g., a fraction of fees that are withheld until specific quality and cost-control goals are reached). Neither the percentage compensated under a bonus incentive system nor the percentage of general practitioners with board certification correlated with HMO consumer satisfaction. A managed health plan's method of practitioner compensation can affect participant satisfaction in a predictable manner.

HMO penetration and physicians' earnings.

Science.gov (United States)

Hadley, J; Mitchell, J M

1999-11-01

The goal of this study is to estimate whether cross-sectional variations in enrollment in health maintenance organizations (HMOs) affected physicians' earnings and hourly income in 1990. Using data from a nationally representative sample of 4,577 younger physicians (penetration is endogenous and used the instrumental variables approach to obtain unbiased estimates. HMO penetration had a negative and statistically significant impact on physicians earnings in 1990. A doubling of the average level of HMO penetration in the market is estimated to reduce annual earnings by 7% to 10.7%, and hourly earnings by approximately 6% to 9%. It appears that HMOs were successful in reducing physicians' annual and per hour earnings in 1990, presumably through a combination of fewer visits and lower payment rates for people covered by HMOs. Although these results cannot be generalized to all physicians, the experience of a younger cohort of physicians may still be a good indicator of the future effects of HMOs because younger physicians may be more susceptible to market forces than older and more established physicians. Moreover, these results may be somewhat conservative because they reflect market behavior in 1990, several years before the rapid growth and more aggressive market behavior of HMOs in recent years.

42 CFR 417.153 - Offer of HMO alternative.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Offer of HMO alternative. 417.153 Section 417.153... § 417.153 Offer of HMO alternative. (a) Basic rule. An employing entity that is subject to this subpart and that elects to include one or more qualified HMOs must offer the HMO alternative in accordance...

Trends in hospital cost and revenue, 1994-2005: how are they related to HMO penetration, concentration, and for-profit ownership?

Science.gov (United States)

Shen, Yu-Chu; Wu, Vivian Y; Melnick, Glenn

2010-02-01

Analyze trends in hospital cost and revenue, as well as price and quantity (1994-2005) as a function of health maintenance organization (HMO) penetration, HMO concentration, and for-profit (FP) HMO market share. Medicare hospital cost reports, AHA Annual Surveys, HMO data from Interstudy, and other supplemental data. A retrospective study of all short-term, general, nonfederal hospitals in metropolitan statistical areas (MSAs) in the United States from 1994 to 2005, using hospital/MSA fixed-effects translog regression models. A 10 percentage point increase in HMO enrollment is associated with 4.1-4.2 percent reduction in costs and revenues in the pre-2000 period but only a 2.1-2.5 percent reduction in the post-2000 period. Hospital revenue in HMO-dominant markets (highly concentrated HMO market and competitive hospital market) is 19-27 percent lower than other types of markets, and the difference is most likely due mainly to lower prices and to a lesser extent lower utilization. The historical difference of lower spending in high HMO penetration markets compared with low HMO markets narrowed after 2000 and the relative concentration between HMO and hospital markets can substantially influence hospital spending. Additional research is needed to understand how different aspects of these two markets have changed and interacted and how they are causally linked to spending trends.

Pricing health care services: applications to the health maintenance organization.

Science.gov (United States)

Sweeney, R E; Franklin, S P

1986-01-01

This article illustrates how management in one type of service industry, the health maintenance organization (HMO), have attempted to formalize pricing. This effort is complicated by both the intangibility of the service delivered and the relatively greater influence in service industries of non-cost price factors such as accessibility, psychology, and delays. The presentation describes a simple computerized approach that allows the marketing manager to formally estimate the effect of incremental changes in rates on the firm's projected patterns of enrollment growth and net revenues. The changes in turn reflect underlying variations in the mix of pricing influences including psychological and other factors. Enrollment projections are crucial to the firm's financial planning and staffing. In the past, most HMO enrollment and revenue projections of this kind were notoriously unreliable. The approach described here makes it possible for HMOs to fine-tune their pricing policies. It also provides a formal and easily understood mechanism by which management can evaluate and reach consensus on alternative scenarios for enrollment growth, staff recruitment and capacity expansion.

Trends in Hospital Cost and Revenue, 1994–2005: How Are They Related to HMO Penetration, Concentration, and For-Profit Ownership?

Science.gov (United States)

Shen, Yu-Chu; Wu, Vivian Y; Melnick, Glenn

2010-01-01

Objective Analyze trends in hospital cost and revenue, as well as price and quantity (1994–2005) as a function of health maintenance organization (HMO) penetration, HMO concentration, and for-profit (FP) HMO market share. Data Medicare hospital cost reports, AHA Annual Surveys, HMO data from Interstudy, and other supplemental data. Study Design A retrospective study of all short-term, general, nonfederal hospitals in metropolitan statistical areas (MSAs) in the United States from 1994 to 2005, using hospital/MSA fixed-effects translog regression models. Principal Findings A 10 percentage point increase in HMO enrollment is associated with 4.1–4.2 percent reduction in costs and revenues in the pre-2000 period but only a 2.1–2.5 percent reduction in the post-2000 period. Hospital revenue in HMO-dominant markets (highly concentrated HMO market and competitive hospital market) is 19–27 percent lower than other types of markets, and the difference is most likely due mainly to lower prices and to a lesser extent lower utilization. Conclusions The historical difference of lower spending in high HMO penetration markets compared with low HMO markets narrowed after 2000 and the relative concentration between HMO and hospital markets can substantially influence hospital spending. Additional research is needed to understand how different aspects of these two markets have changed and interacted and how they are causally linked to spending trends. PMID:19840134

Medicaid HMO penetration and its mix: did increased penetration affect physician participation in urban markets?

Science.gov (United States)

Adams, E Kathleen; Herring, Bradley

2008-02-01

To use changes in Medicaid health maintenance organization (HMO) penetration across markets over time to test for effects on the extent of Medicaid participation among physicians and to test for differences in the effects of increased use of commercial versus Medicaid-dominant plans within the market. The nationally representative Community Tracking Study's Physician Survey for three periods (1996-1997, 1998-1999, and 2000-2001) on 29,866 physicians combined with Centers for Medicare and Medicaid Services (CMS) and InterStudy data. Market-level estimates of Medicaid HMO penetration are used to test for (1) any participation in Medicaid and (2) the degree to which physicians have an "open" (i.e., nonlimited) practice accepting new Medicaid patients. Models account for physician, firm, and local characteristics, Medicaid relative payment levels adjusted for geographic variation in practice costs, and market-level fixed effects. There is a positive effect of increases in commercial Medicaid HMO penetration on the odds of accepting new Medicaid patients among all physicians, and in particular, among office-based physicians. In contrast, there is no effect, positive or negative, from expanding the penetration of Medicaid-dominant HMO plans within the market. Increases in cost-adjusted Medicaid fees, relative to Medicare levels, were associated with increases in the odds of participation and of physicians having an "open" Medicaid practice. Provider characteristics that consistently lower participation among all physicians include being older, board certified, a U.S. graduate and a solo practitioner. The effects of Medicaid HMO penetration on physician participation vary by the type of plan. If states are able to attract and retain commercial plans, participation by office-based physicians is likely to increase in a way that opens existing practices to more new Medicaid patients. Other policy variables that affect participation include the presence of a federally

42 CFR 417.155 - How the HMO option must be included in the health benefits plan.

Science.gov (United States)

2010-10-01

... printed materials that meet the requirements of § 417.124(b). (ii) Access may not be more restrictive or... benefits plan. 417.155 Section 417.155 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... Organizations in Employee Health Benefits Plans § 417.155 How the HMO option must be included in the health...

Market and plan characteristics related to HMO quality and improvement.

Science.gov (United States)

Scanlon, Dennis P; Swaminathan, Shailender; Chernew, Michael; Lee, Woolton

2006-12-01

Existing research on health plan performance examines whether variation in plans' scores is related to enrollee and health plan traits, primarily using cross-sectional research designs. This study extends that literature by incorporating data on market characteristics using a longitudinal framework. We estimate multivariate growth models that relate plan performance on standard measures to market and HMO characteristics using an unbalanced panel of data for 1998 to 2002. We find that HMO competition is not associated with better performance or greater rates of improvement in performance on the HEDIS chronic care measures. HMO penetration, on the other hand, is positively associated with HEDIS performance in several of the chronic care process-and-outcomes measures but not with a greater rate of improvement through time. Our analysis indicates that a significant percentage of the unexplained variation in quality improvement is because of permanent, unobserved plan-level characteristics that future research should strive to identify.

Health maintenance organizations: critical issues raised by restructuring delivery for health systems reform.

Science.gov (United States)

Gold, M

1993-10-01

In sum, the potential that managed care will grow under health systems reform creates an opportunity for the HMO industry but also serves as a challenge and a threat. Faced with greater scrutiny and growing demands, HMOs increasingly are being forced to demonstrate their potential and live up to their expectation. At the same time, the changing nature of the health care system creates a challenge for HMOs. Cost pressures create needs to review the entire delivery system, including the ambulatory component, with a focus on enhancing cost-effectiveness. Greater visibility also creates demands; growing market penetration argues for the creation of a new paradigm to define an appropriate structure for public accountability and management. Finally, the transformation of an HMO industry into a managed care industry is not without its risks as HMO performance becomes evaluated not only against itself but as part of the performance of the broader managed care industry in which HMOs have become embedded.

The impact of HMO and hospital competition on hospital costs.

Science.gov (United States)

Younis, Mustafa Z; Rivers, Patrick A; Fottler, Myron D

2005-01-01

This study examines the impact of HMO penetration and competition on health system performance, as measured by hospital cost per adjusted admissions. The study population consisted of acute-care hospitals in the United States. The findings of this study suggest that there is no relationship between HMO competition and hospital cost per adjusted admission. Governmental efforts to stimulate competition in the hospital market, if focused on promoting HMOs, are not likely to produce cost-containing results quickly.

A randomized controlled open trial of population-based disease and case management in a Medicare Plus Choice health maintenance organization.

Science.gov (United States)

Martin, David C; Berger, Marc L; Anstatt, David T; Wofford, Jonathan; Warfel, DeAnn; Turpin, Robin S; Cannuscio, Carolyn C; Teutsch, Steven M; Mansheim, Bernard J

2004-10-01

The object of this study was to examine the effect of population-based disease management and case management on resource use, self-reported health status, and member satisfaction with and retention in a Medicare Plus Choice health maintenance organization (HMO). Study design consisted of a prospective, randomized controlled open trial of 18 months' duration. Participants were 8504 Medicare beneficiaries aged 65 and older who had been continuously enrolled for at least 12 months in a network model Medicare Plus Choice HMO serving a contiguous nine-county metropolitan area. Members were care managed with an expert clinical information system and frequent telephone contact. Main outcomes included self-reported health status measured by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), resource use measured by admission rates and bed-days per thousand per year, member satisfaction, and costs measured by paid claims. More favorable outcomes occurred in the intervention group for satisfaction with the health plan (P management and case management led to improved self-reported satisfaction and social function but not to a global net decrease in resource use or improved member retention.

Do HMO penetration and hospital competition impact quality of hospital care?

Science.gov (United States)

Rivers, P A; Fottler, M D

2004-11-01

This study examines the impact of HMO penetration and competition on hospital markets. A modified structure-conduct-performance paradigm was applied to the health care industry in order to investigate the impact of HMO penetration and competition on risk-adjusted hospital mortality rates (i.e. quality of hospital care). Secondary data for 1957 acute care hospitals in the USA from the 1991 American Hospital Association's Annual Survey of Hospitals were used. The outcome variables were risk-adjusted mortality rates in 1991. Predictor variables were market characteristics (i.e. managed care penetration and hospital competition). Control variables were environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using statistical regression techniques. Hospital competition had a negative relationship with risk-adjusted mortality rates (a negative indicator of quality of care). HMO penetration, hospital competition, and an interaction effect of HMO penetration and competition were not found to have significant effects on risk-adjusted mortality rates. These findings suggest that when faced with intense competition, hospitals may respond in ways associated with reducing their mortality rates.

Consumer beliefs and health plan performance: it's not whether you are in an HMO but whether you think you are.

Science.gov (United States)

Reschovsky, James D; Hargraves, J Lee; Smith, Albert F

2002-06-01

Surveys that rate how persons enrolled in HMOs and other types of health coverage feel about their health care are used to bolster claims that HMOs provide inferior quality care, providing justification for patient protection legislation. This research illustrates that the conventional wisdom regarding inferior care in HMOs may color how people assess their health care in surveys, resulting in survey findings biased toward showing HMOs provide inferior care and reinforcing existing stereotypes. Using merged data from the Community Tracking Study Household and Insurance Followback surveys, we identify privately insured persons who correctly and incorrectly know what kind of health plan they are covered by. Nearly a quarter misidentified their type of health coverage. Differences between responses by HMO and non-HMO enrollees to questions covering satisfaction with health care and physician choice, the quality of the last physician's visit, and patient trust in their physician shrink or disappear when we control for beliefs about what type of plan they are covered by. Results suggest that researchers and policy makers should be cautious about using consumer surveys to assess the relative quality of care provided under different types of health insurance.

Impact of HMO penetration and other environmental factors on hospital X-inefficiency.

Science.gov (United States)

Rosko, M D

2001-12-01

This study examined the impact of health maintenance organization (HMO) market penetration and other internal and external environmental factors on hospital X-inefficiency in a national sample (N = 1,966) of urban U.S. hospitals in 1997. Stochastic frontier analysis, a frontier regression technique, was used to measure X-inefficiency and estimate parameters of the correlates of X-inefficiency. Log-likelihood restriction tests were used to test a variety of assumptions about the empirical model that guided its selection. Average estimated X-inefficiency in study hospitals was 12.96 percent. Increases in managed care penetration, dependence on Medicare and Medicaid, membership in a multihospital system, and location in areas where competitive pressures and the pool of uncompensated care are greater were associated with less X-inefficiency. Not-for-profit ownership was associated with increased X-inefficiency.

Determinants of information technology outsourcing among health maintenance organizations.

Science.gov (United States)

Wholey, D R; Padman, R; Hamer, R; Schwartz, S

2001-09-01

We analyze the determinants of HMO information technology outsourcing using two studies. Study 1 examines the effect of asset specificity on outsourcing for development and operation activities, using HMO specific fixed effects to control for differences between HMOs. Study 2 regresses the HMO specific fixed effects from Study 1, which measure an HMO's propensity to outsource, on HMO characteristics. The data comes from a 1995 InterStudy survey about information technology organization of HMOs. While HMOs split roughly equally in outsourcing information technology development activities, they are extremely unlikely to outsource the day-to-day operation of information systems. The greater an HMO's information technology capability and the complexity of information systems supported, the less likely is an HMO to outsource. While HMOs less than two years old, for-profit HMOs, local or Blue Cross-affiliated HMOs, and mixed HMOs are more likely to outsource, federally qualified HMOs are less likely to outsource. Policy and managerial implications for the adoption and diffusion of new ways of organizing information technology, such as application service providers (ASPs), are discussed.

The role of service recovery in HMO satisfaction.

Science.gov (United States)

Sarel, D; Marmorstein, H

1999-01-01

Complaint handling and service recovery by HMOs may be more efficient to implement and more determinant of customer satisfaction and retention than other approaches such as improving access to care. The current findings are consistent with research on recovery efforts in other industries. Complaint handling systems must achieve rapid and comprehensive identification and resolution of HMO member problems. Both cultural change and appropriate incentives to re-educate employees within HMO organizations are additional requisites to effective service recovery. The benefits to the HMO of expenditures on service recovery should be more immediate and sustainable than the benefits derived from other methods of increasing member satisfaction.

Paying for quality not quantity: a wisconsin health maintenance organization proposes an incentive model for reimbursement of chiropractic services.

Science.gov (United States)

Pursel, Kevin J; Jacobson, Martin; Stephenson, Kathy

2012-07-01

The purpose of this study is to describe a reimbursement model that was developed by one Health Maintenance Organization (HMO) to transition from fee-for-service to add a combination of pay for performance and reporting model of reimbursement for chiropractic care. The previous incentive program used by the HMO provided best-practice education and additional reimbursement incentives for achieving the National Committee for Quality Assurance Back Pain Recognition Program (NCQA-BPRP) recognition status. However, this model had not leveled costs between doctors of chiropractic (DCs). Therefore, the HMO management aimed to develop a reimbursement model to incentivize providers to embrace existing best-practice models and report existing quality metrics. The development goals included the following: it should (1) be as financially predictable as the previous system, (2) cost no more on a per-member basis, (3) meet the coverage needs of its members, and (4) be able to be operationalized. The model should also reward DCs who embraced best practices with compensation, not simply tied to providing more procedures, the new program needed to (1) cause little or no disruption in current billing, (2) be grounded achievable and defined expectations for improvement in quality, and (3) be voluntary, without being unduly punitive, should the DC choose not to participate in the program. The generated model was named the Comprehensive Chiropractic Quality Reimbursement Methodology (CCQRM; pronounced "Quorum"). In this hybrid model, additional reimbursement, beyond pay-for-procedures will be based on unique payment interpretations reporting selected, existing Physician Quality Reporting System (PQRS) codes, meaningful use of electronic health records, and achieving NCQA-BPRP recognition. This model aims to compensate providers using pay-for-performance, pay-for-quality reporting, pay-for-procedure methods. The CCQRM reimbursement model was developed to address the current needs of one

Impact of HMO market structure on physician-hospital strategic alliances.

Science.gov (United States)

Burns, L R; Bazzoli, G J; Dynan, L; Wholey, D R

2000-04-01

To assess the impact of HMO market structure on the formation of physician-hospital strategic alliances from 1993 through 1995. The two trends, managed care and physician-hospital integration have been prominent in reshaping insurance and provider markets over the past decade. Pooled cross-sectional data from the InterStudy HMO Census and the Annual Survey conducted by the American Hospital Association (AHA) between 1993 and the end of 1995 to examine the effects of HMO penetration and HMO numbers in a market on the formation of hospital-sponsored alliances with physicians. Because prior research has found nonlinear effects of HMOs on a variety of dependent variables, we operationalized HMO market structure two ways: using a Taylor series expansion and cross-classifying quartile distributions of HMO penetration and numbers into 16 dummy indicators. Alliance formation was operationalized using the presence of any alliance model (IPA, PHO, MSO, and foundation) and the sum of the four models present in the hospital. Because managed care and physician-hospital integration are endogenous (e.g., some hospitals also sponsor HMOs), we used an instrumental variables approach to model the determinants of HMO penetration and HMO numbers. These instruments were then used with other predictors of alliance formation: physician supply characteristics, the extent of hospital competition, hospital-level descriptors, population size and demographic characteristics, and indicators for each year. All equations were estimated at the MSA level using mixed linear models and first-difference models. Contrary to conventional wisdom, alliance formation is shaped by the number of HMOs in the market rather than by HMO penetration. This confirms a growing perception that hospital-sponsored alliances with physicians are contracting vehicles for managed care: the greater the number of HMOs to contract with, the greater the development of alliances. The models also show that alliance formation is

Segmenting health maintenance organizations to study productivity and profitability.

Science.gov (United States)

Sobol, M G

2000-01-01

As the decade ended, health maintenance organizations (HMOs) were increasing in popularity as a means of health care delivery. These groups take many forms, so it is important for the analyst to see if the efficiency and financial results for these different forms vary. The four major forms are profit vs. not-for-profit, chain vs. non-chain, group/staff vs. individual practice association (IPA), and federally qualified vs. non-federally qualified. Using a nationwide database of all the HMOs in the United States, the article compares liquidity rates, leverage ratios, profitability ratios, marketing, and per member ratios across the four groups using paired t tests. The two classifications that showed the most differences were group/staff vs. IPA and federally qualified vs. non-federally qualified. IPAs have a better liquidity position and lower leverage ratios than group/staff but their administrative costs are higher and the time to receive payments and to pay debts is higher. Non-federally qualified have somewhat higher liquidity ratios and higher profitability ratios. These significant differences in financial outcomes indicate that studies of HMOs should segment different major forms of organizations and study them separately before trying to show the effects of different policies on HMO efficiency and effectiveness.

Medicare and state health care programs: fraud and abuse, civil money penalties and intermediate sanctions for certain violations by health maintenance organizations and competitive medical plans--HHS. Final rule.

Science.gov (United States)

1994-07-15

This final rule implements sections 9312(c)(2), 9312(f), and 9434(b) of Public Law 99-509, section 7 of Public Law 100-93, section 4014 of Public Law 100-203, sections 224 and 411(k)(12) of Public Law 100-360, and section 6411(d)(3) of Public Law 101-239. These provisions broaden the Secretary's authority to impose intermediate sanctions and civil money penalties on health maintenance organizations (HMOs), competitive medical plans, and other prepaid health plans contracting under Medicare or Medicaid that (1) substantially fail to provide an enrolled individual with required medically necessary items and services; (2) engage in certain marketing, enrollment, reporting, or claims payment abuses; or (3) in the case of Medicare risk-contracting plans, employ or contract with, either directly or indirectly, an individual or entity excluded from participation in Medicare. The provisions also condition Federal financial participation in certain State payments on the State's exclusion of certain prohibited entities from participation in HMO contracts and waiver programs. This final rule is intended to significantly enhance the protections for Medicare beneficiaries and Medicaid recipients enrolled in a HMO, competitive medical plan, or other contracting organization under titles XVIII and XIX of the Social Security Act.

Critical factors in recruiting health maintenance organization physicians.

Science.gov (United States)

Fisher, N B; Smith, H L; Pasternak, D P

1993-01-01

What factors facilitate successful physician recruiting by health care organizations? Answers surfaced in a study of physician recruiting by a large HMO in the Southwest. Professional networking and word-of-mouth advertising appear to be the prominent means by which physicians learn of attractive staff positions. Successful recruiting also depends on a practice setting that fosters quality care, emphasis on patient care delivery, and collegial interaction.

Does competition improve health care quality?

Science.gov (United States)

Scanlon, Dennis P; Swaminathan, Shailender; Lee, Woolton; Chernew, Michael

2008-12-01

To identify the effect of competition on health maintenance organizations' (HMOs) quality measures. Longitudinal analysis of a 5-year panel of the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Health Plans Survey(R) (CAHPS) data (calendar years 1998-2002). All plans submitting data to the National Committee for Quality Assurance (NCQA) were included regardless of their decision to allow NCQA to disclose their results publicly. NCQA, Interstudy, the Area Resource File, and the Bureau of Labor Statistics. Fixed-effects models were estimated that relate HMO competition to HMO quality controlling for an unmeasured, time-invariant plan, and market traits. Results are compared with estimates from models reliant on cross-sectional variation. Estimates suggest that plan quality does not improve with increased levels of HMO competition (as measured by either the Herfindahl index or the number of HMOs). Similarly, increased HMO penetration is generally not associated with improved quality. Cross-sectional models tend to suggest an inverse relationship between competition and quality. The strategies that promote competition among HMOs in the current market setting may not lead to improved HMO quality. It is possible that price competition dominates, with purchasers and consumers preferring lower premiums at the expense of improved quality, as measured by HEDIS and CAHPS. It is also possible that the fragmentation associated with competition hinders quality improvement.

Model citizens. Outsourcing helps start-up Medicare HMO.

Science.gov (United States)

Slavic, B; Adami, S

1999-04-01

Health Plans of Pennsylvania (HPP), the managed care arm of Crozer-Keystone Health System, in Media, Pa. Selecting the information systems and building the infrastructure to support the start-up of a new Medicare HMO product. HPP chose to outsource the information systems needed to integrate all the components of managed care administration into a cost-effective and cohesive program. Because of its aggressive programming and start-up of the MedCarePlus product offering, HPP became the first plan in the country to submit Medicare claims data electronically for encounter reporting to the Health Care Financing Administration (HCFA). "Through an integrated team approach, an organization truly can benefit from the economies of scale gained through outsourcing."

Does anyone understand HMO advertising?

Science.gov (United States)

Bisinger, J M

1986-12-01

Much HMO advertising is executed with technical proficiency, but a high level of technical skill cannot compensate for poor objectives, an inadequate analysis of the business situation, or a lack of advertising effectiveness. Industrial marketing techniques often involve person-to-person selling via a sales staff, sales reps, on-site technical assistance and informational meetings, team selling, etc. Some HMOs also employ these techniques. In general, the promotional focus in these situations is not on mass media; communication tends to be in support of personal sales activities. These personal techniques are used because of the difficulty of selling complicated products or services. Is an HMO a simple product/service? If it is not, consumer promotional tactics will probably be ineffective. If used, these promotional tactics probably will be unintelligible because "consumers" do not select HMOs; their employers do.

Strategic marketing applications of conjoint analysis: an HMO perspective.

Science.gov (United States)

Rosko, M D; DeVita, M; McKenna, W F; Walker, L R

1985-01-01

The purpose of this article is to demonstrate how data from a conjoint analysis study can be used to help determine the most appropriate marketing mix for an operational HMO which is entering a new market--the geriatric population. Included are two features which are absent in previous articles on health care applications of conjoint analysis: external validation of results, and a demonstration of how conjoint analysis can be used to simulate market responses to changes in the provider's marketing mix.

Fabrication of polymer-supported nanosized hydrous manganese dioxide (HMO) for enhanced lead removal from waters

International Nuclear Information System (INIS)

Su, Qing; Pan, Bingcai; Pan, Bingjun; Zhang, Qingrui; Zhang, Weiming; Lv, Lu; Wang, Xiaoshu; Wu, Jun; Zhang, Quanxing

2009-01-01

In the current study, a new hybrid adsorbent HMO-001 was fabricated by impregnating nanosized hydrous manganese dioxide (HMO) onto a porous polystyrene cation exchanger resin (D-001) for enhanced lead removal from aqueous media. D-001 was selected as a support material mainly because of the potential Donnan membrane effect exerted by the immobilized negatively charged sulfonic acid groups bound to the polymeric matrix, which would result in preconcentration and permeation enhancement of lead ions prior to their effective sequestration by the impregnated HMO. HMO-001 was characterized by scanning electron micrograph (SEM), transmission electron micrograph (TEM), and X-ray diffraction (XRD). Lead adsorption onto HMO-001 was dependent upon solution pH due to the ion-exchange nature, and it can be represented by the Freundlich isotherm model and pseudo-first order kinetic model well. The maximum capacity of HMO-001 toward lead ion was about 395 mg/g. As compared to D-001, HMO-001 exhibited highly selective lead retention from waters in the presence of competing Ca 2+ , Mg 2+ , and Na + at much greater levels than the target toxic metal. Fixed-bed column adsorption of a simulated water indicated that lead retention on HMO-001 resulted in a conspicuous decrease of this toxic metal from 1 mg/L to below 0.01 mg/L (the drinking water standard recommended by WHO). The exhausted adsorbent particles are amenable to efficient regeneration by the binary NaAc-HAc solution for repeated use without any significant capacity loss. All the results validated the feasibility of HMO-001 for highly effective removal of lead from contaminated waters.

Evaluating employee assistance policy in an HMO-based alcoholism project.

Science.gov (United States)

Putnam, S L; Stout, R L

1985-01-01

One aspect of successful employee assistance program (EAP) implementation is the adoption of a formal, written policy, reflecting company commitment to EAP guidelines and goals. This study of criteria predictive of such policy adoption was conducted at the occupational alcoholism project of a New England health maintenance organization (HMO). Data on nearly 400 organizations contacted by occupational program consultants (OPCs) over a 20-month period were collected by questionnaire and interview. One third of these organizations adopted employee assistance policies and set about establishing formal programs. Stepwise multiple regression is the principal method used to pinpoint the correlates of policy adoption. Two of the most important of these are the attitudes of contact persons within the organization toward alcoholism and employee assistance programs, particularly their admission of alcohol problems within their social networks; and the consultants' persistence and marketing skills. The adopting organizations also had reputations for being progressive, and actively concerned about employee welfare; they tended to be large, their executives autonomous, and their union membership rates high. Inhibiting policy acceptance were fears that a written policy would jeopardize the reputation and image of the organization, and that an employee assistance program would remove internal control of personal procedures. The adequacy of the evaluative data and methods are discussed, and recommendations are offered in the interests of streamlining the efforts of OPCs and of achieving greater penetration of targeted organizations.

Timely Health Service Utilization of Older Foster Youth by Insurance Type.

Science.gov (United States)

Day, Angelique; Curtis, Amy; Paul, Rajib; Allotey, Prince Addo; Crosby, Shantel

2016-01-01

To evaluate the impact of a policy change for older foster care youth from a fee-for-service (FFS) Medicaid program to health maintenance organization (HMO) providers on the timeliness of first well-child visits (health care physicals). A three-year retrospective study using linked administrative data collected by the Michigan Departments of Human Services and Community Health of 1,657 youth, ages 10-20 years, who were in foster care during the 2009-2012 study period was used to examine the odds of receiving a timely well-child visit within the recommended 30-day time frame controlling for race, age, days from foster care entry to Medicaid enrollment, and number of foster care placements. Youth entering foster care during the HMO period were more likely to receive a timely well-child visit than those in the FFS period (odds ratio, 2.46; 95% confidence interval, 1.84-3.29; p foster care during the FFS period to 29 days for the HMO period. Among the other factors examined, more than 14 days to Medicaid enrollment, being non-Hispanic black and having five or more placements were negatively associated with receipt of a timely first well-child visit. Those youth who entered foster care during the HMO period had significantly greater odds of receiving a timely first well-child visit; however, disparities in access to preventive health care remain a concern for minority foster care youth, those who experience delayed Medicaid enrollment and those who experienced multiple placements. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

A longitudinal study of adult-onset asthma incidence among HMO members.

Science.gov (United States)

Sama, Susan R; Hunt, Phillip R; Cirillo, C I H Priscilla; Marx, Arminda; Rosiello, Richard A; Henneberger, Paul K; Milton, Donald K

2003-08-07

HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored. We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA) cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm. The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469) of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8), and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59%) and allergy (14%). New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7%) cases. Twenty-three of these (72%) indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%. Computerized HMO records can be successfully used to identify AOA. Manual review of these records is important to confirm case status and is useful in evaluation of

Hydrous manganese oxide-polyacrylonitrile (HMO-PAN) composite for the treatment of radioactive laundry wastewater

International Nuclear Information System (INIS)

Sanghwa Oh; Won Sik Shin; Sang-June Choi

2015-01-01

Hydrous manganese oxide-polyacrylonitrile (HMO-PAN) composite was applied for the removal of Co 2+ , Sr 2+ and Cs + from radioactive laundry wastewater. Single- and multi-solute competitive sorptions onto HMO-PAN were investigated. The maximum sorption capacity was in the order of Co 2+ (0.573) > Cs + (0.551) > Sr 2+ (0.310 mmol g -1 ). Sorption of the metals occurred via physical adsorption due to weak van der Waals force and ion exchange with Mn 2+ in HMO-PAN. Sorption behaviors were not related to the types of the surfactants. Among the tested surfactants, SDBS and SOBS remarkably increased the distribution coefficient of Co 2+ and Sr 2+ , respectively. (author)

A longitudinal study of adult-onset asthma incidence among HMO members

Directory of Open Access Journals (Sweden)

Rosiello Richard A

2003-08-01

Full Text Available Abstract Background HMO databases offer an opportunity for community based epidemiologic studies of asthma incidence, etiology and treatment. The incidence of asthma in HMO populations and the utility of HMO data, including use of computerized algorithms and manual review of medical charts for determining etiologic factors has not been fully explored. Methods We identified adult-onset asthma, using computerized record searches in a New England HMO. Monthly, our software applied exclusion and inclusion criteria to identify an "at-risk" population and "potential cases". Electronic and paper medical records from the past year were then reviewed for each potential case. Persons with other respiratory diseases or insignificant treatment for asthma were excluded. Confirmed adult-onset asthma (AOA cases were defined as those potential cases with either new-onset asthma or reactivated mild intermittent asthma that had been quiescent for at least one year. We validated the methods by reviewing charts of selected subjects rejected by the algorithm. Results The algorithm was 93 to 99.3% sensitive and 99.6% specific. Sixty-three percent (n = 469 of potential cases were confirmed as AOA. Two thirds of confirmed cases were women with an average age of 34.8 (SD 11.8, and 45% had no evidence of previous asthma diagnosis. The annualized monthly rate of AOA ranged from 4.1 to 11.4 per 1000 at-risk members. Physicians most commonly attribute asthma to infection (59% and allergy (14%. New-onset cases were more likely attributed to infection, while reactivated cases were more associated with allergies. Medical charts included a discussion of work exposures in relation to asthma in only 32 (7% cases. Twenty-three of these (72% indicated there was an association between asthma and workplace exposures for an overall rate of work-related asthma of 4.9%. Conclusion Computerized HMO records can be successfully used to identify AOA. Manual review of these records is

Reproductive health care for asylum-seeking women - a challenge for health professionals

Directory of Open Access Journals (Sweden)

Zemp Elisabeth

2010-11-01

Full Text Available Abstract Background Dealing with pregnancy, childbirth and the care of newborn babies is a challenge for female asylum seekers and their health care providers. The aim of our study was to identify reproductive health issues in a population of women seeking asylum in Switzerland, and to examine the care they received. The women were insured through a special Health Maintenance Organisation (HMO and were attending the Women's Clinic of the University Hospital in Basel. We also investigated how the health professionals involved perceived the experience of providing health care for these patients. Methods A mixed methods approach combined the analysis of quantitative descriptive data and qualitative data obtained from semi-structured interviews with health care providers and from patients' files. We analysed the records of 80 asylum-seeking patients attending the Women's Clinic insured through an HMO. We conducted semi-structured interviews with 10 care providers from different professional groups. Quantitative data were analysed descriptively. Qualitative data analysis was guided by Grounded Theory. Results The principal health problems among the asylum seekers were a high rate of induced abortions (2.5 times higher than in the local population, due to inadequate contraception, and psychosocial stress due to the experience of forced migration and their current difficult life situation. The language barriers were identified as a major difficulty for health professionals in providing care. Health care providers also faced major emotional challenges when taking care of asylum seekers. Additional problems for physicians were that they were often required to act in an official capacity on behalf of the authorities in charge of the asylum process, and they also had to make decisions about controlling expenditure to fulfil the requirements of the HMO. They felt that these decisions sometimes conflicted with their duty towards the patient. Conclusion

The incidence of duodenal and gastric ulcers in a large health maintenance organization.

Science.gov (United States)

Kurata, J H; Honda, G D; Frankl, H

1985-06-01

We report the incidence of peptic ulcers (duodenal, pyloric canal, gastric, and combined) verified by radiologic, endoscopic, or surgical evidence in a large Health Maintenance Organization (HMO) in Los Angeles, California. For members age 15 and above, the peptic ulcer incidence rate was 0.86 per 1,000 person-years (p-y) (males 1.10, females 0.63). The male to female sex ratio was 1.7. Two hundred twenty-two duodenal, 17 pyloric canal, 89 gastric, and 21 combined first-time diagnosed ulcer cases were located. For duodenal and pyloric canal ulcer, the incidence rate for members age 15 and above was 0.58 per 1,000 p-y (males 0.76, females 0.40). For gastric ulcer, the incidence rate for members age 15 and above was 0.21 per 1,000 p-y (males 0.23, females 0.18). The combined ulcer rate was 0.05 per 1,000 p-y (males 0.07, females 0.02). Gastric ulcer rates were two times higher in 1980 than in 1977. Peptic ulcer age-specific incidence rates increased with age. Incidence rates were much lower than those reported in previous studies, but the gastric to duodenal ulcer ratio and the age and sex relation to ulcer incidence were similar to those previously reported.

Radiology in managed care environment: Opportunities for cost savings in an HMO; Radiologie unter Managed-Care-Bedingungen. Einsparpotenziale aus der Sicht einer Krankenversicherung in den USA

Energy Technology Data Exchange (ETDEWEB)

Schmidt, C. [Universitaet Kiel (Germany). Klinik fuer Allgemeine Chirurgie und Thoraxchirurgie; Mohr, A. [University of California, San Francisco (United States). Dept. of Radiology; Universitaet Kiel (Germany). Klinik fuer Radiologische Diagnostik; Moeller, J. [Universitaet Bielefeld (Germany). Fakultaet fuer Gesundheitswissenschaften; Levin-Scherz, J. [Tufts Healthplan, Boston (United States); Heller, M. [Universitaet Kiel (Germany). Klinik fuer Radiologische Diagnostik

2003-09-01

: Darstellung des Einsparungspotenzials, welches einer effizienten Nutzung von Radiologieleistungen in einer Health-Maintenance-Organisation (HMO) innewohnt, und der zur Realisierung verwendeten Managed-Care-Techniken. Material und Methoden: Im Rahmen eines Projektes zur Kostenreduktion an einer HMO in den USA wurden die Ursachen fuer gestiegene Ausgaben im Bereich Radiologie (''Radiology-Utilisation-Line'') untersucht. Durch umfassende Datenanalysen, Ueberpruefungen der Kodierlogik, Interviews mit Angestellten sowie kritische Beleuchtung der Vertragsbeziehungen zu Leistungserbringern konnte das Einsparpotenzial beziffert werden. Saemtliche Daten wurden in Microsoft Excel {sup trademark} dokumentiert und unter Verwendung von SPSS 8.0 (Statistical Package for the Social Sciences) fuer Windows {sup trademark} mithilfe nicht-parametrischer Tests ausgewertet. Ergebnisse: Hauptursache war eine verstaerkte Verordnung von Radiologieleistungen pro versichertem Patienten, wobei die Kosten pro Untersuchung annaehernd gleich blieben. Ein wesentlicher Kostenhebel lag in der Verbesserung des elektronischen Abrechnungssystems, welches fuer eine Ueberbezahlung von Leistungen verantwortlich war. Die Gestaltung der vertraglichen Risikovereinbarungen zwischen Versicherer und Leistungserbringer sowie die Qualitaet der Managementstrukturen innerhalb der radiologischen Einrichtungen hatten einen signifikanten Einfluss auf deren Wirtschaftlichkeit. Ferner konnte nachgewiesen werden, dass Aerzte mit eigenen Roentgenanlagen bis zu 4-5-mal mehr Untersuchungen veranlassen als Aerzte ohne eigene Roentgenausstattung und so einen erheblichen Kostentreiber darstellen. (orig.)

Does diabetes disease management save money and improve outcomes? A report of simultaneous short-term savings and quality improvement associated with a health maintenance organization-sponsored disease management program among patients fulfilling health employer data and information set criteria.

Science.gov (United States)

Sidorov, Jaan; Shull, Robert; Tomcavage, Janet; Girolami, Sabrina; Lawton, Nadine; Harris, Ronald

2002-04-01

Little is known about the impact of disease management programs on medical costs for patients with diabetes. This study compared health care costs for patients who fulfilled health employer data and information set (HEDIS) criteria for diabetes and were in a health maintenance organization (HMO)-sponsored disease management program with costs for those not in disease management. We retrospectively examined paid health care claims and other measures of health care use over 2 years among 6,799 continuously enrolled Geisinger Health Plan patients who fulfilled HEDIS criteria for diabetes. Two groups were compared: those who were enrolled in an opt-in disease management program and those who were not enrolled. We also compared HEDIS data on HbA(1c) testing, percent not in control, lipid testing, diabetic eye screening, and kidney disease screening. All HEDIS measures were based on a hybrid method of claims and chart audits, except for percent not in control, which was based on chart audits only. Of 6,799 patients fulfilling HEDIS criteria for the diagnosis of diabetes, 3,118 (45.9%) patients were enrolled in a disease management program (program), and 3,681 (54.1%) were not enrolled (nonprogram). Both groups had similar male-to-female ratios, and the program patients were 1.4 years younger than the nonprogram patients. Per member per month paid claims averaged 394.62 dollars for program patients compared with 502.48 dollars for nonprogram patients (P 9.5%, as compared with 79 of 548 (14.4%) nonprogram patients. In this HMO, an opt-in disease management program appeared to be associated with a significant reduction in health care costs and other measures of health care use. There was also a simultaneous improvement in HEDIS measures of quality care. These data suggest that disease management may result in savings for sponsored managed care organizations and that improvements in HEDIS measures are not necessarily associated with increased medical costs.

A new measure of the impact of managed care on healthcare markets.

Science.gov (United States)

Pawlson, L G; Moy, E M; Kim, J I; Griner, P F

2001-11-01

Most studies of managed care impact have used health maintenance organization (HMO) penetration or index of competition as the marker of managed care impact. However, little empirical evidence has been found to support the validity of these or other measures in current use. In addition, as managed care evolves to forms other than HMOs and managed care penetration in large metropolitan areas approaches 100% of commercially insured patients, the utility of the most commonly used measure, HMO penetration, will decrease still further. To provide a preliminary analysis of the use of premiums as a measure of market impact of managed care. Retrospective analysis (quartile, correlation, multiple-variable linear regression) of publicly available datasets. Labor market-adjusted HMO premiums from 3 publicly available sources, for the 56 largest metropolitan areas in the United States, were compared with penetration and index of competition as predictors of the dependent market variable, hospital bed-days per 1000 population. Health maintenance organization premiums in the Federal Employees Health Benefits Program emerged as the best predictor of HMO market impact. Average HMO premiums reported in the Interstudy database and for the Medicare+Choice program also outperformed penetration or index of competition in relating to several commonly available markers of competition such as bed-days per 1000. Premiums charged by HMOs are a useful measure of the impact of managed care on healthcare markets in large metropolitan areas.

Radiology in managed care environment: Opportunities for cost savings in an HMO

International Nuclear Information System (INIS)

Schmidt, C.; Heller, M.

2003-01-01

Purpose: A large regional health plan in the Northeastern United States noted that its radiology costs were increasing more than it anticipated in its pricing, and noted further that other similar health plans in markets with high managed care penetration had significantly lower expenses for radiology services. This study describes the potential areas of improvement and managed care techniques that were implemented to reduce costs and reform processes. Materials and methods: We performed an in-depth analysis of financial data, claims logic, contracting with provider units and conducted interviews with employees, to identify potential areas of improvement and cost reduction. A detailed market analysis of the environment, competitors and vendors was accompanied by extensive literature, Internet and Medline search for comparable projects. All data were documented in Microsoft Excel trademark and analyzed by non-parametric tests using SPSS trademark 8.0 (Statistical Package for the Social Sciences) for Windows trademark . Results: The main factors driving the cost increases in radiology were divided into those internal or external to the HMO. Among the internal factors, the claims logic was allowing overpayment due to limitations of the IT system. Risk arrangements between insurer and provider units (PU) as well as the extent of provider unit management and administration showed a significant correlation with financial performance in terms of variance from budget. Among the external factors, shared risk arrangements between HMO and provider unit were associated with more efficient radiology utilization and overall improvement in financial performance. PU with full-time management had significantly less variance from their budget than those without. Finally, physicians with imaging equipment in their offices ordered up to 4 to 5 times more imaging procedures than physicians who did not perform imaging studies themselves. (orig.) [de

Employer health insurance offerings and employee enrollment decisions.

Science.gov (United States)

Polsky, Daniel; Stein, Rebecca; Nicholson, Sean; Bundorf, M Kate

2005-10-01

To determine how the characteristics of the health benefits offered by employers affect worker insurance coverage decisions. The 1996-1997 and the 1998-1999 rounds of the nationally representative Community Tracking Study Household Survey. We use multinomial logistic regression to analyze the choice between own-employer coverage, alternative source coverage, and no coverage among employees offered health insurance by their employer. The key explanatory variables are the types of health plans offered and the net premium offered. The models include controls for personal, health plan, and job characteristics. When an employer offers only a health maintenance organization married employees are more likely to decline coverage from their employer and take-up another offer (odds ratio (OR)=1.27, phealth plan coverage an employer offers affects whether its employees take-up insurance, but has a smaller effect on overall coverage rates for workers and their families because of the availability of alternative sources of coverage. Relative to offering only a non-HMO plan, employers offering only an HMO may reduce take-up among those with alternative sources of coverage, but increase take-up among those who would otherwise go uninsured. By modeling the possibility of take-up through the health insurance offers from the employer of the spouse, the decline in coverage rates from higher net premiums is less than previous estimates.

Public–private partnership: how successful is the NHIS – HMO ...

African Journals Online (AJOL)

Collaboration between the National Health Insurance Scheme (NHIS) and Health Maintenance Organizations (HMOs) is a form of public-private partnership in health care delivery in Nigeria. National Health Insurance Schemes' adoption of Health Maintenance Organizations to manage NHIS enrollees is seen as an ...

[HADASSAH MEDICAL ORGANIZATION - A PIONEER IN POPULATION HEALTH].

Science.gov (United States)

Calderon-Margalit, Ronit; Levine, Hagai; Israeli, Avi; Paltiel, Ora

2018-03-01

Population health is a term encompassing "the health outcomes of a group of individuals, including the distribution of such outcomes within the group." Only recently have hospitals viewed themselves as focal points for promoting health in a community, involving themselves with population health. Hadassah Medical Organization (HMO), however, has been in the business of population health since its founding. Its early programs, promoting and delivering nutritional support, maternal-child health and other services to the Yishuv's inhabitants, showed that the HMO defined its community broadly. Hospital care came later. The HMO was established together with the Hebrew University Israel's first School of Public Health and Community Medicine in the 1960's, contributing >1200 Israeli alumni, and exposing thousands of medical students to population health. The School's founders developed Community-Oriented Primary Care, aimed at assessing and addressing health determinants and outcomes at the community level implemented in many centers worldwide. Reaching beyond Israel's borders, the School has trained a global public health workforce through its International Masters in Public Health with >820 graduates from 92 countries. HMO's researchers have made important contributions in the fields of epidemiology, health economics and policy and population health methodology as well as hospital and community quality of care. This article reviews HMO's contribution to population health at local, municipal, national and international levels. We will demonstrate the unique circumstances in Hadassah, Jerusalem and Israel which have enabled world-class research and training in population health, identifying important contributions to policy and service provision, as well as addressing future population health challenges.

Do HMO market level factors lead to racial/ethnic disparities in colorectal cancer screening? A comparison between high-risk Asian and Pacific Islander Americans and high-risk whites.

Science.gov (United States)

Ponce, Ninez A; Huh, Soonim; Bastani, Roshan

2005-11-01

Few studies have explored health care market structure and colorectal cancer (CRC) screening test use, and little is known whether market factors contribute to racial/ethnic screening disparities. We investigated whether HMO market level factors, controlling for individual covariates, differentially impact Asian American and Pacific Islander (AAPI) subjects' access to CRC screening compared with white subjects. We used random intercept hierarchical models to predict CRC test use. Individual-level survey data was linked to market data by metropolitan statistical areas from InterStudy. Insured first-degree relatives, ages 40-80, of a random sample of colorectal cancer cases identified from the California Cancer Registry: 515 white subjects and 396 AAPI subjects residing in 36 metropolitan statistical areas (MSAs). Dependent variables were receipt of (1) annual fecal occult blood test only; (2) sigmoidoscopy in the past 5 years; (3) colonoscopy in the past 10 years; and (4) any of these tests over the recommended time interval. Market characteristics were HMO penetration, HMO competition, and proportion of staff/group/network HMOs. Market characteristics were as important as individual-level characteristics for AAPI but not for white subjects. Among AAPI subjects, a 10% increase in the percent of group/staff/network model HMO was associated with a reduction in colonoscopy use (28.9% to 20.5%) and in receipt of any of the CRC tests (53.2% to 45.4%). The prevailing organizational structure of a health care market confers a penalty on access to CRC test use among high-risk AAPI subjects but not among high-risk white subjects. Identifying the differential effect of market structure on race/ethnicity can potentially reduce the cancer burden among disadvantaged racial groups.

Growth of health maintenance organisations in Nigeria and the potential for a role in promoting universal coverage efforts.

Science.gov (United States)

Onoka, Chima A; Hanson, Kara; Mills, Anne

2016-08-01

There has been growing interest in the potential for private health insurance (PHI) and private organisations to contribute to universal health coverage (UHC). Yet evidence from low and middle income countries remains very thin. This paper examines the evolution of health maintenance organisations (HMOs) in Nigeria, the nature of the PHI plans and social health insurance (SHI) programmes and their performance, and the implications of their business practices for providing PHI and UHC-related SHI programmes. An embedded case study design was used with multiple subunits of analysis (individual HMOs and the HMO industry) and mixed (qualitative and quantitative) methods, and the study was guided by the structure-conduct-performance paradigm that has its roots in the neo-classical theory of the firm. Quantitative data collection and 35 in-depth interviews were carried out between October 2012 to July 2013. Although HMOs first emerged in Nigeria to supply PHI, their expansion was driven by their role as purchasers in the government's national health insurance scheme that finances SHI programmes, and facilitated by a weak accreditation system. HMOs' characteristics distinguish the market they operate in as monopolistically competitive, and HMOs as multiproduct firms operating multiple risk pools through parallel administrative systems. The considerable product differentiation and consequent risk selection by private insurers promote inefficiencies. Where HMOs and similar private organisations play roles in health financing systems, effective regulatory institutions and mandates must be established to guide their behaviours towards attainment of public health goals and to identify and control undesirable business practices. Lessons are drawn for policy makers and programme implementers especially in those low and middle-income countries considering the use of private organisations in their health financing systems. Copyright © 2016 Elsevier Ltd. All rights reserved.

Pricing strategies for capitated delivery systems

Science.gov (United States)

Gruenberg, Leonard; Wallack, Stanley S.; Tompkins, Christopher P.

1986-01-01

This article discusses alternative methods for establishing a fairer pricing mechanism for Medicare recipients who enroll in health maintenance organizations and other competitive medical plans. The current method, based upon the adjusted average per capita cost, is inadequate because it fails to adjust premium levels for differences in health status; it establishes undesirable incentives that may lead to underservice, and it is tied to costs in the fee-for-service system. Alternative methods would incorporate health status, have Medicare share the risk with HMO's, and base payment on HMO experience. PMID:10311925

Stakeholders responses on health maintenance organizations ...

African Journals Online (AJOL)

National Health Insurance Scheme uses the services of Health Maintenance Organizations to run the scheme. This model of administering a national health insurance scheme is different from how so many other national health insurance programs are run in other parts of the world. The designing of the NHIS to include the ...

[Radiology in managed care environment: opportunities for cost savings in an HMO].

Science.gov (United States)

Schmidt, C; Mohr, A; Möller, J; Levin-Scherz, J; Heller, M

2003-09-01

A large regional health plan in the Northeastern United States noted that its radiology costs were increasing more than it anticipated in its pricing, and noted further that other similar health plans in markets with high managed care penetration had significantly lower expenses for radiology services. This study describes the potential areas of improvement and managed care techniques that were implemented to reduce costs and reform processes. We performed an in-depth analysis of financial data, claims logic, contracting with provider units and conducted interviews with employees, to identify potential areas of improvement and cost reduction. A detailed market analysis of the environment, competitors and vendors was accompanied by extensive literature, Internet and Medline search for comparable projects. All data were docu-mented in Microsoft Excel(R) and analyzed by non-parametric tests using SPSS(R) 8.0 (Statistical Package for the Social Sciences) for Windows(R). The main factors driving the cost increases in radiology were divided into those internal or external to the HMO. Among the internal factors, the claims logic was allowing overpayment due to limitations of the IT system. Risk arrangements between insurer and provider units (PU) as well as the extent of provider unit management and administration showed a significant correlation with financial performance in terms of variance from budget. Among the external factors, shared risk arrangements between HMO and provider unit were associated with more efficient radiology utilization and overall improvement in financial performance. PU with full-time management had significantly less variance from their budget than those without. Finally, physicians with imaging equipment in their offices ordered up to 4 to 5 times more imaging procedures than physicians who did not perform imaging studies themselves. We identified initiatives with estimated potential savings of approximately $ 5.5 million. Some of these

The determinants of HMOs' contracting with hospitals for bypass surgery.

Science.gov (United States)

Gaskin, Darrell J; Escarce, José J; Schulman, Kevin; Hadley, Jack

2002-08-01

Selective contracting with health care providers is one of the mechanisms HMOs (Health Maintenance Organizations) use to lower health care costs for their enrollees. However, are HMOs compromising quality to lower costs? To address this and other questions we identify factors that influence HMOs' selective contracting for coronary artery bypass surgery (CABG). Using a logistic regression analysis, we estimated the effects of hospitals' quality, costliness, and geographic convenience on HMOs' decision to contract with a hospital for CABG services. We also estimated the impact of HMO characteristics and market characteristics on HMOs' contracting decision. A 1997 survey of a nationally representative sample of 50 HMOs that could have potentially contracted with 447 hospitals. About 44 percent of the HMO-hospital pairs had a contract. We found that the probability of an HMO contracting with a hospital increased as hospital quality increased and decreased as distance increased. Hospital costliness had a negative but borderline significant (0.10 penetration did not affect the probability of contracting. HMO characteristics also had significant effects on contracting decisions. The results suggest that HMOs value quality, geographic convenience, and costliness, and that the importance of quality and costliness vary with HMO. Greater HMO competition encourages broader hospital networks whereas greater hospital competition leads to more restrictive networks.

Associations between hours worked, symptoms and health resource utilization among full-time male Japanese workers.

Science.gov (United States)

Sato, Keiko; Yamazaki, Shin; Hayashino, Yasuaki; Takegami, Misa; Tokuda, Yasuharu; Takahashi, Osamu; Shimbo, Takuro; Hinohara, Shigeaki; Fukui, Tsuguya; Fukuhara, Shunichi

2011-01-01

To investigate the association between hours worked, symptoms experienced, and health resource utilization. Data were collected from a nationally representative sample of households in Japan. We studied full-time male workers aged 18-65 yr who worked 100 h or more per month. First, we examined the association between hours worked and symptoms experienced. Second, we examined the association between hours worked and the type of health resource utilized, such as physician visits, over-the-counter (OTC) medication use, dietary supplement use, and complementary and alternative medicine (CAM) provider visits. We used a multivariable negative binominal model in each analysis. Of the 762 male workers, 598 reported experiencing symptoms at least once a month. We categorized participants based on the number of hours worked per month (h/mo): 100-200 h/mo, 201-250 h/mo, and over 250 h/mo. Compared with those working 201-250 h/mo, those working 100-200 h/mo had more frequent physician visits (rate ratio:1.67, 95% CI: 1.17 to 2.38) and those working over 250 h/mo had significantly lower rates of CAM provider visits and tended to use dietary supplements for symptoms. Participants who worked 201-250 h/mo used OTC medication most frequently. No significant association was observed between the number of hours worked and number of symptoms experienced. The more hours worked by full-time male workers, the more likely they were to use health resources that had a lower time requirement. Greater attention should be paid to patterns of health resource utilization among workers and their consequent influence on long-term health status.

Flight Crew Health Maintenance

Science.gov (United States)

Gullett, C. C.

1970-01-01

The health maintenance program for commercial flight crew personnel includes diet, weight control, and exercise to prevent heart disease development and disability grounding. The very high correlation between hypertension and overweight in cardiovascular diseases significantly influences the prognosis for a coronary prone individual and results in a high rejection rate of active military pilots applying for civilian jobs. In addition to physical fitness the major items stressed in pilot selection are: emotional maturity, glucose tolerance, and family health history.

Medicare program; contracts with health maintenance organizations (HMOs) and competitive medical plans (CMPs)--HCFA. Final rule with comment period.

Science.gov (United States)

1995-09-01

This rule clarifies and updates portions of the HCFA regulations that pertain to the following: The conditions that an HMO or CMP must meet to qualify for a Medicare contract (Subpart J). The contract requirements (Subpart L). The rules for enrollment, entitlement, and disenrollment of Medicare beneficiaries in a contracting HMO or CMP (Subpart K). How a Medicare contract is affected when there is change of ownership or leasing of facilities of a contracting HMO or CMP (Subpart M). These are technical and editorial changes that do not affect the substance of the regulations. They are intended to make it easier to find particular provisions, to provide overviews of the different program aspects, and to better ensure uniform understanding of the rules.

The Science of Sustaining Health Behavior Change: The Health Maintenance Consortium

Science.gov (United States)

Ory, Marcia G.; Smith, Matthew Lee; Mier, Nelda; Wernicke, Meghan M.

2013-01-01

Objective The Health Maintenance Consortium (HMC) is a multisite Grantee Consortium funded by the National Institutes of Health from 2004–2009. The goal of HMC is to enhance understanding of the long-term maintenance of behavior change, as well as effective strategies for achieving sustainable health promotion and disease prevention. Methods This introductory research synthesis prepared by the Resource Center gives context to this theme issue by providing an overview of the HMC and the articles in this journal. Results It explores the contributions to our conceptualization of behavior change processes and intervention strategies, the trajectory of effectiveness of behavioral and social interventions, and factors influencing the long-term maintenance of behavioral and social interventions. Conclusions Future directions for furthering the science of maintaining behavior change and reducing the gaps between research and practice are recommended. PMID:20604691

Cost analysis of a novel interdisciplinary model for advanced illness management.

Science.gov (United States)

Hopp, Faith P; Trzcinski, Eileen; Roth, Roxanne; Deremo, Dorothy; Fonger, Evan; Chiv, Sokchay; Paletta, Michael

2015-05-01

This research project evaluated cost outcomes for patients in the @HOMe Support program, a novel interdisciplinary home-based program for patients and caregivers facing advanced illness drawing on the Chronic Care Model. Cost analysis involved paired sample t-tests to examine pre-post differences in health care expenditures obtained from Health Maintenance Organization (HMO) claims data for program participants. Average 6-month costs per month significantly declined for patients older than 65 years of age from 1 HMO (US$9300-US$5900, P = .001). Evaluation of the second HMO showed that patients less than 65 years of age with lower preentry costs (costs (US$18 787-US$13 781, P = .08). Study findings suggest @HOMe Support is associated with reductions in the use and cost for most health services over time. © The Author(s) 2014.

Implementing evidence-based practices for youth in an HMO: the roles of external ratings and market share.

Science.gov (United States)

Hamilton, John; Daleiden, Eric; Dopson, Sue

2011-05-01

A qualitative study of child clinicians in a non-profit HMO examined implementation of evidence-based practices (EBPs) for anxiety and oppositional defiant disorders using interviews and focus groups with 33 clinicians (97% of participants), and ethnography of emails and meetings. Analysis showed statistical measures of access and service-key elements of rating organizations' "report cards"- were central in creating "pressure" making transition to EBPs difficult. EBPs were secondary to access and service targets. "Research" and "statistics" were perceived as unrealistic, "literature" as lacking authority. Rating organizations should include outcome and fidelity metrics to align market share pressures with children's health.

Preferred Provider Organization (PPO) Plans

Science.gov (United States)

... Find & compare doctors, hospitals, & other providers Preferred Provider Organization (PPO) Plans How PPO Plans Work A Medicare ... extra for these benefits. Related Resources Health Maintenance Organization (HMO) Private Fee-for-Service (PFFS) Special Needs ...

The effects of Medicare Health Management Organizations on hospital operating profit in Florida.

Science.gov (United States)

Large, John T; Sear, Alan M

2005-02-01

Between 1992 and 1997, the number of members enrolled in Medicare Health Management Organizations (HMOs) nationwide in the USA more than doubled. During this period, managed care organizations wielded considerable influence over the health care of a large segment of the Medicare population in Florida. This study examined the impact on operational profit of 148 short-term, acute-care Florida hospitals in this period from Medicare HMO patients, as part of a hospital's payer mix. Three measures of hospital profitability were used: operating profit per actual bed, total operating profit with no adjustment for bed size, and operating margins. The multivariate statistical model employed in this study was a linear mixed model with an autoregressive order one (AR[1]) parametric structure on the covariance matrix. The results of the study indicate that Florida hospitals experienced greater profit pressures from Medicare HMO inpatients than from traditional Medicare inpatients. Further, these hospitals could have experienced positive profit effects with greater traditional Medicare participation and negative financial effects with greater Medicare HMO participation. Additionally, Medicare HMO patients appear to have been admitted to hospitals in worse health condition than those in traditional Medicare. Medicare HMO patients were more likely to have used emergency rooms as the source of admission than traditional Medicare patients. Also, Medicare HMO patients were more likely to have been admitted as emergent cases than traditional Medicare patients. Other research has shown that Medicare HMO patients, at the time of enrolment, are probably healthier than traditional Medicare enrollees, but here they appear to have been admitted to hospitals with higher levels of severity of illness. Explanations are offered for these findings.

Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients

Directory of Open Access Journals (Sweden)

Dube Shanta R

2008-06-01

Full Text Available Abstract Background Prescription drugs account for approximately 11% of national health expenditures. Prior research on adverse childhood experiences (ACEs, which include common forms of child maltreatment and related traumatic stressors, has linked them to numerous health problems. However, data about the relationship of these experiences to prescription drug use are scarce. Method We used the ACE Score (an integer count of 8 different categories of ACEs as a measure of cumulative exposure to traumatic stress during childhood. We prospectively assessed the relationship of the Score to prescription drug use in a cohort of 15,033 adult HMO patients (mean follow-up: 6.1 years and assessed mediation of this relationship by documented ACE-related health and social problems. Results Nearly 1.2 million prescriptions were recorded; prescriptions rates increased in a graded fashion as the ACE Score increased (p for trend Conclusion ACEs substantially increase the number of prescriptions and classes of drugs used for as long as 7 or 8 decades after their occurrence. The increases in prescription drug use were largely mediated by documented ACE-related health and social problems.

Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study.

Science.gov (United States)

Edwards, Valerie J; Holden, George W; Felitti, Vincent J; Anda, Robert F

2003-08-01

This study examined the prevalence of a history of various combinations of childhood maltreatment types (physical abuse, sexual abuse, and witnessing of maternal battering) among adult members of a health maintenance organization (HMO) and explored the relationship with adult mental health of the combinations of types of childhood maltreatment and emotional abuse in the childhood family environment. A total of 8,667 adult members of an HMO completed measures of childhood exposure to family dysfunction, which included items on physical and sexual abuse, witnessing of maternal battering, and emotional abuse in the childhood family environment. The adults' current mental health was assessed by using the mental health scale of the Medical Outcomes Study 36-item Short-Form Health Survey. The prevalences of sexual abuse, physical abuse, and witnessing of maternal violence were 21.6%, 20.6%, and 14.0%, respectively, when the maltreatment types were considered separately. Among respondents reporting any of the maltreatment types, 34.6% reported more than one type of maltreatment. Lower mean mental health scores were associated with higher numbers of abuse categories (mean=78.5, 75.5, 72.8, and 69.9 for respondents with no, one, two, and three abuse types, respectively). Both an emotionally abusive family environment and the interaction of an emotionally abusive family environment with the various maltreatment types had a significant effect on mental health scores. Childhood physical and sexual abuse, as well as witnessing of maternal battering, were common among the adult members of an HMO in this study. Among those reporting any maltreatment, more than one-third had experienced more than one type of maltreatment. A dose-response relation was found between the number of types of maltreatment reported and mental health scores. In addition, an emotionally abusive family environment accentuated the decrements in mental health scores. Future research examining the effects of

42 CFR 417.470 - Basis and scope.

Science.gov (United States)

2010-10-01

...) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Contract Requirements § 417.470 Basis and scope. (a) Basis. This subpart implements those... section 1876(c), (g), (h), and (i) of the Act that pertain to the contract between CMS and an HMO or CMP...

The HMO Research Network Virtual Data Warehouse: A Public Data Model to Support Collaboration.

Science.gov (United States)

Ross, Tyler R; Ng, Daniel; Brown, Jeffrey S; Pardee, Roy; Hornbrook, Mark C; Hart, Gene; Steiner, John F

2014-01-01

The HMO Research Network (HMORN) Virtual Data Warehouse (VDW) is a public, non-proprietary, research-focused data model implemented at 17 health care systems across the United States. The HMORN has created a governance structure and specified policies concerning the VDW's content, development, implementation, and quality assurance. Data extracted from the VDW have been used by thousands of studies published in peer-reviewed journal articles. Advances in software supporting care delivery and claims processing and the availability of new data sources have greatly expanded the data available for research, but substantially increased the complexity of data management. The VDW data model incorporates software and data advances to ensure that comprehensive, up-to-date data of known quality are available for research. VDW governance works to accommodate new data and system complexities. This article highlights the HMORN VDW data model, its governance principles, data content, and quality assurance procedures. Our goal is to share the VDW data model and its operations to those wishing to implement a distributed interoperable health care data system.

Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors

Science.gov (United States)

Joseph, Rodney P.; Daniel, Casey L.; Thind, Herpreet; Benitez, Tanya J.; Pekmezi, Dori

2014-01-01

Behavioral health theory provides a framework for researchers to design, implement, and evaluate the effects of health promotion programs. However, limited research has examined theories used in interventions to promote long-term maintenance of health behaviors. The purpose of this review was to evaluate the available literature and identify prominent behavioral health theories used in intervention research to promote maintenance of health behaviors. We reviewed theories used in intervention research assessing long-term maintenance (≥ 6 months post-intervention) of physical activity, weight loss, and smoking cessation. Five prominent behavioral theories were referenced by the 34 studies included in the review: Self-Determination Theory, Theory of Planned Behavior, Social Cognitive Theory, Transtheoretical Model, and Social Ecological Model. Descriptions and examples of applications of these theories are provided. Implications for future research are discussed. PMID:28217036

Marketing in the HMO industry: an analysis of spending patterns and enrollment growth results.

Science.gov (United States)

Menges, J J

1988-01-01

The purpose of this paper is to assess the level of marketing spending in the HMO industry and the enrollment growth HMOs have achieved in return for their marketing dollars. This study identifies industry norms that are designed to assist HMOs in the evaluation of their marketing performance. The study is based on data from 1985 to 1986 covering approximately half the HMOs in the country and comprising a substantial proportion of industry-wide enrollment (Table 1). The analyses are designed to allow operational HMOs to compare their marketing efforts, enrollment growth, and marketing costs per new member with industry norms within similar age, model type, enrollment level, and geographic categories. The marketing expenses provided by each HMO are an aggregate figure including sales staff salaries, benefits and commissions, advertising, costs for the production and printing of marketing materials, and all other expenses directly related to the marketing effort. Components of the aggregate marketing expenses, such as the amount spent on advertising versus sales staff compensation, were not available.

42 CFR 417.101 - Health benefits plan: Basic health services.

Science.gov (United States)

2010-10-01

...; and (8) Preventive health services, which must be made available to members and must include at least... HMO is required only to make a good-faith effort to provide or arrange for the provision of the...

42 CFR 417.480 - Maintenance of records: Cost HMOs and CMPs.

Science.gov (United States)

2010-10-01

... or CMP, and operation of the HMO's or CMP's financial, medical, and other recordkeeping systems. (2..., sale, or other action. (5) Agreements, contracts, and subcontracts. (6) Franchise, marketing, and management agreements. (7) Schedules of charges for the HMO's or CMP's fee-for-service patients. (8) Matters...

Health-service Use in Women with Binge Eating Disorders

Science.gov (United States)

Dickerson, John; DeBar, Lynn; Perrin, Nancy A.; Lynch, Frances; Wilson, G. Terence; Rosselli, Francine; Kraemer, Helena C.; Striegel-Moore, Ruth H.

2014-01-01

Objective To compare health-care utilization between participants who met DSM-IV criteria for Binge Eating Disorder (BED) and those engaged in Recurrent Binge Eating (RBE) and to evaluate whether objective binge eating (OBE) days, a key measurement for diagnosing BED, predicted health-care costs. Method We obtained utilization and cost data from electronic medical records to augment patient reported data for 100 adult female members of a large health maintenance organization (HMO) who were enrolled in a randomized clinical trial to treat binge eating. Results Total costs did not differ between the BED and RBE groups (β=−0.117, z=−0.48, p=0.629), nor did the number of OBE days predictor total costs (β= −0.017, z=−1.01, p=0.313). Conclusions Findings suggest that the medical impairment, as assessed through health care costs, caused by BED may not be greater than impairment caused by RBE. The current threshold number of two OBE days/week as a criterion for BED may need to be reconsidered PMID:21823138

Comparison of rates of potentially inappropriate medication use according to the Zhan criteria for VA versus private sector medicare HMOs.

Science.gov (United States)

Barnett, Mitchell J; Perry, Paul J; Langstaff, Jodi D; Kaboli, Peter J

2006-06-01

Inappropriate prescribing in the elderly is common, but rates across different health care systems and the impact of formulary restrictions are not well described. To determine if rates of inappropriate medication use in the elderly differ between the Veterans Affairs (VA) health care system and the private sector Medicare health maintenance organization (HMO) patients. A cross-sectional study design compared administrative pharmacy claims from 10 distinct geographic regions in the United States in the VA health care system and 10 analogous regions for patients enrolled in Medicare HMOs. The cohorts included 123,633 VA and 157,517 Medicare HMO patients aged 65 years and older. Inappropriate medication use was identified using the Zhan modification of the Beers criteria, which categorizes 33 potentially inappropriate drugs into 3 major classifications: "always avoid," "rarely appropriate," and "some indications." Comparisons between the VA health care system and the private sector Medicare HMO were performed for overall differences and stratified by gender and age. The drug formulary status of the Zhan-criteria drugs was known for the VA health system but not for the Medicare HMO patients. Compared with private sector patients, VA patients were less likely to receive any inappropriate medication (21% vs. 29%, P private sector for males (21% vs. 24%, P private sector Medicare HMOs, elderly VA patients were less likely to receive medications defined by the Zhan criteria as potentially inappropriate. A restrictive formulary that excludes 12 of the 33 Zhan criteria drugs may be a factor in the reduction of undesired prescribing patterns in elderly populations.

Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction.

Science.gov (United States)

Hadley, J; Mitchell, J M; Sulmasy, D P; Bloche, M G

1999-04-01

to make referrals. These effects were generally reinforced by practicing in an area with a high level of HMO penetration and were offset to some extent by having had exposure to HMOs and the practice of cost-effective medicine while in medical training. Although financial incentives to reduce services are not widespread, there is a legitimate reason to be concerned about possible adverse affects on the quality of care. More research is needed to investigate directly whether changes in patients' health are affected by their physicians' financial incentives.

The impact of HMO penetration on the relationship between nurse staffing and quality.

Science.gov (United States)

Mark, Barbara A; Harless, David W; McCue, Michael

2005-07-01

While there are a number of studies examining the relationship between nurse staffing and quality, none has examined structural differences in the relationship between nurse staffing and quality contingent upon the level of managed care penetration. We used administrative data, and a dynamic panel data model to examine this relationship in a panel of 422 acute care hospitals from 1990 to 1995. We found that there were significant differences in the relationship between nurse staffing and both mortality and length of stay depending upon the level of HMO penetration in the hospital's market.

Increment 23/24 Critical Readiness Review Health Maintenance System

Science.gov (United States)

Nieschwitz, Linda

2010-01-01

This slide presentation reviews the Health Maintenance System. It includes information on the carbon dioxide (CO2) and moisture removal system (CMRS), the variable oxygen system,rendevous station panels, and the crew contamination protection kit (CCPK).

Dynamics of Implementation and Maintenance of Organizational Health Interventions.

Science.gov (United States)

Jalali, Mohammad S; Rahmandad, Hazhir; Bullock, Sally Lawrence; Ammerman, Alice

2017-08-15

In this study, we present case studies to explore the dynamics of implementation and maintenance of health interventions. We analyze how specific interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative obesity prevention case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes.

Do beneficiaries' views matter in healthcare purchasing decisions? Experiences from the Nigerian tax-funded health system and the formal sector social health insurance program of the National Health Insurance Scheme.

Science.gov (United States)

Ibe, Ogochukwu; Honda, Ayako; Etiaba, Enyi; Ezumah, Nkoli; Hanson, Kara; Onwujekwe, Obinna

2017-12-28

Purchasing is a health financing function that involves the transfer of pooled resources to providers on behalf of a covered population. Little attention has been paid to the extent to which the views of that population  are reflected in purchasing decisions. This article explores how purchasers in two financing mechanisms: the Formal Sector Social Health Insurance Programme (FSSHIP) operating under the Nigerian National Health Insurance Scheme (NHIS), and the tax-funded health system perform their roles in light of their responsibilities to the populations. A case study approach was adopted in which each financing mechanism is a case. Sixteen (16) in-depth interviews with purchasers and eight (8) focus group discussions with beneficiaries were held. Agency and organizational behavioural theories were used to characterise the purchaser-citizen relationships. A deductive framework approach was used to assess whether actions identified in a model of 'ideal' strategic purchasing actions were undertaken in each case. For both cases, mechanisms exist to reflect people's health needs in purchasing decisions, including quantitative and qualitative needs assessment, mechanisms to raise awareness of benefit entitlements and allow choice. However, purchasers do not use the mechanisms to effectively engage with and hold themselves accountable to the people. In the tax-funded system, weak information systems and unclear communication channels between the purchaser and citizens constrain assessment of needs; while timeliness of health information and poor engagement practices of Health Maintenance Organisations (HMOs) are the main constraints in FSSHIP. Inadequate information sharing in both mechanisms limits beneficiaries' awareness of entitlements. Although beneficiaries of FSSHIP can choose providers, lack of information on the quality of services offered by providers constrains rational decision-making and the inability to change HMOs reduces HMO responsiveness to

Quality of care in investor-owned vs not-for-profit HMOs.

Science.gov (United States)

Himmelstein, D U; Woolhandler, S; Hellander, I; Wolfe, S M

1999-07-14

The proportion of health maintenance organization (HMO) members enrolled in investor-owned plans has increased sharply, yet little is known about the quality of these plans compared with not-for-profit HMOs. To compare quality-of-care measures for investor-owned and not-for-profit HMOs. Analysis of the Health Plan Employer Data and Information Set (HEDIS) Version 3.0 from the National Committee for Quality Assurance's Quality Compass 1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned and 81 not-for-profit), representing 56% of the total HMO enrollment in the United States. Rates for 14 HEDIS quality-of-care indicators. Compared with not-for-profit HMOs, investor-owned plans had lower rates for all 14 quality-of-care indicators. Among patients discharged from the hospital after myocardial infarction, 59.2% of members in investor-owned HMOs vs 70.6% in not-for-profit plans received a beta-blocker (Pinvestor-owned plans vs 47.9% in not-for-profit plans had annual eye examinations (PInvestor-owned plans had lower rates than not-for-profit plans of immunization (63.9% vs 72.3%; Pinvestor ownership was consistently associated with lower quality after controlling for model type, geographic region, and the method each HMO used to collect data. Investor-owned HMOs deliver lower quality of care than not-for-profit plans.

Survey of relationship between spiritual health and mental health in patients undergoing methadone maintenance treatment (MMT

Directory of Open Access Journals (Sweden)

abolhassan naghibi

2015-12-01

Full Text Available Introduction and goal: Religiosity and spirituality decreasesof the impact of life stress on the tendency to substance use. Everyday addedto the number of people who believe that spirituality is the way to treat neuroses and mental problems. This study aimed to determine the relationship between spiritual health and mental health in patients undergoing to methadone maintenance treatment (MMT dependent on the private and government sector in Sari. Method: This study was cross- sectional study. The target populations of this study were 123 women and men undergoing to methadone maintenance treatment (MMT. The data collected by spiritual and mental health questionnaire and were analyzed using two-sample t-test and spearman correlationin theSPSS (18 software. Findings: The grade average of spiritual health was 43/29 and mental health was 41/26.The results showed that a significant correlation between spiritual health with mental health. The highest correlation was between spiritual healthwith the social function and the lowestcorrelation was with physical problems. There was no significant relationshipbetween of marital status, number of children, sex and spiritual health. Conclusion: According to positive and significant role spiritual health in mental health, so, strengthen the spiritual dimension can to promote mental health and reduce mental disorders and the tendency to addiction.

Optimization of maintenance for power system equipment using a predictive health model

NARCIS (Netherlands)

Bajracharya, G.; Koltunowicz, T.; Negenborn, R.R.; Papp, Z.; Djairam, D.; Schutter, B.D. de; Smit, J.J.

2009-01-01

In this paper, a model-predictive control based framework is proposed for modeling and optimization of the health state of power system equipment. In the framework, a predictive health model is proposed that predicts the health state of the equipment based on its usage and maintenance actions. Based

Disponibilidad, accesibilidad y aceptabilidad en el sistema de atención médica en vías de cambio para los adultos mayores en los Estados Unidos Availability, accessibility, and acceptability in the evolving health care system for older adults in the United States of America

Directory of Open Access Journals (Sweden)

Steven P. Wallace

2001-07-01

Full Text Available Objetivos. Este estudio usa tres dimensiones de acceso a los servicios médicos que contribuyen a una distribución social equitativa: (disponibilidad, accesibilidad y aceptabilidad para examinar la equidad de dos sistemas médicos en los Estados Unidos de América (EE. UU.: el sistema tradicional de indemnización, en el que se paga una "cuota por servicio" o "pago por acto" (PPA y el nuevo sistema de organizaciones de servicios médicos prepagados (health maintenance organizations: HMO. Se compara la equidad entre tres grupos de adultos mayores: euroamericanos (el grupo mayoritario y latinoamericanos y afroamericanos (las minorías. Métodos. Los datos provienen de una encuesta nacional representativa que incluye un total de 858 latinoamericanos, 970 afroamericanos y 8 622 euroamericanos de la tercera edad (65 años o más de áreas urbanas. Para comparar los grupos se usan la ji² y la regresión logística. Resultados. Los datos indican que las personas de la tercera edad pertenecientes a grupos minoritarios, caracterizadas por tener los recursos económicos más bajos y mayores necesidades de servicios médicos, se benefician más en el sistema de HMO porque este les proporciona mayor disponibilidad y acceso a los servicios médicos en comparación con el sistema de PPA. Esta mejora se debe a que el sistema de HMO reduce las barreras económicas para los pacientes. Sin embargo, los latinoamericanos afiliados a HMO en EE. UU. manifiestan una menor satisfacción con sus médicos de cabecera. Conclusiones. El sistema de HMO incrementa el acceso a la atención médica pero no necesariamente mejora la calidad de la relación entre paciente y médico para las personas de la tercera edad de EE. UU. pertenecientes a grupos minoritarios. Este estudio demuestra que es posible evaluar la equidad de los servicios médicos durante un proceso de reforma y, que para asegurarse de su validez, se deben incluir poblaciones vulnerables y diferentes

Design of the system of maintenance operations occupational safety and health database application of nuclear power station

International Nuclear Information System (INIS)

Wang Xuehong; Li Xiangyang; Ye Yongjun

2011-01-01

Based on the KKS code of building equipment in nuclear power station, this paper introduces the method of establishing the system of maintenance operation occupational safety and health database application. Through the application system of maintenance occupational safety and health database, it can summarize systematically all kinds of maintenance operation dangerous factor of nuclear power station, and make a convenience for staff to learn the maintenance operation dangerous factors and the prevention measures, so that it can achieve the management concept of 'precaution crucial, continuous improvement' that advocated by OSHMS. (authors)

Competition between health maintenance organizations and nonintegrated health insurance companies in health insurance markets.

Science.gov (United States)

Baranes, Edmond; Bardey, David

2015-12-01

This article examines a model of competition between two types of health insurer: Health Maintenance Organizations (HMOs) and nonintegrated insurers. HMOs vertically integrate health care providers and pay them at a competitive price, while nonintegrated health insurers work as indemnity plans and pay the health care providers freely chosen by policyholders at a wholesale price. Such difference is referred to as an input price effect which, at first glance, favors HMOs. Moreover, we assume that policyholders place a positive value on the provider diversity supplied by their health insurance plan and that this value increases with the probability of disease. Due to the restricted choice of health care providers in HMOs a risk segmentation occurs: policyholders who choose nonintegrated health insurers are characterized by higher risk, which also tends to favor HMOs. Our equilibrium analysis reveals that the equilibrium allocation only depends on the number of HMOs in the case of exclusivity contracts between HMOs and providers. Surprisingly, our model shows that the interplay between risk segmentation and input price effects may generate ambiguous results. More precisely, we reveal that vertical integration in health insurance markets may decrease health insurers' premiums.

Predicting maintenance of attendance at walking groups: testing constructs from three leading maintenance theories.

Science.gov (United States)

Kassavou, Aikaterini; Turner, Andrew; Hamborg, Thomas; French, David P

2014-07-01

Little is known about the processes and factors that account for maintenance, with several theories existing that have not been subject to many empirical tests. The aim of this study was to test how well theoretical constructs derived from the Health Action Process Approach, Rothman's theory of maintenance, and Verplanken's approach to habitual behavior predicted maintenance of attendance at walking groups. 114 participants, who had already attended walking groups in the community for at least 3 months, completed a questionnaire assessing theoretical constructs regarding maintenance. An objective assessment of attendance over the subsequent 3 months was gained. Multilevel modeling was used to predict maintenance, controlling for clustering within walking groups. Recovery self-efficacy predicted maintenance, even after accounting for clustering. Satisfaction with social outcomes, satisfaction with health outcomes, and overall satisfaction predicted maintenance, but only satisfaction with health outcomes significantly predicted maintenance after accounting for clustering. Self-reported habitual behavior did not predict maintenance despite mean previous attendance being 20.7 months. Recovery self-efficacy, and satisfaction with health outcomes of walking group attendance appeared to be important for objectively measured maintenance, whereas self-reported habit appeared not to be important for maintenance at walking groups. The findings suggest that there is a need for intervention studies to boost recovery self-efficacy and satisfaction with outcomes of walking group attendance, to assess impact on maintenance.

Sexual function in F-111 maintenance workers: the study of health outcomes in aircraft maintenance personnel.

Science.gov (United States)

Brown, Anthony; Gibson, Richard; Tavener, Meredith; Guest, Maya; D'Este, Catherine; Byles, Julie; Attia, John; Horsley, Keith; Harrex, Warren; Ross, James

2009-06-01

In Australia, four formal F-111 fuel tank deseal/reseal (DSRS) repair programs were implemented over more than two decades, each involving different processes and using a range of hazardous substances. However, health concerns were raised by a number of workers. The "Study of Health Outcomes in Aircraft Maintenance Personnel" was commissioned by the Australian Department of Defence to investigate potential adverse health outcomes as a result of being involved in the deseal/reseal processes. To compare measures of sexual function in F-111 aircraft fuel tank DSRS maintenance workers, against two appropriate comparison groups. Exposed and comparison participants completed a postal questionnaire which included general questions of health and health behavior, and two specific questions on sexual functioning. They also completed the International Index of Erectile Function (IIEF) questionnaire. Logistic regression was used to explore exposure status and outcome while adjusting for potential confounders. The three outcomes of interest for this study were the proportion of participants with erectile dysfunction (ED) according to the IIEF, the proportion with self-reported loss of interest in sex, and the proportion with self-reported problems with sexual functioning. Compared with each of the comparison groups, a larger proportion of the exposed group reported sexual problems and were classified as having ED according to the IIEF. In logistic regression, the odds of all three outcomes were higher for exposed participants relative to each comparison group and after adjustment for potentially confounding variables including anxiety and depression. There was a consistent problem with sexual functioning in the exposed group that is not explained by anxiety and depression, and it appears related to DSRS activities.

An opportunity for HMOs to use marketing to increase enrollee satisfaction.

Science.gov (United States)

Dwore, R B; Murray, B P; Parsons, R P; Gustafson, G

2001-01-01

To identify the combination of marketing components (i.e., service, price, access, and promotion) of commercial health maintenance organizations (HMOs) that are related to overall enrollee satisfaction. The researchers focus on factors that commercial HMOs control directly--specifically, health care organization and financing. Descriptive (mail order). This study uses national data provided by a major health benefits consulting firm, which collected data from a 1997 calendar year mail survey of HMO administrators. The administrators responded to an extensive survey, which tapped selected HMO marketing-mix components and the percentage of surveyed members who indicated satisfaction with their HMOs. To test hypotheses, researchers treated marketing-mix components as independent variables and enrollee satisfaction as the dependent variable. This study found statistically significant relationships between overall satisfaction and HMO providers' quality; access, particularly to specialists and out-of-network providers; waiting times for physician services; customer service; and disease prevention/health promotion programs. The researchers did not find significant relationships between overall satisfaction and accreditation by the National Committee for Quality Assurance (NCQA), the presence of physician gatekeepers, numbers of providers, or financial indicators. The relationship between overall satisfaction and utilization was mixed. This study's findings are largely consistent with the literature, consumer- and professional-group position papers, and the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. HMOs can use marketing as a way to address problems and pursue opportunities identified by enrollees. As these findings demonstrate, certain features of HMO design are more appealing to patients. By focusing on these preferences, HMOs can adopt a responsive market orientation that gives rise to more effective marketing mixes

Health and Maintenance Status Determination and Predictive Fault Diagnosis System, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — The objective of this project is to demonstrate intelligent health and maintenance status determination and predictive fault diagnosis techniques for NASA rocket...

Providing Our Fellows in Training with Education on Inflammatory Bowel Disease Health Maintenance to Improve the Quality of Care in Our Health Care System.

Science.gov (United States)

Lee, Ann Joo; Kraemer, Dale F; Smotherman, Carmen; Eid, Emely

2016-01-01

Inflammatory bowel disease (IBD) quality measures were established in an effort to standardize IBD health care. Despite effort to improve clinical performance, considerable variations in practice still exist. To further improve IBD health care, we propose incorporating an in-service educational session on IBD health maintenance to provide trainees with increasing awareness and knowledge on IBD management. Fifty electronic medical charts were randomly selected, and the level of quality documentation was assessed for 15 core IBD quality measures. Data were reported as the percentage of charts meeting audit criteria (compliance score). Fellows then attended an in-service educational session to review IBD quality measures and reinforce practice expectations. A second audit was then performed on an additional 50 patient charts to determine whether documentation practices improved after the educational session. We found a positive correlation between an in-service educational session and fellows' compliance with IBD health maintenance. Overall, the fellows' compliance score increased by 18% (before intervention, 65%; after intervention, 83%; P bases for IBD health maintenance. Incorporating a standard curriculum on IBD health maintenance provides fellows in training with increased awareness and guidance on managing the unique preventive care needs of patients with IBD.

What Predicts Exercise Maintenance and Well-Being? Examining The Influence of Health-Related Psychographic Factors and Social Media Communication.

Science.gov (United States)

Zhou, Xin; Krishnan, Archana

2018-01-26

Habitual exercising is an important precursor to both physical and psychological well-being. There is, thus, a strong interest in identifying key factors that can best motivate individuals to sustain regular exercise regimen. In addition to the importance of psychographic factors, social media use may act as external motivator by allowing users to interact and communicate about exercise. In this study, we examined the influence of health consciousness, health-oriented beliefs, intrinsic motivation, as willingness to communicate about health on social media, social media activity on exercise, and online social support on exercise maintenance and well-being on a sample of 532 American adults. Employing structural equation modeling, we found that health-oriented beliefs mediated the effect of health consciousness on intrinsic motivation which in turn was a significant predictor of exercise maintenance. Exercise maintenance significantly predicted both physical and psychological well-being. Extrinsic motivators, as measured by willingness to communicate about health on social media, social media activity on exercise, and online social support did not however significantly influence exercise maintenance. These findings have implications for the design and implementation of exercise-promoting interventions by identifying underlying factors that influence exercise maintenance.

75 FR 62684 - Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction...

Science.gov (United States)

2010-10-13

... 0938-AM50 Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction Standards Adopted Under the Health Insurance Portability and Accountability Act of 1996 AGENCY: Office of... of the Health Insurance Portability and Accountability Act of 1996 standards made by the Designated...

A "small-changes" workplace weight loss and maintenance program: examination of weight and health outcomes.

Science.gov (United States)

Zinn, Caryn; Schofield, Grant M; Hopkins, Will G

2012-10-01

To compare the effect of "small-changes" and "usual care" workplace interventions on weight loss and to investigate the effect of small changes with or without maintenance on weight and health outcomes. Overweight/obese employees at two New Zealand worksites received a 12-month usual-care intervention (n = 53), followed by a 12-month small-changes intervention (n = 102). Small changes comprised a 12-week component, followed by 9 months of maintenance, implemented at only one worksite. Magnitudes of effects were assessed via a threshold of -5% (weight loss) and standardization (health outcomes). Small changes showed beneficial weight loss relative to usual care in both worksites. For small-changes interventions, worksites reduced weight (12 weeks) and maintained lost weight (12 months). One in every three participants lost 5% or more weight. Some improvements in health outcomes were shown. Regardless of maintenance, the small-changes intervention was successful in sustaining weight loss.

Associations of health literacy with dialysis adherence and health resource utilization in patients receiving maintenance hemodialysis.

Science.gov (United States)

Green, Jamie A; Mor, Maria K; Shields, Anne Marie; Sevick, Mary Ann; Arnold, Robert M; Palevsky, Paul M; Fine, Michael J; Weisbord, Steven D

2013-07-01

Although limited health literacy is common in hemodialysis patients, its effects on clinical outcomes are not well understood. Observational study. 260 maintenance hemodialysis patients enrolled in a randomized clinical trial of symptom management strategies from January 2009 through April 2011. Limited health literacy. Dialysis adherence (missed and abbreviated treatments) and health resource utilization (emergency department visits and end-stage renal disease [ESRD]-related hospitalizations). We assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) and used negative binomial regression to analyze the independent associations of limited health literacy with dialysis adherence and health resource utilization over 12-24 months. 41 of 260 (16%) patients showed limited health literacy (REALM score, ≤60). There were 1,152 missed treatments, 5,127 abbreviated treatments, 552 emergency department visits, and 463 ESRD-related hospitalizations. Limited health literacy was associated independently with an increased incidence of missed dialysis treatments (missed, 0.6% vs 0.3%; adjusted incidence rate ratio [IRR], 2.14; 95% CI, 1.10-4.17), emergency department visits (annual visits, 1.7 vs 1.0; adjusted IRR, 1.37; 95% CI, 1.01-1.86), and hospitalizations related to ESRD (annual hospitalizations, 0.9 vs 0.5; adjusted IRR, 1.55; 95% CI, 1.03-2.34). Generalizability and potential for residual confounding. Patients receiving maintenance hemodialysis who have limited health literacy are more likely to miss dialysis treatments, use emergency care, and be hospitalized related to their kidney disease. These findings have important clinical practice and cost implications. Copyright © 2013 National Kidney Foundation, Inc. All rights reserved.

Impact of a hospitalist system on length of stay and cost for children with common conditions.

Science.gov (United States)

Srivastava, Rajendu; Landrigan, Christopher P; Ross-Degnan, Dennis; Soumerai, Stephen B; Homer, Charles J; Goldmann, Donald A; Muret-Wagstaff, Sharon

2007-08-01

This study examined mechanisms of efficiency in a managed care hospitalist system on length of stay and total costs for common pediatric conditions. We conducted a retrospective cohort study (October 1993 to July 1998) of patients in a not-for-profit staff model (HMO 1) and a non-staff-model (HMO 2) managed care organization at a freestanding children's hospital. HMO 1 introduced a hospitalist system for patients in October 1996. Patients were included if they had 1 of 3 common diagnoses: asthma, dehydration, or viral illness. Linear regression models examining length-of-stay-specific costs for prehospitalist and posthospitalist systems were built. Distribution of length of stay for each diagnosis before and after the system change in both study groups was calculated. Interrupted time series analysis tested whether changes in the trends of length of stay and total costs occurred after implementation of the hospitalist system by HMO1 (HMO 2 as comparison group) for all 3 diagnoses combined. A total of 1970 patients with 1 of the 3 study conditions were cared for in HMO 1, and 1001 in HMO 2. After the hospitalist system was introduced in HMO 1, length of stay was reduced by 0.23 days (13%) for asthma and 0.19 days (11%) for dehydration; there was no difference for patients with viral illness. The largest relative reduction in length of stay occurred in patients with a shorter length of stay whose hospitalizations were reduced from 2 days to 1 day. This shift resulted in an average cost-per-case reduction of $105.51 (9.3%) for patients with asthma and $86.22 (7.8%) for patients with dehydration. During the same period, length of stay and total cost rose in HMO 2. Introduction of a hospitalist system in one health maintenance organization resulted in earlier discharges and reduced costs for children with asthma and dehydration compared with another one, with the largest reductions occurring in reducing some 2-day hospitalizations to 1 day. These findings suggest that

Awakening consumer stewardship of health benefits: prevalence and differentiation of new health plan models.

Science.gov (United States)

Rosenthal, Meredith; Milstein, Arnold

2004-08-01

Despite widespread publicity of consumer-directed health plans, little is known about their prevalence and the extent to which their designs adequately reflect and support consumerism. We examined three types of consumer-directed health plans: health reimbursement accounts (HRAs), premium-tiered, and point-of-care tiered benefit plans. We sought to measure the extent to which these plans had diffused, as well as to provide a critical look at the ways in which these plans support consumerism. Consumerism in this context refers to efforts to enable informed consumer choice and consumers' involvement in managing their health. We also wished to determine whether mainstream health plans-health maintenance organization (HMO), point of service (POS), and preferred provider organization (PPO) models-were being influenced by consumerism. Our study uses national survey data collected by Mercer Human Resource Consulting from 680 national and regional commercial health benefit plans on HMO, PPO, POS, and consumer-directed products. We defined consumer-directed products as health benefit plans that provided (1) consumer incentives to select more economical health care options, including self-care and no care, and (2) information and support to inform such selections. We asked health plans that offered consumer-directed products about 2003 enrollment, basic design features, and the availability of decision support. We also asked mainstream health plans about their activities that supported consumerism (e.g., proactive outreach to inform or influence enrollee behavior, such as self-management or preventive care, reminders sent to patients with identified medical conditions.) We analyzed survey responses for all four product lines in order to identify those plans that offer health reimbursement accounts (HRAs), premium-tiered, or point-of-care tiered models as well as efforts of mainstream health plans to engage informed consumer decision making. The majority of enrollees in

Laboratory equipment maintenance: a critical bottleneck for strengthening health systems in sub-Saharan Africa?

Science.gov (United States)

Fonjungo, Peter N; Kebede, Yenew; Messele, Tsehaynesh; Ayana, Gonfa; Tibesso, Gudeta; Abebe, Almaz; Nkengasong, John N; Kenyon, Thomas

2012-02-01

Properly functioning laboratory equipment is a critical component for strengthening health systems in developing countries. The laboratory can be an entry point to improve population health and care of individuals for targeted diseases - prevention, care, and treatment of TB, HIV/AIDS, and malaria, plus maternal and neonatal health - as well as those lacking specific attention and funding. We review the benefits and persistent challenges associated with sustaining laboratory equipment maintenance. We propose equipment management policies as well as a comprehensive equipment maintenance strategy that would involve equipment manufacturers and strengthen local capacity through pre-service training of biomedical engineers. Strong country leadership and commitment are needed to assure development and sustained implementation of policies and strategies for standardization of equipment, and regulation of its procurement, donation, disposal, and replacement.

Operation and maintenance of thermal power stations best practices and health monitoring

CERN Document Server

Chanda, Pradip

2016-01-01

This book illustrates operation and maintenance practices/guidelines for economic generation and managing health of a thermal power generator beyond its regulatory life. The book provides knowledge for professionals managing power station operations, through its unique approach to chemical analysis of water, steam, oil etc. to identify malfunctioning/defects in equipment/systems much before the physical manifestation of the problem. The book also contains a detailed procedure for conducting performance evaluation tests on different equipment, and for analyzing test results for predicting maintenance requirements, which has lent a new dimension to power systems operation and maintenance practices. A number of real life case studies also enrich the book. This book will prove particularly useful to power systems operations professionals in the developing economies, and also to researchers and students involved in studying power systems operations and control. .

Structural health monitoring methodology for aircraft condition-based maintenance

Science.gov (United States)

Saniger, Jordi; Reithler, Livier; Guedra-Degeorges, Didier; Takeda, Nobuo; Dupuis, Jean Pierre

2001-06-01

Reducing maintenance costs while keeping a constant level of safety is a major issue for Air Forces and airlines. The long term perspective is to implement condition based maintenance to guarantee a constant safety level while decreasing maintenance costs. On this purpose, the development of a generalized Structural Health Monitoring System (SHMS) is needed. The objective of such a system is to localize the damages and to assess their severity, with enough accuracy to allow low cost corrective actions. The present paper describes a SHMS based on acoustic emission technology. This choice was driven by its reliability and wide use in the aerospace industry. The described SHMS uses a new learning methodology which relies on the generation of artificial acoustic emission events on the structure and an acoustic emission sensor network. The calibrated acoustic emission events picked up by the sensors constitute the knowledge set that the system relies on. With this methodology, the anisotropy of composite structures is taken into account, thus avoiding the major cause of errors of classical localization methods. Moreover, it is adaptive to different structures as it does not rely on any particular model but on measured data. The acquired data is processed and the event's location and corrected amplitude are computed. The methodology has been demonstrated and experimental tests on elementary samples presented a degree of accuracy of 1cm.

Medicare annual preventive care visits: use increased among fee-for-service patients, but many do not participate.

Science.gov (United States)

Chung, Sukyung; Lesser, Lenard I; Lauderdale, Diane S; Johns, Nicole E; Palaniappan, Latha P; Luft, Harold S

2015-01-01

Under the Affordable Care Act (ACA), Medicare coverage expanded in 2011 to fully cover annual preventive care visits. We assessed the impact of coverage expansion, using 2007-13 data from primary care patients of Medicare-eligible age at the Palo Alto Medical Foundation (204,388 patient-years), which serves people in four counties near San Francisco, California. We compared trends in preventive visits and recommended preventive services among Medicare fee-for-service and Medicare health maintenance organization (HMO) patients as well as non-Medicare patients ages 65-75 who were covered by private fee-for-service and private HMO plans. Among Medicare fee-for-service patients, the annual use of preventive visits rose from 1.4 percent before the implementation of the ACA to 27.5 percent afterward. This increase was significantly larger than was seen for patients in the other insurance groups. Nevertheless, rates of annual preventive care visit use among Medicare fee-for-service patients remained 10-20 percentage points lower than was the case for people with private coverage (43-44 percent) or those in a Medicare HMO (53 percent). ACA policy changes led to increased preventive service use by Medicare fee-for-service beneficiaries, which suggests that Medicare coverage expansion is an effective way to increase seniors' use of preventive services. Project HOPE—The People-to-People Health Foundation, Inc.

Engine health monitoring systems: Tools for improved maintenance management in the 1980's

Science.gov (United States)

Kimball, J. C.

1981-01-01

The performance monitoring aspect of maintenance, characteristic of the engine health monitoring system are discussed. An overview of the system activities is presented and a summary of programs for improved monitoring in the 1980's are discussed.

Consumer cost sharing and use of biopharmaceuticals for rheumatoid arthritis.

Science.gov (United States)

Robinson, James C

2013-06-01

To evaluate the effect of consumer cost sharing on use of physician-administered and patient self-administered specialty drugs for rheumatoid arthritis. Multivariate statistical analysis of probability and use of physician-administered specialty drugs, patient self-injected specialty drugs, non-biologic disease-modifying anti-rheumatic drugs, and symptom relief drugs. Analyses were conducted for patients enrolling in preferred provider organization (PPO) plans and health maintenance organization (HMO) plans with different cost-sharing requirements, adjusted for patient demographics, health status, and geographical location. Professional, facility, and pharmaceutical claims for beneficiaries of CalPERS, the public employee insurance purchasing alliance in California, for 2008-2009. Consumer cost-sharing requirements were obtained for each type of drug and service for each type of insurance plan. PPO insurance enrollees face substantially higher cost sharing for physician-administered specialty drugs, compared with HMO enrollees in CalPERS. PPO patients with rheumatoid arthritis are only half as likely as HMO enrollees to choose a physician-administered specialty drug (4.2% vs 9.3%) (P ≤.05), and use 25% less of the drugs if they use any ($10,356 vs $13,678) (P ≤.05). They are 30% more likely to use a self-administered specialty drug than are HMO enrollees (29.3% vs 22.1%) (P ≤.05), and use 35% more of the drugs if any ($16,015 vs $12,378) (P ≤.05). Consumer cost sharing reduces the use of physician-administered specialty drugs for rheumatoid arthritis. The higher use of patient self-administered specialty drugs suggests that the disincentives for use of physician-administered drugs were offset by an increased incentive to use self-administered drugs.

Newspaper advertising by health maintenance organizations during the reform of healthcare services in Israel.

Science.gov (United States)

Reuveni, H; Shvarts, S; Meyer, J; Elhayany, A; Greenberg, D

2001-06-01

On 1 January 1995 a new mandatory National Health Insurance Law was enacted in Israel. The new law fostered competition among the four major Israeli healthcare providers (HMOs or sick funds) already operating in the market due to the possibility that an unlimited number of patients and the relative budget share would shift among the HMOs. This led them to launch advertising campaigns to attract new members. To examine newspaper advertising activities during the early stages of healthcare market reform in Israel. Advertising efforts were reviewed during a study period of 24 months (July 1994 to June 1996). Advertisements were analyzed in terms of marketing strategy, costs and quality of information. During the study period 412 newspaper advertisements were collected. The total advertising costs by all HMOs was approximately US$4 million in 1996 prices. Differences were found in marketing strategy, relative advertising costs, contents and priorities among the HMOs. The content of HMOs' newspaper advertising was consistent with their marketing strategy. The messages met the criteria of persuasive advertising in that they cultivated interest in the HMOs but did not provide meaningful information about them. Future developments in this area should include consensus guidelines for advertising activities of HMOs in Israel, instruction concerning the content of messages, and standardization of criteria to report on HMO performance.

Is vertical integration adding value to health systems?

Science.gov (United States)

Weil, T P

2000-04-01

Vertical integration is a concept used by health systems when attempting to achieve economies of scale, greater coordination of services, and improved market penetration. This article focuses on the actual outcomes of utilizing vertical integration in the health field and then compares these findings with those reported in other industries. This analysis concludes that this organizational model does not work particularly well in the health industry, as illustrated by health alliances' poor fiscal performance when they acquire physician practices or when they start their own HMO plans.

Health Information Sources, Perceived Vaccination Benefits, and Maintenance of Childhood Vaccination Schedules.

Science.gov (United States)

Hwang, Juwon; Shah, Dhavan V

2018-06-05

Parental concerns over the safety or necessity of childhood vaccination have increased over the past decades. At the same time, there has been a proliferation of vaccine-related information available through a range of health information sources. This study investigates the associations between evaluations of health information sources, parental perceptions of childhood vaccination benefits, and the maintenance of vaccination schedules for their children. Specifically, this study aims to (a) incorporate social media into the battery of health information sources and (b) differentiate households with a childhood autism diagnosis and those without, given unsubstantiated but persistent concerns about vaccine safety and autism. Analyzing a sample of U.S. households, a total of 4,174 parents who have at least one child under the age of 18 were analyzed, including 138 of parents of households with a childhood autism diagnosis. Results show that the more the parents value interpersonal communication and magazines as sources of health information, the more they perceive vaccination benefits, and the more the value they put on television, the better they keep vaccination schedules up-to-date for their children. On the other hand, social media are negatively associated with their perceptions of vaccination benefits. Although parents of children diagnosed with autism are less likely to perceive vaccination benefits, no interaction effects with evaluations of health information sources are found on parental perceptions of vaccination benefits or maintenance of schedules.

29 CFR 825.211 - Maintenance of benefits under multi-employer health plans.

Science.gov (United States)

2010-07-01

..., DEPARTMENT OF LABOR OTHER LAWS THE FAMILY AND MEDICAL LEAVE ACT OF 1993 Employee Leave Entitlements Under the Family and Medical Leave Act § 825.211 Maintenance of benefits under multi-employer health plans. (a) A... that the employee would have been laid off and the employment relationship terminated; or, (3) The...

Interval of Routine Maintenance and Maintenance Performance: A Literature Review

Directory of Open Access Journals (Sweden)

Au-Yong Cheong Peng

2016-01-01

Full Text Available In high-rise residential buildings, the quality of facilities management services is significant to the normal operation of the facilities. Unfortunately, lack of concern towards building maintenance, especially preventive maintenance, happens in domestic housing industry in Malaysia. Majority of the maintenance operations of condominiums suffer from lack of planning, lack of proactive maintenance plan, and lack of proper implementation. Thus, this paper reviews the implementation of preventive maintenance strategy, routine maintenance in specific. An extensive review of literature published in 1987 to 2014 is performed for the purpose of this research. The publications are sourced from journal articles, conference proceedings and books. The literature analysis confirms that the routine maintenance of facilities and building services is vital and it can be influential towards the maintenance performance. Subsequently, a theoretical framework is developed, which shows the relationship between routine maintenance of building facilities & services and maintenance performance. The building facilities & services are divided into two categories. They are essential facilities & services that ensure the safety, health, habitability, and operability of buildings; while value-added facilities & services deal with property value, return on investment, and quality living of buildings. Based on the findings, a future research is proposed, which aims to identify the appropriate routine of maintenance for the facilities and services in high-rise residential buildings to improve the maintenance performance.

Employee choice of consumer-driven health insurance in a multiplan, multiproduct setting.

Science.gov (United States)

Parente, Stephen T; Feldman, Roger; Christianson, Jon B

2004-08-01

To determine who chooses a Consumer-Driven Health Plan (CDHP) in a multiplan, multiproduct setting, and, specifically, whether the CDHP attracts the sicker employees in a company's risk pool. We estimated a health plan choice equation for employees of the University of Minnesota, who had a choice in 2002 of a CDHP and three other health plans--a traditional health maintenance organization (HMO), a preferred provider organization (PPO), and a tiered network product based on care systems. Data from an employee survey were matched to information from the university's payroll system. Chronic illness of the employee or family members had no effect on choice of the CDHP, but such employees tended to choose the PPO. The employee's age was not related to CDHP choice. Higher-income employees chose the CDHP, as well as those who preferred health plans with a national provider panel that includes their physician in the panel. Employees tended to choose plans with lower out-of-pocket premiums, and surprisingly, employees with a chronic health condition themselves or in their family were more price-sensitive. This study provides the first evidence on who chooses a CDHP in a multiplan, multiproduct setting. The CDHP was not chosen disproportionately by the young and healthy, but it did attract the wealthy and those who found the availability of providers more appealing. Low out-of-pocket premiums are important features of health plans and in this setting, low premiums appeal to those who are less healthy.

The growth of medical groups paid through capitation in California.

Science.gov (United States)

Robinson, J C; Casalino, L P

1995-12-21

In California, it is common for health maintenance organizations (HMOs) to contract with large medical groups that are paid through capitation and are responsible for managing a full spectrum of medical services. We studied six large medical groups in California--Bristol Park Medical, Friendly Hills HealthCare Network, HealthCare Partners Medical Group, Mullikin Medical Centers, Palo Alto Medical Foundation, and San Jose Medical Group--that are paid through capitation and that are growing as a result of contracts with managed-care organizations. We conducted interviews and obtained data on factors such as patient enrollment, capitation and other revenue, numbers of days spent by enrollees in the hospital, and numbers of visits to physicians per enrollee. Between 1990 and 1994, the number of HMO enrollees whose care was paid for through capitation in the six medical groups increased by 91 percent, from 398,359 to 759,474. In 1994, the mean number of hospital days per 1000 HMO enrollees ranged from 120 to 149 for non-Medicare patients and from 643 to 936 days for Medicare patients. By comparison, in 1993 the mean numbers of hospital days per 1000 HMO enrollees not covered by Medicare were 232 for California and 297 for the United States; for HMO enrollees covered by Medicare, the numbers were 1337 for California and 1698 for the United States. In 1994, the average annual number of visits to physicians for HMO patients in the six groups not covered by Medicare ranged from 3.1 to 3.9; for Medicare patients, it ranged from 7.2 to 9.3; these rates were slightly lower than statewide and national rates. Four of the groups have sold their assets (such as facilities, supplies, equipment, and patients' charts) to outside investors; the physicians remain employed by physician-owned professional corporations. Medical groups paid through capitation offer a model for the status of physicians in managed-care systems that differs from the employee status offered by staff-model HMOs

Pricing of surgeries for colon cancer: patient severity and market factors.

Science.gov (United States)

Dor, Avi; Koroukian, Siran; Xu, Fang; Stulberg, Jonah; Delaney, Conor; Cooper, Gregory

2012-12-01

This study examined effects of health maintenance organization (HMO) penetration, hospital competition, and patient severity on the uptake of laparoscopic colectomy and its price relative to open surgery for colon cancer. The MarketScan Database (data from 2002-2007) was used to identify admissions for privately insured colorectal cancer patients undergoing laparoscopic or open partial colectomy (n = 1035 and n = 6389, respectively). Patient and health plan characteristics were retrieved from these data; HMO market penetration rates and an index of hospital market concentration, the Herfindahl-Hirschman index (HHI), were derived from national databases. Logistic and logarithmic regressions were used to examine the odds of having laparoscopic colectomy, effect of covariates on colectomy prices, and the differential price of laparoscopy. Adoption of laparoscopy was highly sensitive to market forces, with a 10% increase in HMO penetration leading to a 10.9% increase in the likelihood of undergoing laparoscopic colectomy (adjusted odds ratio = 1.109; 95% confidence interval [CI] = 1.062, 1.158) and a 10% increase in HHI resulting in 6.6% lower likelihood (adjusted odds ratio = 0.936; 95% CI = 0.880, 0.996). Price models indicated that the price of laparoscopy was 7.6% lower than that of open surgery (transformed coefficient = 0.927; 95% CI = 0.895, 0.960). A 10% increase in HMO penetration was associated with 1.6% lower price (transformed coefficient = 0.985; 95% CI = 0.977, 0.992), whereas a 10% increase in HHI was associated with 1.6% higher price (transformed coefficient = 1.016; 95% CI = 1.006, 1.027; P prices. Moreover, laparoscopic surgery may result in cost savings, while market pressures contribute to its adoption. Copyright © 2012 American Cancer Society.

Selecting Suitable Candidates for Predictive Maintenance

NARCIS (Netherlands)

Tiddens, Wieger Willem; Braaksma, Anne Johannes Jan; Tinga, Tiedo

2018-01-01

Predictive maintenance (PdM) or Prognostics and Health Management (PHM) assists in better predicting the future state of physical assets and making timely and better-informed maintenance decisions. Many companies nowadays ambition the implementation of such an advanced maintenance policy. However,

[A preliminary evaluation of mental status and an investigation of occupational health knowledge demand in operating and maintenance personnel in wind power plants].

Science.gov (United States)

Hu, S Q; Zhang, Q; Zhu, X H; Sun, K; Chen, S Z; Liu, A G; Luo, G L; Huang, W

2016-10-20

Objective: To investigate the mental status, level of occupational health knowledge, health behaviors, and occupational health knowledge demand in operating and maintenance personnel in wind power plants, and to provide a basis for formulating protective measures of occupational health for operating and maintenance personnel in wind power plants. Methods: A cluster sampling was performed in regionally representative wind power plants in the wind power industry from May 2014 to June 2015, and the Symptom Checklist-90 (SCL-90) and a self-made evaluation questionnaire were used to investigate the general status, mental health, and occupational health knowledge demand in 160 operating and maintenance workers. Results: Of all respondents, 26.9% had mental health issues. The awareness rate of infectious disease knowledge and preventive measures was 11.9%. Of all workers, 96.5% wanted to know the occupational hazard factors in the workplace, and 96.3% wanted to get the knowledge of the prevention of related diseases. Conclusion: Mental health issues in operating and maintenance personnel in wind power plants cannot be neglected and there is a high demand for occupational health services and related knowledge. Comprehensive intervention measures for health promotion in the workplace should be adopted to improve working environment, enhance individual mental health education, increase the level of occupational health management, and protect the health of workers.

Maintenance for the Millennium: Another Approach

International Nuclear Information System (INIS)

Sculthorpe, Barruy R.

2002-01-01

Nuclear units nationwide are struggling to increase plant reliability and availability while at the same time reduce their operating and maintenance costs. Some very costly investments have been made in programs such as Reliability Centered Maintenance [RCM]. Florida Power and Light's approach at the St. Lucie Nuclear Plant has taken a slightly different approach. Building on our knowledge of the RCM process and an already existing 'World Class' Predictive Maintenance Program, a 'Condition-Based' Maintenance Program that takes advantage of the RCM philosophy and our toolbox full of advanced and highly successful predictive maintenance technologies. These tools currently consist of vibration analysis, lubricant analysis (both physical property and wear metals analysis, thermographic analysis, motor current signature analysis, tribology and process parameter trending. All employed with the intent to evaluate a machines health. This machine health check allows the forecasting of future preventative maintenance [PM's] tasks and the revision of existing PM's to maximize machine performance and eliminate 'no-value-added' maintenance activities/costs. Within the last year, the Condition-Based Maintenance Program has produced a cost saving of approximately $1.5 million dollars. As the program matures, these cost savings will accumulate well into the millennium. (authors)

Diagnosis-Based Risk Adjustment for Medicare Capitation Payments

Science.gov (United States)

Ellis, Randall P.; Pope, Gregory C.; Iezzoni, Lisa I.; Ayanian, John Z.; Bates, David W.; Burstin, Helen; Ash, Arlene S.

1996-01-01

Using 1991-92 data for a 5-percent Medicare sample, we develop, estimate, and evaluate risk-adjustment models that utilize diagnostic information from both inpatient and ambulatory claims to adjust payments for aged and disabled Medicare enrollees. Hierarchical coexisting conditions (HCC) models achieve greater explanatory power than diagnostic cost group (DCG) models by taking account of multiple coexisting medical conditions. Prospective models predict average costs of individuals with chronic conditions nearly as well as concurrent models. All models predict medical costs far more accurately than the current health maintenance organization (HMO) payment formula. PMID:10172666

Genome-health nutrigenomics and nutrigenetics: nutritional requirements or 'nutriomes' for chromosomal stability and telomere maintenance at the individual level.

Science.gov (United States)

Bull, Caroline; Fenech, Michael

2008-05-01

It is becoming increasingly evident that (a) risk for developmental and degenerative disease increases with more DNA damage, which in turn is dependent on nutritional status, and (b) the optimal concentration of micronutrients for prevention of genome damage is also dependent on genetic polymorphisms that alter the function of genes involved directly or indirectly in the uptake and metabolism of micronutrients required for DNA repair and DNA replication. The development of dietary patterns, functional foods and supplements that are designed to improve genome-health maintenance in individuals with specific genetic backgrounds may provide an important contribution to an optimum health strategy based on the diagnosis and individualised nutritional prevention of genome damage, i.e. genome health clinics. The present review summarises some of the recent knowledge relating to micronutrients that are associated with chromosomal stability and provides some initial insights into the likely nutritional factors that may be expected to have an impact on the maintenance of telomeres. It is evident that developing effective strategies for defining nutrient doses and combinations or 'nutriomes' for genome-health maintenance at the individual level is essential for further progress in this research field.

Maintenance of the classroom health education curricula: results from the CATCH-ON study.

Science.gov (United States)

Johnson, Carolyn C; Li, Donglin; Galati, Todd; Pedersen, Sheryl; Smyth, Mary; Parcel, Guy S

2003-08-01

Maintenance of the interactive Child and Adolescent Trial for Cardiovascular Health (CATCH) third- to fifth-grade curricula was studied in the 56 original intervention schools and 20 of the original control schools 5 years postintervention in four regions of the United States. Target grade teachers completed a self-administered survey that included questions regarding use of the CATCH materials, training in CATCH or other health education, barriers and perceived support for health education, and amount of health education currently taught. Percentage of teachers who continued to teach CATCH in the classroom was low; however, percentages were significantly higher in former intervention compared with control schools, even though control schools received training and materials following the main field trial. The results of this study can provide useful information for future development of classroom health promotion materials with a higher level of sustainability.

Inequalities in maintenance of health and performance between young adult women and men in higher education.

Science.gov (United States)

Löve, Jesper; Dellve, Lotta; Eklöf, Mats; Hagberg, Mats

2009-04-01

Because of ageing populations, most high-income countries are facing an imminent scarcity of labour. Maintenance of health and performance in young adults therefore becomes a crucial prerequisite for sustainable societies. One major obstruction to this accomplishment is the striking health inequalities between young women and young men. Previously these inequalities have mainly been studied in a cross-sectional way, focusing on ill-health. In this study, we compared the prevalence of maintained health and performance between young adult women and men and the predictors for this outcome. The cohort consisted of 1266 participants from a homogenous sample of university students in Sweden. A combined assessment of self-rated 'very good' health and un-impaired performance took place at three time points (i.e. maintained health and performance). Potential predictors covered stable conditions in health-related behaviours, conditions at work/school and work-home interference. Young women had less maintained health and performance than young men. No major differences in predictors were found. However, there was a tendency for psychosocial factors to be the most important predictors, especially in women. That young women had less maintained health and performance in a homogenous sample beyond well-known differentiating factors suggests explanations other than observable structural differences between the sexes. This was also indicated by the importance attached to perceived demands, and work-home interference, especially in women. The combination of less scheduled, and more unscheduled, schoolwork (i.e. time-flexibility) negatively affected the maintenance of health and performance in our study population, suggesting a focus for future studies.

Asbestos exposure of building maintenance personnel.

Science.gov (United States)

Mlynarek, S; Corn, M; Blake, C

1996-06-01

The exposures of building maintenance personnel and occupants to airborne asbestos fibers, and the effects of operations and maintenance programs on those exposures, continue to be an important public health issue. The subject of this investigation was a large metropolitan county with numerous public buildings which routinely conducted air sampling for asbestos. A total of 302 personal air samples in nine task categories collected during maintenance worker activities in proximity to asbestos-containing materials were analyzed; 102 environmental air samples in four task categories were also analyzed. The arithmetic means of the 8-hr time weighted average exposures for personal sampling for each task category were all below the Occupational Safety and Health Administration permissible exposure level of 0.1 fibers (f)/cc > 5 microm. The highest mean 8-hr time weighted average exposure was 0.030 f/cc > 5 microm for ceiling tile replacement. The maximum asbestos concentration during sample collection for environmental samples was 0.027 f/cc > 5 microm. All asbestos-related maintenance work was done within the framework of an Operations and Maintenance Program (OMP) which utilized both personal protective equipment and controls against fiber release/dispersion. Results are presented in association with specific OMP procedures or controls. These results support the effectiveness of using Operations and Maintenance Programs to manage asbestos in buildings without incurring unacceptable risk to maintenance workers performing maintenance tasks.

Maintenance Process Strategic Analysis

Science.gov (United States)

Jasiulewicz-Kaczmarek, M.; Stachowiak, A.

2016-08-01

The performance and competitiveness of manufacturing companies is dependent on the availability, reliability and productivity of their production facilities. Low productivity, downtime, and poor machine performance is often linked to inadequate plant maintenance, which in turn can lead to reduced production levels, increasing costs, lost market opportunities, and lower profits. These pressures have given firms worldwide the motivation to explore and embrace proactive maintenance strategies over the traditional reactive firefighting methods. The traditional view of maintenance has shifted into one of an overall view that encompasses Overall Equipment Efficiency, Stakeholders Management and Life Cycle assessment. From practical point of view it requires changes in approach to maintenance represented by managers and changes in actions performed within maintenance area. Managers have to understand that maintenance is not only about repairs and conservations of machines and devices, but also actions striving for more efficient resources management and care for safety and health of employees. The purpose of the work is to present strategic analysis based on SWOT analysis to identify the opportunities and strengths of maintenance process, to benefit from them as much as possible, as well as to identify weaknesses and threats, so that they could be eliminated or minimized.

Organisation of maintenance of health semi-portable detectors. IPAB-CFA-CABP control bench; Organisation de la maintenance des detecteurs semi-portatifs de sante. Banc de controle des IPAB-CFA-CABP

Energy Technology Data Exchange (ETDEWEB)

De Choudens, H.; Rage, P. [Commissariat a l' energie atomique et aux energies alternatives - CEA, Centre d' Etudes Nucleaires de Grenoble (France)

1963-07-01

As the number of electronic semi-portable health measurement devices is (was) increasing, it appears (appeared) important to organise their maintenance. In this report, the authors describe the implemented organisation. They indicate how a device is identified, which are the performed tests, and discuss results which have been obtained during the first year of implementation of this maintenance organisation. Then, they present the control bench, its operation (supply, measurement circuits), its use (control process for different devices, performed measurements and controls)

Health and maintenance outages in nuclear power plants: an epidemiological survey

International Nuclear Information System (INIS)

Telle, M.A.; Huez, D.; Niedbala, J.M.; Auclair, J.; Canales, J.P.; Duverge, C.; Forest, H.; Gerondal, M.; Paris, P.M.; Renault, J.C.; Bossevain, L.; Blaise, P.; Blanc, M.C.; Goldberg, M.; Charpak, Y.

1995-01-01

An epidemiological survey, started in 1989, was carried out at the nuclear power plants in the Loire river valley and at Le Blayais (France). Working conditions, work organisation and their impact on health during annual maintenance outages were studied. The main areas covered in this cross-sectional study were: anxiety and symptoms of depression using the Spielberger and CES-D scales. Comparisons were made during both a scheduled outage and in normal operation on four distinct groups of workers, each individual being his own control. A chi-square test was used for the quantitative variables and a test on differences for the quantitative variables. During a unit outage, more frequent overtime and atypical working hours were reported (p<0.01); working rhythms and safety rules were felt as more restrictive and exposure to radiation higher (p<0.01). Detrimental modifications of anxiety and symptoms of depression were observed on controllers whereas expected on maintenance agents. Similar results were observed when considering the rates of outages. Possible readings are given with reference to qualitative studies carried out on this topic, which implies extending our research with both the quantitative and qualitative approaches. (authors). 10 refs., 6 tabs

Maintenance of scientific instruments

International Nuclear Information System (INIS)

Lucero, E.

1986-01-01

During the last years Colombia has increased the use of nuclear techniques, instruments and equipment in ambitious health programs, as well as in research centers, industry and education; this has resulted in numerous maintenance problems. As an alternative solution IAN has established a Central Maintenance Laboratory for nuclear instruments within an International Atomic Energy Agency program for eight Latin American and nine Asian Countries. Established strategies and some results are detailed in this writing

Building a comprehensive geriatric health care system: a case study.

Science.gov (United States)

Bleiweiss, L; Simson, S

1976-01-01

This case study focuses on the efforts of three urban medical care institutions--a Health Maintenance Organization, a nursing home, and a university hospital--to form an interorganizational relationship. The purpose of the relationship was to utilize the services of the three organizations in order to respond to the comprehensive health needs of an urban geriatric population. Movements in this triadic organizational relationship are described and analyzed in terms of four conceptual stages--exploration, negotiation, interaction and performance, and termination. Problems arising during these stages were not resolved and the relationship was terminated after approximately two years of existence. A sociological discussion of the case focuses on why the relationship failed. The organizational relationship was disrupted by three stresses that occurred during the four stages of the relationship. Stresses emerged for each organization in the areas of organizational integration, professional coordination, and environmental adaptation, making it difficult for the three to become integrated into an organizational system. As a result, the HMO, the nursing home, and the hospital did not benefit from relationships that could have enabled them to develop the multi-organizational system necessary to sustain an innovative, comprehansive geriatric health project. If, as Whitehead said, the greatest invention of the nineteenth century was the invention of the method of invention, the task of the succedding century has been to organize inventiveness. The difference is not in the nature of invention or of inventors, but in the manner in which the context of social institutions is organized for their support.

Health risk air-conditioning system; Insufficient maintenance increases the risk of illness. Gesundheitsrisiko Klimaanlagen; Unzureichende Wartung erhoeht das Erkrankungsrisiko

Energy Technology Data Exchange (ETDEWEB)

Anon.

1994-01-01

In Germany every fifth employee who works in air-conditioned rooms complains about headache, an increased proneness to colds and influenza infections as well as allergic reactions. These troubles are often caused by the insufficient maintenance of air-conditioning systems. At present only 15% of the estimated annual demand for maintenance of space hvac-systems is actually carried out. Problematic in case of air-conditioning systems are the so-called air washers used for air humidification which can become an ideal cultur medium for microorganisms. A second problematic area are the often very dirty filters. But health risks can be avoided with regular expert maintenance alone. As first step an analysis of the causes of faults is proposed. (BWI)

Managed care market share and cesarean section rates in the United States: is there a link?

Science.gov (United States)

Hueston, W J; Sutton, A

2000-11-01

After peaking during the early 1980s, cesarean section rates in the United States have been falling for the last decade. At the same time, managed care enrollment has increased dramatically. This study examines whether managed care penetration in local markets is associated with lower cesarean section rates in those geographic area. A cross-sectional comparison of cesarean section rates and health maintenance organization (HMO) market penetration in 61 selected metropolitan areas in the United States was conducted. National birth certificate data for 1996 were used to calculate crude and race-adjusted cesarean section rates for residents in each area. No relationship between overall cesarean section rates in the metropolitan areas and managed care penetration was observed. Subanalyses of racial groups demonstrated the existence of a weak association between managed care penetration and cesarean section rates for white women (21.2% for the highest quartile of HMO penetration, compared with 19.1% for the lowest quartile; P = .03), but not for African-Americans or other minorities. Managed care penetration in a market may have an association with cesarean section rates for white women, but the strength of this relationship is small. Even if managed care delivery systems reduce cesarean section rates in their own populations, this change is likely to have only a small impact on overall cesarean rates. HMO penetration is unlikely to influence national cesarean section rates, nor does it appear to explain state variations in these rates.

Human Milk Oligosaccharides and the Preterm Infant: A Journey in Sickness and in Health.

Science.gov (United States)

Moukarzel, Sara; Bode, Lars

2017-03-01

Human milk oligosaccharides (HMOs) are a group of approximately 200 different unconjugated sugar structures in human milk proposed to support infant growth and development. Data from several preclinical animal studies and human cohort studies suggest HMOs reduce preterm infant mortality and morbidity by shaping the gut microbiome and protecting against necrotizing enterocolitis, candidiasis, and several other immune-related diseases. Current feeding practices and clinical algorithms do not consider infant HMO intake when assessing dietary adequacy or disease risk. Advancements in HMO analytical methodologies and HMO synthesis facilitate cohort and intervention studies to investigate which particular HMOs are most relevant in supporting preterm infants. Copyright © 2016 Elsevier Inc. All rights reserved.

Cost Effectiveness of Individual versus Group Cognitive Behavior Therapy for Problems of Depression and Anxiety in an HMO Population.

Science.gov (United States)

Shapiro, Joan; And Others

1982-01-01

Compared the cost effectiveness of cognitive behavior group therapy, traditional process-oriented interpersonal group, and individual cognitive behavior therapy in dealing with depression and anxiety in a health maintenance organization population (N=44). Results suggest that cost considerations can become relatively important when decisions are…

30 CFR 90.204 - Approved sampling devices; maintenance and calibration.

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Approved sampling devices; maintenance and... LABOR COAL MINE SAFETY AND HEALTH MANDATORY HEALTH STANDARDS-COAL MINERS WHO HAVE EVIDENCE OF THE DEVELOPMENT OF PNEUMOCONIOSIS Sampling Procedures § 90.204 Approved sampling devices; maintenance and...

Optimizing preventive maintenance with maintenance templates

International Nuclear Information System (INIS)

Dozier, I.J.

1996-01-01

Rising operating costs has caused maintenance professionals to rethink their strategy for preventive maintenance (PM) programs. Maintenance Templates are pre-engineered PM task recommendations for a component type based on application of the component. Development of the maintenance template considers the dominant failure cause of the component and the type of preventive maintenance that can predict or prevent the failure from occurring. Maintenance template development also attempts to replace fixed frequency tasks with condition monitoring tasks such as vibration analysis or thermography. For those components that have fixed frequency PM intervals, consideration is given to the maintenance drivers such as criticality, environment and usage. This helps to maximize the PM frequency intervals and maximize the component availability. Maintenance Templates have been used at PECO Energy's Limerick Generating Station during the Reliability Centered Maintenance (RCM) Process to optimize their PM program. This paper describes the development and uses of the maintenance templates

29 CFR 2201.10 - Maintenance of statistics.

Science.gov (United States)

2010-07-01

... 29 Labor 9 2010-07-01 2010-07-01 false Maintenance of statistics. 2201.10 Section 2201.10 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH REVIEW COMMISSION REGULATIONS IMPLEMENTING THE FREEDOM OF INFORMATION ACT § 2201.10 Maintenance of statistics. (a) The FOIA Disclosure...

Procedure to evaluate and control efficiently the operations management of medical equipment in the maintenance unit of a health institution

Directory of Open Access Journals (Sweden)

Herrera-Galán Michael

2018-01-01

Full Text Available Maintenance management plays a very important role in the success of any company. As a consequence of this, in the year of 2013, a study was carried out in health facilities found in the South Eastern Region of Jamaica with the objective of evaluating the existing Maintenance Management Program for Medical Equipment. Among the results obtained, it showed that there is an inadequacy in the existing program whose principal deficiency is attributed to the operations management. As such, this work proposes a procedure for evaluating and controlling in an efficient manner the operations management within the Biomedical Department which forms part of the South East Regional Health Authority Maintenance Unit (SERHAMU, this latter is found on the premises of the Bustamante Hospital for Children (BHC, Jamaica. The method used to develop the procedure (GOMHO is based fundamentally on the design of: a codification system to identify control registers and to record failures associated with each equipment, a system of placing equipment into categories and further differentiating them based on the potential hazard such pose on the human body in the event of an operational failure. In addition, this procedure gives the SERHAMU at the BHC the opportunity to calculate the amount of human resources needed to carry out efficiently the preventative and corrective maintenance work being demanded on the department. During the implementation phase, the results demonstrated that from the control procedure designed there was an improvement in the planning and carrying out of maintenance work and a better system of monitoring the activities that are executed. Also, it was evidenced that there is a 61.53% of the amount of human resources needed to carry out the maintenance actions.

Which types of hospital mergers save consumers money?

Science.gov (United States)

Connor, R A; Feldman, R D; Dowd, B E; Radcliff, T A

1997-01-01

This study analyzes the changes in costs and prices from 1986 to 1994 for more than 3,500 U.S. short-term general hospitals, including 122 horizontal mergers. These mergers were generally financially beneficial to consumers, providing average price reductions of approximately 7 percent. Merger-related price reductions were considerably less in market areas with higher market concentration levels. Merger-related price reductions in areas with higher penetration by health maintenance organizations (HMOs) were approximately twice those in areas with lower HMO penetration. Merger-related price reductions were greater for low-occupancy hospitals, nonteaching hospitals, nonsystem hospitals, similar-size hospitals, and hospitals with greater premerger service duplication.

30 CFR 57.8525 - Main fan maintenance.

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Main fan maintenance. 57.8525 Section 57.8525 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE... Underground Only § 57.8525 Main fan maintenance. Main fans shall be maintained according to either the...

42 CFR 417.124 - Administration and management.

Science.gov (United States)

2010-10-01

... program, administrative and management aspects of the HMO. (3) At a minimum, management by an executive... Administration and management. (a) General requirements. Each HMO must have administrative and managerial... 42 Public Health 3 2010-10-01 2010-10-01 false Administration and management. 417.124 Section 417...

Susquehanna SES maintenance supervisor training and certification

International Nuclear Information System (INIS)

Deckman, M.

1991-01-01

Susquehanna's program targets all Supervisors, Supervisor Candidates, and Temporary Supervisors that are responsible for in-plant maintenance or maintenance support activities, including: mechanical maintenance; electrical maintenance; maintenance support (labor support, radwaste, etc.); mobile construction support (mechanical and electrical); chemistry; health physics; maintenance planning; and instrument and controls. The program integrates the three major areas of direct Supervisory responsibilities: (1) Leadership and Management - Skills that require interpersonal activities that are typically humanistic and subjective; such as coaching, motivating, communications, etc. (2) Technical and Administrative - Knowledge that is directly related to the job of Supervising from the production, regulatory, accountability perspective. These topics are very objective and include training on topics such as workpackages, plant chemistry parameters, radiological concerns, etc. (3) Technical Skills - Ensure each Supervisor is technically competent in the plant systems, components, or equipment he/she is tasked with maintaining or overseeing. Typical skills found in this area are, circuit breaker maintenance, primary system sampling, or overhauling pumps

Knowledge and attitude of parents toward oral health maintenance and treatment modalities for their children

Directory of Open Access Journals (Sweden)

Pooja Bodhale

2014-01-01

Full Text Available Background and Aim: Parents have an important role in making decisions about their child′s oral health. The purpose of this study was to determine parental awareness of their children′s oral health maintenance and their attitude toward dental treatment. Materials and Methods: Total 284 parents from different socioeconomic groups participated in the study. Data were collected using a self-administered questionnaire addressing various aspects of knowledge and attitude of parents toward oral health and treatment modalities. Results: Awareness among parents was significantly lower in low socioeconomic group. Their attitude toward dental treatment differed significantly in which only 53% parents from high socioeconomic group preferred going to the pediatric dentist. Conclusion: The level of awareness among parents is relatively low and there is need for the implementation of oral health awareness programs for parents to change their attitude toward dental treatment of their children.

Preventive maintenance and reliability-centered maintenance

International Nuclear Information System (INIS)

Anderson, J.G.

1989-01-01

In the recent past, the primary function of the preventive maintenance program at a nuclear power plant was to maintain the operability and reliability of the plant. Reducing overall maintenance costs by performing effective preventive maintenance, instead of more costly and disruptive corrective maintenance, instead of more costly and disruptive corrective maintenance, was a secondary consideration. In today's operating environment, the preventive maintenance program must meet the test of cost-effectiveness as well as many new standards for performance that are being required by rate regulators. The preventive maintenance program must be able to withstand the challenge of independent audit to a new standard of technical adequacy and compliance with recommendations from component vendors. In this new environment, the standard that is being applied at the San Onofre nuclear generating station (SONGS) is that the preventive maintenance program must meet the test of cost-effectiveness, improve equipment performance, support increased plant availability, and (a) literally implement the recommendations of the vendor, (b) provide other compensation for the vendor recommendation, or (c) provide technical justification for the deviation. The subject of this paper is the way that reliability-centered maintenance (RCM) is helping SONGS meet these challenges

Job-based health benefits in 2002: some important trends.

Science.gov (United States)

Gabel, Jon; Levitt, Larry; Holve, Erin; Pickreign, Jeremy; Whitmore, Heidi; Dhont, Kelley; Hawkins, Samantha; Rowland, Diane

2002-01-01

Based on a national survey of 2,014 randomly selected public and private firms with three or more workers, this paper reports changes in employer-based health insurance from spring 2001 to spring 2002. The cost of health insurance rose 12.7 percent, the highest rate of growth since 1990. Employee contributions for health insurance rose in 2002, from $30 to $38 for single coverage and from $150 to $174 for family coverage. Deductibles and copayments rose also, and employers adopted formularies and three-tier cost-sharing formulas to control prescription drug expenses. PPO and HMO enrollment rose, while the percentage of small employers offering health benefits fell. Because increasing claims expenses rather than the underwriting cycle are the major driver of rising premiums, double-digit growth appears likely to continue.

Comparison of health-related quality of life of children during maintenance therapy with acute lymphoblastic leukemia versus siblings and healthy children in India.

Science.gov (United States)

Bansal, Minakshi; Sharma, Kamlesh K; Vatsa, Manju; Bakhshi, Sameer

2013-05-01

Data on quality of life (QOL) specifically in maintenance therapy of acute lymphoblastic leukemia (ALL) are minimal. This study was done to assess various items listed in domains of QOL (physical, emotional, social and school health domains) of children with ALL during maintenance therapy, and compare the same with those of their siblings and other healthy children. Forty children on maintenance therapy of ALL, 40 siblings and 40 healthy children were assessed for QOL by child self-report using PedsQL 4.0 Generic Core in the local language. Means were computed and compared for each domain with one-way analysis of variance (ANOVA), wherein higher values reflected better QOL. Overall QOL of children with ALL in maintenance therapy (77.16 ± 10.98) was significantly poorer than that of siblings (93.56 ± 4.41) and healthy children (93.02 ± 3.76) (p fear, anger, sleeping problems) among children with ALL. In the social health domain, children with ALL reported difficulty in maintaining friendships and competing. QOL of siblings was as good as that of healthy children in physical, social and school health domains, but they had increased emotional problems such as anger and sadness. Healthy children reported significantly higher future worries and bullying than children with ALL and siblings. This study validated that the QOL of children with ALL during maintenance therapy was significantly poorer than that of siblings and healthy children. The study identified various items in each domain of QOL that were affected in these children, and thus would assist in guiding healthcare professionals to focus on these specific items so as to improve their overall QOL.

Clinical pharmacy cardiac risk service for managing patients with coronary artery disease in a health maintenance organization.

Science.gov (United States)

Sandhoff, Brian G; Nies, Leslie K; Olson, Kari L; Nash, James D; Rasmussen, Jon R; Merenich, John A

2007-01-01

A clinical pharmacy service for managing the treatment of coronary artery disease in a health maintenance organization is described. Despite the proven benefits of aggressive risk factor modification for patients with coronary artery disease (CAD), there remains a treatment gap between consensus- and evidence-based recommendations and their application in patient care. In 1998, Kaiser Permanente of Colorado developed the Clinical Pharmacy Cardiac Risk Service (CPCRS) to focus on the long-term management of patients with CAD to improve clinical outcomes. The primary goals of the CPCRS are to increase the number of CAD patients on lipid-lowering therapy, manage medications shown to decrease the risk of future CAD-related events, assist in the monitoring and control of other diseases that increase cardiovascular risk, provide patient education and recommendations for nonpharmacologic therapy, and act as a CAD information resource for physicians and other health care providers. Using an electronic medical record and tracking database, the service works in close collaboration with primary care physicians, cardiologists, cardiac rehabilitation nurses, and other health care providers to reduce cardiac risk in the CAD population. Particular attention is given to dyslipidemia, blood pressure, diabetes mellitus, and tobacco cessation. Treatment with evidence-based regimens is initiated and adjusted as necessary. Over 11,000 patients are currently being followed by the CPCRS. A clinical pharmacy service in a large health maintenance organization provides cardiac risk reduction for patients with CAD and helps close treatment gaps that may exist for these patients.

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

Science.gov (United States)

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

2017-12-01

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

Utilization and costs of home-based and community-based care within a social HMO: trends over an 18-year period

Directory of Open Access Journals (Sweden)

Walter Leutz

2005-10-01

Full Text Available Purpose: Our objective was to describe the utilization and costs of services from 1985 to 2002 of a Social Health Maintenance Organization (SHMO demonstration project providing a benefit for home-based and community-based as well as short-term institutional (HCB care at Kaiser Permanente Northwest (KPNW, serving the Portland, Oregon area. The HCB care benefit was offered by KPNW as a supplement to Medicare's acute care medical benefits, which KPNW provides in an HMO model. KPNW receives a monthly per capita payment from Medicare to provide medical benefits, and Medicare beneficiaries who choose to join pay a supplemental premium that covers prescription drugs, HCB care benefits, and other services. A HCB care benefit of up to $12,000 per year in services was available to SHMO members meeting requirement for nursing home certification (NHC. Methods: We used aggregate data to track temporal changes in the period 1985 to 2002 on member eligibility, enrollment in HCB care plans, age, service utilization and co-payments. Trends in the overall costs and financing of the HCB care benefit were extracted from quarterly reports, management data, and finance data. Results: During the time period, 14,815 members enrolled in the SHMO and membership averaged 4,531. The proportion of SHMO members aged 85 or older grew from 12 to 25%; proportion meeting requirements for NHC rose from 4 to 27%; and proportion with HCB care plans rose from 4 to 18%. Costs for the HCB care benefit rose from $21 per SHMO member per month in 1985 to $95 in 2002. The HCB care costs were equivalent to 12% to 16% of Medicare reimbursement. The HCB program costs were covered by member premiums (which rose from $49 to $180 and co-payments from members with care plans. Over the 18-year period, spending shifted from nursing homes to a range of community services, e.g. personal care, homemaking, member reimbursement, lifeline, equipment, transportation, shift care, home nursing, adult day

Opportune maintenance and predictive maintenance decision support

OpenAIRE

Thomas , Edouard; Levrat , Eric; Iung , Benoît; Cocheteux , Pierre

2009-01-01

International audience; Conventional maintenance strategies on a single component are being phased out in favour of more predictive maintenance actions. These new kinds of actions are performed in order to control the global performances of the whole industrial system. They are anticipative in nature, which allows a maintenance expert to consider non-already-planned maintenance actions. Two questions naturally emerge: when to perform a predictive maintenance action; how a maintenance expert c...

21 CFR 211.67 - Equipment cleaning and maintenance.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Equipment cleaning and maintenance. 211.67 Section 211.67 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... Equipment cleaning and maintenance. (a) Equipment and utensils shall be cleaned, maintained, and, as...

Operational health and physics service during the maintenance of the Australian National Medical Cyclotron

International Nuclear Information System (INIS)

Mukherjee, B.

1994-01-01

Modern Medical Cyclotrons use intense beams of high energy protons or deuterons to produce large activities of short and medium lived radionuclides. After continuous operation for prolonged periods the Cyclotron components become activated through various nuclear interactions therefore, the risk of personal radiation hazard while handling such activated cyclotron components is high. This paper describes all operational aspects of the Health Physics service evolved during the first preventative maintenance program of the Australian National Medical Cyclotron, which took place in June 1993. 5 refs., 3 tabs., 2 figs

Effect of improved glycemic control on health care costs and utilization.

Science.gov (United States)

Wagner, E H; Sandhu, N; Newton, K M; McCulloch, D K; Ramsey, S D; Grothaus, L C

2001-01-10

Because of the additional costs associated with improving diabetes management, there is interest in whether improved glycemic control leads to reductions in health care costs, and, if so, when such cost savings occur. To determine whether sustained improvements in hemoglobin A(1c) (HbA(1c)) levels among diabetic patients are followed by reductions in health care utilization and costs. Historical cohort study conducted in 1992-1997 in a staff-model health maintenance organization (HMO) in western Washington State. All diabetic patients aged 18 years or older who were continuously enrolled between January 1992 and March 1996 and had HbA(1c) measured at least once per year in 1992-1994 (n = 4744). Patients whose HbA(1c) decreased 1% or more between 1992 and 1993 and sustained the decline through 1994 were considered to be improved (n = 732). All others were classified as unimproved (n = 4012). Total health care costs, percentage hospitalized, and number of primary care and specialty visits among the improved vs unimproved cohorts in 1992-1997. Diabetic patients whose HbA(1c) measurements improved were similar demographically to those whose levels did not improve but had higher baseline HbA(1c) measurements (10.0% vs 7.7%; Pcosts were $685 to $950 less each year in the improved cohort for 1994 (P =.09), 1995 (P =.003), 1996 (P =.002), and 1997 (P =.01). Cost savings in the improved cohort were statistically significant only among those with the highest baseline HbA(1c) levels (>/=10%) for these years but appeared to be unaffected by presence of complications at baseline. Beginning in the year following improvement (1994), utilization was consistently lower in the improved cohort, reaching statistical significance for primary care visits in 1994 (P =.001), 1995 (Pcost savings within 1 to 2 years of improvement.

Production of human milk oligosaccharides by enzymatic and whole-cell microbial biotransformations.

Science.gov (United States)

Sprenger, Georg A; Baumgärtner, Florian; Albermann, Christoph

2017-09-20

Human milk oligosaccharides (HMO) are almost unique constituents of breast milk and are not found in appreciable amounts in cow milk. Due to several positive aspects of HMO for the development, health, and wellbeing of infants, production of HMO would be desirable. As a result, scientists from different disciplines have developed methods for the preparation of single HMO compounds. Here, we review approaches to HMO preparation by (chemo-)enzymatic syntheses or by whole-cell biotransformation with recombinant bacterial cells. With lactose as acceptor (in vitro or in vivo), fucosyltransferases can be used for the production of 2'-fucosyllactose, 3-fucosyllactose, or more complex fucosylated core structures. Sialylated HMO can be produced by sialyltransferases and trans-sialidases. Core structures as lacto-N-tetraose can be obtained by glycosyltransferases from chemical donor compounds or by multi-enzyme cascades; recent publications also show production of lacto-N-tetraose by recombinant Escherichia coli bacteria and approaches to obtain fucosylated core structures. In view of an industrial production of HMOs, the whole cell biotransformation is at this stage the most promising option to provide human milk oligosaccharides as food additive. Copyright © 2017 Elsevier B.V. All rights reserved.

PORTFOLIO OF POTENTIAL STRATEGIES IN AERONAUTIC MAINTENANCE

International Nuclear Information System (INIS)

Rolet, S.

2010-01-01

EADS divisions aim more and more at developing services associated to their platforms. EADS divisions, like Airbus and Eurocopter, are investigating on services associated to their platforms in order to add them value. One possible service consists in structural maintenance operation assistance, especially for NDT operations performed by the customer. EADS Innovation Works envisages three different and complementary enhanced structural maintenance categories. Enhanced NDT improves standard NDT operation environment. This is made possible by the existence of 'smart' NDT tools that are computer based and therefore able to support other functions. These functions range from local smart data processing and display to remote expert assisted operation. Passive Sensor Network relies on sensors permanently installed on aircraft structure. Interrogation of sensors is performed on ground and off line (while structure is not loaded except by its own weight). It can be done at arbitrary times in order to determine structure health. The aim is to give easy access to some hidden ''hot spots,'' to reduce human factor in structure health assessment and optimize maintenance. Structural Health Monitoring goes a step beyond Passive Sensor Network, because interrogation units are on board the aircraft and may be connected to aircraft network. It allows to use on-line techniques such as adapted acoustic emission and to automatically raise an alarm when a defect appears in the structure. This paper presents these different ways of improving structural maintenance operations in service, with their respective advantages and limitations.

Competitive bidding for health insurance contracts: lessons from the online HMO auctions.

Science.gov (United States)

Gupta, Alok; Parente, Stephen T; Sanyal, Pallab

2012-12-01

Healthcare is an important social and economic component of modern society, and the effective use of information technology in this industry is critical to its success. As health insurance premiums continue to rise, competitive bidding may be useful in generating stronger price competition and lower premium costs for employers and possibly, government agencies. In this paper, we assess an endeavor by several Fortune 500 companies to reduce healthcare procurement costs for their employees by having HMOs compete in open electronic auctions. Although the auctions were successful in generating significant cost savings for the companies in the first year, i.e., 1999, they failed to replicate the success and were eventually discontinued after two more years. Over the past decade since the failed auction experiment, effective utilization of information technologies have led to significant advances in the design of complex electronic markets. Using this knowledge, and data from the auctions, we point out several shortcomings of the auction design that, we believe, led to the discontinuation of the market after three years. Based on our analysis, we propose several actionable recommendations that policy makers can use to design a sustainable electronic market for procuring health insurance.

Resilience associated with mental health problems among methadone maintenance treatment patients in Guangzhou, China.

Science.gov (United States)

Jiao, Mingxu; Gu, Jing; Xu, Huifang; Hao, Chun; Lau, Joseph T F; Mo, Phoenix; Liu, Di; Zhao, Yuteng; Zhang, Xiao; Babbitt, Andrew; Hao, Yuantao

2017-05-01

A considerable proportion of methadone maintenance treatment (MMT) clients have experienced mental health problems (e.g., depression and anxiety), and poor mental health status is associated with HIV-related risk behaviors and treatment drop-out. Resilience is known to be a protective factor for mental health problems but is not studied among MMT clients in China. This study aimed to explore the relationship between resilience and mental health problems (depression, anxiety and stress) among clients of community-based MMT clinics in China. A total of 208 MMT clients completed the face-to-face interview conducted at 4 of 11 MMT clinics in Guangzhou. The Chinese short version of Depression Anxiety Stress Scale (DASS-21) was used to assess the presence of depressive, anxiety and stress symptoms, and the Connor-Davidson Resilience Scale (CD-RISC) was used to measure resilience. Logistic regression models were fit in data analyses. Of all participants, 12.8%, 19.5% and 8.3% had depression, anxiety and stress, respectively. The mean resilience score was 57.6 (SD = 15.9). In the univariate analyses, resilience was negatively associated with two studied mental health problems (depression and anxiety, OR u  = 0.96 and 0.96, p mental health problems of MMT users should consider resilience as an important part in the designing of such interventions.

JRR-3 maintenance program utilizing accumulated maintenance data

International Nuclear Information System (INIS)

Izumo, Hironobu; Kato, Tomoaki; Kinase, Masami; Torii, Yoshiya; Murayama, Yoji

2007-07-01

JRR-3(Japan Research Reactor No.3) has been operated for more than 15 years after the modification, without significant troubles by carrying out maintenance such as the preventive maintenance (mainly time-based maintenance) for the safety-grade equipments and the breakdown maintenance for the non-safety-grade equipments. Unscheduled shutdowns causes by aged non-safety-grade equipments have been increasing, and the resources such as budgets have been decreasing year by year. In this situation, JRR-3 maintenance program was reviewed about safety, reliability and economic efficiency. This report offers the policy of the maintenance review and the future direction of maintenance programs. (author)

Principles of MONJU maintenance. Characteristic of MONJU maintenance and reflection of LWR maintenance experience to FBR

International Nuclear Information System (INIS)

Nakai, Satoru; Nishio, Ryuichi; Uchihashi, Masaya; Kaneko, Yoshihisa; Yamashita, Hironobu; Yamaguchi, Atsunori; Aoki, Takayuki

2014-01-01

A sodium cooled fast breeder reactor (FBR) has unique systems and components and different degradation mechanism from light water reactor (LWR) so that need to establish maintenance technology in accordance with its features. The examination of the FBR maintenance technology is carried out in the special committee for considering the maintenance for Monju established in the Japan Society of Maintenology (JSM). As a result of the study such as extraction of Monju maintenance feature, maintenance technology benchmark between Monju and LWR components and survey of LWR maintenance experience, it is clear that principles of maintenance are same as LWR, necessity of LWR maintenance experience reflection and points to be considered in Monju maintenance. The road map to establish a FBR maintenance technology in the technical aspect became clear and it is vital to acquire operation and maintenance experience of the plant to implement this road map, and to establish a fast reactor maintenance. (author)

48 CFR 301.606-73 - Requirements for continuous learning maintenance.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Requirements for continuous learning maintenance. 301.606-73 Section 301.606-73 Federal Acquisition Regulations System HEALTH..., and Responsibilities 301.606-73 Requirements for continuous learning maintenance. Designated Project...

Status of Technical Requirements Development for Maintenance Effectiveness Management

International Nuclear Information System (INIS)

Ahn, Sang Kyu; Kim, Yun Il; Lee, Chang Ju; Chang, Gun Hyun

2012-01-01

It is well known that proper maintenance at nuclear power plant is essential to plant safety and that there is a clear link between effective maintenance and safety as it relates to such factors as the number of transients and challenges to safety systems and the associated need for operability, availability, and reliability of safety equipment. Good maintenance is also important in providing assurance that failures of non-safety related structures, systems, and components (SSCs) that could initiate, adversely affect, or mitigate a transient or an accident are also minimized. Maintenance is also important to ensure that design assumptions and margins in the original design basis are maintained and are not degraded to an unacceptable level. Therefore, good maintenance practice at nuclear power plants is of utmost importance in protecting public health and safety. This paper introduces the status of the development of regulatory technical requirements (Drafts) for utility's management of maintenance effectiveness. The process of Maintenance Effectiveness Management is shown in Figure 1

Inspection of licensee - Maintenance programme and activities

International Nuclear Information System (INIS)

2013-01-01

An effective maintenance programme is critical to sustained safe and reliable operation of nuclear power plants. The Working Group on Inspection Practices (WGIP) concluded that when a licensee has an effective maintenance programme, the overall operating safety of the plant is improved and the protection of public health and safety enhanced. All Regulatory Bodies (RB) consider maintenance to be an important area for oversight. Although a variety of inspection practices are being used; RB are actively monitoring licensee performance. Specifically the following conclusions were reached and commendable practices identified: - Maintenance oversight by regulators appears to be in a stable continuous improvement state. Most regulators are executing inspection oversight based on an existing regulatory framework. - The performance of a licensee's maintenance programme is recognized as important part of maintaining nuclear safety. The result of the maintenance program assessment is included in the overall performance assessment of a license. - Maintenance inspection activities are recognized as an important part of the regulatory oversight process. Inspection activities are based on the safety significance and nature of work being performed by the licensee. - The effectiveness of the maintenance inspection activities is recognized to rely on properly qualified inspectors; who are adequately supported by specialists. Training and qualification of inspectors should be based on how the RB reviews and inspects licensee maintenance programmes. - Reporting requirements are identified to provide information on the licensees maintenance programme, and to help guide inspection activities. - Performance Indicators are recognized as a useful tool for helping focus regulatory activities. Basic PI are identified and tracked by the RB, and use of PI by the licensee is monitored. - Inspections are designed to confirm that the licensee is planning and scheduling maintenance with due

78 FR 50359 - Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); TRICARE Uniform Health...

Science.gov (United States)

2013-08-19

... Organization (HMO) Benefit--Prime Enrollment Fee Exemption for Survivors of Active Duty Deceased Sponsors and... Enrollment Fee Exemption for Survivors of Active Duty Deceased Sponsors and Medically Retired Uniformed Services [[Page 50360

Managed maintenance, the next step in power plant maintenance

International Nuclear Information System (INIS)

Butterworth, G.; Anderson, T.M.

1984-01-01

The Westinghouse Nuclear Services Integration Division managed maintenance services are described. Essential to the management and control of a total plant maintenance programme is the development of a comprehensive maintenance specification. During recent years Westinghouse has jointly developed total plant engineering-based maintenance specifications with a number of utilities. The process employed and the experience to date are described. To efficiently implement the maintenance programme Westinghouse has developed a computer software program specifically designed for day to day use at the power plant by maintenance personnel. This program retains an equipment maintenance history, schedules maintenance activities, issues work orders and performs a number of sophisticated analyses of the maintenance backlog and forecast, equipment failure rates, etc. The functions of this software program are described and details of Westinghouse efforts to support the utilities in reducing outage times through development of predefined outage plans for critical report maintenance activities are given. Also described is the experience gained in the training of specialized maintenance personnel, employing competency-based training techniques and equipment mock-ups, and the benefits experienced, in terms of improved quality and productivity of maintenance performed. The success experienced with these methods has caused Westinghouse to expand the use of these training techniques to the more routine skill areas of power plant maintenance. A significant reduction in the operating costs of nuclear power plants will only be brought about by a significant improvement in the quality of maintenance. Westinghouse intends to effect this change by expanding its international service capabilities and to make major investments in order to promote technological developments in the area of power plant maintenance. (author)

PS3-18: Use of Antidepressant and Anti-Anxiety Medications Among Breast Cancer Survivors in a HMO

Science.gov (United States)

Avila, Chantal; Haque, Reina; Quinn, Virginia; Schottinger, Joanne; Fisher, Alice

2010-01-01

Background: Almost 200,000 U.S. women are diagnosed each year with breast cancer and over 40,000 women will die of the disease. In addition to the medical and functional consequences of the diagnosis and treatment, women experience worry, persistent anxiety, fear and depressive disorders. Overall, 30% of women diagnosed with breast cancer suffer significant distress at some point in their illness trajectory. National health organizations including the Institute of Medicine and National Cancer Institute call for treatment of common symptoms among breast cancer patients such as depression and anxiety. To date, there are only limited reports on the prevalence of treatment, and even fewer studies have examined potential differences by race/ethnicity, age, or tumor characteristics. Aim: To describe the prevalence of pharmacotherapy for depressive symptoms/anxiety among patients diagnosed with breast cancer in a large HMO. Methods: We identified all women diagnosed with primary breast cancer between 2000–2006 (n=10,408) who had been members of Kaiser Permanente Southern California (KPSC) for 1+ years prior to diagnosis. KPSC is a nonprofit comprehensive prepaid health plan serving 3.2 million socioeconomically diverse members. Data was obtained from the KPSC SEER-affiliated cancer registry and automated clinical, pharmacy, and membership databases. We examined patient and tumor characteristics associated with new use of pharmacotherapy for depression/anxiety. Univariate odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression. Results: We found 35% of women (3,611 of 10,408) were newly prescribed either anti-depressant or anti-anxiety medications within a year of breast cancer diagnosis. Younger women (e.g., OR=1.44, CI=1.28–1.63 for 40–49 year olds v. 60–69) and women with higher stage (e.g., OR=3.40, CI=2.87–4.04 for Stage 3 v. Stage 0) were more likely to be prescribed these medications, while African-American (OR=0.81, CI

Cervical cancer screening, human papillomavirus vaccination practices and current infrastructure in Israel.

Science.gov (United States)

Schejter, Eduardo; Bornstein, Jacob; Siegler, Efraim

2013-11-22

The incidence rates for premalignant lesions in Jewish women in Israel are similar to those observed in Western countries, but the incidence of cervical cancer in Israel is low; this discrepancy is not yet clearly understood. Because of the low incidence of cervical cancer in Israel, it was decided to base cervical cancer prevention on opportunistic screening: every woman from the ages of 35-54 years can have a Pap test smear free of charge every 3 years. Over the last decade 12.2% of the women population had an annual Pap test. From 36 to 50% of women who attended the Clalit Health Maintenance Organization (HMO) and the Maccabi HMO, the two largest HMOs in Israel, did so. There were also discrepancies between women of different socio-economic status (SES): Israel Society of Obstetrics and Gynecology recommends continuing cytologic screening in vaccinated women as recommended for the general population. This article forms part of a regional report entitled "Comprehensive Control of HPV Infections and Related Diseases in Israel" Vaccine Volume 31, Supplement 8, 2013. Updates of the progress in the field are presented in a separate monograph entitled "Comprehensive Control of HPV Infections and Related Diseases" Vaccine Volume 30, Supplement 5, 2012. Copyright © 2013. Published by Elsevier Ltd.

An evaluation of substance misuse treatment providers used by an employee assistance program.

Science.gov (United States)

Miller, N A

1992-05-01

Structural measures of access, continuity, and quality of substance misuse treatment services were compared in 30 fee-for-service (FFS) facilities and nine health maintenance organizations (HMOs). Probit models related effects of the provider system (FFS or HMO) and the system's structural characteristics to 243 employees' access to and outcomes from treatment. Access was decreased in Independent Practice Association (IPA)/network HMOs and in all facilities which did not employ an addictionologist or provide coordinated treatment services. When bivariate correlations were examined, both use of copayments and imposing limits to the levels of treatment covered were negatively related to access, while a facility's provision of ongoing professional development was positively associated with access. These correlations did not remain significant in the multivariate probits. Receiving treatment in a staff model HMO and facing limits to the levels of treatment covered were negatively associated with attaining sufficient progress, while receiving treatment in a facility which provided ongoing professional development was positively related to progress: these effects did not remain significant in multivariate analyses. Implications for employee assistance program (EAP) staff in their role as case managers and for EAP staff and employers in their shared role as purchasers of treatment are discussed.

Current status of research and development on remote maintenance for fusion components

International Nuclear Information System (INIS)

Takeda, Nobukazu; Kakudate, Satoshi; Nakahira, Masataka; Shibanuma, Kiyoshi

2008-01-01

There is a growing attention to remote maintenance of nuclear fusion reactors. Remote maintenance is planned in ITER tokamak to keep the health of in-vessel components like blankets and divertors. In this article, current status of the development in the remote maintenance equipments and methods, especially for ITER tokamak are reviewed. The newly developed vehicle type and boom type maintenance devices, manipulator, and transfer cask are illustrated. (J.P.N.)

Program integration of predictive maintenance with reliability centered maintenance

International Nuclear Information System (INIS)

Strong, D.K. Jr; Wray, D.M.

1990-01-01

This paper addresses improving the safety and reliability of power plants in a cost-effective manner by integrating the recently developed reliability centered maintenance techniques with the traditional predictive maintenance techniques of nuclear power plants. The topics of the paper include a description of reliability centered maintenance (RCM), enhancing RCM with predictive maintenance, predictive maintenance programs, condition monitoring techniques, performance test techniques, the mid-Atlantic Reliability Centered Maintenance Users Group, test guides and the benefits of shared guide development

Road Maintenance in Africa: Approaches and Perspectives

Directory of Open Access Journals (Sweden)

M Mostafa Hassan

2018-01-01

Full Text Available In Africa, roads are the dominant mode of passenger and freight transport, for which the need is growing rapidly. It is noticeable that most of the African countries do not do enough to ensure the sustainability of road infrastructure as it has been widely reported that roads are affected, to varying degrees, by premature deterioration. Most of the African countries have adopted institutional reforms, notably entailing the creation of road funds and road agencies, and made significant progress on road maintenance. However, many challenges remain to be addressed in all of them to ensure appropriate maintenance. Although spending on road maintenance has increased over time in all African countries it remains insufficient to cover the needs. Poorly maintained roads constrain mobility, significantly raise vehicle operating costs, increase accident rates and their associated human and property costs, and aggravate isolation, poverty, poor health, and illiteracy in rural communities. This paper focuses, in particular, on road maintenance in some African countries considering types of road maintenance and the different approaches aiming at a comparison to reflect on similarities and differences.

Road Maintenance in Africa: Approaches and Perspectives

Science.gov (United States)

M, Mostafa Hassan

2018-06-01

In Africa, roads are the dominant mode of passenger and freight transport, for which the need is growing rapidly. It is noticeable that most of the African countries do not do enough to ensure the sustainability of road infrastructure as it has been widely reported that roads are affected, to varying degrees, by premature deterioration. Most of the African countries have adopted institutional reforms, notably entailing the creation of road funds and road agencies, and made significant progress on road maintenance. However, many challenges remain to be addressed in all of them to ensure appropriate maintenance. Although spending on road maintenance has increased over time in all African countries it remains insufficient to cover the needs. Poorly maintained roads constrain mobility, significantly raise vehicle operating costs, increase accident rates and their associated human and property costs, and aggravate isolation, poverty, poor health, and illiteracy in rural communities. This paper focuses, in particular, on road maintenance in some African countries considering types of road maintenance and the different approaches aiming at a comparison to reflect on similarities and differences.

An intelligent tele-healthcare environment offering person-centric and wellness-maintenance services.

Science.gov (United States)

Abidi, S S

2001-06-01

Worldwide healthcare delivery trends are undergoing a subtle paradigm shift--patient centered services as opposed to provider centered services and wellness maintenance as opposed to illness management. In this paper we present a Tele-Healthcare project TIDE--Tele-Healthcare Information and Diagnostic Environment. TIDE manifests an 'intelligent' healthcare environment that aims to ensure lifelong coverage of person-specific health maintenance decision-support services--i.e., both wellness maintenance and illness management services--ubiquitously available via the Internet/WWW. Taking on an all-encompassing health maintenance role--spanning from wellness to illness issues--the functionality of TIDE involves the generation and delivery of (a) Personalized, Pro-active, Persistent, Perpetual, and Present wellness maintenance services, and (b) remote diagnostic services for managing noncritical illnesses. Technically, TIDE is an amalgamation of diverse computer technologies--Artificial Intelligence, Internet, Multimedia, Databases, and Medical Informatics--to implement a sophisticated healthcare delivery infostructure.

Effect of Medicaid Managed Care on racial disparities in health care access.

Science.gov (United States)

Cook, Benjamin Lê

2007-02-01

To evaluate the impact of Medicaid Managed Care (MMC) on racial disparities in access to care consistent with the Institute of Medicine (IOM) definition of racial disparity, which excludes differences stemming from health status but includes socioeconomic status (SES)-mediated differences. Secondary data from the Adult Samples of the 1997-2001 National Health Interview Survey, metropolitan statistical area (MSA)-level Medicaid Health Maintenance Organization (MHMO) market share from the 1997 to 2001 InterStudy MSA Trend Dataset, and MSA characteristics from the 1997 to 2001 Area Resource File. I estimate multivariate regression models to compare racial disparities in doctor visits, emergency room (ER) use, and having a usual source of care between enrollees in MMC and Medicaid Fee-for-Service (FFS) plans. To contend with potential selection bias, I use a difference-in-difference analytical strategy and assess the impact of greater MHMO market share at the MSA level on Medicaid enrollees' access measures. To implement the IOM definition of racial disparity, I adjust for health status but not SES factors using a novel method to transform the distribution of health status for minority populations to approximate the white health status distribution. MMC enrollment is associated with lowered disparities in having any doctor visit in the last year for blacks, and in having any usual source of care for both blacks and Hispanics. Increasing Medicaid HMO market share lowered disparities in having any doctor visits in the last year for both blacks and Hispanics. Although disparities in most other measures were not much affected, black-white ER use disparities exist among MMC enrollees and in areas of high MHMO market share. MMC programs' reduction of some disparities suggests that recent shifts in Medicaid policy toward managed care plans have benefited minority enrollees. Future research should investigate whether black-white disparities in ER use within MMC groups

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of health claims related to formulated palm and oat oil emulsion and contribution to the maintenance or achievement of a normal body weight (ID 577) and maintenance of body weight after weight

DEFF Research Database (Denmark)

Tetens, Inge

claims in relation to formulated palm and oat oil emulsion and contribution to the maintenance or achievement of a normal body weight and maintenance of body weight after weight loss. The scientific substantiation is based on the information provided by the Member States in the consolidated list...... of Article 13 health claims and references that EFSA has received from Member States or directly from stakeholders. The food constituent that is the subject of the health claims is formulated palm and oat oil emulsion. The Panel considers that formulated palm and oat oil emulsion is sufficiently...

Cost reduction with maintenance ECT in refractory bipolar disorder.

Science.gov (United States)

Bonds, C; Frye, M A; Coudreaut, M F; Cunningham, M; Spearing, M; McGuire, M; Guze, B

1998-03-01

A case report of outpatient maintenance electroconvulsive therapy (ECT) is presented in a patient with bipolar disorder type I refractory to conventional medication treatment but responsive to ECT. A cost comparison is made showing substantial savings when outpatient maintenance ECT is used in lieu of inpatient hospitalization with ECT. A detailed life chart illustrating multiple medication trials that failed to stabilize the patient accompanies the financial summary. This case highlights the advantages of outpatient maintenance ECT for bipolar depression particularly with regard to safety, efficacy, and significant health care cost reduction.

TECHNICAL MAINTENANCE EFFICIENCY OF THE AIRCRAFT MAINTENANCE-FREE ON-BOARD SYSTEM BETWEEN SCHEDULED MAINTENANCES

Directory of Open Access Journals (Sweden)

A. M. Bronnikov

2017-01-01

Full Text Available The avionics concept of the maintenance-free on-board equipment implies the absence of necessity to maintain onboard systems between scheduled maintenance, preserving the required operational and technical characteristics; it should be achieved by automatic diagnosis of the technical condition and the application of active means of ensuring a failsafe design, allowing to change the structure of the system to maintain its functions in case of failure. It is supposed that such equipment will reduce substantially and in the limit eliminate traditional maintenance of aircraft between scheduled maintenance, ensuring maximum readiness for use, along with improving safety. The paper proposes a methodology for evaluating the efficiency of maintenance-free between scheduled maintenance aircraft system with homogeneous redundancy. The excessive redundant elements allow the system to accumulate failures which are repaired during the routine maintenance. If the number of failures of any reserve is approaching a critical value, the recovery of the on-board system (elimination of all failures is carried out between scheduled maintenance by conducting rescue and recovery operations. It is believed that service work leads to the elimination of all failures and completely updates the on-board system. The process of system operational status changes is described with the discrete-continuous model in the flight time. The average losses in the sorties and the average cost of operation are used as integrated efficiency indicators of system operation. For example, the evaluation of the operation efficiency of formalized on-board system with homogeneous redundancy demonstrates the efficiency of the proposed methodology and the possibility of its use while analyzing the efficiency of the maintenance-free operation equipment between scheduled periods. As well as a comparative analysis of maintenance-free operation efficiency of the on-board system with excessive

Study on Maintenance Practices for School Buildings in Terengganu and Kedah, Malaysia

Directory of Open Access Journals (Sweden)

Mohammad Ropi R.

2014-03-01

Full Text Available Malaysia initiated talks on building maintenance in 1971 during the Second Malaysia Plan of 1971-1975. Later, the government introduced the Building and Common Property (Maintenance and Management Act, 2007 to provide proper maintenance and management of buildings. School buildings are one of the important facilities for basic knowledge in everyday life. Accordingly, the maintenance of school buildings, which serve staff and students, needs considerable attention as effective maintenance protects capital investment, ensures the health and safety of the children, and supports educational performance. Based on a combination of literature survey and questionnaire appraisal, this study evaluates the maintenance practices in designated schools in Malaysia. Overall, the study showed that most of the school buildings do not possess their own maintenance management practices. Moreover, no preventive or planned maintenance was observed, and only emergency maintenance was applied when necessary. The study recommends the implementation of planned maintenance practices, which will be more effective than unplanned maintenance, mostly because of the reduction in repair costs.

Human factor analysis and preventive countermeasures of maintenance in nuclear power plant

International Nuclear Information System (INIS)

Zhang Li; Hu Chao

2008-01-01

Based on the human error analysis theory and the characteristics of maintenance in a nuclear power plant, human factors of maintenance in NPP are divided into three different areas: human, technology, and organization, in which human refers to the individual factors, mainly including psychological quality, physiological characteristic, state of health, knowledge, skill level, and interpersonal relationship. Technology includes the maintenance technology, maintenance strategy, maintenance tool, maintenance interface, maintenance regulation, and work environment. Organization includes task arrangement, information communication, training, personnel external environment, team construction, and leadership. The analysis also reveals that the organization factors, which can indirectly influence personnel performance, are the primary initiators of human error. Based on these, some countermeasures are brought forward in order to reduce human errors. (authors)

Maintenance methods

International Nuclear Information System (INIS)

Sanchis, H.; Aucher, P.

1990-01-01

The maintenance method applied at the Hague is summarized. The method was developed in order to solve problems relating to: the different specialist fields, the need for homogeneity in the maintenance work, the equipment diversity, the increase of the materials used at the Hague's new facilities. The aim of the method is to create a knowhow formalism, to facilitate maintenance, to ensure the running of the operations and to improve the estimation of the maintenance cost. One of the method's difficulties is the demonstration of the profitability of the maintenance operations [fr

Lactitol and the maintenance of normal defecation: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006

DEFF Research Database (Denmark)

Sjödin, Anders Mikael

2015-01-01

that the maintenance of normal defecation is a beneficial physiological effect. A total of 15 human intervention studies were identified as pertinent to the health claim. Twelve studies with various methodological limitations consistently showed that consumption of at least 10 g/day lactitol increases stool frequency......Following an application from DuPont Nutrition BioSciences ApS, submitted pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of the United Kingdom, the Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific...... substantiation of a health claim related to lactitol and the maintenance of normal defecation. The food constituent that is the subject of the claim is lactitol. The Panel considers that the food constituent lactitol, which is the subject of the claim, is sufficiently characterised. The Panel considers...

30 CFR 57.9307 - Design, installation, and maintenance of railroads.

Science.gov (United States)

2010-07-01

... railroads. 57.9307 Section 57.9307 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND..., Railroads, and Loading and Dumping Sites § 57.9307 Design, installation, and maintenance of railroads...

Reliability study: maintenance facilities Portsmouth Gaseous Diffusion Plant

International Nuclear Information System (INIS)

Post, B.E.; Sikorski, P.A.; Fankell, R.; Johnson, O.; Ferryman, D.S.; Miller, R.L.; Gearhart, E.C.; Rafferty, M.J.

1981-08-01

A reliability study of the maintenance facilities at the Portsmouth Gaseous Diffusion Plant has been completed. The reliability study team analyzed test data and made visual inspections of each component contributing to the overall operation of the facilities. The impacts of facilities and equipment failures were given consideration with regard to personnel safety, protection of government property, health physics, and environmental control. This study revealed that the maintenance facilities are generally in good condition. After evaluating the physical condition and technology status of the major components, the study team made several basic recommendations. Implementation of the recommendations proposed in this report will help assure reliable maintenance of the plant through the year 2000

Performance-based maintenance of gas turbines for reliable control of degraded power systems

Science.gov (United States)

Mo, Huadong; Sansavini, Giovanni; Xie, Min

2018-03-01

Maintenance actions are necessary for ensuring proper operations of control systems under component degradation. However, current condition-based maintenance (CBM) models based on component health indices are not suitable for degraded control systems. Indeed, failures of control systems are only determined by the controller outputs, and the feedback mechanism compensates the control performance loss caused by the component deterioration. Thus, control systems may still operate normally even if the component health indices exceed failure thresholds. This work investigates the CBM model of control systems and employs the reduced control performance as a direct degradation measure for deciding maintenance activities. The reduced control performance depends on the underlying component degradation modelled as a Wiener process and the feedback mechanism. To this aim, the controller features are quantified by developing a dynamic and stochastic control block diagram-based simulation model, consisting of the degraded components and the control mechanism. At each inspection, the system receives a maintenance action if the control performance deterioration exceeds its preventive-maintenance or failure thresholds. Inspired by realistic cases, the component degradation model considers random start time and unit-to-unit variability. The cost analysis of maintenance model is conducted via Monte Carlo simulation. Optimal maintenance strategies are investigated to minimize the expected maintenance costs, which is a direct consequence of the control performance. The proposed framework is able to design preventive maintenance actions on a gas power plant, to ensuring required load frequency control performance against a sudden load increase. The optimization results identify the trade-off between system downtime and maintenance costs as a function of preventive maintenance thresholds and inspection frequency. Finally, the control performance-based maintenance model can reduce

Acceptability of financial incentives for maintenance of weight loss in mid-older adults: a mixed methods study.

Science.gov (United States)

McGill, Bronwyn; O'Hara, Blythe J; Grunseit, Anne C; Bauman, Adrian; Osborne, Dale; Lawler, Luke; Phongsavan, Philayrath

2018-02-13

Health insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. The maintenance of weight loss is a public health challenge, and as non-communicable diseases become more prevalent with increasing age, mid-older adults could benefit from programs which motivate weight loss maintenance. However, little is understood about their perceptions of using financial incentives to maintain weight loss. We used mixed methods to explore the attitudes and views of participants who had completed an Australian weight loss and lifestyle modification program offered to overweight and obese health insurance members with weight-related chronic diseases, about the acceptability and usefulness of different types of financial incentives to support weight loss maintenance. An online survey was completed by 130 respondents (mean age = 64 years); and a further 28 participants (mean age = 65 years) attended six focus groups. Both independent samples of participants supported a formalised maintenance program. Online survey respondents reported that non-cash (85.2%) and cash (77%) incentives would be potentially motivating; but only 40.5% reported that deposit contracts would motivate weight loss maintenance. Results of in-depth discussions found overall low support for any type of financial incentive, but particularly deposit contracts and lotteries. Some participants expressed that improved health was of more value than a monetary incentive and that they felt personally responsible for their own health, which was at odds with the idea of financial incentives. Others suggested ongoing program and peer support as potentially useful for weight loss maintenance. If financial incentives are considered for mid-older Australian adults in the health insurance setting, program planners will need to balance the discordance between participant beliefs about the individual responsibility for health and their desire

Context-Dependent Prognostics and Health Assessment: A Condition-Based Maintenance Approach That Supports Mission Compliance

Energy Technology Data Exchange (ETDEWEB)

Allgood, G.O.; Kercel, S.W.

1999-04-19

In today's manufacturing environment, plants, systems, and equipment are being asked to perform at levels not thought possible a decade ago. The intent is to improve process operations and equipment reliability, availability, and maintainability without costly upgrades. Of course these gains must be achieved without impacting operational performance. Downsizing is also taking its toll on operations. Loss of personnel, particularly those who represent the corporate history, is depleting US industries of their valuable experiential base which has been relied on so heavily in the past. These realizations are causing companies to rethink their condition-based maintenance policies by moving away from reacting to equipment problems to taking a proactive approach by anticipating needs based on market and customer requirements. This paper describes a different approach to condition-based maintenance-context-dependent prognostics and health assessment. This diagnostic capability is developed around a context-dependent model that provides a capability to anticipate impending failures and determine machine performance over a protracted period of time. This prognostic capability links operational requirements to an economic performance model. In this context, a system may provide 100% operability with less than 100% functionality. This paradigm is used to facilitate optimal logistic supply and support.

Using focus groups to identify factors affecting healthy weight maintenance in college men.

Science.gov (United States)

Walsh, Jennifer R; White, Adrienne A; Greaney, Mary L

2009-06-01

Healthful eating and physical activity are important for healthy weight maintenance. The hypothesis for this study was that college-aged men would perceive factors affecting eating and physical activity as both contributing to and inhibiting healthy weight maintenance. The overall objective was to explore how men view weight maintenance in the context of these aspects. Subjects (n = 47, mean age = 20.3 +/- 1.7 years) completed an online survey, including the 51-item Three-Factor Eating Questionnaire, and participated in 1 of 6 focus groups. Three face-to-face and 3 online synchronous groups were conducted using a 15-question discussion guide to identify weight maintenance issues around eating, physical activity, and body perceptions. Weight satisfaction decreased with increase in both dietary restraint and disinhibition. Number of attempts to lose weight was positively associated with BMI (r [44] = .465, P = .01) and dietary restraint (r [44] = .515, P = .01). Findings from both focus group formats were similar. Motivators (sports performance/fitness, self-esteem, attractiveness, long-term health) were similar for eating healthfully and being physically active; however, more motivators to be physically active than to eat healthfully emerged. Enablers for eating healthfully included liking the taste, availability of healthful foods, using food rules to guide intake, having a habit of healthful eating, and internal drive/will. Barriers to healthful eating included fat in dairy foods, fruit and vegetable taste, and quick spoilage. Barriers to being physically active included lack of time/time management, obligations, being lazy, and girlfriends. Results may be used to inform future obesity prevention interventions.

Model-based fault diagnosis framework for effective predictive maintenance / B.B. Akindele

OpenAIRE

Akindele, Babatunde Babajide

2010-01-01

Predictive maintenance is a proactive maintenance strategy that is aimed at preventing the unexpected failure of equipment through condition monitoring of the health and performance of the equipment. Incessant equipment outage resulting in low availability of production facilities is a major issue in the Nigerian manufacturing environment. Improving equipment availability in Nigeria industry through institution of a full featured predictive maintenance has been suggested by many authors. T...

30 CFR 90.203 - Certified person; maintenance and calibration.

Science.gov (United States)

2010-07-01

... COAL MINE SAFETY AND HEALTH MANDATORY HEALTH STANDARDS-COAL MINERS WHO HAVE EVIDENCE OF THE DEVELOPMENT OF PNEUMOCONIOSIS Sampling Procedures § 90.203 Certified person; maintenance and calibration. (a) Approved sampling devices shall be maintained and calibrated by a certified person. (b) To be certified, a...

THE BUDGET, THE FAMILY PHYSICIAN AND THE PATIENT A DIFFERENT APPROACH.

Science.gov (United States)

Keidar, Ilan

2014-10-01

Modern medicine offers better health and longer life expectancy, yet consumes huge budgets. The Israeli Health Insurance Law (IHIL) regulates the delivery of health services to all Israel's residents through Health Maintenance Organizations (HMOS). These organizations confront constant struggles with their budgets and have to reduce expenses as much as possible (without harming the health level rendered). In the constant necessity to restrain expenses are embedded difficulties that might cause unrest to the Public Health System (PHS). At the edge of the public health spear are the Family Physicians (FPS) who have not only to supply the best possible medicine to their patients, and at the same time confront budgetary constraints that have the potential to hinder the level of rendered medicine, but also have, at times, to mediate between the conflicting interests of their patients' wish to receive the best available health measures, the FP own medical believes, the HMO's directives and, between the FPS wish, to keep up the number of their (content) patients. One of the World Health Organization's (WHO) concepts, like Israel's one, is that soul and body are inseparable and must be addressed simultaneously in the process of healing. Real life at the Family Physicians' clinics shows, at times, that despite the Israeli physicians' very high professional level, and the Israeli Health System (IHS)'s high efficiency, such a process, due to budgetary constraints, workload and various other reasons, does not always take place and, on the personal level, there are patients who feel that the "system" has treated them incorrectly and in an unsatisfactory manner. Unsatisfied and restless patients might cause undesirable consequences to the "system", like losing faith in one's FP and HMO, which might lead to the patients' reduced cooperation in the healing process, lawsuits amplification, patients leaving their FPS and their HMOs etc. Addressing the patient's soul and body as an

Health care utilization and cost among children with asthma who were enrolled in a health maintenance organization.

Science.gov (United States)

Lozano, P; Fishman, P; VonKorff, M; Hecht, J

1997-06-01

To measure the impact of asthma on the use and cost of health care by children in a managed care organization. Population-based historical cohort study. A medium-sized staff model health maintenance organization in western Washington state. All 71 818 children, between age 1 to 17 years, who were enrolled and used services during 1992. Children were identified with one or more asthma diagnoses during 1992 using automated encounter data. Nonurgent outpatient visits, pharmacy fills, urgent care visits, and hospital days, as well as associated costs were measured. All services were categorized as asthma care or nonasthma care. Multivariate regression analysis was used to compute marginal cost for asthma (difference in total cost between children with asthma and other children using services, adjusted for covariates). Treated prevalence of asthma was 4.9%. Children with asthma incurred 88% more costs ($1060.32 vs $563. 81/yr), filled 2.77 times as many prescriptions (11.59 vs 4.19/yr), made 65% more nonurgent outpatient visits (5.75 vs 3.48/yr), and had twice as many inpatient days (.23 vs .11/yr) compared with the general population of children using services. Asthma care represented 37% of all health care received by children with asthma, while the remaining 63% were for nonasthma services. Almost two-thirds of asthma-related costs were attributable to nonurgent outpatient care and prescriptions; only one third was attributable to urgent care and hospitalizations. Controlling for age, sex, and comorbidities, the marginal cost of asthma was $615.17/yr (95% confidence interval $502.73, $727.61), which includes asthma as well as nonasthma services. This marginal cost represents 58% of all health care costs for children with asthma. Children with asthma use significantly more health services (and incur significantly more costs) than other children using services, attributable largely to asthma care. The majority of all health care costs for children with asthma were for

Maintenance management for nuclear power plant 'Integrated valve maintenance'

International Nuclear Information System (INIS)

Gerner, P.; Zanner, G.

2001-01-01

The deregulation of Europe's power market does force many utilities, and especially nuclear power plant operators, to introduce extensive cost-cutting measures in order to be able to compete within this new environment. The optimization of plant outages provides considerable potential for raising plant availability but can also lower operating costs by reducing e.g. expenditure on maintenance. Siemens Nuclear Power GmbH, in cooperation with plant operators, is currently implementing new and improved service concepts which can have a major effect on the way in which maintenance will be performed in the future. Innovative service packages for maintenance in nuclear power plants are available which can be used to perform a time- and cost-effective maintenance. The concepts encompass optimization of the overall sequence from planning in advance to the individual measures including reduction of the scope of maintenance activities, identification of cost cutting potential and bundling of maintenance activities. The main features of these maintenance activities are illustrated here using the examples of outage planning and integrated valve maintenance. In nuclear power plants approx. 5000 valves are periodically preventively, condition-based or breakdown-based maintained. Because of this large number of valves to be maintained a high potential of improvements and cost reductions can be achieved by performing an optimized, cost-effective maintenance based on innovative methods and tools. Siemens Nuclear Power GmbH has developed and qualified such tools which allow to reduce service costs while maintaining high standards of safety and availability. By changing from preventive to predictive (condition-based) maintenance - the number of valves to be maintained may be reduced considerably. The predictive maintenance is based on the Siemens Nuclear Power GmbH diagnostic and evaluation method (ADAM). ADAM is used to monitor the operability of valves by analytical verification of

Hospital cost and quality performance in relation to market forces: an examination of U.S. community hospitals in the "post-managed care era".

Science.gov (United States)

Jiang, H Joanna; Friedman, Bernard; Jiang, Shenyi

2013-03-01

Managed care substantially transformed the U.S. healthcare sector in the last two decades of the twentieth century, injecting price competition among hospitals for the first time in history. However, total HMO enrollment has declined since 2000. This study addresses whether managed care and hospital competition continued to show positive effects on hospital cost and quality performance in the "post-managed care era." Using data for 1,521 urban hospitals drawn from the Healthcare Cost and Utilization Project, we examined hospital cost per stay and mortality rate in relation to HMO penetration and hospital competition between 2001 and 2005, controlling for patient, hospital, and other market characteristics. Regression analyses were employed to examine both cross-sectional and longitudinal variation in hospital performance. We found that in markets with high HMO penetration, increase in hospital competition over time was associated with decrease in mortality but no change in cost. In markets without high HMO penetration, increase in hospital competition was associated with increase in cost but no change in mortality. Overall, hospitals in high HMO penetration markets consistently showed lower average costs, and hospitals in markets with high hospital competition consistently showed lower mortality rates. Hospitals in markets with high HMO penetration also showed lower mortality rates in 2005 with no such difference found in 2001. Our findings suggest that while managed care may have lost its strength in slowing hospital cost growth, differences in average hospital cost associated with different levels of HMO penetration across markets still persist. Furthermore, these health plans appear to put quality of care on a higher priority than before.

The maintenance management framework models and methods for complex systems maintenance

CERN Document Server

Crespo Márquez, Adolfo

2010-01-01

“The Maintenance Management Framework” describes and reviews the concept, process and framework of modern maintenance management of complex systems; concentrating specifically on modern modelling tools (deterministic and empirical) for maintenance planning and scheduling. It will be bought by engineers and professionals involved in maintenance management, maintenance engineering, operations management, quality, etc. as well as graduate students and researchers in this field.

Improving the TRIGA facility maintenance by predictive maintenance techniques

International Nuclear Information System (INIS)

Preda, M.; Sabau, C.; Barbalata, E.

1997-01-01

This work deals with the specific operation of equipment in radioactive environment or in conditions allowing radioactive contamination. The requirements of remote operation ensuring the operators' protection are presented. Also, the requirements of international standards issued by IAEA-Vienna are reviewed. The organizational withdraws of the maintenance activities, based on the standards and maintenance and repair directives still in force, are shown. It is emphasized the fact that this type of maintenance was adequate to a given level of technical development, characteristic for pre-computerized industry, but, at present, it is obsolete and uneconomic both in utilization and maintenance. Such a system constitutes already a burden hindering the efforts of maximizing the availability, maintenance, prolongation the service life of equipment and utilities, finally, of increasing the efficiency of complex installations. Moreover, the predictive maintenance techniques are strongly requested by the character of radioactive installations precluding the direct access in given zones (a potential risk of irradiation or radioactive contamination) of installations during operation. The results obtained by applying the predictive maintenance techniques in the operation of the double circuit irradiation loop, used in the TRIGA reactors, are presented

Industrial Maintenance Strategies

International Nuclear Information System (INIS)

Sajjad Akbar

2006-01-01

Industrial plants have become more complex due to technological advancement. This has made the task of maintenance more difficult. The maintenance costs in terms of resources and downtime loss are so high that maintenance function has become a critical factor in a plant's profitability. Industry should devote as much forethought to the management of maintenance function as to production. Maintenance has grown from an art to a precise, technical engineering science. Planning, organizing scheduling and control of maintenance using modern techniques pays dividends in the form of reduced costs and increased reliability. The magnitude and the dimension of maintenance have multiplied due to development in the engineering technologies. Production cost and capacities are directly affected by the breakdown time. Total operating cost including the maintenance cost plays an important role in replacement dimension. The integrated system approach would bring forth the desired results of high maintenance standards. The standards once achieved and sustained, would add to the reliability of the plan and relieve heavy stresses and strains on the engineering logistic support. (author)

Knowledge based maintenance

Energy Technology Data Exchange (ETDEWEB)

Sturm, A [Hamburgische Electacitaets-Werke AG Hamburg (Germany)

1998-12-31

The establishment of maintenance strategies is of crucial significance for the reliability of a plant and the economic efficiency of maintenance measures. Knowledge about the condition of components and plants from the technical and business management point of view therefore becomes one of the fundamental questions and the key to efficient management and maintenance. A new way to determine the maintenance strategy can be called: Knowledge Based Maintenance. A simple method for determining strategies while taking the technical condition of the components of the production process into account to the greatest possible degree which can be shown. A software with an algorithm for Knowledge Based Maintenance leads the user during complex work to the determination of maintenance strategies for this complex plant components. (orig.)

Knowledge based maintenance

Energy Technology Data Exchange (ETDEWEB)

Sturm, A. [Hamburgische Electacitaets-Werke AG Hamburg (Germany)

1997-12-31

The establishment of maintenance strategies is of crucial significance for the reliability of a plant and the economic efficiency of maintenance measures. Knowledge about the condition of components and plants from the technical and business management point of view therefore becomes one of the fundamental questions and the key to efficient management and maintenance. A new way to determine the maintenance strategy can be called: Knowledge Based Maintenance. A simple method for determining strategies while taking the technical condition of the components of the production process into account to the greatest possible degree which can be shown. A software with an algorithm for Knowledge Based Maintenance leads the user during complex work to the determination of maintenance strategies for this complex plant components. (orig.)

Protocol of source shielding maintenance in a level measurement systems

International Nuclear Information System (INIS)

Gonzales, E.; Figueroa, J.

1996-01-01

Maintenance labor of the source shielding and locking system is not performed in many Venezuelan enterprises that employ radioactive level gauge in large container. The lack of maintenance and the ambient long lasting action have produced impairment of many devices and their given parts rise to economical and radiological protection problems. In order to help to solve the mentioned problems, principally to reduce the unjustified dose to workers, the IVIC Health Physics Service worked out a protocol to perform, in a safety way, the maintenance of source shielding and its locking system. This protocol is presented in this paper. (authors)

Operations Research Models for Scheduling Railway Infrastructure Maintenance

NARCIS (Netherlands)

G. Budai-Balke (Gabriella)

2009-01-01

textabstractIn the last decades, maintenance of technical systems has become increasingly impor- tant in many industries. Such systems are transport systems (rail, bus, airplane), civil engineering systems (roads, buildings, bridges), health care (hospitals), communication systems, manufacturing

Instrumentalization of Eating Improves Weight Loss Maintenance in Obesity

Directory of Open Access Journals (Sweden)

Bodil Just Christensen

2017-12-01

Full Text Available Aim: The purpose of this study was to identify psychosocial determinants for maintaining weight loss. Methods: 42 obese individuals who achieved a 12% weight loss before entering a 52-week weight maintenance program were interviewed qualitatively. Psychosocial factors related to weight loss maintenance were identified in two contrasting groups: weight reducers and weight regainers. Groups were defined by health-relevant weight maintenance (additional weight loss > 3% at week 52, n = 9 versus weight gain > 3%, at week 52, n = 20. Results: Weight reducers reported structured meal patterns (p = 0.008, no comfort eating (p = 0.016 and less psychosocial stress (p = 0.04 compared to weight regainers. The ability to instrumentalize eating behavior emerged as an important factor (p = 0.007. Nutritional knowledge, motivation or exercise level did not differ between groups (p > 0.05. Conclusions: Successful weight loss maintenance was associated with an interplay between behavioral, affective and contextual changes. ‘Instrumentalization of eating behavior' seems to be an important element in long-term weight maintenance.

Perencanaan Kegiatan Maintenance Dengan Metode Reability Centered Maintenance (Rcm) II

OpenAIRE

Rachmad Hidayat; Nachnul Ansori; Ali Imron

2010-01-01

Maintenance Activity Planning by Reability Centered Maintenance (RCM) II Method. This research discussmaintenance activity by using RCM II method to determine failure function risk at compresor screw. Calculation isgiven to magnitude optimum time maintenance interval by considering the cost maintenance and the cost reparation.From the research results with RPN points out that critical component that needs to get main priority in givemaintenance on compresor screw are bust logistic on timeworn...

Health and safety conditions of building maintenance sites in Nigeria

African Journals Online (AJOL)

To identify the microorganisms, bulk samples were collected on timber buildings classified as maintenance sites over the country and then identify the microorganisms available using the cultivation technique. Eight hundred and fifty nutrient and Sabouraud dextrose agar dishes were prepared. The nutrient agar dishes were ...

Lean Maintenance Applied to Improve Maintenance Efficiency in Thermoelectric Power Plants

Directory of Open Access Journals (Sweden)

Orlando Duran

2017-10-01

Full Text Available Thermoelectric power plants consist of a set of critical equipment that require high levels of availability and reliability. Due to this, maintenance of these physical assets is gaining momentum in industry. Maintenance is considered as an activity that contributes to improving the availability, efficiency and productivity of each piece of equipment. Several techniques have been used to achieve greater efficiencies in maintenance, among which we can find the lean maintenance philosophy. Despite the wide diffusion of lean maintenance, there is no structured method that supports the prescription of lean tools applied to the maintenance function. This paper presents the experience gathered in two lean maintenance projects in thermoelectric power plants. The application of lean techniques was based on using a previously developed multicriterial decision making process that uses the Fuzzy Analytic Hierarchy Process (AHP methodology to carry out a diagnosis and prescription tasks. That methodology allowed the prescription of the appropriated lean techniques to resolve the main deficiencies in maintenance function. The results of applying such lean tools show that important results can be obtained, making the maintenance function in thermoelectric power plants more efficient and lean.

Design of the randomized, Phase III, QUAZAR AML Maintenance trial of CC-486 (oral azacitidine) maintenance therapy in acute myeloid leukemia.

Science.gov (United States)

Roboz, Gail J; Montesinos, Pau; Selleslag, Dominik; Wei, Andrew; Jang, Jun-Ho; Falantes, Jose; Voso, Maria T; Sayar, Hamid; Porkka, Kimmo; Marlton, Paula; Almeida, Antonio; Mohan, Sanjay; Ravandi, Farhad; Garcia-Manero, Guillermo; Skikne, Barry; Kantarjian, Hagop

2016-02-01

Older patients with acute myeloid leukemia (AML) have worse rates of complete remission and shorter overall survival than younger patients. The epigenetic modifier CC-486 is an oral formulation of azacitidine with promising clinical activity in patients with AML in Phase I studies. The Phase III, randomized, double-blind, placebo-controlled QUAZAR AML Maintenance trial (CC-486-AML-001) examines CC-486 maintenance therapy (300 mg/day for 14 days of 28-day treatment cycles) for patients aged ≥55 years with AML in first complete remission. The primary end point is overall survival. Secondary end points include relapse-free survival, safety, health-related quality of life and healthcare resource utilization. This trial will investigate whether CC-486 maintenance can prolong remission and improve survival for older patients with AML.

Maintenance management systems

International Nuclear Information System (INIS)

Rohan, M. de

1989-01-01

This paper is concerned principally with Maintenance Management systems and their effective introduction into organisations. Maintenance improvement is basically a problem of managing the maintenance department in the broadest sense. Improvement does not only lie in the area of special techniques, systems or procedures; although they are valuable tools, but rather in a balanced attack, carefully guided by management. Over recent years, maintenance systems have received the major emphasis and in many instances the selection of the system has become a pre-occupation, whereas the importance of each maintenance function must be recognised and good management practices applied to all maintenance activities. The ingredients for success in the implementation of maintenance management systems are summarised as: having a management committee, clear objectives, project approach using project management techniques and an enthusiastic leader, user managed and data processing supported project, realistic budget and an understanding of the financial audit requirements. (author)

The clinical obesity maintenance model: an integration of psychological constructs including mood, emotional regulation, disordered overeating, habitual cluster behaviours, health literacy and cognitive function.

Science.gov (United States)

Raman, Jayanthi; Smith, Evelyn; Hay, Phillipa

2013-01-01

Psychological distress and deficits in executive functioning are likely to be important barriers to effective weight loss maintenance. The purpose of this paper is twofold. First, in the light of recent evidence in the fields of neuropsychology and obesity, particularly on the deficits in the executive function in overweight and obese individuals, a conceptual and theoretical framework of obesity maintenance is introduced by way of a clinical obesity maintenance model (COMM). It is argued that psychological variables, that of habitual cluster Behaviors, emotional dysregulation, mood, and health literacy, interact with executive functioning and impact on the overeating/binge eating behaviors of obese individuals. Second, cognizant of this model, it is argued that the focus of obesity management should be extended to include a broader range of maintaining mechanisms, including but not limited to cognitive deficits. Finally, a discussion on potential future directions in research and practice using the COMM is provided.

Advanced maintenance research programs

International Nuclear Information System (INIS)

Marston, T.U.; Gelhaus, F.; Burke, R.

1985-01-01

The purpose of this paper is to provide the reader with an idea of the advanced maintenance research program at the Electric Power Research Institute (EPRI). A brief description of the maintenance-related activities is provided as a foundation for the advanced maintenance research projects. The projects can be divided into maintenance planning, preventive maintenance program development and implementation, predictive (or conditional) maintenance, and innovative maintenance techniques. The projects include hardware and software development, human factors considerations, and technology promotion and implementation. The advanced concepts include: the incorporation of artificial intelligence into outage planning; turbine and pump maintenance; rotating equipment monitoring and diagnostics with the aid of expert systems; and the development of mobile robots for nuclear power plant maintenance

Present Status and Future Growth of Advanced Maintenance Technology and Strategy in US Manufacturing.

Science.gov (United States)

Jin, Xiaoning; Weiss, Brian A; Siegel, David; Lee, Jay

2016-01-01

The goals of this paper are to 1) examine the current practices of diagnostics, prognostics, and maintenance employed by United States (U.S.) manufacturers to achieve productivity and quality targets and 2) to understand the present level of maintenance technologies and strategies that are being incorporated into these practices. A study is performed to contrast the impact of various industry-specific factors on the effectiveness and profitability of the implementation of prognostics and health management technologies, and maintenance strategies using both surveys and case studies on a sample of U.S. manufacturing firms ranging from small to mid-sized enterprises (SMEs) to large-sized manufacturing enterprises in various industries. The results obtained provide important insights on the different impacts of specific factors on the successful adoption of these technologies between SMEs and large manufacturing enterprises. The varying degrees of success with respect to current maintenance programs highlight the opportunity for larger manufacturers to improve maintenance practices and consider the use of advanced prognostics and health management (PHM) technology. This paper also provides the existing gaps, barriers, future trends, and roadmaps for manufacturing PHM technology and maintenance strategy.

Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries.

Science.gov (United States)

Gross, D J; Alecxih, L; Gibson, M J; Corea, J; Caplan, C; Brangan, N

1999-04-01

To estimate out-of-pocket health care spending by lower-income Medicare beneficiaries, and to examine spending variations between those who receive Medicaid assistance and those who do not receive such aid. DATA SOURCES AND COLLECTION: 1993 Medicare Current Beneficiary Survey (MCBS) Cost and Use files, supplemented with data from the Bureau of the Census (Current Population Survey); the Congressional Budget Office; the Health Care Financing Administration, Office of the Actuary (National Health Accounts); and the Social Security Administration. We analyzed out-of-pocket spending through a Medicare Benefits Simulation model, which projects out-of-pocket health care spending from the 1993 MCBS to 1997. Out-of-pocket health care spending is defined to include Medicare deductibles and coinsurance; premiums for private insurance, Medicare Part B, and Medicare HMOs; payments for non-covered goods and services; and balance billing by physicians. It excludes the costs of home care and nursing facility services, as well as indirect tax payments toward health care financing. Almost 60 percent of beneficiaries with incomes below the poverty level did not receive Medicaid assistance in 1997. We estimate that these beneficiaries spent, on average, about half their income out-of-pocket for health care, whether they were enrolled in a Medicare HMO or in the traditional fee-for-service program. The 75 percent of beneficiaries with incomes between 100 and 125 percent of the poverty level who were not enrolled in Medicaid spent an estimated 30 percent of their income out-of-pocket on health care if they were in the traditional program and about 23 percent of their income if they were enrolled in a Medicare HMO. Average out-of-pocket spending among fee-for-service beneficiaries varied depending on whether beneficiaries had Medigap policies, employer-provided supplemental insurance, or no supplemental coverage. Those without supplemental coverage spent more on health care goods and

Maintenance Management Update.

Science.gov (United States)

Sternloff, Robert E.

1987-01-01

Current trends in park maintenance are overviewed, including maintenance impact statements, avoidance of cost through efficient use and national resource conservation, horticultural accomplishments that influence maintenance management, and vandalism prevention. (CB)

Barriers to accessing and using health insurance cards among methadone maintenance treatment patients in northern Vietnam.

Science.gov (United States)

Tran, Bach Xuan; Boggiano, Victoria L; Nguyen, Cuong Tat; Nguyen, Long Hoang; Le Nguyen, Anh Tuan; Latkin, Carl A

2017-07-17

Methadone maintenance treatment (MMT) patients face unique costs associated with their healthcare expenditures. As such, it is important that these patients have access to health insurance (HI) to help them pay for both routine and unforeseen health services. In this study, we explored factors related to health insurance enrollment and utilization among MMT patients, to move Vietnam closer to universal coverage among this patient population. A cross-sectional study was conducted with 1003 patients enrolled in MMT in five clinics in Hanoi and Nam Dinh provinces. Patients were asked a range of questions about their health, health expenditures, and health insurance access and utilization. We used multivariate logistic regressions to determine factors associated with health insurance access among participants. The majority of participants (nearly 80%) were not currently enrolled in health insurance at the time of the study. Participants from rural regions were significantly more likely than urban participants to report difficulty using HI. Family members of participants from rural regions were more likely to have overall poor service quality through health insurance compared with family members of participants from urban regions. Overall, 37% of participants endorsed a lack of information about HI, nearly 22% of participants reported difficulty accessing HI, 22% reported difficulty using HI, and more than 20% stated they had trouble paying for HI. Older, more highly educated, and employed participants were more likely to have an easier time accessing HI than their younger, less well educated, and unemployed counterparts. HIV-positive participants were more likely to have sufficient information about health insurance options. Our study highlights the dearth of health insurance utilization among MMT patients in northern Vietnam. It also sheds light on factors associated with increased access to and utilization of health insurance among this underserved population. These

Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project.

Science.gov (United States)

Muellmann, Saskia; Steenbock, Berit; De Cocker, Katrien; De Craemer, Marieke; Hayes, Catherine; O'Shea, Miriam P; Horodyska, Karolina; Bell, Justyna; Luszczynska, Aleksandra; Roos, Gun; Langøien, Lars Jørun; Rugseth, Gro; Terragni, Laura; De Bourdeaudhuij, Ilse; Brug, Johannes; Pischke, Claudia R

2017-12-06

The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland. Six interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher. Active involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured. Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.

Instrumentation maintenance

International Nuclear Information System (INIS)

Mack, D.A.

1976-09-01

It is essential to any research activity that accurate and efficient measurements be made for the experimental parameters under consideration for each individual experiment or test. Satisfactory measurements in turn depend upon having the necessary instruments and the capability of ensuring that they are performing within their intended specifications. This latter requirement can only be achieved by providing an adequate maintenance facility, staffed with personnel competent to understand the problems associated with instrument adjustment and repair. The Instrument Repair Shop at the Lawrence Berkeley Laboratory is designed to achieve this end. The organization, staffing and operation of this system is discussed. Maintenance policy should be based on studies of (1) preventive vs. catastrophic maintenance, (2) records indicating when equipment should be replaced rather than repaired and (3) priorities established to indicate the order in which equipment should be repaired. Upon establishing a workable maintenance policy, the staff should be instructed so that they may provide appropriate scheduled preventive maintenance, calibration and corrective procedures, and emergency repairs. The education, training and experience of the maintenance staff is discussed along with the organization for an efficient operation. The layout of the various repair shops is described in the light of laboratory space and financial constraints

Systematic maintenance analysis with decision support method and tool for optimizing maintenance programme

International Nuclear Information System (INIS)

Laakso, K.; Simola, K.; Dorrepaal, J.; Skogberg, P.

1999-01-01

This report describes an approach to evaluate the effectiveness of test and maintenance programs of technical systems used during several years. The method combines an analysis of the historical data on faults and repairs with an analysis of the history of periodic testing and preventive maintenance action programs. The application of the maintenance analysis from the methodological point of view in the reliability centered maintenance (RCM) project for Barsebaeck nuclear power plant is described. In order to limit the analysis resources, a method for ranking of objects for maintenance analysis is needed. Preliminary suggestions for changes in maintenance action programs are based on signals from simple maintenance indicators and qualitative analysis of underlying data on failures and maintenance. To facilitate generation of maintenance indicators, and make the maintenance analysis more efficient, a powerful and suitable data treatment tool is needed for analysis of the work order history. In the final maintenance decisions, additional decision criteria must be taken into account, and thus a more formal decision analysis is often needed for decision support. (au)

Program plan for future regulatory activity in nuclear-power-plant maintenance

International Nuclear Information System (INIS)

Badalamente, R.V.

1982-10-01

The intent of this paper is to describe the results of a study of nuclear power plant (NPP) maintenance conducted by Battelle's Pacific Northwest Laboratories (PNL) for the Nuclear Regulatory Commission (NRC). The purpose of the study for the NRC was to determine problems affecting human performance in NPP maintenance, pinpoint those which adversely affect public health and safety, review strategies for overcoming the problems, and suggest the direction that regulatory activities should take. Results of the study were presented to the NRC (Division of Human Factors Safety) in the form of a recommended program plan for future regulatory activity in NPP maintenance

With a re-engineering of maintenance to a profitably oriented maintenance

International Nuclear Information System (INIS)

Angelevska, Silvana; Jolevski, Tome

2000-01-01

This paper presents an overview of effectiveness of the profit centered maintenance as a contemporary way of the maintenance management concept. Such redesign of a maintenance procedure results in significant gains in cost reduction and increase of the profitability and competitiveness of energy. The business process re engineering - a modern management control theory that is important aspect of the profit centered maintenance is summarized

Predictive maintenance: A new approach in maintenance of nuclear power plants

International Nuclear Information System (INIS)

Benvenuto, F.; Ferrari, L.

2005-01-01

The maintenance services for a Nuclear Power Plant are in general aimed at reaching the following goals: - Increase component availability and consequently decrease intervention frequency; - Reduce unexpected costs from unexpected repairs; - Progressively decrease the time of each intervention; - Improve the spare parts supply efficiency; - Improve spare parts and consumable warehouse managing; - Decrease maintenance costs. Most of the currently used maintenance activities refer to run-to-failure or preventive approaches: - Run-to-failure or Corrective Maintenance means that work is only carried out when a component or system is faulty and unable to perform its critical function. Non critical components such as filters or components with spare may be maintained in this way; - Preventive or Scheduled Maintenance involves a regular pre-set schedule programme of maintenance work. Programme outlined by the manufacturer of the component in question based on the design life of the component and based on past experience by operation. One step further than Preventive Maintenance is represented by Predictive Maintenance. Whereas Preventive Maintenance bases its schedules on past performance data, a predictive system acquires condition data from the machine to be maintained whilst the machine is in operation. The information obtained from this analysis indicates the condition in real time, provides a diagnosis of wear and shows any trend towards critical conditions. Predictive maintenance mainly consists of the following interventions: - Lubricant analysis; - Collection / analysis of functional parameters, such as motor absorption, flow rate, pressure, temperature, noise, vibration of rotating equipment, thermal efficiency, etc; - Periodical test of lifting systems; - Other operations to acquire sensitive equipment parameters. Predictive Maintenance can reduce the accidental intervention and extend the components life, and, in the end, is increasing the global availability

Assessing maintenance contracts when preventive maintenance is outsourced

International Nuclear Information System (INIS)

Wu Shaomin

2012-01-01

In some companies, corrective maintenance is conducted in-house but preventive maintenance might be outsourced. This raises a need to optimise some parameters such as the number of contracts from a perspective of the equipment owner. This paper considers a maintenance policy for such a situation, analyses the roles of the parameters in a PM model, proposes approaches to defining bonus functions, and finally discusses special cases of both the PM policy and the bonus function. Numerical examples are also given to explore the impact of parameters on the expected lifecycle cost rate.

The Clinical Obesity Maintenance Model: An Integration of Psychological Constructs including Mood, Emotional Regulation, Disordered Overeating, Habitual Cluster Behaviours, Health Literacy and Cognitive Function

Directory of Open Access Journals (Sweden)

Jayanthi Raman

2013-01-01

Full Text Available Psychological distress and deficits in executive functioning are likely to be important barriers to effective weight loss maintenance. The purpose of this paper is twofold. First, in the light of recent evidence in the fields of neuropsychology and obesity, particularly on the deficits in the executive function in overweight and obese individuals, a conceptual and theoretical framework of obesity maintenance is introduced by way of a clinical obesity maintenance model (COMM. It is argued that psychological variables, that of habitual cluster Behaviors, emotional dysregulation, mood, and health literacy, interact with executive functioning and impact on the overeating/binge eating behaviors of obese individuals. Second, cognizant of this model, it is argued that the focus of obesity management should be extended to include a broader range of maintaining mechanisms, including but not limited to cognitive deficits. Finally, a discussion on potential future directions in research and practice using the COMM is provided.

Managing nuclear maintenance

International Nuclear Information System (INIS)

Anon.

1990-01-01

For utilities operating nuclear powerplants, the rules of the game continue to change. Conflicting regulatory pressures and a tougher competitive environment will make management's job more complicated and difficult in the 1990s. Dealing with these pressures successfully requires greater attention to maintenance effectiveness. Utilities can help shape their future environment by developing a well-planned strategy to guide their actions. Parts of the strategy that are discussed include developing a sound maintenance philosophy, selecting a service company, radiation exposure, and managing spare parts. This article also addresses the Swedish experience in maintenance, German philosophy regarding maintenance and the current maintenance practices of the Electricite de France

AIRCRAFT MAINTENANCE HANGAR

Directory of Open Access Journals (Sweden)

GEAMBASU Gabriel George

2017-05-01

Full Text Available The paper presents the maintenance process that is done on an airplane, at a certain period of time, or after a number of flight hours or cycles and describes the checks performed behind each inspection. The first part of research describes the aircraft maintenance process that has to be done after an updated maintenance manual according with aircraft type, followed by a short introduction about maintenance hangar. The second part of the paper presents a hangar design with a foldable roof and walls, which can be folded or extended, over an airplane when a maintenance process is done, or depending on weather condition.

Maintenance Business Plans.

Science.gov (United States)

Adams, Matt

2002-01-01

Discusses maintenance business plans, statements which provide accountability for facilities maintenance organizations' considerable budgets. Discusses the plan's components: statement of plan objectives, macro and detailed description of the facility assets, maintenance function descriptions, description of key performance indicators, milestone…

North American nuclear maintenance best practices compared to Japanese utility maintenance practices

International Nuclear Information System (INIS)

Harazim, M.L.; Ferguson, B.J.

2003-01-01

The purpose of this paper is to compare the best practices in North America concerning Preventive Maintenance, Predictive Maintenance and Reliability Centered Maintenance (RCM) or Preventive Maintenance Optimization (PMO) with the time-directed maintenance philosophies utilized by Japanese utilities, and how the Japanese utilities are considering (and some have begun) adopting North American ways of doing business. Preventive Maintenance Living Programs are also discussed, along with the Institute of Nuclear Power Operations AP-913 process, Equipment Reliability Process. Also, a cost benefit analysis will be demonstrated showing how major cost savings can be achieved by shifting from a predominantly time-directed maintenance philosophy to a predominantly predictive strategy utilizing vibration analysis, lubricating oil analysis, thermography and other predictive technologies to better utilize resources, reduce spare part consumption and to minimize maintenance induced errors. As a result of the strides made while incorporating these new philosophies, we no longer advocate tearing apart perfectly good equipment. (author)

Variation of fee-for-service specialist direct care work effort with patient overall illness burden.

Science.gov (United States)

Goodman, Robert

2011-08-01

To explore whether a common industry measure of overall patient illness burden, used to assess the total costs of members in a health plan, would be suitable to describe variation in a summary metric of utilization that assesses specialist physician direct patient care services not grouped into clinical episodes, but with exclusion criteria applied to reduce any bias in the data. Data sources/study setting Calendar year 2006 administrative data on 153,557 commercial members enrolled in a non-profit single-state statewide Health Maintenance Organization (HMO) and treated by 4356 specialists in 11 specialties. The health plan's global referral process and specialist fee-for-service reimbursement likely makes these results applicable to the non-managed care setting, as once a global referral was authorized there was no required intervention by the HMO or referring primary care provider for the majority of any subsequent specialist direct clinical care. Study design Specialty-specific correlations and ordinary least-squares regression models to assess variations in specialist direct patient care work effort with patient overall illness burden, after the application of exclusion criteria to reduce potential bias in the data. Principle findings Statistically significant positive correlations exist between specialist direct patient care work effort and patient overall illness burden for all studied specialties. Regression models revealed a generally monotonic increasing relationship between illness burden categories and aggregate specialist direct patient care work effort. Almost all regression model differences from the reference category across specialties are statistically significant (P ≤ 0.012). Assessment of additional results demonstrates the relationship has more substantive significance in some specialties and less in others. The most substantive relationships in this study were found in the specialties of orthopaedic surgery, general surgery and interventional

A proactive condition-based maintenance strategy with both perfect and imperfect maintenance actions

International Nuclear Information System (INIS)

Do, Phuc; Voisin, Alexandre; Levrat, Eric; Iung, Benoit

2015-01-01

This paper deals with a proactive condition-based maintenance (CBM) considering both perfect and imperfect maintenance actions for a deteriorating system. Perfect maintenance actions restore completely the system to the ‘as good as new’ state. Their related cost are however often high. The first objective of the paper is to investigate the impacts of imperfect maintenance actions. In fact, both positive and negative impacts are considered. Positive impact means that the imperfect maintenance cost is usually low. Negative impact implies that (i) the imperfect maintenance restores a system to a state between good-as-new and bad-as-old and (ii) each imperfect preventive action may accelerate the speed of the system's deterioration process. The second objective of the paper is to propose an adaptive maintenance policy which can help to select optimally maintenance actions (perfect or imperfect actions), if needed, at each inspection time. Moreover, the time interval between two successive inspection points is determined according to a remaining useful life (RUL) based-inspection policy. To illustrate the use of the proposed maintenance policy, a numerical example finally is introduced. - Highlights: • A new imperfect maintenance model for deterioration system is proposed. • Both positive and negative impacts of an imperfect maintenance action are investigated. • An adaptive condition-based maintenance policy is introduced. • The optimal number of useful imperfect maintenance actions for each life cycle is optimally provided

[Hospital clinical engineer orientation and function in the maintenance system of hospital medical equipment].

Science.gov (United States)

Li, Bin; Zheng, Yunxin; He, Dehua; Jiang, Ruiyao; Chen, Ying; Jing, Wei

2012-03-01

The quantity of medical equipment in hospital rise quickly recent year. It provides the comprehensive support to the clinical service. The maintenance of medical equipment becomes more important than before. It is necessary to study on the orientation and function of clinical engineer in medical equipment maintenance system. Refer to three grade health care system, the community doctors which is called General practitioner, play an important role as the gatekeeper of health care system to triage and cost control. The paper suggests that hospital clinical engineer should play similar role as the gatekeeper of medical equipment maintenance system which composed by hospital clinical engineer, manufacture engineer and third party engineer. The hospital clinical engineer should be responsible of guard a pass of medical equipment maintenance quality and cost control. As the gatekeeper, hospital clinical engineer should take the responsibility of "General engineer" and pay more attention to safety and health of medical equipment. The responsibility description and future transition? development of clinical engineer as "General Engineer" is discussed. More attention should be recommended to the team building of hospital clinical engineer as "General Engineer".

Competence within Maintenance

OpenAIRE

Nerland, Annette Smørholm

2010-01-01

Maintenance can be a contributing factor to unwanted events, as well as desired events and states. Human competence can be defined as the ability to perform a specific task, action or function successfully, and is therefore a key factor to proper execution of maintenance tasks. Hence,maintenance will have negative consequences if done wrong, and give positive results when done right. The purpose of this report is to study the many aspects of maintenance competence. Endeavoring to improve ...

Random maintenance policies

CERN Document Server

Nakagawa, Toshio

2014-01-01

Exploring random maintenance models, this book provides an introduction to the implementation of random maintenance, and it is one of the first books to be written on this subject.  It aims to help readers learn new techniques for applying random policies to actual reliability models, and it provides new theoretical analyses of various models including classical replacement, preventive maintenance and inspection policies. These policies are applied to scheduling problems, backup policies of database systems, maintenance policies of cumulative damage models, and reliability of random redundant systems. Reliability theory is a major concern for engineers and managers, and in light of Japan’s recent earthquake, the reliability of large-scale systems has increased in importance. This also highlights the need for a new notion of maintenance and reliability theory, and how this can practically be applied to systems. Providing an essential guide for engineers and managers specializing in reliability maintenance a...

Plant Maintenance. The Licensee's Viewpoint

Energy Technology Data Exchange (ETDEWEB)

Ungi, T. [Heysham 2 Power Station, Nuclear Electric LTD (United Kingdom)

1997-07-01

Plant maintenance is a very complex process which requires considerable effort from both within the maintenance process and also many support activities. It is important that the plant maintenance policy is translated into a maintenance programme which will define all relevant aspects of the maintenance. An aspect of this maintenance programme will be a maintenance catalogue which will define the maintenance activities to be carried out and at what frequencies. This paper is aimed at discussing the maintenance philosophy and resulting maintenance catalogues currently adopted in Nuclear Electric Ltd, and in particular at Heysham 2 Power Station. It goes on to consider whether these maintenance catalogues contain the optimum maintenance and if not should they be changed. If change is required, the process by which this change will be brought about is also discussed. (author)

Equipment Maintenance management support system based on statistical analysis of maintenance history data

International Nuclear Information System (INIS)

Shimizu, S.; Ando, Y.; Morioka, T.

1990-01-01

Plant maintenance is recently becoming important with the increase in the number of nuclear power stations and in plant operating time. Various kinds of requirements for plant maintenance, such as countermeasures for equipment degradation and saving maintenance costs while keeping up plant reliability and productivity, are proposed. For this purpose, plant maintenance programs should be improved based on equipment reliability estimated by field data. In order to meet these requirements, it is planned to develop an equipment maintenance management support system for nuclear power plants based on statistical analysis of equipment maintenance history data. The large difference between this proposed new method and current similar methods is to evaluate not only failure data but maintenance data, which includes normal termination data and some degree of degradation or functional disorder data for equipment and parts. So, it is possible to utilize these field data for improving maintenance schedules and to evaluate actual equipment and parts reliability under the current maintenance schedule. In the present paper, the authors show the objectives of this system, an outline of this system and its functions, and the basic technique for collecting and managing of maintenance history data on statistical analysis. It is shown, from the results of feasibility tests using simulation data of maintenance history, that this system has the ability to provide useful information for maintenance and the design enhancement

Lean Maintenance Applied to Improve Maintenance Efficiency in Thermoelectric Power Plants

OpenAIRE

Orlando Duran; Andrea Capaldo; Paulo Andrés Duran Acevedo

2017-01-01

Thermoelectric power plants consist of a set of critical equipment that require high levels of availability and reliability. Due to this, maintenance of these physical assets is gaining momentum in industry. Maintenance is considered as an activity that contributes to improving the availability, efficiency and productivity of each piece of equipment. Several techniques have been used to achieve greater efficiencies in maintenance, among which we can find the lean maintenance philosophy. Despi...

Using the system maintenance datastore to characterize lifetime maintenance for PLiM

International Nuclear Information System (INIS)

Watson, P.; Dam, R.; Nickerson, J.

2004-01-01

A comprehensive Plant Life Management (PLiM) program involves evaluating a large amount of information. For any plant, there are numerous maintenance, surveillance and inspection programs for the important systems, structures and components. There is extensive industry experience on component failure modes, degradation mechanisms and recommended maintenance practices. This information forms the basis of the aging assessment work, through which improvements to these plant programs are identified. AECL has developed several tools to manage the quantities of information required in aging assessment studies, such as the SYSTMS (SYtematic approach for the development of STrategy for Maintenance and Surveillance) tool and the System Maintenance Datastore (SMD). The SMD has been developed to serve as a hub to a Systematic based Adaptive Maintenance Program (SAMP), by storing maintenance resource requirements for recommended maintenance tasks for use by the other processes in a SAMP. The SMD can be used to (a) quantify the savings or cost of optimising a maintenance program, (b) characterize and understand long term trends in condition-based maintenance due to component aging, (c) quantify the resource savings due to optimum timing of component replacement or general plant refurbishment, and (d) provide aging assessment cost information for input to plant asset evaluation. The SMD contains data for regular maintenance program tasks, plant condition assessment recommendations, and equipment refurbishment costs. A prototype SMD has been developed with data tables populated with information from operating CANDU stations. The SMD is now available to be used either with a SYSTMS evaluation or with a plant's database of maintenance tasks. (author)

Maintenance of physical activity in patients with rheumaoid arthritis

DEFF Research Database (Denmark)

Løppenthin, Katrine; Esbensen, Bente Appel; Østergaard, Mikkel

2012-01-01

, described experiences of bodily well-being and liberation from illness provided and secured through PA maintenance. The understanding of regular PA as a resistance resource is essential to development future health promoting interventions aimed to encourage PA maintenance in patients with RA........ The analysis was discussed within a multidisciplinary team of qualitative researchers. Results: The analysis revealed tree dimensions of PA maintenance: (1) A bodily dimension: physical sensations of vitality, sparkling energy and liberation in movement; (2) a mental component: referring to experiences of self...... the participants to adjust to the uncertainty of the illness and preserving hope for a future dominated as little as possible by illness. Conclusions: While RA usually forces a negative attention to joint pain, fatigue and limited mobility in parts of the body, the participants in this study, despite illness...

Integrated Design and Approach of Building Maintenance Management in the Built Environment

Directory of Open Access Journals (Sweden)

Md Azree Othuman Mydin

2017-12-01

Full Text Available Building maintenance is such a crucial aspect in the construction industry. The construction industry is characterized as a project-based industry that delivers one of a kind products and services. Thus, building maintenance can guarantee the safety of buildings including human health and property. To some extent, it plays as a guard to supervise the buildings protecting them being suffered collapse and deterioration. The most importantly, preparing for maintenance carried out on buildings is complex and it is related to procurement system dramatically, such as design-and-build, design-build-finance operate, and the private finance initiative and public/private partnerships, all of them need to give much consideration of operational and maintenance needs and costs which are ongoing.. This paper will focus on design and approach of building maintenance management in the construction industry.

Two Different Maintenance Strategies in the Hospital Environment: Preventive Maintenance for Older Technology Devices and Predictive Maintenance for Newer High-Tech Devices.

Science.gov (United States)

Sezdi, Mana

2016-01-01

A maintenance program generated through the consideration of characteristics and failures of medical equipment is an important component of technology management. However, older technology devices and newer high-tech devices cannot be efficiently managed using the same strategies because of their different characteristics. This study aimed to generate a maintenance program comprising two different strategies to increase the efficiency of device management: preventive maintenance for older technology devices and predictive maintenance for newer high-tech devices. For preventive maintenance development, 589 older technology devices were subjected to performance verification and safety testing (PVST). For predictive maintenance development, the manufacturers' recommendations were used for 134 high-tech devices. These strategies were evaluated in terms of device reliability. This study recommends the use of two different maintenance strategies for old and new devices at hospitals in developing countries. Thus, older technology devices that applied only corrective maintenance will be included in maintenance like high-tech devices.

A guiding tool in Unani Tibb for maintenance and preservation of health: a review study.

Science.gov (United States)

Jabin, Farkhunda

2011-01-01

Unani Tibb is a holistic traditional system of medicine. Ever since 1976, WHO has adopted its policy of promoting traditional medicine, Unani Medicine has enjoyed an upsurge of interest, especially in India, where it has been practiced as one of the Indian systems of medicine. Ali et al (2007) opined that "in Tibb, 'temperament' is a notion of primary importance, though a difficult theory as it indicates the properties of an atom, a molecule, a cell, a tissue, an organ and human body as a whole". Temperament of a person represents its physical constitution and tendencies. It is believed in Tibb that imbalance in temperament predisposes human body to various diseases by producing a biotic imbalance with in body. Causes of initial imbalance in temperament lies in more subtle elements of life like air, water, food, rest, activity, work, evacuation of wastes, sleep etc. To quote Bhika (2006a) "health can be preserved and maintained as long as overall quality of humours is in harmony with overall quality of the temperament of the individual and humoural balance is influenced by lifestyle factors." Hence temperament acts as a guiding force for maintenance and preservation of individuals' health.

Financial Motivation Undermines Maintenance in an Intensive Diet and Activity Intervention

Directory of Open Access Journals (Sweden)

Arlen C. Moller

2012-01-01

Full Text Available Financial incentives are widely used in health behavior interventions. However, self-determination theory posits that emphasizing financial incentives can have negative consequences if experienced as controlling. Feeling controlled into performing a behavior tends to reduce enjoyment and undermine maintenance after financial contingencies are removed (the undermining effect. We assessed participants’ context-specific financial motivation to participate in the Make Better Choices trial—a trial testing four different strategies for improving four health risk behaviors: low fruit and vegetable intake, high saturated fat intake, low physical activity, and high sedentary screen time. The primary outcome was overall healthy lifestyle change; weight loss was a secondary outcome. Financial incentives were contingent upon meeting behavior goals for 3 weeks and became contingent upon merely providing data during the 4.5-month maintenance period. Financial motivation for participation was assessed at baseline using a 7-item scale (=.97. Across conditions, a main effect of financial motivation predicted a steeper rate of weight regained during the maintenance period, (165=2.15, =.04. Furthermore, financial motivation and gender interacted significantly in predicting maintenance of healthy diet and activity changes, (160=2.42, =.016, such that financial motivation had a more deleterious influence among men. Implications for practice and future research on incentivized lifestyle and weight interventions are discussed.

Access to health care and community social capital.

Science.gov (United States)

Hendryx, Michael S; Ahern, Melissa M; Lovrich, Nicholas P; McCurdy, Arthur H

2002-02-01

To test the hypothesis that variation in reported access to health care is positively related to the level of social capital present in a community. The 1996 Household Survey of the Community Tracking Study, drawn from 22 metropolitan statistical areas across the United States (n = 19,672). Additional data for the 22 communities are from a 1996 multicity broadcast media marketing database, including key social capital indicators, the 1997 National Profile of Local Health Departments survey, and Interstudy, American Hospital Association, and American Medical Association sources. The design is cross-sectional. Self-reported access to care problems is the dependent variable. Independent variables include individual sociodemographic variables, community-level health sector variables, and social capital variables. Data are merged from the various sources and weighted to be population representative and are analyzed using hierarchical categorical modeling. Persons who live in metropolitan statistical areas featuring higher levels of social capital report fewer problems accessing health care. A higher HMO penetration rate in a metropolitan statistical area was also associated with fewer access problems. Other health sector variables were not related to health care access. The results observed for 22 major U.S. cities are consistent with the hypothesis that community social capital enables better access to care, perhaps through improving community accountability mechanisms.

Integrated maintenance program (IMP)

International Nuclear Information System (INIS)

Zemdegs, R.T.; Chout, Q.B.

1998-01-01

Approaches to the maintenance of nuclear power plants have undergone significant change in the past several decades. The traditional breakdown approach has been displaced by preventive (calendar-based) maintenance and more recently, by condition-based maintenance (CBM). This is largely driven by the fact that traditional maintenance programs, derived primarily from equipment vendor recommendations, are generally unsuccessful in controlling maintenance costs or equipment failures. Many advances in the maintenance field have taken place since the maintenance plans for Ontario Hydro's nuclear plants were initially established. Ontario Hydro nuclear plant operating costs can be substantially reduced and Incapability Factor improved with the application of modern maintenance processes and tools. Pickering is designated as the lead station for IMP. Of immediate concern is the fact that Pickering Nuclear Division has been experiencing a significant backlog of Operating Preventive Maintenance Callups. This backlog, over 2000, is unacceptable to both station management and the nuclear regulator, the Atomic Energy Control Board. In addition there are over 500 callups in various stages of revision (in hyperspace) without an adequate control nor reporting system to manage their completion. There is also considerable confusion about the classification of l icensing c allups, e.g. callups which are mandatory as a result of legal requirements. Furthermore the ineffectiveness of the Preventive Maintenance (PM) has been the subject of peer audits and Atomic Energy Control Board (AECB) findings over the past several years. The current preventive maintenance ratio PM2 /(PM+CM3) at Pickering ND is less than 20%, due to the current high load of equipment breakdown. This past summer, an Independent Integrated Performance Assessment (IIPA) review at Ontario Hydro confirmed these concerns. Over the past several years, Ontario Hydro nuclear staff have evaluated several programs to improve

Maintenance work management system

International Nuclear Information System (INIS)

Kanai, T.; Takahashi, Y.; Takahashi, K.; Nishino, M.; Takeshige, R.

2000-01-01

The maintenance work management system supports the efficient drawing up of various documents for the maintenance work at nuclear power stations and the speeding up of the permission procedure. In addition, it improves the quality assurance of the safety and reliability of the maintenance work. Key merits of the system are: 1. Efficiently drawing up various documents for the maintenance work by using the stored data for the previous maintenance work and the pipe and instrument diagram (P and ID) data. 2. Supporting the management work for the completion of maintenance work safety by using the isolation information stored on the computer system. 3. Speeding up the permission procedure by electronic mail and electronic permission. 4. Displaying additional information such as the specifications of equipment, maintenance result, and maintenance plan by linking up with the database of another system. 5. Reducing the cost of hardware devices by using client/server network configurations of personal computers and a personal computer server. (author)

[Addictive behavior after starting buprenorphine maintenance treatment].

Science.gov (United States)

Fanello, Serge; Daoud, Sidi; Panici, Jean Yves; Parot, Elsa; Hitoto, Hicombo; Garnier, François

2006-02-01

This study of a cohort of drug addicts receiving buprenorphine maintenance treatment in a district in western France focused on changes in their drug use and their social and work lives. It also looked at the health consequences of their drug use before and after maintenance treatment (mean: four years). From the files of an agency providing services to drug addicts, we randomly selected 180 of the 236 patients receiving buprenorphine maintenance treatment (BMT). Usable questionnaires were returned by 118 subjects (66% response rate). This self-administered questionnaire included 32 items. The respondents accounted for half the population receiving drug maintenance treatment and were representative of the population for age and sex. The mean age was 30 +/- 5 years, mean BMT dose 6,5 mg/day, and mean duration of drug maintenance treatment 47 +/- 27 months. Other drug use diminished during the four years of maintenance treatment: three of every four heroin users had stopped, opiate users dropped from 31% to 5% of the population, and cocaine use followed a similar trend. Benzodiazepine use also fell, but remained relatively frequent (27%, compared with 68% four years earlier). Drinking patterns changed from strongly alcoholic beverages to lower-proof drinks. Arrest rates dropped from 70% to 25%. The percentage of persons seropositive for HIV (4%) and HCV (33%) remained low, but too many subjects had not been screened (35%). Roughly 10% of these subjects had returned to work, mainly those who had cut their drug use most. While our survey reveals some positive points, especially a reduction in illegal drug use, several negative observations appeared, including combined use of cannabis and benzodiazepines, inadequate screening, and misuse of BMD. These results underline how important it is for care providers to focus simultaneously on medical treatment and identification of co-morbidities and to provide social work when necessary. The employment rate remains too low.

Maintenance Production Demand and Capacity Analysis of Third Maintenance Battalion

Science.gov (United States)

2017-12-01

Delivery T/E Table of Equipment TFSMS Total Force Structure Management System TFSP Total Force Structure Process TM Technical Manual T/O Table of...exercises each year, both on Okinawa and throughout the Pacific theater. When equipment requires maintenance beyond the organizational -level...demand was analyzed based on customer cycle time (i.e., time that equipment was in Third Maintenance Battalion custody), maintenance cycle time during

A Situational Maintenance Model

DEFF Research Database (Denmark)

Luxhoj, James T.; Thorsteinsson, Uffe; Riis, Jens Ove

1997-01-01

An overview of trend in maintenance management and presentation of a situational model and an analytical tools for identification of managerial efforts in maintenance.......An overview of trend in maintenance management and presentation of a situational model and an analytical tools for identification of managerial efforts in maintenance....

Grounds Maintenance Equipment and Procedures. Building Maintenance. Module VI. Instructor's Guide.

Science.gov (United States)

Crank, Virgil

This curriculum guide, one of six modules keyed to the building maintenance competency profile developed by industry and education professionals, provides materials for two units on grounds maintenance equipment and procedures. The first unit deals with grounds maintenance equipment and includes the following lessons: safety; changing oil/filter…

Site Maintenance Plan: Part 2, Site Maintenance Action Plan for FY 1994

Energy Technology Data Exchange (ETDEWEB)

Fisk, E.L.

1994-06-01

This Fiscal Year (FY) 1994 Site Maintenance Action Plan (SMAP) is Part II of the Site Maintenance Plan, and has been written by Westinghouse Hanford Company (WHC) to outline the requirements stated in DOE Order 4330.4B, Maintenance Management Program, Chapter 1, Paragraph 3.3.1. The SMAP provides an annual status of maintenance initiatives completed and planned, a summary of performance indicators, a summary of maintenance backlog, a listing of real property and capital equipment maintenance cost estimates that were used to create the FY 1996 infrastructure and maintenance budget input, and a listing of proposed line item and general plant projects. Additionally, assumptions for various Site programs are listed to bring the Site Maintenance Plan into focus with overall Site activities. The primary mission at Hanford is to clean up the Site. In this cleanup process WHC will provide scientific and technological expertise to meet global needs, and partnership with stakeholders in the region to develop regional economic diversification. Other missions at the Hanford Site include energy research and development, and waste management and disposal activities. Their primary mission has a 30-year projected life span and will direct the shutting down and cleanup of defense production facilities and the Fast Flux Test Facility. This long-term mission requires continuous maintenance and in many instances, replacement of existing basic infrastructure, support facilities, and utilities. Without adequate maintenance and capital funding these infrastructure, support facilities, and utilities will continue to deteriorate causing an increase in backlogged work.

Site Maintenance Plan: Part 2, Site Maintenance Action Plan for FY 1994

International Nuclear Information System (INIS)

Fisk, E.L.

1994-06-01

This Fiscal Year (FY) 1994 Site Maintenance Action Plan (SMAP) is Part II of the Site Maintenance Plan, and has been written by Westinghouse Hanford Company (WHC) to outline the requirements stated in DOE Order 4330.4B, Maintenance Management Program, Chapter 1, Paragraph 3.3.1. The SMAP provides an annual status of maintenance initiatives completed and planned, a summary of performance indicators, a summary of maintenance backlog, a listing of real property and capital equipment maintenance cost estimates that were used to create the FY 1996 infrastructure and maintenance budget input, and a listing of proposed line item and general plant projects. Additionally, assumptions for various Site programs are listed to bring the Site Maintenance Plan into focus with overall Site activities. The primary mission at Hanford is to clean up the Site. In this cleanup process WHC will provide scientific and technological expertise to meet global needs, and partnership with stakeholders in the region to develop regional economic diversification. Other missions at the Hanford Site include energy research and development, and waste management and disposal activities. Their primary mission has a 30-year projected life span and will direct the shutting down and cleanup of defense production facilities and the Fast Flux Test Facility. This long-term mission requires continuous maintenance and in many instances, replacement of existing basic infrastructure, support facilities, and utilities. Without adequate maintenance and capital funding these infrastructure, support facilities, and utilities will continue to deteriorate causing an increase in backlogged work

Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories.

Science.gov (United States)

Kwasnicka, Dominika; Dombrowski, Stephan U; White, Martin; Sniehotta, Falko

2016-09-01

Behaviour change interventions are effective in supporting individuals in achieving temporary behaviour change. Behaviour change maintenance, however, is rarely attained. The aim of this review was to identify and synthesise current theoretical explanations for behaviour change maintenance to inform future research and practice. Potentially relevant theories were identified through systematic searches of electronic databases (Ovid MEDLINE, Embase, PsycINFO). In addition, an existing database of 80 theories was searched, and 25 theory experts were consulted. Theories were included if they formulated hypotheses about behaviour change maintenance. Included theories were synthesised thematically to ascertain overarching explanations for behaviour change maintenance. Initial theoretical themes were cross-validated. One hundred and seventeen behaviour theories were identified, of which 100 met the inclusion criteria. Five overarching, interconnected themes representing theoretical explanations for behaviour change maintenance emerged. Theoretical explanations of behaviour change maintenance focus on the differential nature and role of motives, self-regulation, resources (psychological and physical), habits, and environmental and social influences from initiation to maintenance. There are distinct patterns of theoretical explanations for behaviour change and for behaviour change maintenance. The findings from this review can guide the development and evaluation of interventions promoting maintenance of health behaviours and help in the development of an integrated theory of behaviour change maintenance.

Maintenance-Ready Web Application Development

Directory of Open Access Journals (Sweden)

Ion IVAN

2016-01-01

Full Text Available The current paper tackles the subject of developing maintenance-ready web applications. Maintenance is presented as a core stage in a web application’s lifecycle. The concept of maintenance-ready is defined in the context of web application development. Web application maintenance tasks types are enunciated and suitable task types are identified for further analysis. The research hypothesis is formulated based on a direct link between tackling maintenance in the development stage and reducing overall maintenance costs. A live maintenance-ready web application is presented and maintenance related aspects are highlighted. The web application’s features, that render it maintenance-ready, are emphasize. The cost of designing and building the web-application to be maintenance-ready are disclosed. The savings in maintenance development effort facilitated by maintenance ready features are also disclosed. Maintenance data is collected from 40 projects implemented by a web development company. Homogeneity and diversity of collected data is evaluated. A data sample is presented and the size and comprehensive nature of the entire dataset is depicted. Research hypothesis are validated and conclusions are formulated on the topic of developing maintenance-ready web applications. The limits of the research process which represented the basis for the current paper are enunciated. Future research topics are submitted for debate.

Exploring Virtual Mental Practice in Maintenance Task Training

Science.gov (United States)

Bauerle, Tim; Brnich, Michael J.; Navoyski, Jason

2016-01-01

Purpose: This paper aims to contribute to a general understanding of mental practice by investigating the utility of and participant reaction to a virtual reality maintenance training among underground coal mine first responders. Design/Methodology/Approach: Researchers at the National Institute for Occupational Safety and Health's Office of Mine…

Building relationships for better maintenance.

Science.gov (United States)

Lee, Hackman Hon Yin; Scott, David

2009-02-01

Effective management of building maintenance is a vital ingredient in ensuring a high quality built environment for any building's occupiers. However, maintenance is not high on the list of priorities for most organisations. Communication between top management personnel looking at maintenance issues from a strategic standpoint and maintenance staff considering them at an operational level is often not as good as it should be. When planning maintenance activities maintenance personnel often draw too heavily on their technical experience and expertise without taking sufficient account of wider organisational objectives or consulting effectively with top management. Senior managers also regularly complain about lack of managerial input from maintenance departments. Such barriers contribute to communication difficulties between top management at a strategic level and maintenance personnel at an operational level. Identifying where the key differences lie in senior managers' and maintenance personnel's viewpoints on maintenance strategy can prove invaluable in achieving some convergence of opinions and optimising the efficiency of the overall building maintenance process.

Maintenance improvement program

International Nuclear Information System (INIS)

Derbonne, D.R.; Plunkett, T.F.; Simpson, J.R.

1989-01-01

During fuel cycle 1 at River Bend station, considerable effort was expended to reduce corrective maintenance work orders (MWOs) to <1,000. This was done by complementing the plant staff with costly contract personnel. Coming out of the first refueling outage, most contract personnel were released. The change in MWO backlog started a steady rise. It became readily apparent that to avoid costly contract staff time, a maintenance improvement program (MIP) was necessary. The MIP Was primarily directed at two areas: crew efficiency improvements and improved preplanned MWO packages. The overall effect of the MIP was to achieve significant productivity improvements with reduced operation and maintenance cost by providing frequent accountability to all levels of maintenance supervision. The MIP also produced a feeling of pride among the maintenance department employees that had not really existed before. This was the best benefit of all

Modern electronic maintenance principles

CERN Document Server

Garland, DJ

2013-01-01

Modern Electronic Maintenance Principles reviews the principles of maintaining modern, complex electronic equipment, with emphasis on preventive and corrective maintenance. Unfamiliar subjects such as the half-split method of fault location, functional diagrams, and fault finding guides are explained. This book consists of 12 chapters and begins by stressing the need for maintenance principles and discussing the problem of complexity as well as the requirements for a maintenance technician. The next chapter deals with the connection between reliability and maintenance and defines the terms fai

Maintenance optimization and prognostics of residual life - A state of the art report

Energy Technology Data Exchange (ETDEWEB)

Nystad, Bent

2006-01-15

In many industries a huge part of the daily operational costs are related to maintenance. One key function in cutting costs is in optimization of the maintenance efforts. A major task is to change the work culture and work processes from being repair oriented, with focus on repairing breakdowns, to being proactive and maintain critical parts/systems before failures occur. Estimation of residual life distributions is of great need to obtain an optimum preventive maintenance strategy. In this report two approaches for estimation of residual life are discussed. The first model assumes that the residual life follows a Weibull distribution where the parameters are dependent on expert judgement, inspection data, repair data, and technical health trends. The second model is based on a continuous time Markov chain. In maintenance optimization a quantitative approach like the mean residual life estimation is needed in addition to a qualitative approach like the Reliability Centred Maintenance (RCM) methodology to give support for e.g. optimization of the maintenance overhaul intervals.The use of residual life knowledge in opportunistic maintenance is also discussed.(auth)

Motivational indictors predicting the engagement, frequency and adequacy of rainwater tank maintenance

Science.gov (United States)

Mankad, Aditi; Greenhill, Murni

2014-01-01

Rainwater tank maintenance is a key social behavior in our changing environment, as tanks are being adopted worldwide to augment household water supplies and reduce urban water stress. The maintenance of rainwater tanks in urban areas is an important pro-environmental behavior that prevents public health issues arising from unhygienic tank use. This study examined motivational differences in maintenance behavior between householders with retrofitted and mandated (compulsory) rainwater tanks on their property (N = 1988). Results showed that retrofitted tank owners were more self-determined in their motivation than mandated owners. Amotivation and integrated regulation were both dominant predictors of engagement in tank maintenance, frequency and adequacy of tank maintenance activities. Those involved in more maintenance activity were likely driven to do so because of feelings of adherence to personal goals and values (e.g., as "sustainable" citizens), whereas individuals who experienced a lack of control and alienation from the activity were likely to view maintenance as meaningless. Thus, people with higher integrated regulation engaged in more tank maintenance activities, whereas more amotivated individuals engaged in less maintenance. As cities begin relying more on citizen self-sufficiency with respect to water and energy resources, issues relating to infrastructure maintenance and operation become paramount. Results show that motivation is important in the impetus to engage in a pro-environmental behavior as well as the frequency and accuracy with which that behavior is undertaken. Policy implications are further discussed.

Condition based maintenance in the context of opportunistic maintenance

NARCIS (Netherlands)

Koochaki, Javid; Bokhorst, Jos A. C.; Wortmann, Hans; Klingenberg, Warse

2012-01-01

Condition based maintenance (CBM) uses the operating condition of a component to predict a failure event. Compared to age based replacement (ABR), CBM usually results in higher availability and lower maintenance costs, since it tries to prevent unplanned downtime and avoid unnecessary preventive

EPR design for maintenance

International Nuclear Information System (INIS)

Krugmann, U.

1998-01-01

Preventive maintenance is very important in achieving high plant availability. For the European Pressurized Reactor (EPR) preventive maintenance has been carefully addressed in the design stage. This is particularly necessary because of the traditionally different maintenance strategies employed in France and Germany. This paper emphasizes the following features introduced in the ERP design to minimize the duration of the refueling outage: (1) containment accessibility during power operation; (2) overall plant layout to facilitate inspections and maintenances within the containment; and (3) safety system design for enabling preventive maintenance during power operation. (author)

Advances in safety related maintenance

International Nuclear Information System (INIS)

2000-03-01

The maintenance of systems, structures and components in nuclear power plants (NPPs) plays an important role in assuring their safe and reliable operation. Worldwide, NPP maintenance managers are seeking to reduce overall maintenance costs while maintaining or improving the levels of safety and reliability. Thus, the issue of NPP maintenance is one of the most challenging aspects of nuclear power generation. There is a direct relation between safety and maintenance. While maintenance alone (apart from modifications) will not make a plant safer than its original design, deficient maintenance may result in either an increased number of transients and challenges to safety systems or reduced reliability and availability of safety systems. The confidence that NPP structures, systems and components will function as designed is ultimately based on programmes which monitor both their reliability and availability to perform their intended safety function. Because of this, approaches to monitor the effectiveness of maintenance are also necessary. An effective maintenance programme ensures that there is a balance between the improvement in component reliability to be achieved and the loss of component function due to maintenance downtime. This implies that the safety level of an NPP should not be adversely affected by maintenance performed during operation. The nuclear industry widely acknowledges the importance of maintenance in NPP safety and operation and therefore devotes great efforts to develop techniques, methods and tools to aid in maintenance planning, follow-up and optimization, and in assuring the effectiveness of maintenance

Predictive maintenance primer

International Nuclear Information System (INIS)

Flude, J.W.; Nicholas, J.R.

1991-04-01

This Predictive Maintenance Primer provides utility plant personnel with a single-source reference to predictive maintenance analysis methods and technologies used successfully by utilities and other industries. It is intended to be a ready reference to personnel considering starting, expanding or improving a predictive maintenance program. This Primer includes a discussion of various analysis methods and how they overlap and interrelate. Additionally, eighteen predictive maintenance technologies are discussed in sufficient detail for the user to evaluate the potential of each technology for specific applications. This document is designed to allow inclusion of additional technologies in the future. To gather the information necessary to create this initial Primer the Nuclear Maintenance Applications Center (NMAC) collected experience data from eighteen utilities plus other industry and government sources. NMAC also contacted equipment manufacturers for information pertaining to equipment utilization, maintenance, and technical specifications. The Primer includes a discussion of six methods used by analysts to study predictive maintenance data. These are: trend analysis; pattern recognition; correlation; test against limits or ranges; relative comparison data; and statistical process analysis. Following the analysis methods discussions are detailed descriptions for eighteen technologies analysts have found useful for predictive maintenance programs at power plants and other industrial facilities. Each technology subchapter has a description of the operating principles involved in the technology, a listing of plant equipment where the technology can be applied, and a general description of the monitoring equipment. Additionally, these descriptions include a discussion of results obtained from actual equipment users and preferred analysis techniques to be used on data obtained from the technology. 5 refs., 30 figs

Preventative Maintenance.

Science.gov (United States)

Migliorino, James

Boards of education must be convinced that spending money up front for preventive maintenance will, in the long run, save districts' tax dollars. A good program of preventive maintenance can minimize disruption of service; reduce repair costs, energy consumption, and overtime; improve labor productivity and system equipment reliability; handle…

Second Line of Defense: Electronic Maintenance Reports, Local Maintenance Provider User Guide, Rev. 3

Energy Technology Data Exchange (ETDEWEB)

Leigh, Richard J.

2012-09-01

The Electronic Maintenance Report forms allow Local Maintenance Providers (LMP) and other program staff to enter maintenance information into a simple and secure system. This document describes the features and information required to complete the Maintenance Report forms. It is expected that all Corrective Maintenance Reports from LMPs will be submitted electronically into the SLD Portal. As an exception (e.g., when access to the SLD Portal is unavailable), Maintenance Reports can be submitted via a secure Adobe PDF form available through the Sustainability Manager assigned to each country.

Outsourcing versus in-house maintenance of medical devices: a longitudinal, empirical study.

Science.gov (United States)

Miguel-Cruz, Antonio; Rios-Rincón, Adriana; Haugan, Gregory L

2014-03-01

To determine what factors have a significant influence on the performance of medical device maintenance outsourcing, and to determine how the performance of external governance structures differs depending on whether a hospital is private or public. This was a longitudinal study of 590 maintenance transactions at 20 hospitals in Bogotá, Colombia, involving 764 medical devices and 72 maintenance service providers. Maintenance performance data (i.e., turn-around time in hours; TAT) for the service providers (either in-house or outsourced) were primarily collected over a 20-month period, from December 2009-August 2011, by means of a monitoring procedure; then, a hazards model was run. The availability of specific repair parts, in-stock, in the city in which the medical devices were located, had a positive impact on the performance of both internal and external governance structures. Online service also had a positive impact on both, with a stronger positive impact on the performance of internal governance than on that of external governance. For transactions governed by external structures, better performance was seen in private hospitals than in public ones. In public health institutions, internal governance showed better performance than external governance. Both internal and external governance structures showed better performance in private healthcare institutions than in public ones. In public health institutions, internal governance shows better performance than external governance; this suggests that healthcare managers should reconsider the trend to eliminate in-house maintenance service staff in public healthcare institutions.

Financial Motivation Undermines Maintenance in an Intensive Diet and Activity Intervention

Science.gov (United States)

Moller, Arlen C.; McFadden, H. Gene; Hedeker, Donald; Spring, Bonnie

2012-01-01

Financial incentives are widely used in health behavior interventions. However, self-determination theory posits that emphasizing financial incentives can have negative consequences if experienced as controlling. Feeling controlled into performing a behavior tends to reduce enjoyment and undermine maintenance after financial contingencies are removed (the undermining effect). We assessed participants' context-specific financial motivation to participate in the Make Better Choices trial—a trial testing four different strategies for improving four health risk behaviors: low fruit and vegetable intake, high saturated fat intake, low physical activity, and high sedentary screen time. The primary outcome was overall healthy lifestyle change; weight loss was a secondary outcome. Financial incentives were contingent upon meeting behavior goals for 3 weeks and became contingent upon merely providing data during the 4.5-month maintenance period. Financial motivation for participation was assessed at baseline using a 7-item scale (α = .97). Across conditions, a main effect of financial motivation predicted a steeper rate of weight regained during the maintenance period, t(165) = 2.15, P = .04. Furthermore, financial motivation and gender interacted significantly in predicting maintenance of healthy diet and activity changes, t(160) = 2.42, P = .016, such that financial motivation had a more deleterious influence among men. Implications for practice and future research on incentivized lifestyle and weight interventions are discussed. PMID:22548152

Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories

Science.gov (United States)

Kwasnicka, Dominika; Dombrowski, Stephan U; White, Martin; Sniehotta, Falko

2016-01-01

ABSTRACT Background: Behaviour change interventions are effective in supporting individuals in achieving temporary behaviour change. Behaviour change maintenance, however, is rarely attained. The aim of this review was to identify and synthesise current theoretical explanations for behaviour change maintenance to inform future research and practice. Methods: Potentially relevant theories were identified through systematic searches of electronic databases (Ovid MEDLINE, Embase, PsycINFO). In addition, an existing database of 80 theories was searched, and 25 theory experts were consulted. Theories were included if they formulated hypotheses about behaviour change maintenance. Included theories were synthesised thematically to ascertain overarching explanations for behaviour change maintenance. Initial theoretical themes were cross-validated. Findings: One hundred and seventeen behaviour theories were identified, of which 100 met the inclusion criteria. Five overarching, interconnected themes representing theoretical explanations for behaviour change maintenance emerged. Theoretical explanations of behaviour change maintenance focus on the differential nature and role of motives, self-regulation, resources (psychological and physical), habits, and environmental and social influences from initiation to maintenance. Discussion: There are distinct patterns of theoretical explanations for behaviour change and for behaviour change maintenance. The findings from this review can guide the development and evaluation of interventions promoting maintenance of health behaviours and help in the development of an integrated theory of behaviour change maintenance. PMID:26854092

Framework for Maintenance Planning

DEFF Research Database (Denmark)

Soares, C. Guedes; Duarte, J. Caldeira; Garbatov, Y.

2010-01-01

the design and during the whole life span of operational use, within an integrated framework founded on risk and reliability based techniques. The document addresses designers, decision makers and professionals responsible for or involved in establishing maintenance plans. The purpose of this document......The present document presents a framework for maintenance planning. Maintenance plays a fundamental role in counteracting degradation effects, which are present in all infrastructure and industrial products. Therefore, maintenance planning is a very critical aspect to consider both during...... is to present maintenance as an integrated approach that needs to be planned, designed, engineered, and controlled by proper qualitative and quantitative techniques. This document outlines the basic premises for maintenance planning and provides the general philosophies that can be followed and points to a best...

Overview of maintenance principles and regulatory supervision of maintenance activities at nuclear power plants in Slovakia

International Nuclear Information System (INIS)

Rohar, S.; Cepcek, S.

1997-01-01

The maintenance represents one of the most important tools to ensure safe and reliable operation of nuclear power plants. The emphasis of Nuclear Regulatory Authority of the Slovak Republic to the maintenance issue is expressed by requirements in the regulations. The current practice of maintenance management in operated nuclear power plants in Slovak Republic is presented. Main aspects of maintenance, as maintenance programme, organization of maintenance, responsibilities for maintenance are described. Activities of nuclear regulatory authority in maintenance process are presented too. (author)

Maintenance of nuclear power plants

International Nuclear Information System (INIS)

1982-01-01

This Guide covers the organizational and procedural aspects of maintenance but does not give detailed technical advice on the maintenance of particular plant items. It gives guidance on preventive and remedial measures necessary to ensure that all structures, systems and components important to safety are capable of performing as intended. The Guide covers the organizational and administrative requirements for establishing and implementing preventive maintenance schedules, repairing defective plant items, providing maintenance facilities and equipment, procuring stores and spare parts, selecting and training maintenance personnel, reviewing and controlling plant modifications arising from maintenance, and for generating, collecting and retaining maintenance records. Maintenance shall be subject to quality assurance in all aspects important to safety. Because quality assurance has been dealt with in detail in other Safety Guides, it is only included here in specific instances where emphasis is required. Maintenance is considered to include functional and performance testing of plant, surveillance and in-service inspection, where these are necessary either to support other maintenance activities or to ensure continuing capability of structures, systems and components important to safety to perform their intended functions

Welfarism versus 'free enterprise': considerations of power and justice in the Philippine healthcare system.

Science.gov (United States)

Sy, Peter A

2003-10-01

The just distribution of benefits and burdens of healthcare, at least in the contemporary Philippine context, is an issue that gravitates towards two opposing doctrines of welfarism and 'free enterprise.' Supported largely by popular opinion, welfarism maintains that social welfare and healthcare are primarily the responsibility of the government. Free enterprise (FE) doctrine, on the other hand, maintains that social welfare is basically a market function and that healthcare should be a private industry that operates under competitive conditions with minimal government control. I will examine the ethical implications of these two doctrines as they inform healthcare programmes by business and government, namely: (a) the Devolution of Health Services and (b) the Philippine Health Maintenance Organization (HMO). I will argue that these doctrines and the health programmes they inform are deficient in following respects: (1) equitable access to healthcare, (2) individual needs for premium healthcare, (3) optimal utilisation of health resources, and (4) the equitable assignment of burdens that healthcare entails. These respects, as considerations of justice, are consistent with an operational definition of 'power' proposed here as 'access to and control of resources.'

A multicriteria decision making approach applied to improving maintenance policies in healthcare organizations.

Science.gov (United States)

Carnero, María Carmen; Gómez, Andrés

2016-04-23

Healthcare organizations have far greater maintenance needs for their medical equipment than other organization, as many are used directly with patients. However, the literature on asset management in healthcare organizations is very limited. The aim of this research is to provide more rational application of maintenance policies, leading to an increase in quality of care. This article describes a multicriteria decision-making approach which integrates Markov chains with the multicriteria Measuring Attractiveness by a Categorical Based Evaluation Technique (MACBETH), to facilitate the best choice of combination of maintenance policies by using the judgements of a multi-disciplinary decision group. The proposed approach takes into account the level of acceptance that a given alternative would have among professionals. It also takes into account criteria related to cost, quality of care and impact of care cover. This multicriteria approach is applied to four dialysis subsystems: patients infected with hepatitis C, infected with hepatitis B, acute and chronic; in all cases, the maintenance strategy obtained consists of applying corrective and preventive maintenance plus two reserve machines. The added value in decision-making practices from this research comes from: (i) integrating the use of Markov chains to obtain the alternatives to be assessed by a multicriteria methodology; (ii) proposing the use of MACBETH to make rational decisions on asset management in healthcare organizations; (iii) applying the multicriteria approach to select a set or combination of maintenance policies in four dialysis subsystems of a health care organization. In the multicriteria decision making approach proposed, economic criteria have been used, related to the quality of care which is desired for patients (availability), and the acceptance that each alternative would have considering the maintenance and healthcare resources which exist in the organization, with the inclusion of a

Paranal maintenance and CMMS experience

Science.gov (United States)

Montano, Nelson

2004-10-01

During the last four years of operations, low technical downtime has been one of the relevant records of the Paranal Observatory. From the beginning of the Very Large Telescope (VLT) project, European Southern Observatory (ESO) has considered the implementation of a proper maintenance strategy a fundamental point in order to ensure low technical down time and preserve the Observatory's assets. The implementation of the maintenance strategy was based on the following aspects: - Strong maintenance sense during the design stage. Line Replacement Unit (LRU) concept, standardization and modularity of the Observatory equipment - Creation of a dedicated team for Maintenance - The implementation of a Computerized Maintenance Management System After four operational years, the result of these aspects has exceeded the expectations; the Observatory has been operating with high availability under a sustainable strategy. The strengths of the maintenance strategy have been based on modern maintenance concepts applied by regular production companies, where any minute of down time involves high cost. The operation of the actual Paranal Maintenance System is based mainly on proactive activities, such as regular inspections, preventive maintenance (PM) and predictive maintenance (PdM) plans. Nevertheless, it has been necessary to implement a strong plan for corrective maintenance (CM). The Spare Parts Strategy has also been an important point linked to the Maintenance Strategy and CMMS implementation. At present, almost 4,000 items related to the Observatory spare parts are loaded into the CMMS database. Currently, we are studying the implementation of a Reliability Centered Maintenance (RCM) project in one of our critical systems The following document presents the actual status of the Paranal Maintenance Strategy and which have been the motivations to implement the established strategy.

Data management in maintenance outsourcing

International Nuclear Information System (INIS)

Murthy, D.N.P.; Karim, M.R.; Ahmadi, A.

2015-01-01

Most businesses view maintenance as tasks carried out by technicians and the data collected is mostly cost related. There is a growing trend towards outsourcing of maintenance and the data collection issues are not addressed properly in most maintenance service contracts. Effective maintenance management requires proper data management - data collection and analysis for decision-making. This requires a proper framework and when maintenance is outsourced it raises several issues and challenges. The paper develops a framework for data management when maintenance is outsourced and looks at a real case study that highlights the need for proper data management. - Highlights: • Framework for data management in maintenance outsourcing. • Black-box to grey-box approaches for modelling. • Improvements to maintenance decision-making. • Case study to illustrate the approaches and the shortcomings in data collection

A Novel Short-Term Maintenance Strategy for Power Transmission and Transformation Equipment Based on Risk-Cost-Analysis

Directory of Open Access Journals (Sweden)

Hang Yang

2017-11-01

Full Text Available Current studies on preventive condition-based maintenance of power transmission and transformation equipment mainly focus on mid-term or long-term maintenance, and cannot meet the requirements of short-term especially temporary maintenance. In order to solve the defects of the present preventive maintenance strategies, according to the engineering application and based on risk-cost analysis, a short-term maintenance strategy is proposed in this manuscript. For the equipment working in bad health condition, its active maintenance costs and operation risk costs are evaluated, respectively. Then the latest maintenance time is calculated in accordance with the principle that its operation risk costs are no higher than active maintenance costs. Utilizing the latest maintenance time, the best maintenance time is calculated by setting the maximum relative earnings of postponing maintenance as the target, which provides the operation staffs with comprehensive maintenance-decision support. In the end, different cases on the IEEE 24-bus system are simulated. The effectiveness and advantages of the proposed strategy are demonstrated by the simulation results.

Open system architecture for condition based maintenance applied to a hydroelectric power plant

Energy Technology Data Exchange (ETDEWEB)

Amaya, E.J.; Alvares, A.J. [University of Brasilia (UnB), DF (Brazil). Mechanical and Mechatronic Dept.], Emails: eamaya@unb.br, alvares@AlvaresTech.com; Gudwin, R.R. [State University of Campinas (UNICAMP), SP (Brazil). Computer Engineering and Industrial Automation Dept.], E-mail: gudwin@dca.fee.unicamp.br

2009-07-01

The hydroelectric power plant of Balbina is implementing a condition based maintenance system applying an open, modular and scalable integrated architecture to provide comprehensive solutions and support to the end users like operational and maintenance team. The system called SIMPREBAL (Predictive Maintenance System of Balbina) is advocate of open standards, in particular through collaborative research programmers. In the developing is clearly understands the need for both, industry standards and a simple to use software development tool chain, supporting the development of complex condition based maintenance systems with multiple partners. The Open System Architecture for Condition Based Maintenance (OSA-CBM) is a standard that consider seven hierarchic layers that represent a logic transition or performed data flow from the data acquisition layer, through the intermediates layers as signal processing, condition monitor, health assessment, prognostics and decision support, to arrive to the presentation layer. SIMPREBAL is being implementing as an OSA-CBM software framework and tool set that allows the creation of truly integrated, comprehensive maintenance solutions through the internet. This paper identifies specific benefits of the application of the OSA-CBM in comprehensive solutions of condition based maintenance for a hydroelectric power plant. (author)

Suncor maintenance and reliability

Energy Technology Data Exchange (ETDEWEB)

Little, S. [Suncor Energy, Calgary, AB (Canada)

2006-07-01

Fleet maintenance and reliability at Suncor Energy was discussed in this presentation, with reference to Suncor Energy's primary and support equipment fleets. This paper also discussed Suncor Energy's maintenance and reliability standard involving people, processes and technology. An organizational maturity chart that graphed organizational learning against organizational performance was illustrated. The presentation also reviewed the maintenance and reliability framework; maintenance reliability model; the process overview of the maintenance and reliability standard; a process flow chart of maintenance strategies and programs; and an asset reliability improvement process flow chart. An example of an improvement initiative was included, with reference to a shovel reliability review; a dipper trip reliability investigation; bucket related failures by type and frequency; root cause analysis of the reliability process; and additional actions taken. Last, the presentation provided a graph of the results of the improvement initiative and presented the key lessons learned. tabs., figs.

An Optimization Method for Condition Based Maintenance of Aircraft Fleet Considering Prognostics Uncertainty

Directory of Open Access Journals (Sweden)

Qiang Feng

2014-01-01

Full Text Available An optimization method for condition based maintenance (CBM of aircraft fleet considering prognostics uncertainty is proposed. The CBM and dispatch process of aircraft fleet is analyzed first, and the alternative strategy sets for single aircraft are given. Then, the optimization problem of fleet CBM with lower maintenance cost and dispatch risk is translated to the combinatorial optimization problem of single aircraft strategy. Remain useful life (RUL distribution of the key line replaceable Module (LRM has been transformed into the failure probability of the aircraft and the fleet health status matrix is established. And the calculation method of the costs and risks for mission based on health status matrix and maintenance matrix is given. Further, an optimization method for fleet dispatch and CBM under acceptable risk is proposed based on an improved genetic algorithm. Finally, a fleet of 10 aircrafts is studied to verify the proposed method. The results shows that it could realize optimization and control of the aircraft fleet oriented to mission success.

Relationship between National Institutes of Health research awards to US medical schools and managed care market penetration.

Science.gov (United States)

Moy, E; Mazzaschi, A J; Levin, R J; Blake, D A; Griner, P F

1997-07-16

Medical research conducted in academic medical centers is often dependent on support from clinical revenues generated in these institutions. Anecdotal evidence suggests that managed care has the potential to affect research conducted in academic medical centers by challenging these clinical revenues. To examine whether empirical evidence supports a relationship between managed care and the ability of US medical schools to sustain biomedical research. Data on annual extramural research grants awarded to US medical schools by the National Institutes of Health (NIH) from fiscal years 1986 to 1995 were obtained, and each medical school was matched to a market for which information about health maintenance organization (HMO) penetration in 1995 was available. Growth in total NIH awards, traditional research project (R01) awards, R01 awards to clinical and basic science departments, and changes in institutional ranking by NIH awards were compared among schools located in markets with low, medium, and high managed care penetration. Medical schools in all markets had comparable rates of growth in NIH awards from 1986 to 1990. Thereafter, medical schools in markets with high managed care penetration had slower growth in the dollar amounts and numbers of NIH awards compared with schools in markets with low or medium managed care penetration. This slower growth for schools in high managed care markets was associated with loss of share of NIH awards, equal to $98 million in 1995, and lower institutional ranking by NIH awards. Much of this revenue loss can be explained by the slower growth of R01 awards to clinical departments in medical schools in high managed care markets. These findings provide evidence of an inverse relationship between growth in NIH awards during the past decade and managed care penetration among US medical schools. Whether this association is causal remains to be determined.

Condition Based Maintenance of Space Exploration Vehicles Using Structural Health Monitoring, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — Acellent Technologies proposes to develop an autonomous and automated diagnostic system for condition based maintenance (CBM) of safety critical structures for space...

Outsourcing versus in-house maintenance of medical devices: a longitudinal, empirical study

Directory of Open Access Journals (Sweden)

Antonio Miguel-Cruz

2014-03-01

Full Text Available OBJECTIVE: To determine what factors have a significant influence on the performance of medical device maintenance outsourcing, and to determine how the performance of external governance structures differs depending on whether a hospital is private or public. METHODS: This was a longitudinal study of 590 maintenance transactions at 20 hospitals in Bogotá, Colombia, involving 764 medical devices and 72 maintenance service providers. Maintenance performance data (i.e., turn-around time in hours; TAT for the service providers (either in-house or outsourced were primarily collected over a 20-month period, from December 2009-August 2011, by means of a monitoring procedure; then, a hazards model was run. RESULTS: The availability of specific repair parts, in-stock, in the city in which the medical devices were located, had a positive impact on the performance of both internal and external governance structures. Online service also had a positive impact on both, with a stronger positive impact on the performance of internal governance than on that of external governance. For transactions governed by external structures, better performance was seen in private hospitals than in public ones. In public health institutions, internal governance showed better performance than external governance. Both internal and external governance structures showed better performance in private healthcare institutions than in public ones. CONCLUSIONS: In public health institutions, internal governance shows better performance than external governance; this suggests that healthcare managers should reconsider the trend to eliminate in-house maintenance service staff in public healthcare institutions.

Maintenance pharmacotherapy for recurrent major depressive disorder in primary care: A 5-year follow-up study.

Science.gov (United States)

Riihimäki, K; Vuorilehto, M; Isometsä, E

2017-03-01

Most practice guidelines recommend maintenance antidepressant treatment for recurrent major depressive disorder. However, the degree to which such guidance is actually followed in primary health care has remained obscure. We investigated the provision of maintenance antidepressant treatment within a representative primary care five-year cohort study. In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 adult patients was screened for depression using the Prime-MD. Depressive and comorbid psychiatric disorders were diagnosed using SCID-I/P and SCID-II interviews. Of the 137 patients with depressive disorders, 82% completed the prospective five-year follow-up. A graphic life chart enabling evaluation of the longitudinal course of episodes plus duration of pharmacotherapies was used. In accordance with national guidelines, an indication for maintenance treatment was defined to exist after three or more lifetime major depressive episodes (MDEs); maintenance treatment was to commence four months after onset of full remission. Of the cohort patients, 34% (46/137) had three or more lifetime MDEs, thus indicating the requirement for maintenance pharmacotherapy. Of these, half (54%, 25/46) received maintenance treatment, for only 29% (489/1670) of the months indicated. In this cohort of depressed primary care patients, half of patients with indications for maintenance treatment actually received it, and only for a fraction of the time indicated. Antidepressant maintenance treatment for the prevention of recurrences is unlikely to be subject to large-scale actualization as recommended, which may significantly undermine the potential public health benefits of treatment. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Gym-based exercise and home-based exercise with telephone support have similar outcomes when used as maintenance programs in adults with chronic health conditions: a randomised trial

Directory of Open Access Journals (Sweden)

Paul Jansons

2017-07-01

Trial registration: ACTRN12610001035011. [Jansons P, Robins L, O’Brien L, Haines T (2017 Gym-based exercise and home-based exercise with telephone support have similar outcomes when used as maintenance programs in adults with chronic health conditions: a randomised trial. Journal of Physiotherapy 63: 154–160

National Synchrotron Light Source Facility Manual Maintenance Management Program. Revision 1

Energy Technology Data Exchange (ETDEWEB)

Fewell, N.

1993-12-01

The purpose of this program s to meet the policy and objectives for the management and performance of cost-effective maintenance and repair of the National Synchrotron Light Source, as required by the US Department of Energy order DOE 433O.4A. It is the DOE`s policy that: The maintenance management program for the NSLS be consistent with this Order and that NSLS property is maintained in a manner which promotes operational safety, worker health, environmental protection and compliance, property preservation, and cost-effectiveness while meeting the NSLS`s programmatic mission. Structures, components and systems (active and passive) that are imporant to safe operation of the NSLS shall be subject to a maintenance program to ensure that they meet or exceed their design requirements throughout the life of the NSLS. Periodic examination of structures, systems components and equipment be performed to determine deterioration or technical obsolescence which may threaten performance and/or safety. Primary responsibility, authority, and accountability for the direction and management of the maintenance program at the NSLS reside with the line management assigned direct programmatic responsibility. Budgeting and accounting for maintenance programs are consistent with DOE Orders guidance.

Building Maintenance, Management, and Budgeting.

Science.gov (United States)

Pawsey, M. R.

1982-01-01

Australian methods and formulas for funding building maintenance and management are outlined and found to be haphazard. Discussed are: ultimate costs of deferred maintenance, major plant replacements, life cycle costing, types of maintenance programs (including full preventive maintenance), use of computer programs for planning, and organization…

On line performance monitoring for predictive maintenance [Paper No.: VIA - 2

International Nuclear Information System (INIS)

Gupta, R.K.; Chandra, Rajesh

1981-01-01

There will always be progressive deterioration in the performance of dynamic equipment due to normal inevitable wear, malfunctions, failures and other reasons. In most cases it is possible to monitor some parameters of a system which would get progressively affected with the deterioration in the health of the system. By on-line monitoring of such predetermined parameters, compared with preset base data generated for a healthy system earlier, would prove very helpful in avoiding breakdowns and in proper planning of preventive and predictive maintenance. With increasing use of on-line computerised controls the generation of design base data and also the in-built self checking feature of monitoring the equipment health can be achieved by incorporating suitable software. This type of system will be helpful in: (a) predicting the life of component, (b) prewarning the operator about impending malfunctions, (c) establishing a maintenance schedule and spare inventory, and (d) analysing the failures. This type of centralised predictive maintenance is increasingly becoming important where: (a) the number of equipments are large, (b) the operation of equipment is critical from safety criteria, and (c) the minimum safety margin in the performance of the component is to be maintained. Keeping this in mind, the Fuel Handling System of Narora Atomic Power Project and the future power plants having computerised controls will have facility for on-line performance monitoring for predictive maintenance. The paper also describes methodology of the technique in detail, with a few representative cases. (author)

Maintenance performance improvement with System Dynamics : A Corrective Maintenance showcase

NARCIS (Netherlands)

Deenen, R.E.M.; Van Daalen, C.E.; Koene, E.G.C.

2008-01-01

This paper presents a case study of an analysis of a Corrective Maintenance process to realize performance improvement. The Corrective Maintenance process is supported by SAP, which has indicated the performance realisation problem. System Dynamics is used in a Group Model Building process to

Analysis of maintenance strategies

International Nuclear Information System (INIS)

Laakso, K.; Simola, K.

1998-01-01

The main topics of the presentation include: (1) an analysis model and methods to evaluate maintenance action programs and the support decision to make changes in them and (2) to understand the maintenance strategies in a systems perspective as a basis for future developments. The subproject showed how systematic models for maintenance analysis and decision support, utilising computerised and statistical tool packages, can be taken into use for evaluation and optimisation of maintenance of active systems from the safety and economic point of view

Automation: the competitive edge for HMOs and other alternative delivery systems.

Science.gov (United States)

Prussin, J A

1987-12-01

Until recently, many, if not most, Health Maintenance Organizations (HMO) were not automated. Moreover, HMOs that were automated tended to be automated only on a limited basis. Recently, however, the highly competitive marketplace within which HMOs and other Alternative Delivery Systems (ADS) exist has required that they operate at a maximum effectiveness and efficiency. Given the complex nature of ADSs, the volume of transactions in ADSs, the large number of members served by ADSs, and the numerous providers who are paid at different rates and on different bases by ADSs, it is impossible for an ADS to operate effectively or efficiently, let alone show optimal performance, without a sophisticated, comprehensive automated system. Reliable automated systems designed specifically to address ADS functions such as enrollment and premium billing, finance and accounting, medical information and patient management, and marketing have recently become available at a reasonable cost.

EFSA Panel on Dietetic Products, Nutrition and Allergies; Scientific Opinion on the substantiation of a health claim related to collagen hydrolysate and maintenance of joints pursuant to Article 13(5) of Regulation (EC) No 1924/2006

DEFF Research Database (Denmark)

Tetens, Inge

Following an application from Gelita AG, submitted via the Competent Authority of Germany, the Panel on Dietetic Products, Nutrition and Allergies was asked to deliver an opinion on the scientific substantiation of a health claim related to collagen hydrolysate and maintenance of joint health...... hydrolysate is sufficiently characterised. The claimed effect is “maintenance of joint health”. The target population as proposed by the applicant is physically active people. The Panel considers that the maintenance of joints is a beneficial physiological effect. The applicant provided one narrative review...... was not controlled and no scientific conclusions could be drawn from these studies for the substantiation of the claimed effect. One trial in 147 active student athletes evaluated a total of 15 parameters related to joint pain/discomfort. There were no significant differences between groups for any endpoint when...

23 CFR 633.208 - Maintenance.

Science.gov (United States)

2010-04-01

... responsibility of the State. The State may arrange for maintenance of such roads or portions thereof, by... 23 Highways 1 2010-04-01 2010-04-01 false Maintenance. 633.208 Section 633.208 Highways FEDERAL... PROVISIONS Federal-Aid Contracts (Appalachian Contracts) § 633.208 Maintenance. Maintenance of all highway...

Historical maintenance relevant information road-map for a self-learning maintenance prediction procedural approach

Science.gov (United States)

Morales, Francisco J.; Reyes, Antonio; Cáceres, Noelia; Romero, Luis M.; Benitez, Francisco G.; Morgado, Joao; Duarte, Emanuel; Martins, Teresa

2017-09-01

A large percentage of transport infrastructures are composed of linear assets, such as roads and rail tracks. The large social and economic relevance of these constructions force the stakeholders to ensure a prolonged health/durability. Even though, inevitable malfunctioning, breaking down, and out-of-service periods arise randomly during the life cycle of the infrastructure. Predictive maintenance techniques tend to diminish the appearance of unpredicted failures and the execution of needed corrective interventions, envisaging the adequate interventions to be conducted before failures show up. This communication presents: i) A procedural approach, to be conducted, in order to collect the relevant information regarding the evolving state condition of the assets involved in all maintenance interventions; this reported and stored information constitutes a rich historical data base to train Machine Learning algorithms in order to generate reliable predictions of the interventions to be carried out in further time scenarios. ii) A schematic flow chart of the automatic learning procedure. iii) Self-learning rules from automatic learning from false positive/negatives. The description, testing, automatic learning approach and the outcomes of a pilot case are presented; finally some conclusions are outlined regarding the methodology proposed for improving the self-learning predictive capability.

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of a health claim related to OptiEFAX™ and maintenance of normal blood HDL-cholesterol concentrations pursuant to Article 13(5) of Regulation (EC) No 1924/2006

DEFF Research Database (Denmark)

Tetens, Inge

on the scientific substantiation of a health claim related to OptiEFAX™ and maintenance of normal blood HDL-cholesterol concentrations. The food that is the subject of the health claim, OptiEFAX™, which is standardised pure krill oil, is sufficiently characterised in relation to the claimed effect. The claimed...... effect, maintenance of normal blood HDL-cholesterol concentrations, is a beneficial physiological effect. The target population proposed by the applicant is the general population. No human studies have been provided from which conclusions could be drawn for the scientific substantiation of the claim....... A cause and effect relationship has not been established between the consumption of OptiEFAX™ and maintenance of normal blood HDL-cholesterol concentrations....

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of a health claim related to OptiEFAX™ and maintenance of normal blood LDL-cholesterol concentrations pursuant to Article 13(5) of Regulation (EC) No 1924/2006

DEFF Research Database (Denmark)

Tetens, Inge

substantiation of a health claim related to OptiEFAX™ and maintenance of normal blood LDL-cholesterol concentrations. The food that is the subject of the health claim, OptiEFAX™, which is standardised pure krill oil, is sufficiently characterised in relation to the claimed effect. The claimed effect, maintenance...... of normal blood LDL-cholesterol concentrations, is a beneficial physiological effect. The target population proposed by the applicant is the general population. No human studies have been provided from which conclusions could be drawn for the scientific substantiation of the claim. A cause and effect...... relationship has not been established between the consumption of OptiEFAX™ and maintenance of normal blood LDL-cholesterol concentrations....

Asphalt in Pavement Maintenance.

Science.gov (United States)

Asphalt Inst., College Park, MD.

Maintenance methods that can be used equally well in all regions of the country have been developed for the use of asphalt in pavement maintenance. Specific information covering methods, equipment and terminology that applies to the use of asphalt in the maintenance of all types of pavement structures, including shoulders, is provided. In many…

Human milk oligosaccharides: Every baby needs a sugar mama

Science.gov (United States)

Bode, Lars

2012-01-01

Human milk oligosaccharides (HMOs) are a family of structurally diverse unconjugated glycans that are highly abundant in and unique to human milk. Originally, HMOs were discovered as a prebiotic “bifidus factor” that serves as a metabolic substrate for desired bacteria and shapes an intestinal microbiota composition with health benefits for the breast-fed neonate. Today, HMOs are known to be more than just “food for bugs”. An accumulating body of evidence suggests that HMOs are antiadhesive antimicrobials that serve as soluble decoy receptors, prevent pathogen attachment to infant mucosal surfaces and lower the risk for viral, bacterial and protozoan parasite infections. In addition, HMOs may modulate epithelial and immune cell responses, reduce excessive mucosal leukocyte infiltration and activation, lower the risk for necrotizing enterocolitis and provide the infant with sialic acid as a potentially essential nutrient for brain development and cognition. Most data, however, stem from in vitro, ex vivo or animal studies and occasionally from association studies in mother–infant cohorts. Powered, randomized and controlled intervention studies will be needed to confirm relevance for human neonates. The first part of this review introduces the pioneers in HMO research, outlines HMO structural diversity and describes what is known about HMO biosynthesis in the mother's mammary gland and their metabolism in the breast-fed infant. The second part highlights the postulated beneficial effects of HMO for the breast-fed neonate, compares HMOs with oligosaccharides in the milk of other mammals and in infant formula and summarizes the current roadblocks and future opportunities for HMO research. PMID:22513036

CANDU plant maintenance: Recent developments

International Nuclear Information System (INIS)

Charlebois, P.

2000-01-01

CANDU units have long been recognized for their exceptional safety and reliability. Continuing development in the maintenance area has played a key role in achieving this performance level. For over two decades, safety system availability has been monitored closely and system maintenance programs adjusted accordingly to maintain high levels of performance. But as the plants approach mid life in a more competitive environment and component aging becomes a concern, new methods and techniques are necessary. As a result, recent developments are moving the maintenance program largely from a corrective and preventive approach to predictive and condition based maintenance. The application of these techniques is also being extended to safety related systems. These recent developments include use of reliability centred methods to define system maintenance requirements and strategies. This approach has been implemented on a number of systems at Canadian CANDU plants with positive results. The pilot projects demonstrated that the overall maintenance effort remained relatively constant while the system performance improved. It was also possible to schedule some of the redundant component maintenance during plant operation without adverse impact on system availability. The probabilistic safety assessment was found to be useful in determining the safety implications of component outages. These new maintenance strategies are now making use of predictive and condition based maintenance techniques to anticipate equipment breakdown and schedule preventive maintenance as the need arises rather than time based. Some of these techniques include valve diagnostics, vibration monitoring, oil analysis, thermography. Of course, these tools and techniques must form part of an overall maintenance management system to ensure that maintenance becomes a living program. To facilitate this process and contain costs, new information technology tools are being introduced to provide system engineers

Maintenance analysis method and operational feedback: a comprehensive maintenance management

International Nuclear Information System (INIS)

Mathieu Riou; Victor Planchon

2006-01-01

Full text of publication follows: Current periodic inspections program carried out on the COGEMA LOGISTICS casks is required by regulations and approved by the competent Authority. Thus, Safety and casks conformity to the according certificate of approval are guaranteed. Nonetheless, based on experience it appeared that some maintenance operations did not seem relevant or were redundant. Then, it was decided to rethink completely our maintenance program to reach the following objectives: - Set up the 'a minima' required inspection operations required to guarantee Safety and conformity to the certificate of approval, - Optimize criteria and periodicities of inspections taking into account: operational feedback, routine inspections carried out for each transport, regulations, environmental impact (ALARA, waste reduction,...), cost-effectiveness (reduction of cask's immobilization period,...). - Set up a maintenance program in Safety Analysis Reports that: stands alone (no need to check the specification or the certificate of approval to have the complete list of inspections mandatory to guarantee Safety), gives objectives instead of means of controls. This approach needs then to be re-evaluated by the competent Authority. Study's scope has been limited to the TN TM 12 cask family which is intensely used. COGEMA LOGISTICS has a high operational feedback on these casks. After Authority agreement, and in accordance with its requirements, study will then be extended to the other casks belonging to the COGEMA LOGISTICS cask fleet. Actually, the term 'maintenance' is linked to 'Base maintenance' and 'Main maintenance' and implicitly means that the cask is immobilized for a given period. To emphasize the modifications, the term 'maintenance' is no longer used and is substituted by 'periodic upkeep'. By changing the name, COGEMA LOGISTICS wants to emphasize that: some operations can for instance be realized while the cask is unloaded, periodicities are thought in terms of

Dukovany NPP maintenance management

International Nuclear Information System (INIS)

Siegel, F.

2005-01-01

Maintenance planning and management for the technological equipment of the Dukovany NPP are described. A Maintenance Control and Evaluation System has been developed and is in use to help manage the complex maintenance issue. Practical examples of outputs of the System, with a comprehensive use of the cost, reliability and safety related data, are presented. (author)

Weight maintenance as a tight rope walk - a Grounded Theory study

Directory of Open Access Journals (Sweden)

Weinehall Lars

2010-02-01

Full Text Available Abstract Background Overweight and obesity are considerable public health problems internationally as well as in Sweden. The long-term results of obesity treatment are modest as reported by other studies. The importance of extending the focus to not only comprise obesity treatment but also prevention of weight gain is therefore being emphasized. However, despite the suggested change in focus there is still no consensus on how to prevent obesity or maintain weight. This study reports findings from a qualitative study focusing on attitudes, behaviors and strategies important for primary weight maintenance in a middle-aged population. Methods In depth interviews were conducted with 23 maintainers and four slight gainers in Sweden. The interviews were transcribed and an analysis of weight maintenance was performed using Grounded Theory. Results Based on the informants' stories, describing attitudes, behaviors and strategies of importance for primary weight maintenance, a model illustrating the main findings, was constructed. Weight maintenance was seen as "a tightrope walk" and four strategies of significance for this "tightrope walk" were described as "to rely on heritage", "to find the joy", "to find the routine" and "to be in control". Eleven "ideal types" were included in the model to illustrate different ways of relating to the main strategies. These "ideal types" described more specific attitudes and behaviors such as; eating food that is both tasteful and nutritious, and choosing exercise that provides joy. However, other somewhat contradictory behaviors were also found such as; only eating nutritious food regardless of taste, and being physically active to control stress and emotions. Conclusion This study show great variety with regards to attitudes, strategies and behaviors important for weight maintenance, and considerations need to be taken before putting the model into practice. However, the results from this study can be used within

Machine Maintenance Scheduling with Reliability Engineering Method and Maintenance Value Stream Mapping

Science.gov (United States)

Sembiring, N.; Nasution, A. H.

2018-02-01

Corrective maintenance i.e replacing or repairing the machine component after machine break down always done in a manufacturing company. It causes the production process must be stopped. Production time will decrease due to the maintenance team must replace or repair the damage machine component. This paper proposes a preventive maintenance’s schedule for a critical component of a critical machine of an crude palm oil and kernel company due to increase maintenance efficiency. The Reliability Engineering & Maintenance Value Stream Mapping is used as a method and a tool to analize the reliability of the component and reduce the wastage in any process by segregating value added and non value added activities.

PROCESS OF CHANGES OF MAINTENANCE-FREE ONBOARD SYSTEM OPERATIONAL STATUS BETWEEN SCHEDULED MAINTENANCES

Directory of Open Access Journals (Sweden)

Andrey Mikhaylovich Bronnikov

2017-01-01

Full Text Available In this article the authors consider the problem of simulating the process of a maintenance-free between scheduled maintenance aircraft system operational status changes, which failure during the flight leads to the disaster. On-board equipment with automatic self-repair between routine maintenance in the event the components fail is called maintenance-free. During operation, onboard equipment accumulates failures maintaining its functions with a safety level not lower than the required minimum. Trouble shooting is carried out either at the end of between-maintenance period (as a rule, or after the failure, which led to the functions disorder or to the decrease below the target level of flight safety (as an exception. The system contains both redundant and nonredundant units and elements with the known failure rates. The system can be in one of the three states: operable, extreme, failed. The excessive redundant elements allow the system to accumulate failures which are repaired during the routine maintenance. The process of system operational status changes is described with the discrete-continuous model in the flight time. Basing on the information about the probabilities of the on-board equipment being in an operable, extreme or failed state, it is possible to calculate such complex efficiency indicators as the average loss of sorties, the average operating costs, the expected number of emergency recovery operations and others. Numerical studies have been conducted to validate the proposed model. It is believed that maintenance work completely updates the system. The analysis of these indicators will allow to evaluate the maintenance-free aircraft equipment operation efficiency, as well as to make an effectiveness comparison with other methods of technical operation. The model can be also used to assess the technical operation systems performance. The model can be used to optimize the period between maintenance.

Maintenance Trades Guidelines

Science.gov (United States)

Weidner, Theodore J.

2008-01-01

In 2002, APPA published "Maintenance Staffing Guidelines for Educational Facilities," the first building maintenance trades staffing guideline designed to assist educational facilities professionals with their staffing needs. addresses how facilities professionals can determine the appropriate size and mix of their organization. Contents…

Longview District Operations and Maintenance Headquarters: Environmental assessment

International Nuclear Information System (INIS)

1992-03-01

Bonneville Power Administration (BPA) operations and maintenance staff are presently based at a headquarters next to the Longview Substation. These headquarters buildings, however, were built in 1941 and have deteriorated to the point of needing extensive repair. They also lack sufficient inside storage space. New buildings cannot be constructed on the site because of surrounding development. In addition, the site is within an area exposed to industrial fallout (coal tar pitch and metallic particles) that may be damaging buildings, equipment, and vehicles. BPA is concerned about the potential health risk to headquarters staff from the fallout. In light of these problems, BPA proposes to construct a new operations and maintenance headquarters at a different location, and to demolish the existing headquarters. This paper discusses the environmental impacts of the proposed action and alternatives

National infrastructure maintenance strategy for South Africa

CSIR Research Space (South Africa)

Wall, K

2009-05-01

Full Text Available Conference, Addis Ababa, Ethiopia, 2009 WATER, SANITATION AND HYGIENE: SUSTAINABLE DEVELOPMENT AND MULTISECTORAL APPROACHES A National Infrastructure Maintenance Strategy for South Africa Kevin Wall, South Africa [OFFICE USE ONLY: REVIEWED...; − effects on human health and economic growth; − lack of effective countermeasures in the event of failure of the service; and − the risk generally to government's growth objectives. Wastewater treatment works are often problematic, as are water...

Routine maintenance: safety term based work selection; Selecao de trabalho baseado no prazo seguro

Energy Technology Data Exchange (ETDEWEB)

Camargo, Albair de; Filho, Antnio S.; Brendler, Fabiano E.; Adamatti, Gilberto A.; Naruto, Itiro; Araujo, Luiz C.F.; Puerari, Roberto [PETROBRAS, Rio de Janeiro, RJ (Brazil)

2004-07-01

This work has objective to present the experience of improvement of routine maintenance system in some refineries of the PETROBRAS system, with the purpose to increase the efficiency in the Industrial Maintenance Management (cost), Utilization and HSE (Health, Safety and Environment), key of success of a petroleum company. The new system is based on the implantation of the culture of work selection in the safe period, through elaboration of new maintenance procedure, with emphasis in decisions shared between Operation and Maintenance Team, resulting in reduction of emergencies, making possible contract of services of maintenance for packages and improved allocation of resources. This work treat about improvement of the system in use, in view of that it has already taken in consideration the consequence of fail in the maintenance with participation of the operators. Besides of these challenge, this modification was made without causing riots in the process of implantation of SAP. As main result, financial profits had got better of resources with increase of safety, considering that they are analyzed in a way it that systematized potential risks. (author)

Optimization of surface maintenance

International Nuclear Information System (INIS)

Oeverland, E.

1990-01-01

The present conference paper deals with methods of optimizing the surface maintenance of steel-made offshore installations. The paper aims at identifying important approaches to the problems regarding the long-range planning of an economical and cost effective maintenance program. The methods of optimization are based on the obtained experiences from the maintenance of installations on the Norwegian continental shelf. 3 figs

Nuclear maintenance and management system

International Nuclear Information System (INIS)

Yamaji, Yoshihiro; Abe, Norihiko

2000-01-01

The Mitsubishi Electric Co., Ltd. has developed to introduce various computer systems for desk-top business assistance in a power plant such as system isolation assisting system, operation parameter management system, and so on under aiming at business effectiveness since these ten and some years. Recently, by further elapsed years of the plants when required for further cost reduction and together with change of business environment represented by preparation of individual personal computer, further effectiveness, preparation of the business environment, and upgrading of maintenance in power plant business have been required. Among such background, she has carried out various proposals and developments on construction of a maintenance and management system integrated the business assistant know-hows and the plant know-hows both accumulated previously. They are composed of three main points on rationalization of business management and document management in the further effectiveness, preparation of business environment, TBM maintenance, introduction of CBM maintenance and introduction of maintenance assistance in upgrading of maintenance. Here was introduced on system concepts aiming at the further effectiveness of the nuclear power plant business, preparation of business environment, upgrading of maintenance and maintenance, and so on, at a background of environment around maintenance business in the nuclear power plants (cost-down, highly elapsed year of the plant, change of business environment). (G.K)

Information-Based Maintenance Optimization with Focus on Predictive Maintenance (Informatiegebaseerde onderhoudsoptimalisatie met focus op predictief onderhoud)

OpenAIRE

Van Horenbeek, Adriaan

2013-01-01

This dissertation presents an information-based maintenance optimization methodology for physical assets; with focus on, but not limited to, predictive maintenance (PdM). The overall concept of information-based maintenance is that of updating maintenance decisions based on evolving knowledge of operation history and anticipated usage of the machinery, as well as the physics and dynamics of material degradation in critical machinery components. Within this concept, predictive maintenance is a...

The impact of self-efficacy on physical activity maintenance in patients with hip osteoarthritis

DEFF Research Database (Denmark)

Hammer, Nanna Maria; Bieler, Theresa; Beyer, Nina Ann-Marie

2016-01-01

Purpose: Understanding motivational factors related to physical activity (PA) maintenance is essential in promoting long-term exercise benefits. This study explored the impact of self-efficacy (SE) on post-intervention PA maintenance in patients with hip osteoarthritis. Method: An SE-theory based...... mixed-methods sub-study of a trial investigating the effects of 4 months supervised exercise in patients with hip osteoarthritis. Questionnaire data (n = 52; baseline and 12 months) on PA and SE (Arthritis Self-Efficacy Scale, ASES, score-range 10–100) were analysed (Mann–Whitney test) for differences...... from incorporating the self-efficacy theory in the planning and execution of exercise interventions to promote post-intervention physical activity maintenance and long term health benefits. •Post-intervention physical activity maintenance may be increased by focussing on the patients’ exercise self-efficacy...

Development of plant maintenance systems

International Nuclear Information System (INIS)

Tomita, Jinji; Ike, Masae; Nakayama, Kenji; Kato, Hisatomo

1989-01-01

Toshiba is making active efforts for the continuing improvement of reliability and maintainability of operating nuclear power plants. As a part of these efforts, the company has developed new maintenance administration systems, diagnostic monitoring facilities for plant equipments, computer-aided expert systems, and remote-controlled machines for maintenance work. The maintenance administration systems provide efficient work plans and data acquisition capabilities for the management of personnel and equipments involved in nuclear power plant maintenance. The plant diagnostic facilities monitor and diagnose plant conditions for preventive maintenance, as well as enabling rapid countermeasures to be carried out should they be required. Expert systems utilizing artificial intelligence (AI) technology are also employed. The newly developed remote-controlled machines are useful tools for the maintenance inspection of equipment which can not be easily accessed. (author)

A Planned Preventive Maintenance Program. A Handbook for Chief Business Officers and Supervisors of Maintenance with Suggestions on Maintenance for Consideration by Presidents of Higher Institutions.

Science.gov (United States)

Daniel, Clarence H.

This handbook explains planned preventive maintenance program, which is an operational system of maintenance designed to increase the effectiveness of the maintenance staff and the use of maintenance funds through efficient scheduling of inspections and follow-through of work to be performed. Sections are included for the chief administrative…

[Population-based study of diabetic retinopathy in Wolfsburg].

Science.gov (United States)

Hesse, L; Grüsser, M; Hoffstadt, K; Jörgens, V; Hartmann, P; Kroll, P

2001-11-01

Since November 1997 the complete documentation of an ophthalmological examination of diabetics has been annually subsidized by the Volkswagen Corporation Health Maintenance Organization (VW-HMO). The results of an annual ophthalmological examination were recorded in a standardised history sheet developed by the Initiative Group for Early Detection of Diabetic Eye Diseases. These data included visual acuity, intraocular pressure, lens status and a description of fundus abnormalities. Within 26 months ophthalmological examinations of 2,801 patients were completed which represented 4.5% of all VW-HMO insured patients. On average, patients suffered from diabetes for 9.6 years (SD +/- 8.3), artificial intraocular lenses were present in 357 eyes (6.4%) and 1,216 eyes (12.0%) were diagnosed with cataract or posterior capsule opacification impairing visual acuity. Out of 263 patients younger than 40 years old, 18.8% had a mild or moderate and 3.3% a severe non-proliferative diabetic retinopathy (NPDR). A proliferative diabetic retinopathy (PDR) was found in 2.2% of the younger patients. Of 2,228 patients aged 40 years and older, 11.9% had a mild or moderate and 2.6% a severe NPDR. In 0.9% of this group PDR was diagnosed. An annual ophthalmological screening based on a survey sheet of the Initiative Group was successfully introduced. For the first time a population-based evaluation on the prevalence of diabetic retinopathy was carried out for inhabitants of a German city. The prevalence of PDR was found to be lower than previously published in comparable studied.

Scientific Opinion on the substantiation of health claims related to glycaemic carbohydrates and maintenance of normal brain function pursuant to Article 13(5) of Regulation (EC) No 1924/2006

DEFF Research Database (Denmark)

Tetens, Inge

2015-01-01

Following applications from Dextro Energy GmbH & Co. KG, submitted for the authorisation of health claims pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of Germany, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver...... an opinion on the scientific substantiation of health claims related to glycaemic carbohydrates and maintenance of normal brain function. The scope of the applications was proposed to fall under health claims based on newly developed scientific evidence. The Panel considers that the food constituent...

Plant Maintenance. The Licensee's Viewpoint

International Nuclear Information System (INIS)

Ungi, T.

1997-01-01

Plant maintenance is a very complex process which requires considerable effort from both within the maintenance process and also many support activities. It is important that the plant maintenance policy is translated into a maintenance programme which will define all relevant aspects of the maintenance. An aspect of this maintenance programme will be a maintenance catalogue which will define the maintenance activities to be carried out and at what frequencies. This paper is aimed at discussing the maintenance philosophy and resulting maintenance catalogues currently adopted in Nuclear Electric Ltd, and in particular at Heysham 2 Power Station. It goes on to consider whether these maintenance catalogues contain the optimum maintenance and if not should they be changed. If change is required, the process by which this change will be brought about is also discussed. (author)

Competencies Development and Self-Assessment in Maintenance Management E-Training

Science.gov (United States)

Papathanassiou, Nikos; Pistofidis, Petros; Emmanouilidis, Christos

2013-01-01

The maintenance management function requires staff to possess a truly multidisciplinary set of skills. This includes competencies from engineering and information technology to health and safety, management and finance, while also taking into account the normative and legislative issues. This body of knowledge is rarely readily available within a…

Geometric Process-Based Maintenance and Optimization Strategy for the Energy Storage Batteries

Directory of Open Access Journals (Sweden)

Yan Li

2016-01-01

Full Text Available Renewable energy is critical for improving energy structure and reducing environment pollution. But its strong fluctuation and randomness have a serious effect on the stability of the microgrid without the coordination of the energy storage batteries. The main factors that influence the development of the energy storage system are the lack of valid operation and maintenance management as well as the cost control. By analyzing the typical characteristics of the energy storage batteries in their life cycle, the geometric process-based model including the deteriorating system and the improving system is firstly built for describing the operation process, the preventive maintenance process, and the corrective maintenance process. In addition, this paper proposes an optimized management strategy, which aims to minimize the long-run average cost of the energy storage batteries by defining the time interval of the detection and preventive maintenance process as well as the optimal corrective maintenance times, subjected to the state of health and the reliability conditions. The simulation is taken under the built model by applying the proposed energy storage batteries’ optimized management strategy, which verifies the effectiveness and applicability of the management strategy, denoting its obvious practicality on the current application.

Component-Based Data-Driven Predictive Maintenance to Reduce Unscheduled Maintenance Events

NARCIS (Netherlands)

Verhagen, W.J.C.; Curran, R.; de Boer, L.W.M.; Chen, C.H.; Trappey, A.C.; Peruzzini, M.; Stjepandić, J.; Wognum, N.

2017-01-01

Costs associated with unscheduled and preventive maintenance can contribute significantly to an airline's expenditure. Reliability analysis can help to identify and plan for maintenance events. Reliability analysis in industry is often limited to statistically based

Anticipated affective consequences of physical activity adoption and maintenance.

Science.gov (United States)

Dunton, Genevieve Fridlund; Vaughan, Elaine

2008-11-01

The expected emotional consequences of future actions are thought to play an important role in health behavior change. This research examined whether anticipated affective consequences of success and failure vary across stages of physical activity change and differentially predict physical activity adoption as compared to maintenance. Using a prospective design over a 3-month period, a community sample of 329 healthy, middle-aged adults were assessed at 2 time points. Anticipated positive and negative emotions, stage of behavior change (precontemplation [PC], contemplation [C], preparation [P], action [A], maintenance [M]), and level of physical activity. At baseline, anticipated positive emotions were greater in C versus PC, whereas anticipated negative emotions were greater in M versus A and in M versus P. Higher anticipated positive but not negative emotions predicted physical activity adoption and maintenance after 3 months. Although the expected affective consequences of future success and failure differentiated among individuals in the early and later stages of physical activity change, respectively; only the anticipated affective consequences of success predicted future behavior.

Competencies development and self-assessment in maintenance management e-training

Science.gov (United States)

Papathanassiou, Nikos; Pistofidis, Petros; Emmanouilidis, Christos

2013-10-01

The maintenance management function requires staff to possess a truly multidisciplinary set of skills. This includes competencies from engineering and information technology to health and safety, management and finance, while also taking into account the normative and legislative issues. This body of knowledge is rarely readily available within a single university course. The potential of e-learning in this field is significant, as it is a flexible and less costly alternative to conventional training. Furthermore, trainees can follow their own pace, as their available time is often a commodity. This article discusses the development of tools to support competencies development and self-assessment in maintenance management. Based on requirements arising from professional bodies' guidelines and a user survey, the developed tools implement a dedicated maintenance management training curriculum. The results from pilot testing on academic and industrial user groups are discussed and user evaluations are linked with specific e-learning design issues.

75 FR 57849 - Maintenance of Incombustible Content of Rock Dust in Underground Coal Mines

Science.gov (United States)

2010-09-23

... correlation between higher job risk and higher wages, suggesting that employees demand monetary compensation... DEPARTMENT OF LABOR Mine Safety and Health Administration 30 CFR Part 75 RIN 1219-AB76 Maintenance of Incombustible Content of Rock Dust in Underground Coal Mines AGENCY: Mine Safety and Health...

Remote maintenance for fusion experimental reactor

International Nuclear Information System (INIS)

Koizumi, Koichi; Takeda, Nobukazu

2000-01-01

Here was introduced on maintenance of reactor core portion operated by remote control among maintenance of the International Thermonuclear Experimental Reactor (ITER) begun on its design since 1988 under international cooperation of U.S.A., Europe, Russia and Japan. Every appliances constructing the reactor core portion is necessary to carry out all of their inspection and maintenance by using remote controlled apparatus because of their radiation due to neutron generated by DT combustion of plasma. For engineering design activity (EDA) in ITER, not only design and development of the remote control appliances but also design under consideration of remote maintenance for from structural design of maintained objective appliances to access method to appliances, transportation and preservation method of radiated matters, and out-reactor maintenance in a hot cell, is now under progress. Here were also reported on basic concept on maintenance and conservation of ITER, maintenance design of diverter and blanket with high maintenance frequency and present state on development of maintenance appliances. (G.K.)

Estimating Maintenance Cost for Web Applications

Directory of Open Access Journals (Sweden)

Ion IVAN

2016-01-01

Full Text Available The current paper tackles the issue of determining a method for estimating maintenance costs for web applications. The current state of research in the field of web application maintenance is summarized and leading theories and results are highlighted. The cost of web maintenance is determined by the number of man-hours invested in maintenance tasks. Web maintenance tasks are categorized into content maintenance and technical maintenance. Research is centered on analyzing technical maintenance tasks. The research hypothesis is formulated on the assumption that the number of man-hours invested in maintenance tasks can be assessed based on the web application’s user interaction level, complexity and content update effort. Data regarding the costs of maintenance tasks is collected from 24 maintenance projects implemented by a web development company that tackles a wide area of web applications. Homogeneity and diversity of collected data is submitted for debate by presenting a sample of the data and depicting the overall size and comprehensive nature of the entire dataset. A set of metrics dedicated to estimating maintenance costs in web applications is defined based on conclusions formulated by analyzing the collected data and the theories and practices dominating the current state of research. Metrics are validated with regards to the initial research hypothesis. Research hypothesis are validated and conclusions are formulated on the topic of estimating the maintenance cost of web applications. The limits of the research process which represented the basis for the current paper are enunciated. Future research topics are submitted for debate.

Exposure of highway maintenance workers to fine particulate matter and noise

Science.gov (United States)

In this study we assessed the mixed exposure of highway maintenance workers to airborne particles, noise and gaseous co-pollutants. The aims were to provide a better understanding of the workers exposure to facilitate the evaluation of short-term effects on cardiovascular health ...

Residual life management. Maintenance improvement

International Nuclear Information System (INIS)

Sainero Garcia, J.; Hevia Ruperez, F.

1995-01-01

The terms Residual Life Management, Life Cycle Management and Long-Term Management are synonymous with a concept which aims to establish efficient maintenance for the profitable and safe operation of a power plant for as long as possible. A Residual Life Management programme comprises a number of stages, of which Maintenance Evaluation focuses on how power plant maintenance practices allow the mitigation and control of component ageing. with this objective in mind, a methodology has been developed for the analysis of potential degradative phenomena acting on critical components in terms of normal power plant maintenance practices. This methodology applied to maintenance evaluation enables the setting out of a maintenance programme based on the Life Management concept, and the programme's subsequent up-dating to allow for new techniques and methods. Initial applications have shown that although, in general terms, power plant maintenance is efficient, the way in which Residual Life Management is approached requires changes in maintenance practices. These changes range from modifications to existing inspection and surveillance methods or the establishment of new ones, to the monitoring of trends or the performance of additional studies, the purpose of which is to provide an accurate evaluation of the condition of the installations and the possibility of life extension. (Author)

Software evolution and maintenance

CERN Document Server

Tripathy, Priyadarshi

2014-01-01

Software Evolution and Maintenance: A Practitioner's Approach is an accessible textbook for students and professionals, which collates the advances in software development and provides the most current models and techniques in maintenance.Explains two maintenance standards: IEEE/EIA 1219 and ISO/IEC14764Discusses several commercial reverse and domain engineering toolkitsSlides for instructors are available onlineInformation is based on the IEEE SWEBOK (Software Engineering Body of Knowledge)

Turbine maintenance and modernization

Energy Technology Data Exchange (ETDEWEB)

Unga, E [Teollisuuden Voima Oy, Olkiluoto (Finland)

1999-12-31

The disturbance-free operation of the turbine plant plays an important role in reaching good production results. In the turbine maintenance of the Olkiluoto nuclear power plant the lifetime and efficiency of turbine components and the lifetime costs are taken into account in determining the turbine maintenance and modernization/improvement program. The turbine maintenance program and improvement/modernization measures taken in the plant units are described in this presentation. (orig.)

Laboratory equipment maintenance contracts.

Science.gov (United States)

Boudreau, D A; Scheer, W D; Catrou, P G

1985-12-01

The increasing level of technical sophistication and complexity found in clinical laboratory instrumentation today more than ever demands careful attention to maintenance service needs. The time-worn caution for careful definition of requirements for acquisition of a system should also carry over to acquisition of maintenance service. Guidelines are presented for specifications of terms and conditions for maintenance service from the perspective of the laboratorian in the automated clinical laboratory.

Turbine maintenance and modernization

Energy Technology Data Exchange (ETDEWEB)

Unga, E. [Teollisuuden Voima Oy, Olkiluoto (Finland)

1998-12-31

The disturbance-free operation of the turbine plant plays an important role in reaching good production results. In the turbine maintenance of the Olkiluoto nuclear power plant the lifetime and efficiency of turbine components and the lifetime costs are taken into account in determining the turbine maintenance and modernization/improvement program. The turbine maintenance program and improvement/modernization measures taken in the plant units are described in this presentation. (orig.)

Remote maintenance systems requirements are being developed to provide design guidelines for machine components, to define maintenance interfaces, and to quantify maintenance equipment and procedures needed

International Nuclear Information System (INIS)

Spampinato, P.T.; Tabor, M.A.

1988-01-01

Remote maintenance systems requirements are being developed to provide design guidelines for machine components, to define maintenance interfaces, and to quantify maintenance equipment and procedures needed

Research and development of remote maintenance equipment for ITER divertor maintenance

International Nuclear Information System (INIS)

Takeda, Nobukazu; Kakudate, Satoshi; Nakahira, Masataka

2005-02-01

To facilitate easy remote maintainability, the ITER divertor is divided into 60 cassettes, which are transported in the toroidal and radial directions for replacement through maintenance ports located every 90 degrees using the divertor remote maintenance equipment such as in- and ex-vessel transporters. The cassette of 25 tons has to be transported and installed in the vacuum vessel with a positioning accuracy less than 2 mm in the limited space of the vacuum vessel and maintenance port under the intense gamma radiation field. Based on these requirements, the following design and tests were performed. (1) Link mechanism was studied to apply to the transportation of the heavy cassette in the restricted space. A compact mechanism with links for transportation of heavy cassette is designed through the optimization of the link angle taking account of space requirement and force efficiency. As a test result, the lifting capacity of 30 tons (larger than the cassette weight of 25 tons) using two link mechanisms has been demonstrated in the limited space. (2) Compact link mechanism was also studied to apply for locking of the cassette through the optimization of the link angle taking account of space requirement and force efficiency. As a test result, the final positioning accuracy of 0.03 mm for the 25 tons-cassette installation on the vacuum vessel from the initial positioning error of 5 mm has been demonstrated, so that the test result satisfies the requirement less than 2 mm using the link mechanisms in the limited space. (3) Sensor-based control using simple sensors such as optical fiber for divertor maintenance was tested using the full-scale mock-up divertor cassette and remote maintenance equipment. As a result, it is found that the positioning accuracy of 0.16 mm has been achieved by the optical fiber sensor and this value is sufficient for sensor-based control. In addition, the maintenance operation has been carried out through the human-machine interface

Two Different Maintenance Strategies in the Hospital Environment: Preventive Maintenance for Older Technology Devices and Predictive Maintenance for Newer High-Tech Devices

OpenAIRE

Sezdi, Mana

2016-01-01

A maintenance program generated through the consideration of characteristics and failures of medical equipment is an important component of technology management. However, older technology devices and newer high-tech devices cannot be efficiently managed using the same strategies because of their different characteristics. This study aimed to generate a maintenance program comprising two different strategies to increase the efficiency of device management: preventive maintenance for older tec...

Total Productive Maintenance at Paccar INC

OpenAIRE

Ştefan Farkas

2010-01-01

This paper reports the application of total productive maintenance method at Paccar Inc. truck’s plant in Victoria, Australia. The total productive maintenance method and total productive maintenance house are presented. The global equipment effectiveness is computed and exemplified. The production structure and organising maintenance are presented. Resultas of the variation of global equipment effectiveness and autonomous maintenance in a two weeks period of time are reported.

Evaluation of prototype Advanced Life Support (ALS) pack for use by the Health Maintenance Facility (HMF) on Space Station Freedom (SSF)

Science.gov (United States)

Krupa, Debra T.; Gosbee, John; Murphy, Linda; Kizzee, Victor D.

1991-01-01

The purpose is to evaluate the prototype Advanced Life Support (ALS) Pack which was developed for the Health Maintenance Facility (HMF). This pack will enable the Crew Medical Officer (CMO) to have ready access to advanced life support supplies and equipment for time critical responses to any situation within the Space Station Freedom. The objectives are: (1) to evaluate the design of the pack; and (2) to collect comments for revision to the design of the pack. The in-flight test procedures and other aspects of the KC-135 parabolic test flight to simulate weightlessness are presented.

Extracting and analyzing ejection fraction values from electronic echocardiography reports in a large health maintenance organization.

Science.gov (United States)

Xie, Fagen; Zheng, Chengyi; Yuh-Jer Shen, Albert; Chen, Wansu

2017-12-01

The left ventricular ejection fraction value is an important prognostic indicator of cardiovascular outcomes including morbidity and mortality and is often used clinically to indicate severity of heart disease. However, it is usually reported in free-text echocardiography reports. We developed and validated a computerized algorithm to extract ejection fraction values from echocardiography reports and applied the algorithm to a large volume of unstructured echocardiography reports between 1995 and 2011 in a large health maintenance organization. A total of 621,856 echocardiography reports with a description of ejection fraction values or systolic functions were identified, of which 70 percent contained numeric ejection fraction values and the rest (30%) were text descriptions explicitly indicating the systolic left ventricular function. The 12.1 percent (16.0% for male and 8.4% for female) of these extracted ejection fraction values are <45 percent. Validation conducted based on a random sample of 200 reports yielded 95.0 percent sensitivity and 96.9 percent positive predictive value.

Automated System Checkout to Support Predictive Maintenance for the Reusable Launch Vehicle

Science.gov (United States)

Patterson-Hine, Ann; Deb, Somnath; Kulkarni, Deepak; Wang, Yao; Lau, Sonie (Technical Monitor)

1998-01-01

The Propulsion Checkout and Control System (PCCS) is a predictive maintenance software system. The real-time checkout procedures and diagnostics are designed to detect components that need maintenance based on their condition, rather than using more conventional approaches such as scheduled or reliability centered maintenance. Predictive maintenance can reduce turn-around time and cost and increase safety as compared to conventional maintenance approaches. Real-time sensor validation, limit checking, statistical anomaly detection, and failure prediction based on simulation models are employed. Multi-signal models, useful for testability analysis during system design, are used during the operational phase to detect and isolate degraded or failed components. The TEAMS-RT real-time diagnostic engine was developed to utilize the multi-signal models by Qualtech Systems, Inc. Capability of predicting the maintenance condition was successfully demonstrated with a variety of data, from simulation to actual operation on the Integrated Propulsion Technology Demonstrator (IPTD) at Marshall Space Flight Center (MSFC). Playback of IPTD valve actuations for feature recognition updates identified an otherwise undetectable Main Propulsion System 12 inch prevalve degradation. The algorithms were loaded into the Propulsion Checkout and Control System for further development and are the first known application of predictive Integrated Vehicle Health Management to an operational cryogenic testbed. The software performed successfully in real-time, meeting the required performance goal of 1 second cycle time.

Knowledge maintenance in myCBR

OpenAIRE

Aul, Vani; Sauer, Christian; Roth-Berghofer, Thomas

2014-01-01

CBR systems, being knowledge based systems, process knowledge. Due to changes in the environment a CBR system’s knowledge model can become outdated, thus creating a need for constant maintenance of said knowledge model. In this paper, we describe an implementation of (semi-)automatic knowledge maintenance of two of the four knowledge containers of CBR systems, specifically case base maintenance and maintenance of similarity measures within the CBR system development SDK myCBR. We describe our...

GRAPHICAL MODELS OF THE AIRCRAFT MAINTENANCE PROCESS

Directory of Open Access Journals (Sweden)

Stanislav Vladimirovich Daletskiy

2017-01-01

Full Text Available The aircraft maintenance is realized by a rapid sequence of maintenance organizational and technical states, its re- search and analysis are carried out by statistical methods. The maintenance process concludes aircraft technical states con- nected with the objective patterns of technical qualities changes of the aircraft as a maintenance object and organizational states which determine the subjective organization and planning process of aircraft using. The objective maintenance pro- cess is realized in Maintenance and Repair System which does not include maintenance organization and planning and is a set of related elements: aircraft, Maintenance and Repair measures, executors and documentation that sets rules of their interaction for maintaining of the aircraft reliability and readiness for flight. The aircraft organizational and technical states are considered, their characteristics and heuristic estimates of connection in knots and arcs of graphs and of aircraft organi- zational states during regular maintenance and at technical state failure are given. It is shown that in real conditions of air- craft maintenance, planned aircraft technical state control and maintenance control through it, is only defined by Mainte- nance and Repair conditions at a given Maintenance and Repair type and form structures, and correspondingly by setting principles of Maintenance and Repair work types to the execution, due to maintenance, by aircraft and all its units mainte- nance and reconstruction strategies. The realization of planned Maintenance and Repair process determines the one of the constant maintenance component. The proposed graphical models allow to reveal quantitative correlations between graph knots to improve maintenance processes by statistical research methods, what reduces manning, timetable and expenses for providing safe civil aviation aircraft maintenance.

Total Productive Maintenance at Paccar INC

Directory of Open Access Journals (Sweden)

Ştefan Farkas

2010-06-01

Full Text Available This paper reports the application of total productive maintenance method at Paccar Inc. truck’s plant in Victoria, Australia. The total productive maintenance method and total productive maintenance house are presented. The global equipment effectiveness is computed and exemplified. The production structure and organising maintenance are presented. Resultas of the variation of global equipment effectiveness and autonomous maintenance in a two weeks period of time are reported.

42 CFR 417.572 - Budget and enrollment forecast and interim reports.

Science.gov (United States)

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Budget and enrollment forecast and interim reports... PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.572 Budget and enrollment forecast and interim reports. (a) Annual submittal. The HMO or CMP must submit an annual operating budget...

Depot Maintenance: Executed Workload and Maintenance Operations at DOD Depots

Science.gov (United States)

2017-02-03

in turn enable testing of helicopter rotor blades. The Army has also made investments in logistics software at all of its depots. According to the...maintenance and repair of structural helicopter airframes and blades; advanced composite technologies; flight controls and control surfaces; and...level maintenance on a wide range of vehicles and other military assets, including helicopters , combat vehicles, ships, aircraft, engines, and software

Safety related maintenance in the framework of the reliability centered maintenance concept

International Nuclear Information System (INIS)

1992-07-01

Elevated safety requirements and ever increasing costs of maintenance of nuclear power plants stimulate the interest in different methods and approaches to optimize maintenance activities. Among different concepts, the Reliability Centered Maintenance (RCM) as an approach to improve Preventive Maintenance (PM) programmes is being widely discussed an applied in several IAEA Member States. In order to summarize basic principles and current implementation of the RCM, the IAEA organized a Consultants Meeting in November 1990. The report prepared during that meeting was discussed during the Technical Committee Meeting (TCM) held in May 1991. Numerous technical presentations as well as panel and plenary discussions took place at the TCM. This document contains the report of the Consultants Meeting (modified to include comments of the TCM), a summary of the most important discussions as well as all 14 papers presented at the TCM

Maintenance planning for nuclear power plants

International Nuclear Information System (INIS)

Mattu, R.K.; Cooper, S.E.; Lauderdale, J.R.

2004-01-01

Maintenance planning for nuclear power plants is similar to that in other industrial plants but it is heavily influenced by regulatory rules, with consequent costs of compliance. Steps by the nuclear industry and the Nuclear Regulatory Commission to address that problem include development of guidelines for maintenance of risk-critical equipment, using PRA-based techniques to select a set of equipment that requires maintenance and reliability-centered maintenance (RCM) approaches for determining what maintenance is required. The result of the process is a program designed to ensure effective maintenance of the equipment most critical to plant safety. (author)

The present status and future growth of maintenance in US manufacturing: results from a pilot survey.

Science.gov (United States)

Jin, Xiaoning; Siegel, David; Weiss, Brian A; Gamel, Ellen; Wang, Wei; Lee, Jay; Ni, Jun

A research study was conducted (1) to examine the practices employed by US manufacturers to achieve productivity goals and (2) to understand what level of intelligent maintenance technologies and strategies are being incorporated into these practices. This study found that the effectiveness and choice of maintenance strategy were strongly correlated to the size of the manufacturing enterprise; there were large differences in adoption of advanced maintenance practices and diagnostics and prognostics technologies between small and medium-sized enterprises (SMEs). Despite their greater adoption of maintenance practices and technologies, large manufacturing organizations have had only modest success with respect to diagnostics and prognostics and preventive maintenance projects. The varying degrees of success with respect to preventative maintenance programs highlight the opportunity for larger manufacturers to improve their maintenance practices and use of advanced prognostics and health management (PHM) technology. The future outlook for manufacturing PHM technology among the manufacturing organizations considered in this study was overwhelmingly positive; many manufacturing organizations have current and planned projects in this area. Given the current modest state of implementation and positive outlook for this technology, gaps, future trends, and roadmaps for manufacturing PHM and maintenance strategy are presented.

Application of reliability centred maintenance to optimize operation and maintenance in nuclear power plants

International Nuclear Information System (INIS)

2007-05-01

In order to increase Member States capabilities in utilizing good engineering and management practices the Agency has developed a series of Technical Documents (TECDOCs) to describe best practices and members experience in the application of them. This TECDOC describes the concept of Reliability Centred Maintenance (RCM) which is the term used to describe a systematic approach to the evaluation, design and development of cost effective maintenance programmes for plant and equipment. The concept has been in existence for over 25 years originating in the civil aviation sector. This TECDOC supplements previous IAEA publications on the subject and seeks to reflect members experience in the application of the principles involved. The process focuses on the functionality of the plant and equipment and the critical failure mechanisms that could result in the loss of functionality. When employed effectively the process can result in the elimination of unnecessary maintenance activities and the identification and introduction of measures to address deficiencies in the maintenance programme. Overall the process can result in higher levels of reliability for the plant and equipment at reduced cost and demands on finite maintenance resources. The application of the process requires interaction between the operators and the maintenance practitioners which is often lacking in traditional maintenance programmes. The imposition of this discipline produces the added benefit of improved information flows between the key players in plant and equipment management with the result that maintenance activities and operational practices are better informed. This publication was produced within IAEA programme on nuclear power plants operating performance and life cycle management

A STEPPING STONE TOWARDS KNOWLEDGE BASED MAINTENANCE

OpenAIRE

G. Waeyenbergh; L. Pintelon; L. Gelders

2012-01-01

Maintenance decision making becomes more and more a management concern. Some decades ago, maintenance was still often considered as an unavoidable side effect of production. The perception of maintenance has evolved considerably. One of the current issues is the maintenance concept, being the mix of maintenance interventions and the general framework for determining this mix. In this paper we describe a modular framework, called Knowledge Based Maintenance, for developing a customised mainten...

Interactive videodisc in maintenance

International Nuclear Information System (INIS)

Zwingelstein, G.; Nguyen Van Nghi, B.

1986-01-01

After a recall of the videodisc characteristics, this paper presents its utilization by Electricite de France in the framework of training and maintenance. The SICMA (Interactive Communication System in Maintenance) developed and tested by Electricte de France is presented as also its utilization. It has been tested on the sites of Dampierre and Paluel in the cases of training and maintenance (deconnexion of drive rods of control elements); the conclusions of this experimentation are finally given. 4 refs [fr

Status of fusion maintenance

International Nuclear Information System (INIS)

Fuller, G.M.

1984-01-01

Effective maintenance will be an essential ingredient in determining fusion system productivity. This level of productivity will result only after close attention is paid to the entire system as an entity and appropriate integration of the elements is made. The status of fusion maintenance is reviewed in the context of the entire system. While there are many challenging developmental tasks ahead in fusion maintenance, the required technologies are available in several high-technology industries, including nuclear fission

Condition-based maintenance for complex systems : Coordinating maintenance and logistics planning for the process industries

NARCIS (Netherlands)

Olde Keizer, Minou Catharina Anselma

2016-01-01

Maintenance planning in the process industries is extremely complex for various reasons. Plants often run nonstop, allowing little time for performing preventive maintenance. Failures should be prevented, however, as they can lead to system downtime and high losses of revenue. Corrective maintenance

PREVENTIVE MAINTENANCE. HONEYWELL PLANNING GUIDE.

Science.gov (United States)

Honeywell, Inc., Minneapolis, Minn.

THIS HONEYWELL PAMPHLET DISCUSSES SOME ASPECTS OF PREVENTIVE MAINTENANCE OF AUTOMATIC CONTROLS, HEATING, VENTILATING, AND AIR CONDITIONING, AND COMPARES IN-PLANT WITH CONTRACT SERVICE, CONCLUDING THAT CONTRACT SERVICE IS PREFERABLE AND DESCRIBING A NUMBER OF MAINTENANCE PLANS WHICH THEY FURNISH. PREVENTIVE MAINTENANCE PROVIDES--(1) MORE EFFICIENT…

Estimativa por DSC das entalpias de sublimação da etilenouréia e da propilenouréia: algumas correlações empíricas envolvendo amidas e tioamidas

OpenAIRE

Farias,Robson Fernandes de

1999-01-01

By using DSC data, the enthaplies of sublimation for ethyleneurea and propyleneurea, are calculated as 84 and 89 kJ mol-1 respectively. Using the vaporization enthalpy values for dimethylethyleneurea and dimethylprophyleneurea, as obtained from literature, the empirical relation: Dcrg Hmo (1)/ Dcrg Hmo (2) = Dlg Hmo (1)/ Dlg Hmo(2) = constant, that relate sublimation or vaporization enthalpies of two different substances and of its methylated derivatives, is obtained. Correlations like that a...

Pacific Northwest Laboratory Maintenance Implementation plan

International Nuclear Information System (INIS)

Bright, J.D.

1992-06-01

This Maintenance Implementation plan has been developed for Pacific Northwest Laboratory's (PNL) Nuclear Facilities: 306W, 324, 325, 327 and 329NMF. It is based on a graded approach, self-assessment of the existing maintenance program(s) per the requirements specified by US Department of Energy (DOE) Order 4330.4A, Chapter II, Change number-sign 3. The results of this assessment were evaluated to determine needed improvements in PNL Craft Services' current maintenance program. The objective of this implementation plan is to provide baseline information for compliance to the DOE 4330.4A, and for needed improvements. The prime consideration in applying a graded approach to the Order has been to maintain safe and reliable operations, environmental compliance, safeguards and security, programmatic mission, facility preservation, and/or other facility-specific requirements. Using the results of the self-assessment, PNL has selected nine of the 18 elements of the Maintenance Program defined by DOE Order 4330.4A for improvement. The elements selected for improvement are Training and Qualification of Maintenance Personnel; Maintenance Procedures; Planning, Scheduling, and Coordination of Maintenance; Control of Maintenance Activities; Post-Maintenance Testing; Facility Condition Inspection; Management Involvement; Maintenance History; and Additional Maintenance Requirements. Based upon graded approach and current funding, those elements considered most important have been selected as goals for earliest compliance. Commitment dates for these elements have been established for compliance. The remaining elements of noncompliance will be targeted for implementation during later budget periods

Development of blanket remote maintenance system

International Nuclear Information System (INIS)

Kakudate, Satoshi; Nakahira, Masataka; Oka, Kiyoshi; Taguchi, Kou

1998-01-01

ITER in-vessel components such as blankets are scheduled maintenance components, including complete shield blanket replacement for breeding blankets. In-vessel components are activated by 14 MeV neutrons, so blanket maintenance requires remote handling equipment and tools able to handle heavy payloads of about 4 tons within a positioning accuracy of 2 mm under intense gamma radiation. To facilitate remote maintenance, blankets are segmented into 730 modules and rail-mounted vehicle remote maintenance was developed. According to the ITER R and D program, critical technology related to blanket maintenance was developed extensively through joint efforts of the Japan, EU, and U.S. home teams. This paper summarizes current blanket maintenance technology conducted by the Japan Home Team, including development of full-scale remote handling equipment and tools for blanket maintenance. (author)

Development of blanket remote maintenance system

Energy Technology Data Exchange (ETDEWEB)

Kakudate, Satoshi; Nakahira, Masataka; Oka, Kiyoshi; Taguchi, Kou [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

1998-04-01

ITER in-vessel components such as blankets are scheduled maintenance components, including complete shield blanket replacement for breeding blankets. In-vessel components are activated by 14 MeV neutrons, so blanket maintenance requires remote handling equipment and tools able to handle heavy payloads of about 4 tons within a positioning accuracy of 2 mm under intense gamma radiation. To facilitate remote maintenance, blankets are segmented into 730 modules and rail-mounted vehicle remote maintenance was developed. According to the ITER R and D program, critical technology related to blanket maintenance was developed extensively through joint efforts of the Japan, EU, and U.S. home teams. This paper summarizes current blanket maintenance technology conducted by the Japan Home Team, including development of full-scale remote handling equipment and tools for blanket maintenance. (author)

[Provision of building maintenance services in healthcare facilities].

Science.gov (United States)

Amorim, Gláucia Maria; Quintão, Eliana Cardoso Vieira; Martelli Júnior, Hercílio; Bonan, Paulo Rogério Ferreti

2013-01-01

The scope of this paper was to evaluate the provision of building maintenance services in health units, by means of a descriptive, quantitative and cross-sectional study, considering the five types of facilities (Primary Health, Emergency, Specialty, Hospital and Mental Health Units). The research was approved by the Research Ethics Comittee of FHEMIG with the Terms of Agreement signed with the Unified Health System of Betim. Comparative analysis was conducted by checking the requirements of "Physical-Functional Structure Management" of the "Brazilian Hospital Accreditation Manual" of the National Accreditation Organization. Nonconformities were noted in the physical-functional management of the health centers, especially the primary health units. The assessment was important, considering that compliance with formal, technical and structural requirements, welfare activities, according to the service organization and appropriate to the profile and complexity, can collaborate to minimize the risks of users. To improve the quality of health care establishments, it is essential that managers, backed by "top management," prioritize financial, human and material resources in planning to ensure compliance with security requirements of users in buildings.

Mechanical configuration and maintenance

International Nuclear Information System (INIS)

Brown, T.G.; Casini, G.; Churakov, G.F.

1982-01-01

The INTOR engineering design has been strongly influenced by considerations for assembly and maintenance. A maintenance philosophy was established at the outset of the conceptual design to insure that the tokamak configuration would be developed to accommodate maintenance requirements. The main features of the INTOR design are summarized in this paper with primary emphasis on the impact of maintenance considerations. The most apparent configuration design feature is the access provided for torus maintenance. Particular attention was given to the size and location of superconducting magnets and the location of vacuum boundaries. All of the poloidal field (PF) coils are placed outside of the bore of the toroidal field (TF) coils and located above and below an access opening between adjacent TF coils through which torus sectors are removed. A magnet structural configuration consisting of mechanically attached reinforcing members has been designed which facilitates the open access space for torus sector removal. For impurity control, a single null poloidal divertor was selected over a double null design in order to maintain sufficient access for pumping and maintenance of the collector. A double null divertor was found to severely limit access to the torus with the addition of divertor collectors and pumping at the top. For this reason, a single null concept was selected in spite of the more difficult design problems associated with the required asymmetric PF system and higher particle loadings

Discussion group networks in occupational medicine: A tool for continuing education to promote the integration of workers with disabilities.

Science.gov (United States)

Rinsky-Halivni, Lilah; Lerman, Yehuda

2018-04-01

Despite their legal rights, individuals with disabilities face numerous obstacles to integration in the workplace which can result in their discharge from the labor force. Currently occupational physicians have few resources to help decide whether to integrate disabled workers in pre-placement, or in cases of return-to-work. A network of 13 discussion groups comprised of the occupational physicians of each regional clinic of a large Health Maintenance Organization (HMO) in Israel was created to deal with disability management dilemmas. A moderator compiles and shares the physicians' opinions and experiences with all network members thus assisting the consulting physician in decision-making. Successful management of three representative cases is described to illustrate real-life implementations of this network. The network enables both the consulting and other physicians to tap a large knowledge base and decision-making experience concerning cases of occupational disability management, contributing to professional development and improved service delivery. © 2018 Wiley Periodicals, Inc.

Competitive bidding in Medicare: who benefits from competition?

Science.gov (United States)

Song, Zirui; Landrum, Mary Beth; Chernew, Michael E

2012-09-01

To conduct the first empirical study of competitive bidding in Medicare. We analyzed 2006-2010 Medicare Advantage data from the Centers for Medicare and Medicaid Services using longitudinal models adjusted for market and plan characteristics. A $1 increase in Medicare's payment to health maintenance organization (HMO) plans led to a $0.49 (P service plans included, higher Medicare payments increased bids less ($0.33 per dollar), suggesting more competition among these latter plans. As a market-based alternative to cost control through administrative pricing, competitive bidding relies on private insurance plans proposing prices they are willing to accept for insuring a beneficiary. However, competition is imperfect in the Medicare bidding market. As much as half of every dollar in increased plan payment went to higher bids rather than to beneficiaries. While having more insurers in a market lowered bids, the design of any bidding system for Medicare should recognize this shortcoming of competition.

Development of system decision support tools for behavioral trends monitoring of machinery maintenance in a competitive environment

Science.gov (United States)

Adeyeri, Michael Kanisuru; Mpofu, Khumbulani

2017-06-01

The article is centred on software system development for manufacturing company that produces polyethylene bags using mostly conventional machines in a competitive world where each business enterprise desires to stand tall. This is meant to assist in gaining market shares, taking maintenance and production decisions by the dynamism and flexibilities embedded in the package as customers' demand varies under the duress of meeting the set goals. The production and machine condition monitoring software (PMCMS) is programmed in C# and designed in such a way to support hardware integration, real-time machine conditions monitoring, which is based on condition maintenance approach, maintenance decision suggestions and suitable production strategies as the demand for products keeps changing in a highly competitive environment. PMCMS works with an embedded device which feeds it with data from the various machines being monitored at the workstation, and the data are read at the base station through transmission via a wireless transceiver and stored in a database. A case study was used in the implementation of the developed system, and the results show that it can monitor the machine's health condition effectively by displaying machines' health status, gives repair suggestions to probable faults, decides strategy for both production methods and maintenance, and, thus, can enhance maintenance performance obviously.

AUTOMOTIVE DIESEL MAINTENANCE 1. UNIT XX, CUMMINS DIESEL ENGINE, MAINTENANCE SUMMARY.

Science.gov (United States)

Minnesota State Dept. of Education, St. Paul. Div. of Vocational and Technical Education.

THIS MODULE OF A 30-MODULE COURSE IS DESIGNED TO PROVIDE A SUMMARY OF THE REASONS AND PROCEDURES FOR DIESEL ENGINE MAINTENANCE. TOPICS ARE WHAT ENGINE BREAK-IN MEANS, ENGINE BREAK-IN, TORQUING BEARINGS (TEMPLATE METHOD), AND THE NEED FOR MAINTENANCE. THE MODULE CONSISTS OF A SELF-INSTRUCTIONAL BRANCH PROGRAMED TRAINING FILM "CUMMINS DIESEL ENGINE…

Managed care and the delivery of primary care to the elderly and the chronically ill.

Science.gov (United States)

Wholey, D R; Burns, L R; Lavizzo-Mourey, R

1998-06-01

To analyze primary care staffing in HMOs and to review the literature on primary care organization and performance in managed care organizations, with an emphasis on the delivery of primary care to the elderly and chronically ill. Analysis of primary care staffing: InterStudy HMO census data on primary care (n = 1,956) and specialist (n = 1,777) physician staffing levels from 1991 through 1995. Primary care organization and performance for the chronically ill and elderly were analyzed using a review of published research. For the staffing-level models, the number of primary care and specialist physicians per 100,000 enrollees was regressed on HMO characteristics (HMO type [group, staff, network, mixed], HMO enrollment, federal qualification, profit status, national affiliation) and community characteristics (per capita income, population density, service area size, HMO competition). For the review of organization and performance, literature published was summarized in a tabular format. The analysis of physician staffing shows that group and staff HMOs have fewer primary care and specialist physicians per 100,000 enrollees than do network and mixed HMOs, which have fewer than IPAs. Larger HMOs use fewer physicians per 100,000 enrollees than smaller HMOs. Federally qualified HMOs have fewer primary care and specialist physicians per 100,000 enrollees. For-profit, nationally affiliated, and Blue Cross HMOs have more primary care and specialist physicians than do local HMOs. HMOs in areas with high per capita income have more PCPs per 100,000 and a greater proportion of PCPs in the panel. HMO penetration decreases the use of specialists, but the number of HMOs increases the use of primary care and specialist physicians in highly competitive markets. Under very competitive conditions, HMOs appear to compete by increasing access to both PCPs and specialists, with a greater emphasis on access to specialists. The review of research on HMO performance suggests that access

eHealth Literacy and Health Behaviors Affecting Modern College Students: A Pilot Study of Issues Identified by the American College Health Association

Science.gov (United States)

Collins, William Bart; Wilson, Kari; Linnemeier, Georgiann; Englebert, Andrew Mark

2017-01-01

Background The eHealth Literacy Scale (eHEALS) has been widely adopted by researchers to understand how eHealth literacy can be put into context. eHealth researchers need to know how to promote positive health behavior changes across college students, given the importance of the Internet to acquire and use health information. The American College Health Association identified a set of key health issues that affect college students today. By understanding how eHEALS might be related to college students’ maintenance of their health and their use of online health resources, researchers will be provided with a better understanding of eHealth literacy and its pragmatic implications for health campaigns and future interventions. Objective The goal of the study was to examine what eHEALS reveals about college student health behaviors identified by the American College Health Association. To understand college student current health maintenance and their intentions to maintain their health and use online resources, the theory of planned behavior was used as the theoretical framework for the study. Methods Data were collected via a survey of 422 college students that included the eHEALS measure and questions about health issues based on the recommendations of the American College Health Association. These questions asked about college student current health, subsequent use of online health resources, and their intention to maintain their health and make use of such resources in the future. Results eHEALS was positively and significantly associated with all 8 areas of health issues identified by the American College Health Association for college student current maintenance of health and use of online health resources and for future intention of health maintenance and use of online resources. Key issues that emerged with eHealth literacy were maintaining safe sex practices and seeking out related information, seeking out information on an exercise regime, information on

75 FR 4099 - Maintenance Wage Rate Wage Recommendation and Maintenance Wage Survey; Report of Additional...

Science.gov (United States)

2010-01-26

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5376-N-06] Maintenance Wage Rate Wage Recommendation and Maintenance Wage Survey; Report of Additional Classification and Wage Rate AGENCY: Office of... proposal. The information is used by HUD to determine or adopt prevailing wage rates for maintenance...

75 FR 37457 - Maintenance Wage Rate Wage Recommendation and Maintenance Wage Survey; Report of Additional...

Science.gov (United States)

2010-06-29

... DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT [Docket No. FR-5376-N-54] Maintenance Wage Rate Wage Recommendation and Maintenance Wage Survey; Report of Additional Classification and Wage Rate AGENCY: Office of... proposal. The information is used by HUD to determine or adopt prevailing wage rates for maintenance...

Building Maintenance Management System for Heritage Museum

Directory of Open Access Journals (Sweden)

Md Azree Othuman Mydin

2012-09-01

Full Text Available An investment in the building maintenance aspect is massive throughout the world. In most of the countries, it signifies approximately 50% of the entire revenue of the construction industry. The value of buildings depends on the eminence of the maintenance invested in them. Maintenance management engages obtaining utmost advantage from the investment made on the maintenance activities. At the moment, maintenance in buildings in Malaysia is on the increase in spite of size, category, location, and ownership. This study focuses on Building Maintenance Management System for Heritage Museum, which consists of two case studies in Penang State Museum and Art Gallery, Malaysia and Museum of Perak, Malaysia. The aim of this study is to propose methods to improve the maintenance management system for heritage museum. From the results, the common problem occurs during the implementation for the maintenance of each building is the budget for the maintenance and worker’s skill. The department of each museum must have their own maintenance unit to keep an eye on the maintenance activities for their buildings in order to improve the maintenance management system in their building.

Unsurfaced Road Maintenance Management

Science.gov (United States)

1992-12-01

This draft manual describes an unsurfaced road maintenance management system for use on military installations. This system is available in either a manual or computerized mode (Micro PAVER). The maintenance standards prescribed should protect Govern...

Remote maintenance development for ITER

International Nuclear Information System (INIS)

Tada, Eisuke; Shibanuma, Kiyoshi

1998-01-01

This paper describes the overall ITER remote maintenance design concept developed mainly for in-vessel components such as diverters and blankets, and outlines the ITER R and D program to develop remote handling equipment and radiation hard components. Reactor structures inside the ITER cryostat must be maintained remotely due to DT operation, making remote handling technology basic to reactor design. The overall maintenance scenario and design concepts have been developed, and maintenance design feasibility, including fabrication and testing of full-scale in-vessel remote maintenance handling equipment and tool, is being verified. (author)

Remote maintenance development for ITER

Energy Technology Data Exchange (ETDEWEB)

Tada, Eisuke [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment; Shibanuma, Kiyoshi

1998-04-01

This paper describes the overall ITER remote maintenance design concept developed mainly for in-vessel components such as diverters and blankets, and outlines the ITER R and D program to develop remote handling equipment and radiation hard components. Reactor structures inside the ITER cryostat must be maintained remotely due to DT operation, making remote handling technology basic to reactor design. The overall maintenance scenario and design concepts have been developed, and maintenance design feasibility, including fabrication and testing of full-scale in-vessel remote maintenance handling equipment and tool, is being verified. (author)

Relationship Maintenance on Facebook: Development of a Measure, Relationship to General Maintenance, and Relationship Satisfaction

Science.gov (United States)

Dainton, Marianne

2013-01-01

Previous research indicates that the primary reason college students use Facebook is for relationship maintenance. The present study sought to determine the relationship between Facebook maintenance and general maintenance efforts in college student romantic relationships, as well as the impacts of such behaviors on the relationship. Survey data…

Variation in consumption of human milk oligosaccharides by infant gut-associated strains of Bifidobacterium breve.

Science.gov (United States)

Ruiz-Moyano, Santiago; Totten, Sarah M; Garrido, Daniel A; Smilowitz, Jennifer T; German, J Bruce; Lebrilla, Carlito B; Mills, David A

2013-10-01

Human milk contains a high concentration of complex oligosaccharides that influence the composition of the intestinal microbiota in breast-fed infants. Previous studies have indicated that select species such as Bifidobacterium longum subsp. infantis and Bifidobacterium bifidum can utilize human milk oligosaccharides (HMO) in vitro as the sole carbon source, while the relatively few B. longum subsp. longum and Bifidobacterium breve isolates tested appear less adapted to these substrates. Considering the high frequency at which B. breve is isolated from breast-fed infant feces, we postulated that some B. breve strains can more vigorously consume HMO and thus are enriched in the breast-fed infant gastrointestinal tract. To examine this, a number of B. breve isolates from breast-fed infant feces were characterized for the presence of different glycosyl hydrolases that participate in HMO utilization, as well as by their ability to grow on HMO or specific HMO species such as lacto-N-tetraose (LNT) and fucosyllactose. All B. breve strains showed high levels of growth on LNT and lacto-N-neotetraose (LNnT), and, in general, growth on total HMO was moderate for most of the strains, with several strain differences. Growth and consumption of fucosylated HMO were strain dependent, mostly in isolates possessing a glycosyl hydrolase family 29 α-fucosidase. Glycoprofiling of the spent supernatant after HMO fermentation by select strains revealed that all B. breve strains can utilize sialylated HMO to a certain extent, especially sialyl-lacto-N-tetraose. Interestingly, this specific oligosaccharide was depleted before neutral LNT by strain SC95. In aggregate, this work indicates that the HMO consumption phenotype in B. breve is variable; however, some strains display specific adaptations to these substrates, enabling more vigorous consumption of fucosylated and sialylated HMO. These results provide a rationale for the predominance of this species in breast-fed infant feces and

Maintenance of nuclear power plants

International Nuclear Information System (INIS)

Migaud, D.; Hutin, J.P.; Jouette, I.; Eymond, P.; Devie, P.; Cudelou, C.; Magnier, S.; Frydman, M.

2016-01-01

This document gathers different articles concerning the maintenance of the French nuclear power plants. The first article analyses the impact of the recent law on the energetic transition that sets the share of nuclear power at 50% of the electricity produced by 2025. A consequence may be the decommissioning of 17 to 20 reactors by 2025 and the huge maintenance program called 'Grand Carenage' whose aim is to extend operating life over 40 years will have to be re-considered in order to avoid useless expenses. The second article shows that in 2015 the French nuclear reactor fleet got very good results in terms of availability and safety. There were 49 scheduled outages and among them some ended ahead of time. The third article describes the specificities of the maintenance of a nuclear power plant, for instance the redundancy of some systems implies that maintenance has to deal with systems that have never functioned but must be ready to operate at any moment. Another specificity is the complexity of a nuclear power plant that implies an essential phase of preparation for maintenance operations. Because of safety requirements any maintenance operation has to be controlled, checked and may provide feedback. The fourth article presents the 'Grand Carenage' maintenance program that involves the following operations: the replacement of steam generators, the re-tubing of condensers, the replacement of the filtering drums used for cooling water, the testing of the reactor building, the hydraulic test of the primary circuit and the inspection of the reactor vessel. The fifth article focuses on the organization of the work-site for maintenance operations and the example of the Belleville-sur-Loire is described in the sixth article. Important maintenance operations like 'Grand Carenage' requires a strong collaboration with a network of specialized enterprises and as no reactor (except Flamanville EPR) is being built in France, maintenance

Maintenance manual. Vol. 1. Maintenance management; 2. completely rev. ed.; Handbuch Instandhaltung. Bd. 1. Instandhaltungsmanagement

Energy Technology Data Exchange (ETDEWEB)

Warnecke, H.J. [ed.] [Fraunhofer-Institut fuer Produktionstechnik und Automatisierung (IPA), Stuttgart (Germany)

1992-12-31

This manual is the second, completely revised edition of the standard manual ``Maintenance - Fundamentals``, which was first published in 1981. It presents an outline of all relevant fields of maintenance today and contains practical information on new and established methods of maintenance management and technology. With its comprehensive concept, which addresses any industrial enterprise that wants to remain competitive, the manual is indispensable for maintenance managers in industry, service enterprises and consultancies. Vol.1, ``Maintenance Management``, informs the reader on fundamentals, design with a view to maintenance, organisation of maintenance work, personnel management, industrial safety and economic aspects of maintenance. Current issues such as product liability, electronic data processing, expert systems, environmental protection, controlling based on characteristic data, etc. are gone into. Graphical representations, concrete procedural information and exemplary solutions may be used directly as working tools for the practice of maintenance. (orig.) [Deutsch] Das vorliegende Handbuch ist die zweite, voellig ueberarbeitete und erweiterte Auflage des Standardwerkes ``Instandhaltung - Grundlagen``, das 1981 erstmals erschien. Es gibt einen Ueberblick ueber alle relevanten Gebiete einer modernen Instandhaltung und vermittelt praxisnahes Wissen ueber neue und bewaehrte Methoden und Verfahren des Instandhaltungsmanagements und der Instandhaltungstechnik. Mit dieser umfassenden Konzeption, die auf die Belange des im Wettbewerb stehenden Industriebetriebes ausgerichtet ist, wendet sich das Handbuch an die Fuehrungskraefte der Instandhaltung in der Industrie sowie an Dienstleistungs- und Beratungsunternehmen. Im Band 1 ``Instandhaltungsmanagement`` kann sich der Leser ueber Grundlagen, instandhaltungsgerechtes Konstruieren, Organisation der Instandhaltung, Personalmanagement, Arbeitssicherheit sowie Wirtschaftlichkeit der Instandhaltung informieren

Winter maintenance performance measure.

Science.gov (United States)

2016-01-01

The Winter Performance Index is a method of quantifying winter storm events and the DOTs response to them. : It is a valuable tool for evaluating the States maintenance practices, performing post-storm analysis, training : maintenance personnel...

Space Telescope maintenance and refurbishment

Science.gov (United States)

Trucks, H. F.

1983-01-01

The Space Telescope (ST) represents a new concept regarding spaceborne astronomical observatories. Maintenance crews will be brought to the orbital worksite to make repairs and replace scientific instruments. For major overhauls the telescope can be temporarily returned to earth with the aid of the Shuttle. It will, thus, be possible to conduct astronomical studies with the ST for two decades or more. The five first-generation scientific instruments used with the ST include a wide field/planetary camera, a faint object camera, a faint object spectrograph, a high resolution spectrograph, and a high speed photometer. Attention is given to the optical telescope assembly, the support systems module, aspects of mission and science operations, unscheduled maintenance, contingency orbital maintenance, planned on-orbit maintenance, ground maintenance, ground refurbishment, and ground logistics.

Development of divertor remote maintenance system

Energy Technology Data Exchange (ETDEWEB)

Takeda, Nobukazu; Oka, Kiyoshi; Akou, Kentaro; Takiguchi, Yuji [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

1998-04-01

The ITER divertor is categorized as a scheduled maintenance component because of extreme heat and particle loads it is exposed to by plasma. It is also highly activated by 14 MeV neutrons. Reliable remote handling equipment and tools are required for divertor maintenance under intense gamma radiation. To facilitate remote maintenance, the divertor is segmented into 60 cassettes, and each cassette weighing about 25 tons and maintained and replaced through four maintenance ports each 90 degrees. Divertor cassettes must be transported toroidally and radially for replacement through maintenance ports. Remote handling involving cassette movers and carriers for toroidal and radial transport has been developed. Under the ITER R and D program, technology critical to divertor cassette maintenance is being developed jointly by Japan, E.U., and U.S. home teams. This paper summarizes divertor remote maintenance design and the status of technology development by the Japan Home Team. (author)

Development of divertor remote maintenance system

International Nuclear Information System (INIS)

Takeda, Nobukazu; Oka, Kiyoshi; Akou, Kentaro; Takiguchi, Yuji

1998-01-01

The ITER divertor is categorized as a scheduled maintenance component because of extreme heat and particle loads it is exposed to by plasma. It is also highly activated by 14 MeV neutrons. Reliable remote handling equipment and tools are required for divertor maintenance under intense gamma radiation. To facilitate remote maintenance, the divertor is segmented into 60 cassettes, and each cassette weighing about 25 tons and maintained and replaced through four maintenance ports each 90 degrees. Divertor cassettes must be transported toroidally and radially for replacement through maintenance ports. Remote handling involving cassette movers and carriers for toroidal and radial transport has been developed. Under the ITER R and D program, technology critical to divertor cassette maintenance is being developed jointly by Japan, E.U., and U.S. home teams. This paper summarizes divertor remote maintenance design and the status of technology development by the Japan Home Team. (author)

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of a health claim related to monacolin K in SYLVAN BIO red yeast rice and maintenance of normal blood LDL - cholesterol concentrations pursuant to Article 13(5) of Regulation (EC) No 1924/2006

DEFF Research Database (Denmark)

Tetens, Inge

on the scientific substantiation of a health claim related to monacolin K in SYLVAN BIO red yeast rice and maintenance of normal blood LDL-cholesterol concentrations. The food, monacolin K in SYLVAN BIO red yeast rice, that is the subject of the health claim is sufficiently characterised. The claimed effect......, maintenance of normal blood LDL-cholesterol concentrations, is a beneficial physiological effect. A claim on monacolin K from red yeast rice and maintenance of normal blood LDL-cholesterol concentrations has already been assessed with a favourable outcome at daily intakes of 10 mg monacolin K from any red...... on blood LDL-cholesterol concentrations. © European Food Safety Authority, 2013...

Optimizing preventive maintenance

International Nuclear Information System (INIS)

DiCola, F.E.

1988-01-01

The traditional approach to preventive maintenance (PM) is based on adherence to manufacturers's requirements and recommended frequencies. When equipment fails, either new procedures are established or the frequency is increased. This leads to an increase in the number of PM activities, overloading not only maintenance resources, but support as well. There is no correlation between more PM and an increase in equipment reliability. More PM may actually induce failures. Reliability-centered maintenance, a new concept in utility maintenance, is based on identifying system/subsystem functions, failures, and dominant failure modes to develop or revise PM tasks. The activities described in this paper are based on actual implementation of this concept on an ongoing project to upgrade the PM program at one of the largest electric utilities in the country. Optimum PM activities are those that, when implemented, will minimize factors that c cause equipment to fail. One technique described illustrates how equipment performance, failure modes, and causes can be related to minimize the occurrence of failures. Operating history and service life of a component are key factors in determining the most effective PM activities, provided that the factors are related to failure modes and causes

Maintenance for life management

International Nuclear Information System (INIS)

Hevia, F.

1997-01-01

Life Management is based on the detection, monitoring and control of long-term degradation that affects individual plant components and important populations. Experience has shown that in many cases current maintenance practices do not attend to ageing directly; instead they deal with the consequences when it is already too late, when good Life Management is no longer practical. This has brought about the need for specific Maintenance Evaluation and Improvement Programmes to adjust to the basic objective of Life Management which is to project against, monitor and mitigate ageing that can affect the safe and profitable operating life of the facility. New regulatory requirements for ageing monitoring and effective maintenance to ensure safety (Maintenance Rule) have made it even more necessary to implement the Maintenance Evaluation Programme to cope with ageing, and to integrate that tasks in both programmes to optimise effort and use of tools. This paper presents a brief description of the objectives and methodologies of these Programmes which has been applied to plants around the world and in Spain at the Garona and Vandellos II plants in Spain as part of the PIE project for developing a Remanent Life Evaluation System for nuclear power plants. (Author)

Maintenance training centre at NPP Paks, Hungary

International Nuclear Information System (INIS)

Babos, K.

1996-01-01

The lecture shows the feature of WWER-440/213 units maintenance, the existing maintenance training system, the necessity of the change in maintenance training system at NPP Paks. The author introduces the would-be maintenance training centre, the training facilities and the main tasks related to the maintenance training. (author)

[Cost-effectiveness of Antipsychotics in the Maintenance Treatment of Schizophrenia in Colombia].

Science.gov (United States)

Quitian Reyes, Hoover; Arciniegas Barrera, Jair Alberto; Bohórquez Peñaranda, Adriana; Gómez Restrepo, Carlos

2016-01-01

Assess the cost-effectiveness of the antipsychotics for treatment of schizophrenia. A five-year Markov model was built form patients with schizophrenia on the stage of maintenance. Costs were taken from the perspective of the Colombian health care system (Sistema General de Seguridad Social en Salud). The effectiveness was measured in years of life under the same maintenance plan. The Markov model indicated clozapine as the as the most cost-effective alternative between the first line antipsychotics and haloperidol is it when comparing other antipsychotics. Clozapine it's the cost-effectiveness strategy among the first line of antipsychotics and haloperidol is it among the other antipsychotics. Strategies prioritizing the use of cost-effective antipsychotics could improve the resources allocation in the Colombian health care system. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Maintenance Support System Development for Maintenance Personnel in Nuclear Power Plants

International Nuclear Information System (INIS)

Yim, Ho Bin; Kim, In; Lee, Seung Min; Seong, Poong Hyun

2009-01-01

As plants or factories get old, the number of maintenance activities increases, and so does the necessity of maintenance itself. Industries have adopted the latest technologies such as RFID, wireless sensor networking, and augmented reality to develop systems which increase human performances as well as productivity. Due to safety related concerns, nuclear power industries have been reluctant to use these fancy technologies. However, from the economics point of view, it is necessary to take advantages of novel technologies. This empirical study considers not only ergonomics view, but also the economics view when building maintenance support systems. This paper introduces brief features of five subsystems which were built to reduce human errors and advantages when each system successfully reduces those human errors

Maintenance Support System Development for Maintenance Personnel in Nuclear Power Plants

Energy Technology Data Exchange (ETDEWEB)

Yim, Ho Bin; Kim, In; Lee, Seung Min; Seong, Poong Hyun [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)

2009-05-15

As plants or factories get old, the number of maintenance activities increases, and so does the necessity of maintenance itself. Industries have adopted the latest technologies such as RFID, wireless sensor networking, and augmented reality to develop systems which increase human performances as well as productivity. Due to safety related concerns, nuclear power industries have been reluctant to use these fancy technologies. However, from the economics point of view, it is necessary to take advantages of novel technologies. This empirical study considers not only ergonomics view, but also the economics view when building maintenance support systems. This paper introduces brief features of five subsystems which were built to reduce human errors and advantages when each system successfully reduces those human errors.

Walking a single path with spirit over maintenance for the past two decades

International Nuclear Information System (INIS)

2004-04-01

This book reports the 20 years history of KPS. It is divided into fire chapters, which describes history of power, development of power industry in Korea, establishment of Hana Company, the first maintenance company, early business and establishment of KEPCO, effort for management and independence for technology, man power management, establishment of Korea plant service and Engineering CO. LTD, effort for the accumulation of technology and extension of business, growth as the technical company for generation of electricity and maintenance, management innovation safety and health policy and management ethics.

Space station orbit maintenance

Science.gov (United States)

Kaplan, D. I.; Jones, R. M.

1983-01-01

The orbit maintenance problem is examined for two low-earth-orbiting space station concepts - the large, manned Space Operations Center (SOC) and the smaller, unmanned Science and Applications Space Platform (SASP). Atmospheric drag forces are calculated, and circular orbit altitudes are selected to assure a 90 day decay period in the event of catastrophic propulsion system failure. Several thrusting strategies for orbit maintenance are discussed. Various chemical and electric propulsion systems for orbit maintenance are compared on the basis of propellant resupply requirements, power requirements, Shuttle launch costs, and technology readiness.

Nuclear power plants maintenance

International Nuclear Information System (INIS)

Anon.

1988-01-01

Nuclear power plants maintenance now appears as an important factor contributing to the competitivity of nuclea energy. The articles published in this issue describe the way maintenance has been organized in France and how it led to an actual industrial activity developing and providing products and services. An information note about Georges Besse uranium enrichment plant (Eurodif) recalls that maintenance has become a main data not only for power plants but for all nuclear industry installations. (The second part of this dossier will be published in the next issue: vol. 1 January-February 1989) [fr

A STEPPING STONE TOWARDS KNOWLEDGE BASED MAINTENANCE

Directory of Open Access Journals (Sweden)

G. Waeyenbergh

2012-01-01

Full Text Available Maintenance decision making becomes more and more a management concern. Some decades ago, maintenance was still often considered as an unavoidable side effect of production. The perception of maintenance has evolved considerably. One of the current issues is the maintenance concept, being the mix of maintenance interventions and the general framework for determining this mix. In this paper we describe a modular framework, called Knowledge Based Maintenance, for developing a customised maintenance concept. After describing the general framework and its decision support use, some case experiences are given. This experience covers some elements of the proposed framework.

Remote maintenance development for ITER

International Nuclear Information System (INIS)

Tada, Eisuke; Shibanuma, Kiyoshi

1997-01-01

This paper both describes the overall design concept of the ITER remote maintenance system, which has been developed mainly for use with in-vessel components such as divertor and blanket, and outlines of the ITER R and D program, which has been established to develop remote handling equipment/tools and radiation hard components. In ITER, the reactor structures inside cryostat have to be maintained remotely because of activation due to DT operation. Therefore, remote-handling technology is fundamental, and the reactor-structure design must be made consistent with remote maintainability. The overall maintenance scenario and design concepts of the required remote handling equipment/tools have been developed according to their maintenance classification. Technologies are also being developed to verify the feasibility of the maintenance design and include fabrication and testing of a fullscale remote-handling equipment/tools for in-vessel maintenance. (author)

Lean thinking for a maintenance process

Directory of Open Access Journals (Sweden)

Sherif Mostafa

2015-01-01

Full Text Available The maintenance process shares significant operating costs in an organisation. Lean thinking can be incorporated into maintenance activities through applying its principles and practices/tools. Lean maintenance (LM is a prerequisite for lean manufacturing systems. This research proposes a new structure for LM process based on a systematic literature review of a significant number of related articles that were published on LM. The process structure is designed based on the five lean principles to guide and support organisations to pursue maintenance excellence. This study establishes a scheme for LM tools that are structured into 2 level 4 bundles and 26 lean practices/tools and develops a House of Waste (HoW to demonstrate the association between maintenance wastes and the LM tools. With a successful accomplishment of the proposed scheme, the performance of a maintenance department can create more improvement opportunities over time to reach the maintenance excellence status.

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of health claims related to glycaemic carbohydrates and maintenance of normal brain function (ID 603, 653) pursuant to Article 13(1) of Regulation (EC) No 1924/2006

DEFF Research Database (Denmark)

Tetens, Inge

; attention; memory”. The target population is assumed to be the general population. In the context of the proposed wordings, the Panel assumes that the claimed effects refer to the maintenance of normal brain function. The Panel considers that maintenance of normal brain function is a beneficial...... claims in relation to glycaemic carbohydrates and maintenance of normal brain function. The scientific substantiation is based on the information provided by the Member States in the consolidated list of Article 13 health claims and references that EFSA has received from Member States or directly from...

Estimativa por DSC das entalpias de sublimação da etilenouréia e da propilenouréia: algumas correlações empíricas envolvendo amidas e tioamidas Estimative by DSC data of the sublimation enthalpies for ethyleneurea and propyleneurea: some empirical correlations with amides and tioamides

Directory of Open Access Journals (Sweden)

Robson Fernandes de Farias

1999-07-01

Full Text Available By using DSC data, the enthaplies of sublimation for ethyleneurea and propyleneurea, are calculated as 84 and 89 kJ mol-1 respectively. Using the vaporization enthalpy values for dimethylethyleneurea and dimethylprophyleneurea, as obtained from literature, the empirical relation: Dcrg Hmo (1/ Dcrg Hmo (2 = Dlg Hmo (1/ Dlg Hmo(2 = constant, that relate sublimation or vaporization enthalpies of two different substances and of its methylated derivatives, is obtained. Correlations like that are found to another ureas and thioureas.

Developing optimized prioritizing road maintenance

Directory of Open Access Journals (Sweden)

Ewadh Hussein Ali

2018-01-01

Full Text Available Increased demand for efficient maintenance of the existing roadway system needs optimal usage of the allocated funds. The paper demonstrates optimized methods for prioritizing maintenance implementation projects. A selected zone of roadway system in Kerbala city represents the study area to demonstrate the application of the developed prioritization process. Paver system PAVER integrated with GIS is used to estimate and display the pavement condition index PCI, thereby to establish a priority of maintenance. In addition to simple ranking method by PCI produced by the output of PAVER, the paper introduces PCI measure for each section of roadway. The paper introduces ranking by multiple measures investigated through expert knowledge about measures that affect prioritization and their irrespective weights due to a predesigned questionnaire. The maintenance priority index (MPI is related to cost of suitable proposed maintenance, easiness of proposed maintenance, average daily traffic and functional classification of the roadway in addition to PCI. Further, incremental benefit-cost analysis ranking provide an optimized process due to benefit and cost of maintenance. The paper introduces efficient display of layout and ranking for the selected zone of roadway system based on MPI index and incremental BCR method. Although the two developed methods introduce different layout display for priority, statistical test shows that no significant difference between ranking of all methods of prioritization.

340 Facility maintenance implementation plan

International Nuclear Information System (INIS)

1995-03-01

This Maintenance Implementation Plan (MIP) has been developed for maintenance functions associated with the 340 Facility. This plan is developed from the guidelines presented by Department of Energy (DOE) Order 4330.4B, Maintenance Management Program (DOE 1994), Chapter II. The objective of this plan is to provide baseline information for establishing and identifying Westinghouse Hanford Company (WHC) conformance programs and policies applicable to implementation of DOE order 4330.4B guidelines. In addition, this maintenance plan identifies the actions necessary to develop a cost-effective and efficient maintenance program at the 340 Facility. Primary responsibility for the performance and oversight of maintenance activities at the 340 Facility resides with Westinghouse Hanford Company (WHC). Maintenance at the 340 Facility is performed by ICF-Kaiser Hanford (ICF-KH) South Programmatic Services crafts persons. This 340 Facility MIP provides interface requirements and responsibilities as they apply specifically to the 340 Facility. This document provides an implementation schedule which has been developed for items considered to be deficient or in need of improvement. The discussion sections, as applied to implementation at the 340 Facility, have been developed from a review of programs and practices utilizing the graded approach. Biennial review and additional reviews are conducted as significant programmatic and mission changes are made. This document is revised as necessary to maintain compliance with DOE requirements

340 Facility maintenance implementation plan

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-03-01

This Maintenance Implementation Plan (MIP) has been developed for maintenance functions associated with the 340 Facility. This plan is developed from the guidelines presented by Department of Energy (DOE) Order 4330.4B, Maintenance Management Program (DOE 1994), Chapter II. The objective of this plan is to provide baseline information for establishing and identifying Westinghouse Hanford Company (WHC) conformance programs and policies applicable to implementation of DOE order 4330.4B guidelines. In addition, this maintenance plan identifies the actions necessary to develop a cost-effective and efficient maintenance program at the 340 Facility. Primary responsibility for the performance and oversight of maintenance activities at the 340 Facility resides with Westinghouse Hanford Company (WHC). Maintenance at the 340 Facility is performed by ICF-Kaiser Hanford (ICF-KH) South Programmatic Services crafts persons. This 340 Facility MIP provides interface requirements and responsibilities as they apply specifically to the 340 Facility. This document provides an implementation schedule which has been developed for items considered to be deficient or in need of improvement. The discussion sections, as applied to implementation at the 340 Facility, have been developed from a review of programs and practices utilizing the graded approach. Biennial review and additional reviews are conducted as significant programmatic and mission changes are made. This document is revised as necessary to maintain compliance with DOE requirements.

Reliability-based maintenance evaluations and standard preventive maintenance programs

International Nuclear Information System (INIS)

Varno, M.; McKinley, M.

1993-01-01

Due to recent issuance of 10CFR50.65, the U.S. Nuclear Regulatory Commission maintenance rule (Rule), and the open-quotes Industry Guideline for Monitoring the Effectiveness of Maintenance at Nuclear Power Plantsclose quotes prepared by the Nuclear Management and Resources Council, many utilities are undertaking review or evaluation of current preventive maintenance (PM) programs. Although PM optimization and documentation are not specifically required by the Rule, an appropriate and effective PM program (PMP) will be the cornerstone of the successful and cost-effective implementation of the Rule. Currently, a project is being conducted at the Vermont Yankee Nuclear Power Station (VYNPS) in conjunction with Quadrex Energy Services to evaluate, optimize, and document the PMP. The project began in March 1993 and is scheduled for completion in mid-1995. The initial scope for the project is the evaluation of those structures, systems, and components that are within the scope of the Rule. Because of the number of systems to be evaluated (∼50), the desired completion schedule, and cost considerations, a streamlined approach to PM optimization and documentation is being utilized

Black tea and maintenance of normal endotheliumdependent vasodilation: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006

DEFF Research Database (Denmark)

Sjödin, Anders Mikael

2018-01-01

on the scientific substantiation of a health claim related to black tea and maintenance of normal endotheliumdependent vasodilation. The scope of the application was proposed to fall under a health claim based on newly developed scientific evidence. The food proposed by the applicant as the subject of the health...... claim is black tea beverages, either freshly prepared or reconstituted from water extract powders of black tea, characterised by the content of flavanols (expressed as catechins plus theaflavins) of at least 30 mg per 200 mL serving. The Panel considers that black tea characterised by the content....... Of the five human intervention studies provided on the chronic effect of black tea consumption on endothelium-dependent vasodilation, two investigated the effect after regular consumption of black tea for a sufficiently long time period (i.e. at least 4 weeks). These two studies did not allow an effect...

The impact of the fee-for-service reimbursement system on the ...

African Journals Online (AJOL)

three medical aid schemes in which providers are paid on a fee-far-service basis. ... The majority of health care providers in the private sector in. South Mrica are ... hospital, which bills the HMO for all services and accommo- dation expenses.

Glossary of Managed Care Definitions

Science.gov (United States)

... or treatment provided to a plan member. Coverage : decision making process that identifies what services or products are ... themselves and pay a monthly premium for it. Mental health care : medical ... abuse. Mixed model or network HMO : a managed care plan that ...

Nuclear maintenance strategy and first steps for preliminary maintenance plan of the EU HCLL & HCPB Test Blanket Systems

Energy Technology Data Exchange (ETDEWEB)

Galabert, Jose, E-mail: jose.galabert@f4e.europa.eu [F4E Fusion for Energy, EU Domestic Agency, c/Josep Pla, 2. B3, 08019, Barcelona (Spain); Hopper, Dave [AMEC Foster Wheeler, Faraday Street, Birchwood Park, WA3 6GN (United Kingdom); Neviere, Jean-Cristophe [ITER Organization, Route de Vinon-sur-Verdon, CS 90046, 13067, St. Paul Lez Durance Cedex (France); Nodwell, David [CCFE, Culham Science Centre, Abingdon, OX14 3DB, Oxfordshire (United Kingdom); Pascal, Romain [ITER Organization, Route de Vinon-sur-Verdon, CS 90046, 13067, St. Paul Lez Durance Cedex (France); Poitevin, Yves; Ricapito, Italo [F4E Fusion for Energy, EU Domestic Agency, c/Josep Pla, 2. B3, 08019, Barcelona (Spain); White, Gareth [AMEC Foster Wheeler, Faraday Street, Birchwood Park, WA3 6GN (United Kingdom)

2017-03-15

Highlights: • Nuclear maintenance strategy for the two European (EU) Test Blanket Systems (TBS): i/. Helium Cooled Lead Lithium (HCLL) and ii/. Helium Cooled Pebble Bed (HCPB). • Preliminary identification of maintenance tasks for most relevant components of the EU HCLL & HCPB TBS. • Preliminary feasibility analysis for hands-on maintenance tasks of some relevant components of the European Test Blanket Systems. • Design recommendations for enhancement of the European Test Blanket Systems maintainability. - Abstract: This paper gives an overview of nuclear maintenance strategy to be followed for the European HCLL & HCPB Test Blanket Systems (TBS) to be installed in ITER. One of the several core documents to prepare in view of their licensing is their respective ‘Maintenance Plan’. This document is fundamental for ensuring sound performance and safety of the TBS during ITER’s operational phase and shall include, amongst others, relevant information on: maintenance organization, preventive and corrective maintenance task procedures, condition monitoring for key components, maintenance work planning, and a spare parts plan, just to mention some of the key topics. In compliance with the ITER Plant Maintenance policy, first steps have been taken aimed at defining nuclear maintenance strategy for some of the most relevant HCLL & HCPB TBS components, conducted by F4E in collaboration with industry. After a brief recall of maintenance strategy of the TBM Program (PBS-56), this paper analyses main features of EU HCLL & HCPB TBS maintainability and identifies, at their conceptual design phase, a preliminary list of maintenance tasks to be developed for their most representative components. In addition, the paper also presents the first nuclear maintenance studies conducted for replacement of the Q{sub 2} Getter Beds, identifying some design recommendations for their sound maintainability.

Nuclear maintenance strategy and first steps for preliminary maintenance plan of the EU HCLL & HCPB Test Blanket Systems

International Nuclear Information System (INIS)

Galabert, Jose; Hopper, Dave; Neviere, Jean-Cristophe; Nodwell, David; Pascal, Romain; Poitevin, Yves; Ricapito, Italo; White, Gareth

2017-01-01

Highlights: • Nuclear maintenance strategy for the two European (EU) Test Blanket Systems (TBS): i/. Helium Cooled Lead Lithium (HCLL) and ii/. Helium Cooled Pebble Bed (HCPB). • Preliminary identification of maintenance tasks for most relevant components of the EU HCLL & HCPB TBS. • Preliminary feasibility analysis for hands-on maintenance tasks of some relevant components of the European Test Blanket Systems. • Design recommendations for enhancement of the European Test Blanket Systems maintainability. - Abstract: This paper gives an overview of nuclear maintenance strategy to be followed for the European HCLL & HCPB Test Blanket Systems (TBS) to be installed in ITER. One of the several core documents to prepare in view of their licensing is their respective ‘Maintenance Plan’. This document is fundamental for ensuring sound performance and safety of the TBS during ITER’s operational phase and shall include, amongst others, relevant information on: maintenance organization, preventive and corrective maintenance task procedures, condition monitoring for key components, maintenance work planning, and a spare parts plan, just to mention some of the key topics. In compliance with the ITER Plant Maintenance policy, first steps have been taken aimed at defining nuclear maintenance strategy for some of the most relevant HCLL & HCPB TBS components, conducted by F4E in collaboration with industry. After a brief recall of maintenance strategy of the TBM Program (PBS-56), this paper analyses main features of EU HCLL & HCPB TBS maintainability and identifies, at their conceptual design phase, a preliminary list of maintenance tasks to be developed for their most representative components. In addition, the paper also presents the first nuclear maintenance studies conducted for replacement of the Q_2 Getter Beds, identifying some design recommendations for their sound maintainability.

Excellence through maintenance mastering

International Nuclear Information System (INIS)

Lamarche, M.; Guillot, M.; Monier, M.

1987-01-01

To improve the overall availability factor of nuclear power plants you have to cut either the forced outage role and the planned outage time or you need to reduce simultaneously the failures and the efforts devoted to avoiding them. Among other results, this goal leads to a decrease in the number of real or anticipated problems. Electricite de France policy, in this matter, is to focus on decreasing the compoents' maintenance needs through a comprehensive modification program, targeted to eliminating the weak points as revealed by the operation. Thereby one may reach, for simple equipment, a nearly maintenance-free condition in which the only maintenance needed is surveillance, which provides assurance that everything is operating properly. A good example of this type of equipment is the family of static components, drums, and pipes whose corrective maintenance is almost nil when their initial condition is good

Electric motor predictive and preventive maintenance guide

International Nuclear Information System (INIS)

Oliver, J.A.

1992-07-01

Electric motor performance is vital to the reliable and efficient operation of power plants. The failure of one or more critical motors could cause lost capacity and excessive repair and maintenance cost. However, existing maintenance recommendations proposed by vendors for electric motors have sometimes encouraged many overly conservative maintenance practices. These practices have lead to excessive maintenance activities and costs which have provided no extra margin of operability. EPRI has sponsored RP2814-35 to develop a guide which provides power plants with information and guidance for establishing an effective maintenance program which will aid in preventing unexpected motor failures and assist in planning motor maintenance efforts. The guide includes a technical description which summarizes technical data relative to the four basic types of motors and their components in general use in power plants. The significant causes of motor failures are investigated and described in detail and methods to optimize service life and minimize maintenance cost through appropriate preventive maintenance and conditioning program are presented. This guide provides a foundation for an effective electric motor maintenance program and simplifies the selection of predictive and preventive maintenance tasks. Its use will enable maintenance personnel in nuclear and fossil plants to plan motor repairs during scheduled outages and avoid costly unexpected failures

The ITER remote maintenance system

International Nuclear Information System (INIS)

Tesini, A.; Palmer, J.

2008-01-01

The aim of this paper is to summarize the ITER approach to machine components maintenance. A major objective of the ITER project is to demonstrate that a future power producing fusion device can be maintained effectively and offer practical levels of plant availability. During its operational lifetime, many systems of the ITER machine will require maintenance and modification; this can be achieved using remote handling methods. The need for timely, safe and effective remote operations on a machine as complex as ITER and within one of the world's most hostile remote handling environments represents a major challenge at every level of the ITER Project organization, engineering and technology. The basic principles of fusion reactor maintenance are presented. An updated description of the ITER remote maintenance system is provided. This includes the maintenance equipment used inside the vacuum vessel, inside the hot cell and the hot cell itself. The correlation between the functions of the remote handling equipment, of the hot cell and of the radwaste processing system is also described. The paper concludes that ITER has equipped itself with a good platform to tackle the challenges presented by its own maintenance and upgrade needs

Digital maintenance field technology for the maintenance of nuclear power plant

International Nuclear Information System (INIS)

Sato, Tomomasa; Asama, Hajime; Kita, Nobuyuki; Numano, Masayoshi

2002-01-01

This paper proposes a concept of 'Digital Maintenance Field Technology', which enables human beings and working robots making fully use of the necessary information for maintenance activity not only in any location of the maintenance field (seamless in location) but also in any moment from the past to the future (seamless in time) and in any format in presenting to human (seamless in semantics). The paper points out the following three essential components of the technology: 1) 'Digital Field Construction Technology', 2) 'Digital Field Archival Technology' and 3) 'Digital Field Presentation Technology'. The necessary capabilities are extracted and our approaches and state of the art of realizing these capabilities are introduced in addition to present the state of the art of home application example. The future extension is also illustrated. (author)

Maintenance optimization after RCM

International Nuclear Information System (INIS)

Doyle, E.K.; Lee, C.-G.; Cho, D.

2005-01-01

Variant forms of RCM (Reliability Centered Maintenance) have been the maintenance optimizing tools of choice in industry for the last 20 years. Several such optimization techniques have been implemented at the Bruce Nuclear Station. Further cost refinement of the Station preventive maintenance strategy whereby decisions are based on statistical analysis of historical failure data are now being evaluated. The evaluation includes a requirement to demonstrate that earlier optimization projects have long term positive impacts. This proved to be a significant challenge. Eventually a methodology was developed using Crowe/AMSAA (Army Materials Systems Analysis Activity) plots to justify expenditures on further optimization efforts. (authors)

Strategy to maximize maintenance operation

OpenAIRE

Espinoza, Michael

2005-01-01

This project presents a strategic analysis to maximize maintenance operations in Alcan Kitimat Works in British Columbia. The project studies the role of maintenance in improving its overall maintenance performance. It provides strategic alternatives and specific recommendations addressing Kitimat Works key strategic issues and problems. A comprehensive industry and competitive analysis identifies the industry structure and its competitive forces. In the mature aluminium industry, the bargain...

Mobile Healthcare Applications and Gamification for Sustained Health Maintenance

Directory of Open Access Journals (Sweden)

Changjun Lee

2017-05-01

Full Text Available This paper examines how gamification affects user intention to use mobile healthcare applications (mHealth and how the effect of gamification works differently according to health status, age, and gender. We use data from a mobile survey conducted by a Korean representative survey agency. We estimate the effect of gamification on user intention to use mobile healthcare applications based on a structural equation model and examine the moderating effects of self-reported health status, age, and gender. We find that gamification is effective in increasing user intention to use mHealth, especially in the healthy and younger groups. These findings suggest that mHealth, with the gamification factor, would encourage healthy (but lack exercise people as well as unhealthy people to maintain their health status, and thus the mHealth developers need to consider the gamification factor when they develop mHealth services for healthy people.

eHealth Literacy and Health Behaviors Affecting Modern College Students: A Pilot Study of Issues Identified by the American College Health Association.

Science.gov (United States)

Britt, Rebecca Katherine; Collins, William Bart; Wilson, Kari; Linnemeier, Georgiann; Englebert, Andrew Mark

2017-12-19

The eHealth Literacy Scale (eHEALS) has been widely adopted by researchers to understand how eHealth literacy can be put into context. eHealth researchers need to know how to promote positive health behavior changes across college students, given the importance of the Internet to acquire and use health information. The American College Health Association identified a set of key health issues that affect college students today. By understanding how eHEALS might be related to college students' maintenance of their health and their use of online health resources, researchers will be provided with a better understanding of eHealth literacy and its pragmatic implications for health campaigns and future interventions. The goal of the study was to examine what eHEALS reveals about college student health behaviors identified by the American College Health Association. To understand college student current health maintenance and their intentions to maintain their health and use online resources, the theory of planned behavior was used as the theoretical framework for the study. Data were collected via a survey of 422 college students that included the eHEALS measure and questions about health issues based on the recommendations of the American College Health Association. These questions asked about college student current health, subsequent use of online health resources, and their intention to maintain their health and make use of such resources in the future. eHEALS was positively and significantly associated with all 8 areas of health issues identified by the American College Health Association for college student current maintenance of health and use of online health resources and for future intention of health maintenance and use of online resources. Key issues that emerged with eHealth literacy were maintaining safe sex practices and seeking out related information, seeking out information on an exercise regime, information on vaccinations, and maintaining a balanced

Maintenance evaluation using risk based criteria

International Nuclear Information System (INIS)

Torres Valle, A.

1996-01-01

The maintenance evaluation is currently performed by using economic and, in some case, technical equipment failure criteria, however this is done to a specific equipment level. In general, when statistics are used the analysis for maintenance optimization are made isolated and whit a post mortem character; The integration provided by mean of Probabilistic Safety assessment (PSA) together with the possibilities of its applications, allow for evaluation of maintenance on the basis of broader scope criteria in regard to those traditionally used. The evaluate maintenance using risk based criteria, is necessary to follow a dynamic and systematic approach, in studying the maintenance strategy, to allow for updating the initial probabilistic models, for including operational changes that often take place during operation of complex facilities. This paper proposes a dynamic evaluation system of maintenance task. The system is illustrated by means of a practical example

The Role of Stigma in Weight Loss Maintenance Among U.S. Adults.

Science.gov (United States)

Puhl, Rebecca M; Quinn, Diane M; Weisz, Bradley M; Suh, Young J

2017-10-01

Challenges of maintaining long-term weight loss are well-established and present significant obstacles in obesity prevention and treatment. A neglected but potentially important barrier to weight-loss maintenance is weight stigmatization. We examined the role of weight stigma-experienced and internalized-as a contributor to weight-loss maintenance and weight regain in adults. A diverse, national sample of 2702 American adults completed an online battery of questionnaires assessing demographics, weight-loss history, subjective weight category, experienced and internalized weight stigma, weight-monitoring behaviors, physical activity, perceived stress, and physical health. Analyses focused exclusively on participants who indicated that their body weight a year ago was at least 10% less than their highest weight ever (excluding pregnancy), the weight loss was intentional, and that attempts to lose or maintain weight occurred during the past year (n = 549). Participants were further classified as weight regainers (n = 235) or weight-loss maintainers (n = 314) based on subsequent weight loss/gain. Data were collected in 2015 and analyzed in 2016. Hierarchical logistic regression models showed that internalized weight stigma and subjective weight category made significant individual contributions to prediction of weight-loss maintenance, even after accounting for demographics, perceived stress, experienced stigma, physical health, and weight-loss behaviors. For every one-unit increase in internalized weight stigma, the odds of maintaining weight loss decreased by 28% (95% CI: 14-40%, p < .001). Findings provide initial evidence that overlooked psychosocial factors, like weight stigma, may hinder weight-loss maintenance. Implications for addressing stigma in obesity-focused clinical interventions are highlighted.

Weight loss maintenance in relation to locus of control: The MedWeight study.

Science.gov (United States)

Anastasiou, Costas A; Fappa, Evaggelia; Karfopoulou, Eleni; Gkza, Anastasia; Yannakoulia, Mary

2015-08-01

Locus of control, i.e. the degree of an individual's belief on the control of his/her life, has been related to many health outcomes, including weight loss in overweight/obese individuals. No information is available on the impact of locus of control in maintaining weight loss. We aimed to investigate the effect of locus of control in weight loss maintenance and explore potential associations with lifestyle factors. Study participants included 239 individuals (41% males) who had lost at least 10% of body weight in the past and either maintained the loss (maintainers: weight maintenance of at least 10% of initial weight) or regained it (regainers). Locus of control was defined by a relevant multi-dimensional scale; participants were categorised to internals and externals, based on "internal" and "others" sub-scales. A significant interaction was found between locus of control and weight loss maintenance status (p locus of control. Individualised treatment, according to locus of control, may increase weight loss maintenance rates in former overweight/obese individuals. Copyright © 2015 Elsevier Ltd. All rights reserved.

Maintenance: problem and solution

CERN Multimedia

CERN Bulletin

2012-01-01

Equipment that is often unique, machines that are as old as the Laboratory, continuous and demanding performance requirements: these are the challenges faced by CERN’s accelerator maintenance teams. There are some twenty such teams, attached to different departments. A new project aims to standardise their procedures to make their work easier, and you can be a part of it.   “For the past year or so, the Accelerator and Technologies Sector and the GS Department have been working together on identifying the needs of the different teams that perform maintenance on CERN’s equipment. We are now ready to provide computer support with detailed specifics about the processes that need to be set up,” explains Goran Perinić, one of the leaders in CERN’s new Maintenance Management project (MMP). Since the LHC entered operation, the responsibilities of the technical teams have been broadened to cover maintenance of the collider and that of its injectors...

RCM [reliability-centered maintenance] at Ginna: Preventive maintenance program optimization at year 20

International Nuclear Information System (INIS)

Edgar, E.C.

1989-01-01

The reliability-centered maintenance (RCM) program at Rochester Gas ampersand Electric Company's Ginna station is entering its second year. Of the 20 systems originally selected for evaluation, 10 are in various stages of completion, and recommendations resulting from the earliest systems studied are now being implemented. As expected, few major discoveries have been made in terms of preventive maintenance program failings or excesses. The performance of the now 20-yr-old plant has been excellent in recent years, and objectives focus more on ensuring continued high standards of safety, reliability, and economy than on maintenance program cost reduction

Machine maintenance: the rules of the game

CERN Multimedia

Antonella Del Rosso

2013-01-01

GCO, GMIO, GSPO – ever heard of them? These acronyms stand for the “roles” that best practices identify as vital to successful maintenance management. CERN’s Maintenance Management Project (MMP) team is working with the technical departments to ensure that they implement these procedures when they deal with the maintenance of the collider and its injectors and infrastructure.   The participants of the workshop on asset and maintenance management (AMMW2013), which took place at CERN in November. Since its creation in 2012, CERN’s Maintenance Framework Implementation Office (MFIO) has been promoting the deployment of harmonised maintenance management methods across the BE, GS, EN and TE Departments. “The definition and identification of the Group Coding Officers (GCO), Group Maintenance Information Officers (GMIO) and Group Spare Part Officers (GSPO) are one of the best practices that should be adopted each time a maintenance programme...

Enthalpy of formation of anisole: implications for the controversy on the O-H bond dissociation enthalpy in phenol.

Science.gov (United States)

Simões, Ricardo G; Agapito, Filipe; Diogo, Hermínio P; da Piedade, Manuel E Minas

2014-11-20

Significant discrepancies in the literature data for the enthalpy of formation of gaseous anisole, ΔfHmo(PhOCH3, g), have fueled an ongoing controversy regarding the most reliable enthalpy of formation of the phenoxy radical and of the gas phase O-H bond dissociation enthalpy, DHo(PhO-H), in phenol. In the present work ΔfHmo(PhOCH3, g) was reassessed using a combination of calorimetric determinations and high-level (W2-F12) ab initio calculations. Static-bomb combustion calorimetry led to the standard molar enthalpy of formation of liquid anisole at 298.15 K, ΔfHmo(PhOCH3, l) = −(117.1 ± 1.4) kJ·mol(-1). The corresponding enthalpy of vaporization was obtained as, ΔvapHmo(PhOCH3) = 46.41 ± 0.26 kJ·mol(-1), by Calvet-drop microcalorimetry. These results give ΔfHmo(PhOCH3, g) = −(70.7 ± 1.4) kJ·mol(-1), in excellent agreement with ΔfHmo(PhOCH3, g) = −(70.8 ± 3.2) kJ·mol(-1), obtained from the W2-F12 calculations. The ΔfHmo(PhOCH3, g) here recommended leads to ΔfHmo(PhO•, g) = 55.5 ± 2.4 kJ·mol(-)1 and DH°(PhO-H) = 368.1 ± 2.6 kJ·mol(-1).

Condition based maintenance pilot projects at Pickering ND

International Nuclear Information System (INIS)

Zemdegs, R.T.

1995-01-01

Ontario Hydro has recognized that the approaches to maintenance have undergone significant changes to the past decades. The traditional break down maintenance approach has been replaced by preventative maintenance and more recently, by condition based maintenance. The nuclear plants of Ontario Hydro have evaluated on a number of alternative programs to improve their maintenance effectiveness and to reduce costs, including Reliability Centred Maintenance (RCM), call-up review, component-based PM programs, analysis of failure history and so on. Pickering ND (nuclear division) and Ontario Hydro's Nuclear Technologies Services Division, have embarked on a Condition Based Maintenance pilot project to address the above issues as a breakthrough solution for smarter maintenance. The Condition Based Maintenance pilot project will demonstrate an end-to-end process utilizing a Reliability Centred Maintenance structured approach to re-engineer and redefine the existing maintenance programs. The project emphasizes on-condition maintenance where justified, and utilizes an information management tool to provide the required records keeping and analysis infrastructure. This paper briefly describes the planned maintenance model at Pickering ND used to guide the CBM pilot, and an overview of the methodology used to develop on-condition equipment indicators as part of a re-engineered maintenance plan

GRAPHICAL MODELS OF THE AIRCRAFT MAINTENANCE PROCESS

OpenAIRE

Stanislav Vladimirovich Daletskiy; Stanislav Stanislavovich Daletskiy

2017-01-01

The aircraft maintenance is realized by a rapid sequence of maintenance organizational and technical states, its re- search and analysis are carried out by statistical methods. The maintenance process concludes aircraft technical states con- nected with the objective patterns of technical qualities changes of the aircraft as a maintenance object and organizational states which determine the subjective organization and planning process of aircraft using. The objective maintenance pro- cess is ...

Structural health monitoring with a wireless vibration sensor network

NARCIS (Netherlands)

Basten, T.G.H.; Sas, P; Schiphorst, F.B.A.; Jonckheere, S.; Moens, D.

2012-01-01

Advanced maintenance strategies for infrastructure assets such as bridges or off shore wind turbines require actual and reliable information of the maintenance status. Structural health monitoring based on vibration sensing can help in supplying the input needed for structural health monitoring

Maintenance and Outage Management Assessment (MOMA)

International Nuclear Information System (INIS)

2005-01-01

The competitive environment has significant implications for nuclear power plant (NPP) operations, which include, inter alia, the need for efficient use of resources and effective management of plant activities of maintenance and outages. The purpose of NPP maintenance and outages is to allow NPPs to use all those functions necessary for safe and reliable power production by keeping them available and adequate maintenance programme is essential. The maintenance programme covers all preventive and remedial measures, both administrative and technical, necessary to identify and mitigate degradation of a functioning system, structure or component, or restore the design functions of a failed system, structure or component to an acceptable level. In response to the needs of MSs, NPES (Nuclear Power Section, Division of Nuclear Power, IAEA) plans to strengthen its services. NPES services will not only continue to provide its 'traditional' products of publications of nuclear industrial best practices and technical implementation of TC projects on plant maintenance and outage management, but also be expanded to deliver, in a timely manner, technical support missions as requested by MSs for NPPs. One of many services is Maintenance and Outage Management Assessment (MOMA). The NPP can obtain support and assistance in assessment and optimisation of its maintenance program and/or outage management. It aims to help the NPP improve its performance of maintenance and outage in a competitive nuclear power business environment. The specific benefits of the assessment are as follows: a) disseminate nuclear industrial best practices on maintenance program and outage management in the world, b) benchmark, evaluate and optimise the approach of maintenance program and outage management and c) identify solutions to known problems at nuclear power plants, if any. MOMA is conducted at the request of NPPs of any IAEA Member States. MOMA consists in a technical mission/visit for 1-3 weeks by

Shifting physician prescribing to a preferred histamine-2-receptor antagonist. Effects of a multifactorial intervention in a mixed-model health maintenance organization.

Science.gov (United States)

Brufsky, J W; Ross-Degnan, D; Calabrese, D; Gao, X; Soumerai, S B

1998-03-01

This study was undertaken to determine whether a program of education, therapeutic reevaluation of eligible patients, and performance feedback could shift prescribing to cimetidine from other histamine-2 receptor antagonists, which commonly are used in the management of ulcers and reflux, and reduce costs without increasing rates of ulcer-related hospital admissions. This study used an interrupted monthly time series with comparison series in a large mixed-model health maintenance organization. Physicians employed in health centers (staff model) and physicians in independent medical groups contracting to provide health maintenance organization services (group model) participated. The comparative percentage prescribed of specific histamine-2 receptor antagonists (market share), total histamine-2 receptor antagonist prescribing, cost per histamine-2 receptor antagonist prescription, and the rate of hospitalization for gastrointestinal illness were assessed. In the staff model, therapeutic reevaluation resulted in a sudden increase in market share of the preferred histamine-2 receptor antagonist cimetidine (+53.8%) and a sudden decrease in ranitidine (-44.7%) and famotidine (-4.8%); subsequently, cimetidine market share grew by 1.1% per month. In the group model, therapeutic reevaluation resulted in increased cimetidine market share (+9.7%) and decreased prescribing of other histamine-2 receptor antagonists (ranitidine -11.6%; famotidine -1.2%). Performance feedback did not result in further changes in prescribing in either setting. Use of omeprazole, an expensive alternative, essentially was unchanged by the interventions, as were overall histamine-2 receptor antagonist prescribing and hospital admissions for gastrointestinal illnesses. This intervention, which cost approximately $60,000 to implement, resulted in estimated annual savings in histamine-2 receptor antagonist expenditures of $1.06 million. Annual savings in histamine-2 receptor antagonist expenditures

Collaborative learning in condition based maintenance

NARCIS (Netherlands)

Koochaki, J.; Ao, SI; Gelman, L; Hukins, DWL; Hunter, A; Korsunsky, AM

2009-01-01

In recent years, the importance of reliable and consistent production equipments has increased. As a result, companies are shifting their maintenance policy from preventive maintenance towards Condition Based Maintenance (CBM). Despite the growing trend in this area and success stories of CBM

Maintenance Staffing Standards for Zero-Based Budgeting.

Science.gov (United States)

Adams, Matthew C.; And Others

1998-01-01

Discusses school preventive maintenance and the variables associated with maintenance staffing standards that address a zero-based budgeting environment. Explores preventive-maintenance measurement for staffing requirements, defines staffing levels and job descriptions, and outlines the factors to consider when creating a maintenance program and…

Human milk oligosaccharide effects on intestinal function and inflammation after preterm birth in pigs

DEFF Research Database (Denmark)

Rasmussen, Stine O.; Martin, Lena; Østergaard, Mette V.

2017-01-01

(IF) improves intestinal function, bacterial colonization and NEC resistance immediately after preterm birth, as tested in a preterm pig model. Mixtures of HMOs were investigated in intestinal epithelial cells and in preterm pigs (n=112) fed IF supplemented without (CON) or with a mixture of four HMOs...... (4-HMO) or >25 HMOs (25-HMO, 5-10 g/L given for 5 or 11 days). The 25-HMO blend decreased cell proliferation and both HMO blends decreased lipopolysaccharide-induced interleukin-8 secretion in IPEC-J2 cells, relative to control (P

Mobile network maintenance (GSM)

CERN Multimedia

IT Department

2009-01-01

Maintenance work will be carried out on the CERN mobile network infrastructure (GSM) on the 23 and 24 July from 6 p.m. to 6 a.m. in order to replace discontinued equipment and to increase the bandwidth capacity of the GSM mobile network. All CERN GSM emitters (40 units) will be moved one by one to the new infrastructure during the maintenance. The call of a user connected to an emitter at the time of its maintenance will be cut off. However, the general overlapping of the GSM radio coverage should mean that users are able immediately to call again should their call be interrupted. IT/CS/CS

Initiating statistical maintenance optimization

International Nuclear Information System (INIS)

Doyle, E. Kevin; Tuomi, Vesa; Rowley, Ian

2007-01-01

Since the 1980 s maintenance optimization has been centered around various formulations of Reliability Centered Maintenance (RCM). Several such optimization techniques have been implemented at the Bruce Nuclear Station. Further cost refinement of the Station preventive maintenance strategy includes evaluation of statistical optimization techniques. A review of successful pilot efforts in this direction is provided as well as initial work with graphical analysis. The present situation reguarding data sourcing, the principle impediment to use of stochastic methods in previous years, is discussed. The use of Crowe/AMSAA (Army Materials Systems Analysis Activity) plots is demonstrated from the point of view of justifying expenditures in optimization efforts. (author)

Sensor/signal monitoring and plant maintenance