Alabama statewide mobility report, 2014.

Science.gov (United States)

2015-09-01

This Alabama Statewide Mobility Report for 2014 is a new way to analyze interstate mobility performance over an entire year. Over half a billion speed records were acquired, stored, and analyzed for this report. These observations capture recurring c...

Statewide mesoscopic simulation for Wyoming.

Science.gov (United States)

2013-10-01

This study developed a mesoscopic simulator which is capable of representing both city-level and statewide roadway : networks. The key feature of such models are the integration of (i) a traffic flow model which is efficient enough to : scale to larg...

Preliminary concept for statewide intercity bus and rail transit system : priority corridor ranking and analysis.

Science.gov (United States)

2009-03-01

This product summarizes the preliminary concept and priority corridors for development of a potential : statewide intercity bus and rail network. The concept is based upon the results of Tasks 1 through 5 of Texas : Department of Transportation Proje...

Making an Impact Statewide to Benefit 21st-Century School Leadership

Science.gov (United States)

Hewitt, Kimberly Kappler; Mullen, Carol A.; Davis, Ann W.; Lashley, Carl

2012-01-01

How can institutions of higher education, local education agencies, and departments of education partner to build capacity for 21st-Century school leadership? The model (IMPACT V) we describe utilizes a systems-wide partnership approach to cultivate shared leadership within influenced middle and high schools statewide to leverage technology as a…

Criminal Justice Profile--Statewide, 1984. Supplement to "Crime and Delinquency in California."

Science.gov (United States)

California State Dept. of Justice, Sacramento. Bureau of Criminal Statistics and Special Services.

This California annual Criminal Justice Statewide Profile presents data which supplements the Bureau of Criminal Statistics' (BCS) annual Crime and Delinquency publication. This monograph summarizes and combines data pertaining to California's justice system. The profile consists of two sections. The first section consists of 12 tables displaying…

Effects of Road Salt on Connecticut's Groundwater: A Statewide Centennial Perspective.

Science.gov (United States)

Cassanelli, James P; Robbins, Gary A

2013-01-01

This study examined the extent to which development and road salting has affected Connecticut's groundwater. We gathered water quality data from different time periods between 1894 and the present and analyzed the data using maps generated with ESRI ArcGIS. Historical reports illustrate a statewide baseline trend of decreasing chloride concentration northward across the State (average, 2 ppm). Since then, statewide chloride concentrations in ground water have increased by more than an order of magnitude on average. Analysis indicates spatial correlation between chloride impacts and major roadways. Furthermore, increases in statewide chloride concentration parallel increases in road salt application. Projected trends suggest that statewide baseline concentrations will increase by an amount equal to five times background levels between the present and the year 2030. The analytical process outlined herein can be readily applied to any region to investigate salt impacts on large spatial and temporal scales. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Successful long-term maintenance following Nutrition Care Process Terminology implementation across a state-wide health-care system.

Science.gov (United States)

Vivanti, Angela; O'Sullivan, Therese A; Porter, Jane; Hogg, Marion

2017-09-01

Three years following a state-wide Nutrition Care Process Terminology (NCPT) implementation project, the present study aimed to (i) assess changes in NCPT knowledge and attitudes, (ii) identify implementation barriers and enablers and (iii) seek managers' opinions post-implementation. Pre-implementation and three years post-implementation, all Queensland Government hospitals state-wide were invited to repeat a validated NCPT survey. Additionally, a separate survey sought dietetic managers' opinions regarding NCPT's use and acceptance, usefulness for patient care, role in service planning and continued use. A total of 238 dietitians completed the survey in 2011 and 82 dietitians in 2014. Use of diagnostic statement in the previous six months improved (P  0.05). Key elements in sustaining NCPT implementation over three years included ongoing management support, workshops/tutorials, discussion and mentor and peer support. The most valued resources were pocket guides, ongoing workshops/tutorials and mentor support. Dietetic managers held many positive NCPT views, however, opinions differed around the usefulness of service planning, safer practice, improving patient care and facilitating communication. Some managers would not support NCPT unless it was recommended for practice. Immediate improvements following the NCPT implementation project were sustained over three years. Moving forward, a professional focus on continuing to incorporate NCPT into standard practice will provide structure for process and outcomes assessment. © 2017 State of Queensland. Nutrition and Dietetics © 2017 Dietitians Association of Australia.

WisDOT statewide customer satisfaction survey.

Science.gov (United States)

2013-02-01

The purpose of this study was to develop and initiate a new customer satisfaction tool that would establish a set of baseline : departmental performance measures and be sustainable for future use. ETC Institute completed a statewide customer : survey...

Successful Statewide Walking Program Websites

Science.gov (United States)

Teran, Bianca Maria; Hongu, Nobuko

2012-01-01

Statewide Extension walking programs are making an effort to increase physical activity levels in America. An investigation of all 20 of these programs revealed that 14 use websites as marketing and educational tools, which could prove useful as the popularity of Internet communities continues to grow. Website usability information and an analysis…

Statewide improvement approach to clinician burnout: Findings from the baseline year

Directory of Open Access Journals (Sweden)

Heather R. Britt

2017-12-01

We propose a socio-ecological framework for acting on burnout, using a data-driven quality improvement paradigm enabled by a statewide coalition, to ensure that continued efforts do not rest solely at the feet of individuals or systems. Despite high burnout levels, engagement and satisfaction with work are also high, suggesting there is still hope for stemming the tide of burnout.

The Soft Underbelly of System Change: The Role of Leadership and Organizational Climate in Turnover during Statewide Behavioral Health Reform.

Science.gov (United States)

Aarons, Gregory A; Sommerfeld, David H; Willging, Cathleen E

2011-01-01

This study examined leadership, organizational climate, staff turnover intentions, and voluntary turnover during a large-scale statewide behavioral health system reform. The initial data collection occurred nine months after initiation of the reform with a follow-up round of data collected 18 months later. A self-administered structured assessment was completed by 190 participants (administrators, support staff, providers) employed by 14 agencies. Key variables included leadership, organizational climate, turnover intentions, turnover, and reform-related financial stress ("low" versus "high") experienced by the agencies. Analyses revealed that positive leadership was related to a stronger empowering climate in both high and low stress agencies. However, the association between more positive leadership and lower demoralizing climate was evident only in high stress agencies. For both types of agencies empowering climate was negatively associated with turnover intentions, and demoralizing climate was associated with stronger turnover intentions. Turnover intentions were positively associated with voluntary turnover. Results suggest that strong leadership is particularly important in times of system and organizational change and may reduce poor climate associated with turnover intentions and turnover. Leadership and organizational context should be addressed to retain staff during these periods of systemic change.

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

Science.gov (United States)

Barrows, Randolph C; Ezzard, John

2011-01-01

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

Taking Stock of Private-School Choice: Scholars Review the Research on Statewide Programs

Science.gov (United States)

Wolf, Patrick J.; Harris, Douglas N.; Berends, Mark; Waddington, R. Joseph; Austin, Megan

2018-01-01

In the past few years, four states have established programs that provide public financial support to students who choose to attend a private school. These programs--a tax-credit-funded scholarship initiative in Florida and voucher programs in Indiana, Louisiana, and Ohio--offer a glimpse of what expansive statewide choice might look like. What…

The smoking ban next door: do hospitality businesses in border areas have reduced sales after a statewide smoke-free policy?

Science.gov (United States)

Klein, Elizabeth G; Hood, Nancy E

2015-01-01

Despite numerous studies demonstrating no significant economic effects on hospitality businesses following a statewide smoke-free (SF) policy, regional concerns suggest that areas near states without SF policies may experience a loss of hospitality sales across the border. The present study evaluated the impact of Ohio's statewide SF policy on taxable restaurant and bar sales in border and non-border areas. Spline regression analysis was used to assess changes in monthly taxable sales at the county level in full-service restaurants and bars in Ohio. Data were analyzed from four years prior to policy implementation to three years post-policy. Change in the differences in the slope of taxable sales for border (n = 21) and non-border (n = 67) counties were evaluated for changes following the statewide SF policy enforcement, adjusted for unemployment rates, general trends in the hospitality sector, and seasonality. After adjusting for covariates, there was no statistically significant change in the difference in slope for taxable sales for either restaurants (β = 0.9, p = 0.09) or bars (β = 0.2, p = 0.07) following the SF policy for border areas compared to non-border areas of Ohio. Border regions in Ohio did not experience a significant change in bar and restaurant sales compared to non-border areas following a statewide SF policy. Results support that Ohio's statewide SF policy did not impact these two areas differently, and provide additional evidence for the continued use of SF policies to provide protection from exposure to secondhand smoke for both workers and the general public. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Road Map to Statewide Implementation of the Pyramid Model. Roadmap to Effective Intervention Practices #6

Science.gov (United States)

Dunlap, Glen; Smith, Barbara J.; Fox, Lise; Blase, Karen

2014-01-01

This document is a guide--a "Road Map"--for implementing widespread use of the Pyramid Model for Promoting Social Emotional Competence in Infants and Young Children (http://www.challengingbehavior.org/do/pyramid_model. htm). It is a road map of systems change. The Road Map is written for statewide systems change, although it could be…

Mixed methods for implementation research: application to evidence-based practice implementation and staff turnover in community-based organizations providing child welfare services.

Science.gov (United States)

Aarons, Gregory A; Fettes, Danielle L; Sommerfeld, David H; Palinkas, Lawrence A

2012-02-01

Many public sector service systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This article describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. The authors integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research.

Tactical emergency medical support programs: a comprehensive statewide survey.

Science.gov (United States)

Bozeman, William P; Morel, Benjamin M; Black, Timothy D; Winslow, James E

2012-01-01

Specially trained tactical emergency medical support (TEMS) personnel provide support to law enforcement special weapons and tactics (SWAT) teams. These programs benefit law enforcement agencies, officers, suspects, and citizens. TEMS programs are increasingly popular, but there are wide variations in their organization and operation and no recent data on their prevalence. We sought to measure the current prevalence and specific characteristics of TEMS programs in a comprehensive fashion in a single southeastern state. North Carolina emergency medical services (EMS) systems have county-based central EMS oversight; each system was surveyed by phone and e-mail. The presence and selected characteristics of TEMS programs were recorded. U.S. Census data were used to measure the population impact of the programs. All of the 101 EMS systems statewide were successfully contacted. Thirty-three counties (33%) have TEMS programs providing medical support to 56 local law enforcement agencies as well as state and federal agencies. TEMS programs tend to be located in more populated urban and suburban areas, serving a population base of 5.9 million people, or 64% of the state's population. Tactical medics in the majority of these programs (29/33; 88%) are not sworn law enforcement officers. Approximately one-third of county-based EMS systems in North Carolina have TEMS programs. These programs serve almost two-thirds of the state's population base, using primarily nonsworn tactical medics. Comparison with other regions of the country will be useful to demonstrate differences in prevalence and program characteristics. Serial surveillance will help track trends and measure the growth and impact of this growing subspecialty field.

Mixed Methods for Implementation Research: Application to Evidence-Based Practice Implementation and Staff Turnover in Community Based Organizations Providing Child Welfare Services

Science.gov (United States)

Aarons, Gregory A.; Fettes, Danielle L.; Sommerfeld, David H.; Palinkas, Lawrence

2013-01-01

Many public sector services systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well-suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems. This paper describes the process of using mixed methods in implementation research and provides an applied example of an examination of factors impacting staff retention during an evidence-based intervention implementation in a statewide child welfare system. We integrate qualitative data with previously published quantitative analyses of job autonomy and staff turnover during this statewide implementation project in order to illustrate the utility of mixed method approaches in providing a more comprehensive understanding of opportunities and challenges in implementation research. PMID:22146861

Data integration for statewide transportation planning : final report

Science.gov (United States)

2009-08-01

The goal of this study was to investigate the data availability, accessibility, and interoperability issues arisen from the statewide : transportation planning activities undertaken at WisDOT and to identify possible approaches for addressing these i...

Emergency Department Visits Prior to Suicide and Homicide: Linking Statewide Surveillance Systems.

Science.gov (United States)

Cerel, Julie; Singleton, Michael D; Brown, Margaret M; Brown, Sabrina V; Bush, Heather M; Brancado, Candice J

2016-01-01

Emergency departments (EDs) serve a wide range of patients who present at risk of impending suicide and homicide. Two statewide surveillance systems were probabilistically linked to understand who utilizes EDs and then dies violently within 6 weeks. Each identified case was matched with four randomly selected controls on sex, race, date of birth, resident zip code, and date of ED visit vs. date of death. Matched-pair odds ratios were estimated by conditional logistic regression to assess differences between cases and controls on reported diagnoses and expected payment sources. Of 1,599 suicides and 569 homicides in the 3-year study period, 10.7% of decedents who died by suicide (mean = 13.6 days) and 8.3% who died by homicide (mean = 16.3 days) were seen in a state ED within 6 weeks prior to death. ED attendees who died by suicide were more likely to have a diagnosis of injury/ poisoning diagnosis or mental disorder and more likely to have Medicare. Those who died by homicide were more likely to have a diagnosis of injury/poisoning and less likely to have commercial insurance. It is essential for research to further explore risk factors for imminent suicide and homicide in ED patients who present for psychiatric conditions and general injuries.

Building Statewide Infrastructure for the Academic Support of Students With Mild Traumatic Brain Injury.

Science.gov (United States)

Gioia, Gerard A; Glang, Ann E; Hooper, Stephen R; Brown, Brenda Eagan

To focus attention on building statewide capacity to support students with mild traumatic brain injury (mTBI)/concussion. Consensus-building process with a multidisciplinary group of clinicians, researchers, policy makers, and state Department of Education personnel. The white paper presents the group's consensus on the essential components of a statewide educational infrastructure to support the management of students with mTBI. The nature and recovery process of mTBI are briefly described specifically with respect to its effects on school learning and performance. State and local policy considerations are then emphasized to promote implementation of a consistent process. Five key components to building a statewide infrastructure for students with mTBI are described including (1) definition and training of the interdisciplinary school team, (2) professional development of the school and medical communities, (3) identification, assessment, and progress monitoring protocols, (4) a flexible set of intervention strategies to accommodate students' recovery needs, and (5) systematized protocols for active communication among medical, school, and family team members. The need for a research to guide effective program implementation is stressed. This guiding framework strives to assist the development of support structures for recovering students with mTBI to optimize academic outcomes. Until more evidence is available on academic accommodations and other school-based supports, educational systems should follow current best practice guidelines.

A guide for statewide impaired-driving task forces.

Science.gov (United States)

2009-09-01

The purpose of the guide is to assist State officials and other stakeholders who are interested in establishing an : Impaired-Driving Statewide Task Force or who are exploring ways to improve their current Task Force. The guide : addresses issues suc...

Tobacco Smoke Pollution in Hospitality Venues Before and After Passage of Statewide Smoke-Free Legislation.

Science.gov (United States)

Buettner-Schmidt, Kelly; Boursaw, Blake; Lobo, Marie L; Travers, Mark J

2017-03-01

In 2012, North Dakota enacted a comprehensive statewide law prohibiting smoking in enclosed public places. Disparities in tobacco control exist in rural areas. This study's objective was to determine the extent to which the passage of a comprehensive, statewide, smoke-free law in a predominantly rural state influenced tobacco smoke pollution in rural and nonrural venues. A longitudinal cohort design study comparing the levels of tobacco smoke pollution before and after passage of the statewide smoke-free law was conducted in 64 restaurants and bars statewide in North Dakota. Particulate matter with a median aerodynamic diameter of <2.5 μm (a valid atmospheric marker of tobacco smoke pollution) was assessed. A significant 83% reduction in tobacco smoke pollution levels occurred after passage of the law. Significant reductions in tobacco smoke pollution levels occurred in each of the rural categories; however, no difference by rurality was noted in the analysis after passage of the law, in contrast to the study before passage. To our knowledge, this was the largest, single, rural postlaw study globally. A comprehensive statewide smoke-free law implemented in North Dakota dramatically decreased the level of tobacco smoke pollution in bars and restaurants. © 2016 The Authors. Public Health Nursing Published by Wiley Periodicals, Inc.

Analysis of Gastric Lavage Reported to a Statewide Poison Control System.

Science.gov (United States)

Donkor, Jimmy; Armenian, Patil; Hartman, Isaac N; Vohra, Rais

2016-10-01

As decontamination trends have evolved, gastric lavage (GL) has become a rare procedure. The current information regarding use, outcomes, and complications of GL could help refine indications for this invasive procedure. We sought to determine case type, location, and complications of GL cases reported to a statewide poison control system. This is a retrospective review of the California Poison Control System (CPCS) records from 2009 to 2012. Specific substances ingested, results and complications of GL, referring hospital ZIP codes, and outcomes were examined. Nine hundred twenty-three patients who underwent GL were included in the final analysis, ranging in age from 9 months to 88 years. There were 381 single and 540 multiple substance ingestions, with pill fragment return in 27%. Five hundred thirty-six GLs were performed with CPCS recommendation, while 387 were performed without. Complications were reported for 20 cases. There were 5 deaths, all after multiple ingestions. Among survivors, 37% were released from the emergency department, 13% were admitted to hospital wards, and 48% were admitted to intensive care units. The most commonly ingested substances were nontricyclic antidepressant psychotropics (n = 313), benzodiazepines (n = 233), acetaminophen (n = 191), nonsteroidal anti-inflammatory drugs (n = 107), diphenhydramine (n = 70), tricyclic antidepressants (n = 45), aspirin (n = 45), lithium (n = 36), and antifreeze (n = 10). The geographic distribution was clustered near regions of high population density, with a few exceptions. Toxic agents for which GL was performed reflected a broad spectrum of potential hazards, some of which are not life-threatening or have effective treatments. Continuing emergency physician and poison center staff education is required to assist in patient selection. Copyright © 2016 Elsevier Inc. All rights reserved.

A case study: planning a statewide information resource for health professionals: an evidence-based approach

Science.gov (United States)

Chew, Katherine; Watson, Linda; Parker, Mary

2009-01-01

Question: What is the best approach for implementing a statewide electronic health library (eHL) to serve all health professionals in Minnesota? Setting: The research took place at the University of Minnesota Health Sciences Libraries. Methods: In January 2008, the authors began planning a statewide eHL for health professionals following the five-step process for evidence-based librarianship: formulating the question, finding the best evidence, appraising the evidence, assessing costs and benefits, and evaluating the effectiveness of resulting actions. Main Results: The authors identified best practices for developing a statewide eHL for health professionals relating to audience or population served, information resources, technology and access, funding model, and implementation and sustainability. They were compared to the mission of the eHL project to drive strategic directions by developing recommendations. Conclusion: EBL can guide the planning process for a statewide eHL, but findings must be tailored to the local environment to address information needs and ensure long-term sustainability. PMID:19851487

Statewide Transportation Engineering Warehouse for Archived Regional Data (STEWARD).

Science.gov (United States)

2009-12-01

This report documents Phase III of the development and operation of a prototype for the Statewide Transportation : Engineering Warehouse for Archived Regional Data (STEWARD). It reflects the progress on the development and : operation of STEWARD sinc...

Characteristics and Effects of a Statewide STEM Program

Directory of Open Access Journals (Sweden)

Jeffrey D. Weld

2015-10-01

Full Text Available A comprehensive statewide STEM (science, technology, engineering, mathematics reform initiative enters its fifth year in the U.S. state of Iowa. A significant proportion of the state’s pre K-12 students and teachers participate in one or more of the twenty programs offered, ranging from classroom curricular innovations to teacher professional development, and from community STEM festivals to career exploration events. An external, inter-university evaluation consortium measures annual progress of the initiative through the Iowa STEM Monitoring Project. Results show citizens to be increasingly aware of and supporting of STEM education; students to be increasingly interested in STEM as well as outperforming nonparticipating peers on state math and science tests; and teachers more confident and knowledgeable in teaching STEM. Iowa’s STEM initiative has garnered national acclaim though challenges remain with regard to expanding the participation of learners of diversity, as well as ensuring the long-term sustainability of the programs and structures that define Iowa’s statewide STEM initiative.

A California Statewide App to Simulate Fate of Nitrate in Irrigated Agricultural System

Science.gov (United States)

Diamantopoulos, E.; Walkinshaw, M.; Harter, T.; O'Geen, A. T.

2017-12-01

Groundwater resources are very important for California's economic development and environmental sustainability. Nitrate is by far the most widespread anthropogenic groundwater pollutant in California's mostly alluvial groundwater basins. Major sources are synthetic fertilizer and dairy manure, but also septic systems and urban wastewater effluent. Here, we evaluate agricultural soils in California according to their risk for nitrate leaching. We conducted over 1 million numerical simulations taking into account the effect of climate, crop type, irrigation and fertilization management scenarios across all 4,568 agricultural soil profiles occurring in California. The assessment was done solving 1-D Richards equation and the advection-dispersion equation numerically. This study is focused on the complex water and nitrate dynamics occurring at the shallow vadose zone (rootzone). The results of this study allow the construction of state-wide maps which can be used for the identification of high-risk regions and the design of agricultural nutrient management policy. We investigate how pollution risk can be minimized by adopting simple irrigation and fertilization methods. Furthermore, we show that these methods are more effective for the most permeable soil profiles along with high demanding crops in terms of fertilization amount and irrigation water. We also present how seasonal (winter) climate conditions contribute on nitrate leaching.

Nebraska Statewide Wind Integration Study: April 2008 - January 2010

Energy Technology Data Exchange (ETDEWEB)

EnerNex Corporation, Knoxville, Tennessee; Ventyx, Atlanta, Georgia; Nebraska Power Association, Lincoln, Nebraska

2010-03-01

Wind generation resources in Nebraska will play an increasingly important role in the environmental and energy security solutions for the state and the nation. In this context, the Nebraska Power Association conducted a state-wide wind integration study.

Pharmacy-based statewide naloxone distribution: A novel "top-down, bottom-up" approach.

Science.gov (United States)

Morton, Kate J; Harrand, Brianna; Floyd, Carly Cloud; Schaefer, Craig; Acosta, Julie; Logan, Bridget Claire; Clark, Karen

To highlight New Mexico's multifaceted approach to widespread pharmacy naloxone distribution and to share the interventions as a tool for improving pharmacy-based naloxone practices in other states. New Mexico had the second highest drug overdose death rate in 2014 of which 53% were related to prescription opioids. Opioid overdose death is preventable through the use of naloxone, a safe and effective medication that reverses the effects of prescription opioids and heroin. Pharmacists can play an important role in providing naloxone to individuals who use prescription opioids. Not applicable. Not applicable. A multifaceted approach was utilized in New Mexico from the top down with legislative passage of provisions for a statewide standing order and New Mexico Department of Health support for pharmacy-based naloxone delivery. A bottom up approach was also initiated with the development and implementation of a training program for pharmacists and pharmacy technicians. Naloxone Medicaid claims were used to illustrate statewide distribution and utilization of the pharmacist statewide standing order for naloxone. Percent of pharmacies dispensing naloxone in each county were calculated. Trained pharmacy staff completed a program evaluation form. Questions about quality of instruction and ability of trainer to meet stated objectives were rated on a Likert scale. There were 808 naloxone Medicaid claims from 100 outpatient pharmacies during the first half of 2016, a 9-fold increase over 2014. The "A Dose of R x eality" training program evaluation indicated that participants felt the training was free from bias and met all stated objectives (4 out of 4 on Likert scale). A multi-pronged approach coupling state and community collaboration was successful in overcoming barriers and challenges associated with pharmacy naloxone distribution and ensured its success as an effective avenue for naloxone acquisition in urban and rural communities. Copyright © 2017 American Pharmacists

Employment status matters: a statewide survey of quality-of-life, prevention behaviors, and absenteeism and presenteeism.

Science.gov (United States)

Merchant, James A; Kelly, Kevin M; Burmeister, Leon F; Lozier, Matt J; Amendola, Alison; Lind, David P; KcKeen, Arlinda; Slater, Tom; Hall, Jennifer L; Rohlman, Diane S; Buikema, Brenda S

2014-07-01

To estimate quality-of-life (QoL), primary care, health insurance, prevention behaviors, absenteeism, and presenteeism in a statewide sample of the unemployed, self-employed, and organizationally employed. A statewide survey of 1602 Iowans included items from the Centers for Disease Control and Prevention QoL and Behavioral Risk Factor Surveillance System Survey prevention behavior questionnaires used to assess employee well-being; their indicator results are related to World Health Organization's Health and Work Performance Questionnaire-derived absenteeism and presenteeism scores. The unemployed exhibited poorer QoL and prevention behaviors; the self-employed exhibited many better QoL scores due largely to better prevention behaviors than those employed by organizations. Higher QoL measures and more prevention behaviors are associated with lower absenteeism and lower presenteeism. Employment status is related to measures of well-being, which are also associated with absenteeism and presenteeism.

Statewide screening for low-level radioactive waste shallow land burial sites

International Nuclear Information System (INIS)

Staub, W.P.; Cannon, J.B.; Stratton, L.E.

1984-01-01

A methodology was developed for statewide low-level waste site screening based on NRC site selection criteria. The methodology and criteria were tested in Tennessee to determine their effectiveness in narrowing the choice of sites for more intensive localized site screening. The statewide screening methodology entailed two steps. The first step was to select one or more physiographic provinces wherein sites meeting the criteria were most likely to be found. The second step was to select one or more suitable outcrop bands from within the most favorable physiographic provinces. These selections were based entirely on examination of existing literature and maps at scales no larger than 1:250,000. The statewide screening project identified only one suitable physiographic province (the Mississippi Embayment region) and one favorable outcrop band (the Coon Creek Formation) within a three county area of western Tennessee. Ground water monitoring and predictability proved to be the most difficult criterion to meet. This criterion alone eliminated other outcrop bands in the Mississippi Embayment as well as the Eastern Highland Rim and Western Highland Rim physiographic provinces. Other provinces failed to meet several screening criteria. 3 references, 3 figures, 1 table

Statewide and Metropolitan Transportation Planning Processes : a TPCB Peer Exchange

Science.gov (United States)

2016-04-20

This report highlights key recommendations and noteworthy practices identified at Statewide and Metropolitan Transportation Planning Processes Peer Exchange held on September 9-10, 2015 in Shepherdstown, West Virginia. This event was sponsored ...

California Statewide Plug-In Electric Vehicle Infrastructure Assessment

Energy Technology Data Exchange (ETDEWEB)

Melaina, Marc; Helwig, Michael

2014-05-01

The California Statewide Plug-In Electric Vehicle Infrastructure Assessment conveys to interested parties the Energy Commission’s conclusions, recommendations, and intentions with respect to plug-in electric vehicle (PEV) infrastructure development. There are several relatively low-risk and high-priority electric vehicle supply equipment (EVSE) deployment options that will encourage PEV sales and

Delivery of State-Provided Predictive Analytics to Schools: Wisconsin's DEWS and the Proposed EWIMS Dashboard. WCER Working Paper No. 2016-3

Science.gov (United States)

Clune, Bill; Knowles, Jared

2016-01-01

Since 2012, the Wisconsin Department of Public Instruction (DPI) has maintained a statewide predictive analytics system providing schools with an early warning in middle grades of students at risk for not completing high school. DPI is considering extending and enhancing this system, known as the Dropout Early Warning System (DEWS). The proposed…

Louisiana's statewide beach cleanup

Science.gov (United States)

Lindstedt, Dianne M.; Holmes, Joseph C.

1989-01-01

Litter along Lousiana's beaches has become a well-recognized problem. In September 1987, Louisiana's first statewide beach cleanup attracted about 3300 volunteers who filled 16,000 bags with trash collected along 15 beaches. An estimated 800,173 items were gathered. Forty percent of the items were made of plastic and 11% were of polystyrene. Of all the litter collected, 37% was beverage-related. Litter from the oil and gas, commercial fishing, and maritime shipping industries was found, as well as that left by recreational users. Although beach cleanups temporarily rid Louisiana beaches of litter, the real value of the effort is in public participation and education. Civic groups, school children, and individuals have benefited by increasing their awareness of the problems of trash disposal.

A School-Based Dental Program Evaluation: Comparison to the Massachusetts Statewide Survey.

Science.gov (United States)

Culler, Corinna S; Kotelchuck, Milton; Declercq, Eugene; Kuhlthau, Karen; Jones, Kari; Yoder, Karen M

2017-10-01

School-based dental programs target high-risk communities and reduce barriers to obtaining dental services by delivering care to students in their schools. We describe the evaluation of a school-based dental program operating in Chelsea, a city north of Boston, with a low-income and largely minority population, by comparing participants' oral health to a Massachusetts oral health assessment. Standardized dental screenings were conducted for students in kindergarten, third, and sixth grades. Outcomes were compared in bivariate analysis, stratified by grade and income levels. A greater percentage of Chelsea students had untreated decay and severe treatment need than students statewide. Yet, fewer Chelsea third graders had severe treatment need, and more had dental sealants. There was no significant difference in the percentage of Chelsea students having severe treatment need or dental sealants by income level. Students participating in our program do not have lower decay levels than students statewide. However, they do have lower levels of severe treatment need, likely due to treatment referrals. Our results confirm that school-based prevention programs can lead to increased prevalence of dental sealants among high-risk populations. Results provide support for the establishment of full-service school-based programs in similar communities. © 2017, American School Health Association.

WiFi RFID demonstration for resource tracking in a statewide disaster drill.

Science.gov (United States)

Cole, Stacey L; Siddiqui, Javeed; Harry, David J; Sandrock, Christian E

2011-01-01

To investigate the capabilities of Radio Frequency Identification (RFID) tracking of patients and medical equipment during a simulated disaster response scenario. RFID infrastructure was deployed at two small rural hospitals, in one large academic medical center and in two vehicles. Several item types from the mutual aid equipment list were selected for tracking during the demonstration. A central database server was installed at the UC Davis Medical Center (UCDMC) that collected RFID information from all constituent sites. The system was tested during a statewide disaster drill. During the drill, volunteers at UCDMC were selected to locate assets using the traditional method of locating resources and then using the RFID system. This study demonstrated the effectiveness of RFID infrastructure in real-time resource identification and tracking. Volunteers at UCDMC were able to locate assets substantially faster using RFID, demonstrating that real-time geolocation can be substantially more efficient and accurate than traditional manual methods. A mobile, Global Positioning System (GPS)-enabled RFID system was installed in a pediatric ambulance and connected to the central RFID database via secure cellular communication. This system is unique in that it provides for seamless region-wide tracking that adaptively uses and seamlessly integrates both outdoor cellular-based mobile tracking and indoor WiFi-based tracking. RFID tracking can provide a real-time picture of the medical situation across medical facilities and other critical locations, leading to a more coordinated deployment of resources. The RFID system deployed during this study demonstrated the potential to improve the ability to locate and track victims, healthcare professionals, and medical equipment during a region-wide disaster.

Benchmarking statewide trauma mortality using Agency for Healthcare Research and Quality's patient safety indicators.

Science.gov (United States)

Ang, Darwin; McKenney, Mark; Norwood, Scott; Kurek, Stanley; Kimbrell, Brian; Liu, Huazhi; Ziglar, Michele; Hurst, James

2015-09-01

Improving clinical outcomes of trauma patients is a challenging problem at a statewide level, particularly if data from the state's registry are not publicly available. Promotion of optimal care throughout the state is not possible unless clinical benchmarks are available for comparison. Using publicly available administrative data from the State Department of Health and the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs), we sought to create a statewide method for benchmarking trauma mortality and at the same time also identifying a pattern of unique complications that have an independent influence on mortality. Data for this study were obtained from State of Florida Agency for Health Care Administration. Adult trauma patients were identified as having International Classification of Disease ninth edition codes defined by the state. Multivariate logistic regression was used to create a predictive inpatient expected mortality model. The expected value of PSIs was created using the multivariate model and their beta coefficients provided by the AHRQ. Case-mix adjusted mortality results were reported as observed to expected (O/E) ratios to examine mortality, PSIs, failure to prevent complications, and failure to rescue from death. There were 50,596 trauma patients evaluated during the study period. The overall fit of the expected mortality model was very strong at a c-statistic of 0.93. Twelve of 25 trauma centers had O/E ratios benchmarking method that screens at risk trauma centers in the state for higher than expected mortality. Stratifying mortality based on failure to prevent PSIs may identify areas of needed improvement at a statewide level. Copyright © 2015 Elsevier Inc. All rights reserved.

Development of a model web-based system to support a statewide quality consortium in radiation oncology.

Science.gov (United States)

Moran, Jean M; Feng, Mary; Benedetti, Lisa A; Marsh, Robin; Griffith, Kent A; Matuszak, Martha M; Hess, Michael; McMullen, Matthew; Fisher, Jennifer H; Nurushev, Teamour; Grubb, Margaret; Gardner, Stephen; Nielsen, Daniel; Jagsi, Reshma; Hayman, James A; Pierce, Lori J

A database in which patient data are compiled allows analytic opportunities for continuous improvements in treatment quality and comparative effectiveness research. We describe the development of a novel, web-based system that supports the collection of complex radiation treatment planning information from centers that use diverse techniques, software, and hardware for radiation oncology care in a statewide quality collaborative, the Michigan Radiation Oncology Quality Consortium (MROQC). The MROQC database seeks to enable assessment of physician- and patient-reported outcomes and quality improvement as a function of treatment planning and delivery techniques for breast and lung cancer patients. We created tools to collect anonymized data based on all plans. The MROQC system representing 24 institutions has been successfully deployed in the state of Michigan. Since 2012, dose-volume histogram and Digital Imaging and Communications in Medicine-radiation therapy plan data and information on simulation, planning, and delivery techniques have been collected. Audits indicated >90% accurate data submission and spurred refinements to data collection methodology. This model web-based system captures detailed, high-quality radiation therapy dosimetry data along with patient- and physician-reported outcomes and clinical data for a radiation therapy collaborative quality initiative. The collaborative nature of the project has been integral to its success. Our methodology can be applied to setting up analogous consortiums and databases. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

A statewide teleradiology system reduces radiation exposure and charges in transferred trauma patients.

Science.gov (United States)

Watson, Justin J J; Moren, Alexis; Diggs, Brian; Houser, Ben; Eastes, Lynn; Brand, Dawn; Bilyeu, Pamela; Schreiber, Martin; Kiraly, Laszlo

2016-05-01

Trauma transfer patients routinely undergo repeat imaging because of inefficiencies within the radiology system. In 2009, the virtual private network (VPN) telemedicine system was adopted throughout Oregon allowing virtual image transfer between hospitals. The startup cost was a nominal $3,000 per hospital. A retrospective review from 2007 to 2012 included 400 randomly selected adult trauma transfer patients based on a power analysis (200 pre/200 post). The primary outcome evaluated was reduction in repeat computed tomography (CT) scans. Secondary outcomes included cost savings, emergency department (ED) length of stay (LOS), and spared radiation. All data were analyzed using Mann-Whitney U and chi-square tests. P less than .05 indicated significance. Spared radiation was calculated as a weighted average per body region, and savings was calculated using charges obtained from Oregon Health and Science University radiology current procedural terminology codes. Four-hundred patients were included. Injury Severity Score, age, ED and overall LOS, mortality, trauma type, and gender were not statistically different between groups. The percentage of patients with repeat CT scans decreased after VPN implementation: CT abdomen (13.2% vs 2.8%, P < .01) and cervical spine (34.4% vs 18.2%, P < .01). Post-VPN, the total charges saved in 2012 for trauma transfer patients was $333,500, whereas the average radiation dose spared per person was 1.8 mSV. Length of stay in the ED for patients with Injury Severity Score less than 15 transferring to the ICU was decreased (P < .05). Implementation of a statewide teleradiology network resulted in fewer total repeat CT scans, significant savings, decrease in radiation exposure, and decreased LOS in the ED for patients with less complex injuries. The potential for health care savings by widespread adoption of a VPN is significant. Copyright © 2016 Elsevier Inc. All rights reserved.

A Statewide Partnership for Implementing Inquiry Science

Science.gov (United States)

Lytle, Charles

The North Carolina Infrastructure for Science Education (NC-ISE) is a statewide partnership for implementing standards-based inquiry science using exemplary curriculum materials in the public schools of North Carolina. North Carolina is the 11th most populous state in the USA with 8,000,000 residents, 117 school districts and a geographic area of 48,718 miles. NC-ISE partners include the state education agency, local school systems, three branches of the University of North Carolina, the state mathematics and science education network, businesses, and business groups. The partnership, based upon the Science for All Children model developed by the National Science Resources Centre, was initiated in 1997 for improvement in teaching and learning of science and mathematics. This research-based model has been successfully implemented in several American states during the past decade. Where effectively implemented, the model has led to significant improvements in student interest and student learning. It has also helped reduce the achievement gap between minority and non-minority students and among students from different economic levels. A key program element of the program is an annual Leadership Institute that helps teams of administrators and teachers develop a five-year strategic plan for their local systems. Currently 33 of the117 local school systems have joined the NC-ISE Program and are in various stages of implementation of inquiry science in grades K-8.

Development of a statewide motorcycle safety plan for Texas : technical report.

Science.gov (United States)

2013-02-01

The objective of this research project was to develop a statewide plan to reduce motorcycle crashes and : injuries in the state of Texas. The project included a review of published literature on current and proposed : countermeasures for reducing the...

Technology scan of future traveler information systems and applications in Georgia.

Science.gov (United States)

2013-10-01

Statewide traveler information provided in Georgia through its NaviGAtor/5-1-1 system is : primarily based on Intelligent Transportation Systems (ITS) related to freeway traffic : management. The purpose of this study is to evaluate traveler informat...

Illinois statewide gas utility plan, 1993-2002. Volume 1. Executive summary

International Nuclear Information System (INIS)

1992-12-01

The second Illinois Statewide Natural Gas Utility Plan is a continuation of the Least-Cost Planning effort introduced by the Public Utilities Act of 1986. The purpose of the Plan, like its predecessor, is to provide a framework and a set of policies which will allow and encourage local distribution companies to develop least-cost plans consistent with the goals of the Act: to provide efficient, environmentally sound, reliable, and equitable public utility service at the least possible cost. The Plan assesses natural gas demand and supply under five scenarios for the period 1993-2002. Key issues related to the development of least-cost natural gas plans are identified, and policies for addressing the issues are developed. The rationale and potential for natural gas demand side management (DSM) programs and policies are explored, and recommendations made with respect to utility DSM capability-building and DSM cost-recovery

Results of the 1992 State-Wide Business and Industry Survey.

Science.gov (United States)

Jarrett, Carole, Comp.; And Others

As part of an effort to develop courses and programs that reflect California business and industry's current and future needs, two studies were performed by Solano Community College to examine statewide trends and issues related to office automation and marketing and management. In conducting the study of office automation, 5,000 surveys were…

Establishment of a Web-based System for Collection of Patient-reported Outcomes After Radical Prostatectomy in a Statewide Quality Improvement Collaborative.

Science.gov (United States)

Lucas, Steven M; Kim, Tae-Kyung; Ghani, Khurshid R; Miller, David C; Linsell, Susan; Starr, Jay; Peabody, James O; Hurley, Patrick; Montie, James; Cher, Michael L

2017-09-01

To report on the establishment of a unified, electronic patient-reported outcome (PRO) infrastructure and pilot results from the first 5 practices enrolled in the web-based collection system developed by the Michigan Urological Surgery Improvement Collaborative. Eligible patients were those undergoing radical prostatectomy of 5 academic and community practices. PRO was obtained using a validated 21-item web-based questionnaire, regarding urinary function, erection function, and sexual interest and satisfaction. Data were collected preoperatively, at 3 months, and 6 months postoperatively. Patients were provided a link via email to complete the surveys. Perioperative and PRO data were analyzed as reports for individual patients and summary performance reports for individual surgeons. Among 773 eligible patients, 688 (89%) were enrolled preoperatively. Survey completion rate was 88%, 84%, and 90% preoperatively, at 3 months, and 6 months. Electronic completion rates preoperatively, at 3 months, and 6 months were 70%, 70%, and 68%, respectively. Mean urinary function scores were 18.3, 14.3, and 16.6 (good function ≥ 17), whereas mean erection scores were 18.7, 7.3, and 9.1 (good erection score ≥ 22) before surgery, at 3 months, and 6 months. Variation was noted for erectile function among the practices. Collection of electronic PRO via this unified, web-based format was successful and provided results that reflect expected recovery and identify opportunities for improvement. This will be extended to more practices statewide to improve outcomes after radical prostatectomy. Copyright © 2017 Elsevier Inc. All rights reserved.

State Systems Change Spotlight: Nevada. Transforming State Systems to Improve Outcomes for Children with Disabilities

Science.gov (United States)

Ruedel, Kristin; Nelson, Gena; Bailey, Tessie; Pierce, Jennifer

2018-01-01

Data show that effective and ongoing communication and evaluation can have a positive impact on local and statewide systems change. Local and statewide systems change requires ongoing communication and evaluation. The Nevada Department of Education (NDE) used a communication protocol to support implementation of the Assess-Plan-Teach (APT) model.…

Human bromethalin exposures reported to a U.S. Statewide Poison Control System.

Science.gov (United States)

Huntington, Serena; Fenik, Yelena; Vohra, Rais; Geller, Richard J

2016-03-01

Bromethalin is an increasingly used alternative to long-acting anticoagulant and cholecalciferol rodenticides. There are few reports of human exposures, and no existing professional society guidelines on medical management of bromethalin ingestions. The aim of this retrospective data review is to characterize bromethalin exposures reported to the California Poison Control System (CPCS) between 1997 and 2014. This is an observational retrospective case review of our statewide poison control system's electronic medical records. Following Institutional Board Review and Research Committee approvals, poison center exposures related to bromethalin were extracted using substance code and free text search strategies. Case notes of bromethalin exposures were reviewed for demographic, clinical, laboratory, and outcome information; inclusion criteria for the study was single-substance, human exposure to bromethalin. There were 129 calls related to human bromethalin exposures (three cases met exclusion criteria). The age range of cases was 7 months-90 years old, with the majority of exposures (89 cases; 70.6%), occurring in children younger than 5 years of age (median age of 2 years). Most exposures occurred in the pediatric population as a result of exploratory oral exposure. One hundred and thirteen patients (89.7%) had no effects post exposure, while 10 patients (7.9%) had a minor outcome. Adverse effects were minor, self-limited, and mostly gastrointestinal upset. There were no moderate, major, or fatal effects in our study population. The approximate ingested dose, available in six cases, ranged from 0.067 mg/kg to 0.3 mg/kg (milligrams of bromethalin ingested per kilogram of body weight), and no dose-symptom threshold could be established from this series. Exposures were not confirmed through urine or serum laboratory testing. The prognosis for most accidental ingestions appears to be excellent. However, bromethalin exposures may result in a higher number of

Pediatric Exposures to Topical Benzocaine Preparations Reported to a Statewide Poison Control System.

Science.gov (United States)

Vohra, Rais; Huntington, Serena; Koike, Jennifer; Le, Kevin; Geller, Richard J

2017-08-01

Topical benzocaine is a local anesthetic commonly used to relieve pain caused by teething, periodontal irritation, burns, wounds, and insect bites. Oral preparations may contain benzocaine concentrations ranging from 7.5% to 20%. Pediatric exposure to such large concentrations may result in methemoglobinemia and secondarily cause anemia, cyanosis, and hypoxia. This is a retrospective study of exposures reported to a statewide poison control system. The electronic health records were queried for pediatric exposures to topical benzocaine treated at a healthcare facility from 2004 to 2014. Cases of benzocaine exposure were reviewed for demographic and clinical information, and descriptive statistical analysis was performed. The query resulted in 157 cases; 58 were excluded due to co-ingestants, or miscoding of non-benzocaine exposures. Children four years of age and younger represented the majority of cases (93%) with a median age of 1 year. There were 88 cases of accidental/ exploratory exposure, while 6 cases resulted from therapeutic application or error, 4 cases from adverse reactions, and 1 case from an unknown cause. Asymptomatic children accounted for 75.5% of cases, but major clinical effects were observed in 5 patients. Those with serious effects were exposed to a range of benzocaine concentrations (7.5-20%), with 4 cases reporting methemoglobin levels between 20.2%-55%. Methylene blue was administered in 4 of the cases exhibiting major effects. The majority of exposures were accidental ingestions by young children. Most exposures resulted in minor to no effects. However, some patients required treatment with methylene blue and admission to a critical care unit. Therapeutic application by parents or caregivers may lead to adverse effects from these commonly available products.

State-wide performance criteria for international safeguards

International Nuclear Information System (INIS)

Budlong-Sylvester, K.W.; Pilat, Joseph F.; Stanbro, W.D.

2001-01-01

Traditionally, the International Atomic Energy Agency (IAEA) has relied upon prescriptive criteria to guide safeguards implementation. The prospect of replacing prescriptive safeguards criteria with more flexible performance criteria would constitute a structural change in safeguards and raises several important questions. Performance criteria imply that while safeguards goals will be fixed, the means of attaining those goals will not be explicitly prescribed. What would the performance objectives be under such a system? How would they be formulated? How would performance be linked to higher level safeguards objectives? How would safeguards performance be measured State-wide? The implementation of safeguards under performance criteria would also signal a dramatic change in the manner the Agency does business. A higher degree of flexibility could, in principle, produce greater effectiveness and efficiency, but would come with a need for increased Agency responsibility in practice. To the extent that reliance on prescriptive criteria decreases, the burden of justifying actions and ensuring their transparency will rise. Would there need to be limits to safeguards implementation? What would be the basis for setting such limits? This paper addresses these and other issues and questions relating to both the formulation and the implementation of performance-based criteria.

23 CFR 450.216 - Development and content of the statewide transportation improvement program (STIP).

Science.gov (United States)

2010-04-01

... Programming § 450.216 Development and content of the statewide transportation improvement program (STIP). (a... Equity Bonus funds; (5) Emergency relief projects (except those involving substantial functional...

Cost-effectiveness analysis of a statewide media campaign to promote adolescent physical activity.

Science.gov (United States)

Peterson, Michael; Chandlee, Margaret; Abraham, Avron

2008-10-01

A cost-effectiveness analysis of a statewide social marketing campaign was performed using a statewide surveillance survey distributed to 6th through 12th graders, media production and placement costs, and 2000 census data. Exposure to all three advertisements had the highest impact on both intent and behavior with 65.6% of the respondents considering becoming more active and 58.3% reporting becoming more active. Average cost of the entire campaign was $4.01 per person to see an ad, $7.35 per person to consider being more active, and $8.87 per person to actually become more active, with billboards yielding the most positive cost-effectiveness. Findings highlight market research as an essential part of social marketing campaigns and the importance of using multiple marketing modalities to enhance cost-effectiveness and impact.

The trauma ecosystem: The impact and economics of new trauma centers on a mature statewide trauma system.

Science.gov (United States)

Ciesla, David J; Pracht, Etienne E; Leitz, Pablo T; Spain, David A; Staudenmayer, Kristan L; Tepas, Joseph J

2017-06-01

Florida serves as a model for the study of trauma system performance. Between 2010 and 2104, 5 new trauma centers were opened alongside 20 existing centers. The purpose of this study was to explore the impact of trauma system expansion on system triage performance and trauma center patients' profiles. A statewide data set was queried for all injury-related discharges from adult acute care hospitals using International Classification of Diseases, Ninth Revision (ICD-9) codes for 2010 and 2014. The data set, inclusion criteria, and definitions of high-risk injury were chosen to match those used by the Florida Department of Health in its trauma registry. Hospitals were classified as existing Level I (E1) or Level II (E2) trauma centers and new E2 (N2) centers. Five N2 centers were established 11.6 to 85.3 miles from existing centers. Field and overall trauma system triage of high-risk patients was less accurate with increased overtriage and no change in undertriage. Annual volume at N2 centers increased but did not change at E1 and E2 centers. In 2014, Patients at E1 and E2 centers were slightly older and less severely injured, while those at N2 centers were substantially younger and more severely injured than in 2010. The injured patient-payer mix changed with a decrease in self-pay and commercial patients and an increase in government-sponsored patients at E1 and E2 centers and an increase in self-pay and commercial patients with a decrease in government-sponsored patients at N2 centers. Designation of new trauma centers in a mature system was associated with a change in established trauma center demographics and economics without an improvement in trauma system triage performance. These findings suggest that the health of an entire trauma system network must be considered in the design and implementation of a regional trauma system. Therapeutic/care management study, level IV; epidemiological, level IV.

Pediatric Exposures to Topical Benzocaine Preparations Reported to a Statewide Poison Control System

Directory of Open Access Journals (Sweden)

Rais Vohra

2017-07-01

Full Text Available Introduction: Topical benzocaine is a local anesthetic commonly used to relieve pain caused by teething, periodontal irritation, burns, wounds, and insect bites. Oral preparations may contain benzocaine concentrations ranging from 7.5% to 20%. Pediatric exposure to such large concentrations may result in methemoglobinemia and secondarily cause anemia, cyanosis, and hypoxia. Methods: This is a retrospective study of exposures reported to a statewide poison control system. The electronic health records were queried for pediatric exposures to topical benzocaine treated at a healthcare facility from 2004 to 2014. Cases of benzocaine exposure were reviewed for demographic and clinical information, and descriptive statistical analysis was performed. Results: The query resulted in 157 cases; 58 were excluded due to co-ingestants, or miscoding of non-benzocaine exposures. Children four years of age and younger represented the majority of cases (93% with a median age of 1 year. There were 88 cases of accidental/ exploratory exposure, while 6 cases resulted from therapeutic application or error, 4 cases from adverse reactions, and 1 case from an unknown cause. Asymptomatic children accounted for 75.5% of cases, but major clinical effects were observed in 5 patients. Those with serious effects were exposed to a range of benzocaine concentrations (7.5–20%, with 4 cases reporting methemoglobin levels between 20.2%–55%. Methylene blue was administered in 4 of the cases exhibiting major effects. Conclusion: The majority of exposures were accidental ingestions by young children. Most exposures resulted in minor to no effects. However, some patients required treatment with methylene blue and admission to a critical care unit. Therapeutic application by parents or caregivers may lead to adverse effects from these commonly available products.

A Statewide Survey for Container-Breeding Mosquitoes in Mississippi.

Science.gov (United States)

Goddard, Jerome; Moraru, Gail M; Mcinnis, Sarah J; Portugal, J Santos; Yee, Donald A; Deerman, J Hunter; Varnado, Wendy C

2017-09-01

Container-breeding mosquitoes are important in public health due to outbreaks of Zika, chikungunya, and dengue viruses. This paper documents the distribution of container-breeding mosquito species in Mississippi, with special emphasis on the genus Aedes. Five sites in each of the 82 Mississippi counties were sampled monthly between May 1 and August 31, 2016, and 50,109 mosquitoes in 14 species were collected. The most prevalent and widely distributed species found was Ae. albopictus, being found in all 82 counties, especially during July. A recent invasive, Ae. japonicus, seems to be spreading rapidly in Mississippi since first being discovered in the state in 2011. The most abundant Culex species collected were Cx. quinquefasciatus (found statewide), Cx. salinarius (almost exclusively in the southern portion of the state), and Cx. restuans (mostly central and southern Mississippi). Another relatively recent invasive species, Cx. coronator, was found in 20 counties, predominantly in the southern one-third of the state during late summer. Co-occurrence data of mosquito species found in the artificial containers were also documented and analyzed. Lastly, even though we sampled extensively in 410 sites across Mississippi, no larval Ae. aegypti were found. These data represent the first modern statewide survey of container species in Mississippi, and as such, allows for better public health readiness for emerging diseases and design of more effective vector control programs.

2011-2013 Indiana Statewide Imagery and LiDAR Program: Lake Michigan Watershed Counties

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Indiana's Statewide LiDAR data is produced at 1.5-meter average post spacing for all 92 Indiana Counties covering more than 36,420 square miles. New LiDAR data was...

Effects of patient health literacy, patient engagement and a system-level health literacy attribute on patient-reported outcomes: a representative statewide survey.

Science.gov (United States)

Kaphingst, Kimberly A; Weaver, Nancy L; Wray, Ricardo J; Brown, Melissa L R; Buskirk, Trent; Kreuter, Matthew W

2014-10-07

The effects of health literacy are thought to be based on interactions between patients' skill levels and health care system demands. Little health literacy research has focused on attributes of health care organizations. We examined whether the attribute of individuals' experiences with front desk staff, patient engagement through bringing questions to a doctor visit, and health literacy skills were related to two patient-reported outcomes. We administered a telephone survey with two sampling frames (i.e., household landline, cell phone numbers) to a randomly selected statewide sample of 3358 English-speaking adult residents of Missouri. We examined two patient-reported outcomes - whether or not respondents reported knowing more about their health and made better choices about their health following their last doctor visit. Multivariable logistic regression models were used to examine the independent contributions of predictor variables (i.e., front desk staff, bringing questions to a doctor visit, health literacy skills). Controlling for self-reported health, having a personal doctor, time since last visit, number of chronic conditions, health insurance, and sociodemographic characteristics, respondents who had a good front desk experience were 2.65 times as likely (95% confidence interval [CI]: 2.13, 3.30) and those who brought questions were 1.73 times as likely (95% CI: 1.32, 2.27) to report knowing more about their health after seeing a doctor. In a second model, respondents who had a good front desk experience were 1.57 times as likely (95% CI: 1.26, 1.95) and those who brought questions were 1.66 times as likely (95% CI: 1.29, 2.14) to report making better choices about their health after seeing a doctor. Patients' health literacy skills were not associated with either outcome. Results from this representative statewide survey may indicate that one attribute of a health care organization (i.e., having a respectful workforce) and patient engagement through

Correspondence of biological condition models of California streams at statewide and regional scales

Science.gov (United States)

May, Jason T.; Brown, Larry R.; Rehn, Andrew C.; Waite, Ian R.; Ode, Peter R; Mazor, Raphael D; Schiff, Kenneth C

2015-01-01

We used boosted regression trees (BRT) to model stream biological condition as measured by benthic macroinvertebrate taxonomic completeness, the ratio of observed to expected (O/E) taxa. Models were developed with and without exclusion of rare taxa at a site. BRT models are robust, requiring few assumptions compared with traditional modeling techniques such as multiple linear regression. The BRT models were constructed to provide baseline support to stressor delineation by identifying natural physiographic and human land use gradients affecting stream biological condition statewide and for eight ecological regions within the state, as part of the development of numerical biological objectives for California’s wadeable streams. Regions were defined on the basis of ecological, hydrologic, and jurisdictional factors and roughly corresponded with ecoregions. Physiographic and land use variables were derived from geographic information system coverages. The model for the entire state (n = 1,386) identified a composite measure of anthropogenic disturbance (the sum of urban, agricultural, and unmanaged roadside vegetation land cover) within the local watershed as the most important variable, explaining 56 % of the variance in O/E values. Models for individual regions explained between 51 and 84 % of the variance in O/E values. Measures of human disturbance were important in the three coastal regions. In the South Coast and Coastal Chaparral, local watershed measures of urbanization were the most important variables related to biological condition, while in the North Coast the composite measure of human disturbance at the watershed scale was most important. In the two mountain regions, natural gradients were most important, including slope, precipitation, and temperature. The remaining three regions had relatively small sample sizes (n ≤ 75 sites) and had models that gave mixed results. Understanding the spatial scale at which land use and land cover affect

Predictors of Suicidal Ideation in a Statewide Sample of Transgender Individuals

OpenAIRE

Rood, Brian A.; Puckett, Julia A.; Pantalone, David W.; Bradford, Judith B.

2015-01-01

Transgender individuals experience violence and discrimination, which, in addition to gender transitioning, are established correlates of psychological distress. In a statewide sample of 350 transgender adults, we investigated whether a history of violence and discrimination increased the odds of reporting lifetime suicidal ideation (SI) and whether differences in SI were predicted by gender transition status. Violence, discrimination, and transition status significantly predicted SI. Compare...

Coaching and Quality Assistance in Quality Rating Improvement Systems: Approaches Used by TA Providers to Improve Quality in Early Care and Education Programs and Home-Based Settings

Science.gov (United States)

Smith, Sheila; Robbins, Taylor; Schneider, Will; Kreader, J. Lee; Ong, Christine

2012-01-01

Quality Rating Improvement Systems (QRISs) commonly offer on-site technical assistance (TA) and coaching to help early care and education settings achieve quality improvements and a higher QRIS rating. In surveys of administrators overseeing statewide QRISs, almost all states reported the use of on-site TA and coaching in both center-based and…

FINAL TECHNICAL REPORT FOR FORESTRY BIOFUEL STATEWIDE COLLABORATION CENTER (MICHIGAN)

Energy Technology Data Exchange (ETDEWEB)

LaCourt, Donna M.; Miller, Raymond O.; Shonnard, David R.

2012-04-24

A team composed of scientists from Michigan State University (MSU) and Michigan Technological University (MTU) assembled to better understand, document, and improve systems for using forest-based biomass feedstocks in the production of energy products within Michigan. Work was funded by a grant (DE-EE-0000280) from the U.S. Department of Energy (DOE) and was administered by the Michigan Economic Development Corporation (MEDC). The goal of the project was to improve the forest feedstock supply infrastructure to sustainably provide woody biomass for biofuel production in Michigan over the long-term. Work was divided into four broad areas with associated objectives: • TASK A: Develop a Forest-Based Biomass Assessment for Michigan – Define forest-based feedstock inventory, availability, and the potential of forest-based feedstock to support state and federal renewable energy goals while maintaining current uses. • TASK B: Improve Harvesting, Processing and Transportation Systems – Identify and develop cost, energy, and carbon efficient harvesting, processing and transportation systems. • TASK C: Improve Forest Feedstock Productivity and Sustainability – Identify and develop sustainable feedstock production systems through the establishment and monitoring of a statewide network of field trials in forests and energy plantations. • TASK D: Engage Stakeholders – Increase understanding of forest biomass production systems for biofuels by a broad range of stakeholders. The goal and objectives of this research and development project were fulfilled with key model deliverables including: 1) The Forest Biomass Inventory System (Sub-task A1) of feedstock inventory and availability and, 2) The Supply Chain Model (Sub-task B2). Both models are vital to Michigan’s forest biomass industry and support forecasting delivered cost, as well as carbon and energy balance. All of these elements are important to facilitate investor, operational and policy decisions. All

Hawai'i Youth at Risk? Conceptual Challenges in Communicating a Statewide Mentoring Initiative.

Science.gov (United States)

Pollard, Vincent Kelly

This paper discusses several issues considered as part of a statewide mentoring initiative. It is divided into three sections. The first section summarizes the key issues associated with short-term mentoring and mentoring in a longer-term, socially transformative context. Data from Comprehensive School Alienation Program is discussed concerning…

Statewide Dissemination of a Rural, Non-Chain Restaurant Intervention: Adoption, Implementation and Maintenance

Science.gov (United States)

Nothwehr, F.; Haines, H.; Chrisman, M.; Schultz, U.

2014-01-01

The obesity epidemic calls for greater dissemination of nutrition-related programs, yet there remain few studies of the dissemination process. This study, guided by elements of the RE-AIM model, describes the statewide dissemination of a simple, point-of-purchase restaurant intervention. Conducted in rural counties of the Midwest, United States,…

Real-time web-based assessment of total population risk of future emergency department utilization: statewide prospective active case finding study.

Science.gov (United States)

Hu, Zhongkai; Jin, Bo; Shin, Andrew Y; Zhu, Chunqing; Zhao, Yifan; Hao, Shiying; Zheng, Le; Fu, Changlin; Wen, Qiaojun; Ji, Jun; Li, Zhen; Wang, Yong; Zheng, Xiaolin; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng B

2015-01-13

An easily accessible real-time Web-based utility to assess patient risks of future emergency department (ED) visits can help the health care provider guide the allocation of resources to better manage higher-risk patient populations and thereby reduce unnecessary use of EDs. Our main objective was to develop a Health Information Exchange-based, next 6-month ED risk surveillance system in the state of Maine. Data on electronic medical record (EMR) encounters integrated by HealthInfoNet (HIN), Maine's Health Information Exchange, were used to develop the Web-based surveillance system for a population ED future 6-month risk prediction. To model, a retrospective cohort of 829,641 patients with comprehensive clinical histories from January 1 to December 31, 2012 was used for training and then tested with a prospective cohort of 875,979 patients from July 1, 2012, to June 30, 2013. The multivariate statistical analysis identified 101 variables predictive of future defined 6-month risk of ED visit: 4 age groups, history of 8 different encounter types, history of 17 primary and 8 secondary diagnoses, 8 specific chronic diseases, 28 laboratory test results, history of 3 radiographic tests, and history of 25 outpatient prescription medications. The c-statistics for the retrospective and prospective cohorts were 0.739 and 0.732 respectively. Integration of our method into the HIN secure statewide data system in real time prospectively validated its performance. Cluster analysis in both the retrospective and prospective analyses revealed discrete subpopulations of high-risk patients, grouped around multiple "anchoring" demographics and chronic conditions. With the Web-based population risk-monitoring enterprise dashboards, the effectiveness of the active case finding algorithm has been validated by clinicians and caregivers in Maine. The active case finding model and associated real-time Web-based app were designed to track the evolving nature of total population risk, in a

Barriers, facilitators, and potential strategies for increasing HPV vaccination: A statewide assessment to inform action

Directory of Open Access Journals (Sweden)

Kathleen B. Cartmell

2018-06-01

Full Text Available Objective: The objective was to investigate how state level strategies in South Carolina could maximize HPV vaccine uptake. Design: An environmental scan identified barriers, facilitators, and strategies for improving HPV vaccination in South Carolina. Interviews were conducted with state leaders from relevant organizations such as public health agencies, medical associations, K-12 schools, universities, insurers, and cancer advocacy organizations. A thematic content analysis design was used. Digital interview files were transcribed, a data dictionary was created and data were coded using the data dictionary. Results: Thirty four interviews were conducted with state leaders. Barriers to HPV vaccination included lack of HPV awareness, lack of provider recommendation, HPV vaccine concerns, lack of access and practice-level barriers. Facilitators included momentum for improving HPV vaccination, school-entry Tdap requirement, pharmacy-based HPV vaccination, state immunization registry, HEDIS measures and HPV vaccine funding. Strategies for improving HPV vaccination fell into three categories: 1 addressing lack of awareness about the importance of HPV vaccination among the public and providers; 2 advocating for policy changes around HPV vaccine coverage, vaccine education, and pharmacy-based vaccination; and 3 coordination of efforts. Discussion: A statewide environmental scan generated a blueprint for action to be used to improve HPV vaccination in the state. Keywords: HPV, HPV vaccines, Cervical cancer, Prevention, Health systems, Barriers, Facilitators, Strategies, South Carolina

Designing a system for patients controlling providers' access to their electronic health records: organizational and technical challenges.

Science.gov (United States)

Leventhal, Jeremy C; Cummins, Jonathan A; Schwartz, Peter H; Martin, Douglas K; Tierney, William M

2015-01-01

Electronic health records (EHRs) are proliferating, and financial incentives encourage their use. Applying Fair Information Practice principles to EHRs necessitates balancing patients' rights to control their personal information with providers' data needs to deliver safe, high-quality care. We describe the technical and organizational challenges faced in capturing patients' preferences for patient-controlled EHR access and applying those preferences to an existing EHR. We established an online system for capturing patients' preferences for who could view their EHRs (listing all participating clinic providers individually and categorically-physicians, nurses, other staff) and what data to redact (none, all, or by specific categories of sensitive data or patient age). We then modified existing data-viewing software serving a state-wide health information exchange and a large urban health system and its primary care clinics to allow patients' preferences to guide data displays to providers. Patients could allow or restrict data displays to all clinicians and staff in a demonstration primary care clinic, categories of providers (physicians, nurses, others), or individual providers. They could also restrict access to all EHR data or any or all of five categories of sensitive data (mental and reproductive health, sexually transmitted diseases, HIV/AIDS, and substance abuse) and for specific patient ages. The EHR viewer displayed data via reports, data flowsheets, and coded and free text data displayed by Google-like searches. Unless patients recorded restrictions, by default all requested data were displayed to all providers. Data patients wanted restricted were not displayed, with no indication they were redacted. Technical barriers prevented redacting restricted information in free textnotes. The program allowed providers to hit a "Break the Glass" button to override patients' restrictions, recording the date, time, and next screen viewed. Establishing patient

A task force model for statewide change in nursing education: building quality and safety.

Science.gov (United States)

Mundt, Mary H; Clark, Margherita Procaccini; Klemczak, Jeanette Wrona

2013-01-01

The purpose of this article was to describe a statewide planning process to transform nursing education in Michigan to improve quality and safety of patient care. A task force model was used to engage diverse partners in issue identification, consensus building, and recommendations. An example of a statewide intervention in nursing education and practice that was executed was the Michigan Quality and Safety in Nursing Education Institute, which was held using an integrated approach to academic-practice partners from all state regions. This paper describes the unique advantage of leadership by the Michigan Chief Nurse Executive, the existence of a nursing strategic plan, and a funding model. An overview of the Task Force on Nursing Education is presented with a focus on the model's 10 process steps and resulting seven recommendations. The Michigan Nurse Education Council was established to implement the recommendations that included quality and safety. Copyright © 2013 Elsevier Inc. All rights reserved.

Real time alert system: a disease management system leveraging health information exchange.

Science.gov (United States)

Anand, Vibha; Sheley, Meena E; Xu, Shawn; Downs, Stephen M

2012-01-01

Rates of preventive and disease management services can be improved by providing automated alerts and reminders to primary care providers (PCPs) using of health information technology (HIT) tools. Using Adaptive Turnaround Documents (ATAD), an existing Health Information Exchange (HIE) infrastructure and office fax machines, we developed a Real Time Alert (RTA) system. RTA is a computerized decision support system (CDSS) that is able to deliver alerts to PCPs statewide for recommended services around the time of the patient visit. RTA is also able to capture structured clinical data from providers using existing fax technology. In this study, we evaluate RTA's performance for alerting PCPs when their patients with asthma have an emergency room visit anywhere in the state. Our results show that RTA was successfully able to deliver "just in time" patient-relevant alerts to PCPs across the state. Furthermore, of those ATADs faxed back and automatically interpreted by the RTA system, 35% reported finding the provided information helpful. The PCPs who reported finding information helpful also reported making a phone call, sending a letter or seeing the patient for follow up care. We have successfully demonstrated the feasibility of electronically exchanging important patient related information with the PCPs statewide. This is despite a lack of a link with their electronic health records. We have shown that using our ATAD technology, a PCP can be notified quickly of an important event such as a patient's asthma related emergency room admission so further follow up can happen in near real time.

A California statewide three-dimensional seismic velocity model from both absolute and differential times

Science.gov (United States)

Lin, G.; Thurber, C.H.; Zhang, H.; Hauksson, E.; Shearer, P.M.; Waldhauser, F.; Brocher, T.M.; Hardebeck, J.

2010-01-01

We obtain a seismic velocity model of the California crust and uppermost mantle using a regional-scale double-difference tomography algorithm. We begin by using absolute arrival-time picks to solve for a coarse three-dimensional (3D) P velocity (VP) model with a uniform 30 km horizontal node spacing, which we then use as the starting model for a finer-scale inversion using double-difference tomography applied to absolute and differential pick times. For computational reasons, we split the state into 5 subregions with a grid spacing of 10 to 20 km and assemble our final statewide VP model by stitching together these local models. We also solve for a statewide S-wave model using S picks from both the Southern California Seismic Network and USArray, assuming a starting model based on the VP results and a VP=VS ratio of 1.732. Our new model has improved areal coverage compared with previous models, extending 570 km in the SW-NE directionand 1320 km in the NW-SE direction. It also extends to greater depth due to the inclusion of substantial data at large epicentral distances. Our VP model generally agrees with previous separate regional models for northern and southern California, but we also observe some new features, such as high-velocity anomalies at shallow depths in the Klamath Mountains and Mount Shasta area, somewhat slow velocities in the northern Coast Ranges, and slow anomalies beneath the Sierra Nevada at midcrustal and greater depths. This model can be applied to a variety of regional-scale studies in California, such as developing a unified statewide earthquake location catalog and performing regional waveform modeling.

Preventing child maltreatment: Examination of an established statewide home-visiting program.

Science.gov (United States)

Chaiyachati, Barbara H; Gaither, Julie R; Hughes, Marcia; Foley-Schain, Karen; Leventhal, John M

2018-05-01

Although home visiting has been used in many populations in prevention efforts, the impact of scaled-up home-visiting programs on abuse and neglect remains unclear. The objective of this study was to assess the impact of voluntary participation in an established statewide home-visiting program for socially high-risk families on child maltreatment as identified by Child Protective Services (CPS). Propensity score matching was used to compare socially high-risk families with a child born between January 1, 2008 and December 31, 2011 who participated in Connecticut's home-visiting program for first-time mothers and a comparison cohort of families who were eligible for the home-visiting program but did not participate. The main outcomes were child maltreatment investigations, substantiations, and out-of-home placements by CPS between January 1, 2008 and December 31, 2013. In the unmatched sample, families who participated in home-visiting had significantly higher median risk scores (P home visiting. First substantiations also occurred later in the child's life among home-visited families. There was a trend toward decreased out-of-home placement (HR 0.73, 95% CI 0.53-1.02, P = .06). These results from a scaled-up statewide program highlight the potential of home visiting as an important approach to preventing child abuse and neglect. Copyright © 2018 Elsevier Ltd. All rights reserved.

Improving Accuracy and Relevance of Race/Ethnicity Data: Results of a Statewide Collaboration in Hawaii.

Science.gov (United States)

Pellegrin, Karen L; Miyamura, Jill B; Ma, Carolyn; Taniguchi, Ronald

2016-01-01

Current race/ethnicity categories established by the U.S. Office of Management and Budget are neither reliable nor valid for understanding health disparities or for tracking improvements in this area. In Hawaii, statewide hospitals have collaborated to collect race/ethnicity data using a standardized method consistent with recommended practices that overcome the problems with the federal categories. The purpose of this observational study was to determine the impact of this collaboration on key measures of race/ethnicity documentation. After this collaborative effort, the number of standardized categories available across hospitals increased from 6 to 34, and the percent of inpatients with documented race/ethnicity increased from 88 to 96%. This improved standardized methodology is now the foundation for tracking population health indicators statewide and focusing quality improvement efforts. The approach used in Hawaii can serve as a model for other states and regions. Ultimately, the ability to standardize data collection methodology across states and regions will be needed to track improvements nationally.

Contracting for Statewide Student Achievement Tests: A Review. Department of Public Instruction 98-4.

Science.gov (United States)

Wisconsin State Legislative Audit Bureau, Madison.

The Wisconsin legislature has required the Department of Public Instruction to adopt or approve standardized tests for statewide use to measure student attainment of knowledge and concepts in grades 4, 8, and 10. Although school districts generally gave high ratings to the contents of TerraNova (McGraw Hill), the testing instrument most recently…

Sewer System Management Plan.

Energy Technology Data Exchange (ETDEWEB)

Holland, Robert C. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2017-08-01

A Sewer System Management Plan (SSMP) is required by the State Water Resources Control Board (SWRCB) Order No. 2006-0003-DWQ Statewide General Waste Discharge Requirements (WDR) for Sanitary Sewer Systems (General Permit). DOE, National Nuclear Security Administration (NNSA), Sandia Field Office has filed a Notice of Intent to be covered under this General Permit. The General Permit requires a proactive approach to reduce the number and frequency of sanitary sewer overflows (SSOs) within the State. SSMPs must include provisions to provide proper and efficient management, operation, and maintenance of sanitary sewer systems and must contain a spill response plan.

A Multilevel, Statewide Investigation of School District Anti-Bullying Policy Quality and Student Bullying Involvement

Science.gov (United States)

Gower, Amy L.; Cousin, Molly; Borowsky, Iris W.

2017-01-01

Background: Although nearly all states in the United States require school districts to adopt anti-bullying policies, little research examines the effect of these policies on student bullying and health. Using a statewide sample, we investigated associations between the quality of school district anti-bullying policies and student bullying…

Implementing Statewide Severe Maternal Morbidity Review: The Illinois Experience.

Science.gov (United States)

Koch, Abigail R; Roesch, Pamela T; Garland, Caitlin E; Geller, Stacie E

2018-03-07

Severe maternal morbidity (SMM) rates in the United States more than doubled between 1998 and 2010. Advanced maternal age and chronic comorbidities do not completely explain the increase in SMM or how to effectively address it. The Centers for Disease Control and Prevention and American College of Obstetricians and Gynecologists have called for facility-level multidisciplinary review of SMM for potential preventability and have issued implementation guidelines. Within Illinois, SMM was identified as any intensive or critical care unit admission and/or 4 or more units of packed red blood cells transfused at any time from conception through 42 days postpartum. All cases meeting this definition were counted during statewide surveillance. Cases were selected for review on the basis of their potential to yield insights into factors contributing to preventable SMM or best practices preventing further morbidity or death. If the SMM review committee deemed a case potentially preventable, it identified specific factors associated with missed opportunities and made actionable recommendations for quality improvement. Approximately 1100 cases of SMM were identified from July 1, 2016, to June 30, 2017, yielding a rate of 76 SMM cases per 10 000 pregnancies. Reviews were conducted on 142 SMM cases. Most SMM cases occurred during delivery hospitalization and more than half were delivered by cesarean section. Hemorrhage was the primary cause of SMM (>50% of the cases). Facility-level SMM review was feasible and acceptable in statewide implementation. States that are planning SMM reviews across obstetric facilities should permit ample time for translation of recommendations to practice. Although continued maternal mortality reviews are valuable, they are not sufficient to address the increasing rates of SMM and maternal death. In-depth multidisciplinary review offers the potential to identify factors associated with SMM and interventions to prevent women from moving along the

The relationship between processes and outcomes for injured older adults: a study of a statewide trauma system.

Science.gov (United States)

Saillant, N N; Earl-Royal, E; Pascual, J L; Allen, S R; Kim, P K; Delgado, M K; Carr, B G; Wiebe, D; Holena, D N

2017-02-01

Age is a risk factor for death, adverse outcomes, and health care use following trauma. The American College of Surgeons' Trauma Quality Improvement Program (TQIP) has published "best practices" of geriatric trauma care; adoption of these guidelines is unknown. We sought to determine which evidence-based geriatric protocols, including TQIP guidelines, were correlated with decreased mortality in Pennsylvania's trauma centers. PA's level I and II trauma centers self-reported adoption of geriatric protocols. Survey data were merged with risk-adjusted mortality data for patients ≥65 from a statewide database, the Pennsylvania Trauma Systems Foundation (PTSF), to compare mortality outlier status and processes of care. Exposures of interest were center-specific processes of care; outcome of interest was PTSF mortality outlier status. 26 of 27 eligible trauma centers participated. There was wide variation in care processes. Four trauma centers were low outliers; three centers were high outliers for risk-adjusted mortality rates in adults ≥65. Results remained consistent when accounting for center volume. The only process associated with mortality outlier status was age-specific solid organ injury protocols (p = 0.04). There was no cumulative effect of multiple evidence-based processes on mortality rate (p = 0.50). We did not see a link between adoption of geriatric best-practices trauma guidelines and reduced mortality at PA trauma centers. The increased susceptibility of elderly to adverse consequences of injury, combined with the rapid growth rate of this demographic, emphasizes the importance of identifying interventions tailored to this population. III. Descriptive.

New Mexico statewide geothermal energy program. Final technical report

Energy Technology Data Exchange (ETDEWEB)

Icerman, L.; Parker, S.K. (ed.)

1988-04-01

This report summarizes the results of geothermal energy resource assessment work conducted by the New Mexico Statewide Geothermal Energy Program during the period September 7, 1984, through February 29, 1988, under the sponsorship of the US Dept. of Energy and the State of New Mexico Research and Development Institute. The research program was administered by the New Mexico Research and Development Institute and was conducted by professional staff members at New Mexico State University and Lightning Dock Geothermal, Inc. The report is divided into four chapters, which correspond to the principal tasks delineated in the above grant. This work extends the knowledge of the geothermal energy resource base in southern New Mexico with the potential for commercial applications.

Use of a Novel Accounting and Grouping Method for Major Trunk Injury-Analysis of Data from a Statewide Trauma Financial Survey.

Science.gov (United States)

Joubert, Kyla D; Mabry, Charles D; Kalkwarf, Kyle J; Betzold, Richard D; Spencer, Horace J; Spinks, Kara M; Porter, Austin; Karim, Saleema; Robertson, Ronald D; Sutherland, Michael J; Maxson, Robert T

2016-09-01

Major trunk trauma is common and costly, but comparisons of costs between trauma centers (TCs) are rare. Understanding cost is essential to improve quality, manage trauma service lines, and to facilitate institutional commitment for trauma. We have used results of a statewide trauma financial survey of Levels I to IV TC to develop a useful grouping method for costs and clinical characteristics of major trunk trauma. The trauma financial survey collected billing and clinical data on 75 per cent of the state trauma registry patients for fiscal year 2012. Cost was calculated by separately accounting for embedded costs of trauma response and verification, and then adjusting reasonable costs from the Medicare cost report for each TC. The cost-to-charge ratios were then recalculated and used to determine uniform cost estimates for each patient. From the 13,215 patients submitted for the survey, we selected 1,094 patients with major trunk trauma: lengths of stay ≥ 48 hours and a maximum injury of AIS ≥3 for either thorax or abdominal trauma. These patients were then divided into three Injury Severity Score (ISS) groups of 9 to 15, 16 to 24, or 25+ to stratify patients into similar injury groups for analysis of cost and cost drivers. For abdominal injury, average total cost for patients with ISS 9 to 15 was $17,429. Total cost and cost per day increased with severity of injury, with $51,585 being the total cost for those with ISS 25. Similar trends existed for thoracic injury. Use of the Medicare cost report and cost-to-charge ratios to compute uniform costs with an innovative grouping method applied to data collected across a statewide trauma system provides unique information regarding cost and outcomes, which affects quality improvement, trauma service line management, and decisions on TC participation.

Towards automated statewide land cover mapping in Wisconsin using satellite remote sensing and GIS techniques

International Nuclear Information System (INIS)

Cosentino, B.L.; Lillesand, T.M.

1991-01-01

Attention is given to an initial research project being performed by the University of Wisconsin-Madison, Environmental Remote Sensing Center in conjunction with seven local, state, and federal agencies to implement automated statewide land cover mapping using satellite remote sensing and geographical information system (GIS) techniques. The basis, progress, and future research needs for this mapping program are presented. The research efforts are directed toward strategies that integrate satellite remote sensing and GIS techniques in the generation of land cover data for multiple users of land cover information. The project objectives are to investigate methodologies that integrate satellite data with other imagery and spatial data resident in emerging GISs in the state for particular program needs, and to develop techniques that can improve automated land cover mapping efficiency and accuracy. 10 refs

A Guide to Effective Statewide Laws/Policies: Preventing Discrimination against LGBT Students in K-12 Schools.

Science.gov (United States)

Lambda Legal Defense and Education Fund, New York, NY.

This document presents guidance for stopping discrimination, harassment, and violence against lesbian, gay, bisexual, and transgender (LGBT) students in schools. Section 1, "Lambda Legal Defense and Education Fund on the Legal Considerations for Creating and Changing Statewide Laws and Policies," discusses the various types of statewide…

Development of a central data warehouse for statewide ITS and transportation data in Florida phase III : final report.

Science.gov (United States)

2009-12-15

This report documents Phase III of the development and operation of a prototype for the Statewide Transportation : Engineering Warehouse for Archived Regional Data (STEWARD). It reflects the progress on the development and : operation of STEWARD sinc...

Preliminary construction of a service provider--informed domestic violence research agenda.

Science.gov (United States)

Murray, Christine E; Welch, Metoka L

2010-12-01

This article presents the results of a statewide survey of domestic violence (DV) service providers that focused on the needs, background characteristics, and opinions of service providers related to research. The survey included an examination of service providers' motivation for working in the field, research background and training, and perceptions of research as well as the topics they believe are important for researchers to study, the resources they consult to learn about DV, and their suggestions to help researchers learn more about the nature of their work. The results are integrated into a preliminary agenda for future DV research that accounts for the needs and insight of service providers.

Management systems for service providers

International Nuclear Information System (INIS)

Bolokonya, Herbert Chiwalo

2015-02-01

In the field of radiation safety and protection there are a number of institutions that are involved in achieving different goals and strategies. These strategies and objectives are achieved based on a number of tools and systems, one of these tools and systems is the use of a management system. This study aimed at reviewing the management system concept for Technical Service Providers in the field of radiation safety and protection. The main focus was on personal monitoring services provided by personal dosimetry laboratories. A number of key issues were found to be prominent to make the management system efficient. These are laboratory accreditation, approval; having a customer driven operating criteria; and controlling of records and good reporting. (au)

The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.

Science.gov (United States)

Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L

2014-01-01

In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised

Automated Cancer Registry Notifications: Validation of a Medical Text Analytics System for Identifying Patients with Cancer from a State-Wide Pathology Repository.

Science.gov (United States)

Nguyen, Anthony N; Moore, Julie; O'Dwyer, John; Philpot, Shoni

2016-01-01

The paper assesses the utility of Medtex on automating Cancer Registry notifications from narrative histology and cytology reports from the Queensland state-wide pathology information system. A corpus of 45.3 million pathology HL7 messages (including 119,581 histology and cytology reports) from a Queensland pathology repository for the year of 2009 was analysed by Medtex for cancer notification. Reports analysed by Medtex were consolidated at a patient level and compared against patients with notifiable cancers from the Queensland Oncology Repository (QOR). A stratified random sample of 1,000 patients was manually reviewed by a cancer clinical coder to analyse agreements and discrepancies. Sensitivity of 96.5% (95% confidence interval: 94.5-97.8%), specificity of 96.5% (95.3-97.4%) and positive predictive value of 83.7% (79.6-86.8%) were achieved for identifying cancer notifiable patients. Medtex achieved high sensitivity and specificity across the breadth of cancers, report types, pathology laboratories and pathologists throughout the State of Queensland. The high sensitivity also resulted in the identification of cancer patients that were not found in the QOR. High sensitivity was at the expense of positive predictive value; however, these cases may be considered as lower priority to Cancer Registries as they can be quickly reviewed. Error analysis revealed that system errors tended to be tumour stream dependent. Medtex is proving to be a promising medical text analytic system. High value cancer information can be generated through intelligent data classification and extraction on large volumes of unstructured pathology reports.

Design of a statewide radiation survey

International Nuclear Information System (INIS)

Nagda, N.L.; Koontz, M.D.; Rector, H.E.; Nifong, G.D.

1989-01-01

The Florida Institute of Phosphate Research (FIPR) recently sponsored a statewide survey to identify all significant land areas in Florida where the state's environmental radiation rule should be applied. Under this rule, newly constructed buildings must be tested for radiation levels unless approved construction techniques are used. Two parallel surveys - a land-based survey and a population-based survey - were designed and conducted to address the objective. Each survey included measurements in more than 3000 residences throughout the state. Other information sources that existed at the outset of the study, such as geologic profiles mapped by previous investigators and terrestrial uranium levels characterized through aerial gamma radiation surveys, were also examined. Initial data analysis efforts focused on determining the extent of evidence of radon potential for each of 67 counties in the state. Within 18 countries that were determined to have definite evidence of elevated radon potential, more detailed spatial analyses were conducted to identify areas of which the rule should apply. A total of 74 quadrangles delineated by the U.S. Geological Survey, representing about 7% of those constituting the state, were identified as having elevated radon potential and being subject to the rule

Predictors of Suicidal Ideation in a Statewide Sample of Transgender Individuals.

Science.gov (United States)

Rood, Brian A; Puckett, Julia A; Pantalone, David W; Bradford, Judith B

2015-09-01

Transgender individuals experience violence and discrimination, which, in addition to gender transitioning, are established correlates of psychological distress. In a statewide sample of 350 transgender adults, we investigated whether a history of violence and discrimination increased the odds of reporting lifetime suicidal ideation (SI) and whether differences in SI were predicted by gender transition status. Violence, discrimination, and transition status significantly predicted SI. Compared with individuals with no plans to transition, individuals with plans or who were living as their identified gender reported greater odds of lifetime SI. We discuss implications for SI disparities using Meyer's minority stress model.

Design and implementation of an integrated, continuous evaluation, and quality improvement system for a state-based home-visiting program.

Science.gov (United States)

McCabe, Bridget K; Potash, Dru; Omohundro, Ellen; Taylor, Cathy R

2012-10-01

To describe the design and implementation of an evaluation system to facilitate continuous quality improvement (CQI) and scientific evaluation in a statewide home visiting program, and to provide a summary of the system's progress in meeting intended outputs and short-term outcomes. Help Us Grow Successfully (HUGS) is a statewide home visiting program that provides services to at-risk pregnant/post-partum women, children (0-5 years), and their families. The program goals are to improve parenting skills and connect families to needed services and thus improve the health of the service population. The evaluation system is designed to: (1) integrate evaluation into daily workflow; (2) utilize standardized screening and evaluation tools; (3) facilitate a culture of CQI in program management; and, (4) facilitate scientifically rigorous evaluations. The review of the system's design and implementation occurred through a formative evaluation process (reach, dose, and fidelity). Data was collected through electronic and paper surveys, administrative data, and notes from management meetings, and medical chart review. In the design phase, four process and forty outcome measures were selected and are tracked using standardized screening and monitoring tools. During implementation, the reach and dose of training were adequate to successfully launch the evaluation/CQI system. All staff (n = 165) use the system for management of families; the supervisors (n = 18) use the system to track routine program activities. Data quality and availability is sufficient to support periodic program reviews at the region and state level. In the first 7 months, the HUGS evaluation system tracked 3,794 families (7,937 individuals). System use and acceptance is high. A successful implementation of a structured evaluation system with a strong CQI component is feasible in an existing, large statewide program. The evaluation/CQI system is an effective mechanism to drive modest change in management

Avoiding a knowledge gap in a multiethnic statewide social marketing campaign: is cultural tailoring sufficient?

Science.gov (United States)

Buchthal, O Vanessa; Doff, Amy L; Hsu, Laura A; Silbanuz, Alice; Heinrich, Katie M; Maddock, Jay E

2011-03-01

In 2007, the State of Hawaii, Healthy Hawaii Initiative conducted a statewide social-marketing campaign promoting increased physical activity and nutrition. The campaign included substantial formative research to develop messages tailored for Hawaii's multiethnic Asian and Pacific Islander populations. The authors conducted a statewide random digital dialing telephone survey to assess the campaign's comparative reach among individuals with different ethnicities and different levels of education and income. This analysis suggests that the intervention was successful in reaching its target ethnic audiences. However, a knowledge gap related to the campaign appeared among individuals with incomes less than 130% of the poverty level and those with less than a high school education. These results varied significantly by message and the communication channel used. Recall of supermarket-based messages was significantly higher among individuals below 130% of the poverty level and those between 18 and 35 years of age, 2 groups that showed consistently lower recall of messages in other channels. Results suggest that cultural tailoring for ethnic audiences, although important, is insufficient for reaching low-income populations, and that broad-based social marketing campaigns should consider addressing socioeconomic status-related channel preferences in formative research and campaign design.

A statewide consortium's adoption of a unified nursing curriculum: evaluation of the first two years.

Science.gov (United States)

Tse, Alice M; Niederhauser, Victoria; Steffen, John J; Magnussen, Lois; Morrisette, Nova; Polokoff, Rachael; Chock, Johnelle

2014-01-01

This article provides an evaluation of the first two years of implementation of a statewide nursing consortium (SNC) curriculum on nursing faculty work life, teaching productivity, and quality of education. In response to the call for nursing education reform, the SNC incorporated new approaches to competency-based, student-centered learning and clinical education. Faculty and two cohorts of students were measured at three points over the first two years of the curriculum implementation. The expected positive impact of the SNC was documented at the start of the first year, but not sustained. Students reported having more confidence in their clinical skills at the start of the first year, yet demonstrated significantly less confidence in their ability after two years. Faculty indicated that the SNC allowed greater opportunity for collaboration, but that the experience did not alter their classroom performance or satisfaction beyond the first year.

An Annual Report to the Legislature on Oregon Public Schools. Oregon Statewide Report Card. 2014-2015

Science.gov (United States)

Oregon Department of Education, 2015

2015-01-01

The Oregon Statewide Report Card is an annual publication required by law (ORS 329.115), which reports on the state of public schools and their progress towards the goals of the Oregon Educational Act for the 21st Century. The purpose of the Oregon Report Card is to monitor trends among school districts and Oregon's progress toward achieving the…

Variations in statewide water quality of New Jersey streams, water years 1998-2009

Science.gov (United States)

Heckathorn, Heather A.; Deetz, Anna C.

2012-01-01

Statistical analyses were conducted for six water-quality constituents measured at 371 surface-water-quality stations during water years 1998-2009 to determine changes in concentrations over time. This study examined year-round concentrations of total dissolved solids, dissolved nitrite plus nitrate, dissolved phosphorus, total phosphorus, and total nitrogen; concentrations of dissolved chloride were measured only from January to March. All the water-quality data analyzed were collected by the New Jersey Department of Environmental Protection and the U.S. Geological Survey as part of the cooperative Ambient Surface-Water-Quality Monitoring Network. Stations were divided into groups according to the 1-year or 2-year period that the stations were part of the Ambient Surface-Water-Quality Monitoring Network. Data were obtained from the eight groups of Statewide Status stations for water years 1998, 1999, 2000, 2001-02, 2003-04, 2005-06, 2007-08, and 2009. The data from each group were compared to the data from each of the other groups and to baseline data obtained from Background stations unaffected by human activity that were sampled during the same time periods. The Kruskal-Wallis test was used to determine whether median concentrations of a selected water-quality constituent measured in a particular 1-year or 2-year group were different from those measured in other 1-year or 2-year groups. If the median concentrations were found to differ among years or groups of years, then Tukey's multiple comparison test on ranks was used to identify those years with different or equal concentrations of water-quality constituents. A significance level of 0.05 was selected to indicate significant changes in median concentrations of water-quality constituents. More variations in the median concentrations of water-quality constituents were observed at Statewide Status stations (randomly chosen stations scattered throughout the State of New Jersey) than at Background stations

Filling the Void: The Roles of a Local Applied Research Center and a Statewide Workforce Training Consortium

Science.gov (United States)

Perniciaro, Richard C.; Nespoli, Lawrence A.; Anbarasan, Sivaraman

2015-01-01

This chapter describes the development of an applied research center at Atlantic Cape Community College and a statewide workforce training consortium run by the community college sector in New Jersey. Their contributions to the economic development mission of the colleges as well as their impact on the perception of community colleges by…

State of Hawaii, Department of Health, Clean Water Branch State-wide Water Quality Sampling Dataset 1999-2006 (NODC Accession 0013723)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The Monitoring Section of the State of Hawaii, Department of Health, Clean Water Branch collects water quality data at over 300 coastal locations state-wide using...

State of Hawaii, Department of Health, Clean Water Branch State-wide Water Quality Sampling Dataset 1973-1998 (NODC Accession 0013724)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — The Monitoring Section of the State of Hawaii, Department of Health, Clean Water Branch collects water quality data at over 300 coastal locations state-wide using...

Level and Intensity of Early Intervention Services for Infants and Toddlers with Disabilities: The Impact of Child, Family, System, and Community-Level Factors on Service Provision

Science.gov (United States)

Hallam, Rena A.; Rous, Beth; Grove, Jaime; LoBianco, Tony

2009-01-01

Data from a statewide billing and information system for early intervention are used to examine the influence of multiple factors on the level and intensity of services provided in a state early intervention system. Results indicate that child and family factors including entry age, gestational age, Medicaid eligibility, access to third party…

A GIS-Enabled, Michigan-Specific, Hierarchical Groundwater Modeling and Visualization System

Science.gov (United States)

Liu, Q.; Li, S.; Mandle, R.; Simard, A.; Fisher, B.; Brown, E.; Ross, S.

2005-12-01

Efficient management of groundwater resources relies on a comprehensive database that represents the characteristics of the natural groundwater system as well as analysis and modeling tools to describe the impacts of decision alternatives. Many agencies in Michigan have spent several years compiling expensive and comprehensive surface water and groundwater inventories and other related spatial data that describe their respective areas of responsibility. However, most often this wealth of descriptive data has only been utilized for basic mapping purposes. The benefits from analyzing these data, using GIS analysis functions or externally developed analysis models or programs, has yet to be systematically realized. In this talk, we present a comprehensive software environment that allows Michigan groundwater resources managers and frontline professionals to make more effective use of the available data and improve their ability to manage and protect groundwater resources, address potential conflicts, design cleanup schemes, and prioritize investigation activities. In particular, we take advantage of the Interactive Ground Water (IGW) modeling system and convert it to a customized software environment specifically for analyzing, modeling, and visualizing the Michigan statewide groundwater database. The resulting Michigan IGW modeling system (IGW-M) is completely window-based, fully interactive, and seamlessly integrated with a GIS mapping engine. The system operates in real-time (on the fly) providing dynamic, hierarchical mapping, modeling, spatial analysis, and visualization. Specifically, IGW-M allows water resources and environmental professionals in Michigan to: * Access and utilize the extensive data from the statewide groundwater database, interactively manipulate GIS objects, and display and query the associated data and attributes; * Analyze and model the statewide groundwater database, interactively convert GIS objects into numerical model features

Development of a State-Wide 3-D Seismic Tomography Velocity Model for California

Science.gov (United States)

Thurber, C. H.; Lin, G.; Zhang, H.; Hauksson, E.; Shearer, P.; Waldhauser, F.; Hardebeck, J.; Brocher, T.

2007-12-01

We report on progress towards the development of a state-wide tomographic model of the P-wave velocity for the crust and uppermost mantle of California. The dataset combines first arrival times from earthquakes and quarry blasts recorded on regional network stations and travel times of first arrivals from explosions and airguns recorded on profile receivers and network stations. The principal active-source datasets are Geysers-San Pablo Bay, Imperial Valley, Livermore, W. Mojave, Gilroy-Coyote Lake, Shasta region, Great Valley, Morro Bay, Mono Craters-Long Valley, PACE, S. Sierras, LARSE 1 and 2, Loma Prieta, BASIX, San Francisco Peninsula and Parkfield. Our beta-version model is coarse (uniform 30 km horizontal and variable vertical gridding) but is able to image the principal features in previous separate regional models for northern and southern California, such as the high-velocity subducting Gorda Plate, upper to middle crustal velocity highs beneath the Sierra Nevada and much of the Coast Ranges, the deep low-velocity basins of the Great Valley, Ventura, and Los Angeles, and a high- velocity body in the lower crust underlying the Great Valley. The new state-wide model has improved areal coverage compared to the previous models, and extends to greater depth due to the data at large epicentral distances. We plan a series of steps to improve the model. We are enlarging and calibrating the active-source dataset as we obtain additional picks from investigators and perform quality control analyses on the existing and new picks. We will also be adding data from more quarry blasts, mainly in northern California, following an identification and calibration procedure similar to Lin et al. (2006). Composite event construction (Lin et al., in press) will be carried out for northern California for use in conventional tomography. A major contribution of the state-wide model is the identification of earthquakes yielding arrival times at both the Northern California Seismic

Determining Provider Needs for Respite Training, Results of an Alabama Survey

Directory of Open Access Journals (Sweden)

Brian F. Geiger

2014-12-01

Full Text Available The Alabama Lifespan Respite Resource Network™ enhances respite services for family caregivers. University evaluators conducted a statewide assessment of respite providers using multiple formats. The purpose was to determine met and unmet needs for respite training among providers serving family caregivers of individuals with disabilities and chronic illnesses. A total of 317 respite providers attempted and 191 completed survey items, revealing respite experience, disabilities and chronic illnesses, areas of difficulty, prior training and confidence, training needs and preferences. Results will be used by a state Network to match content and delivery of training to providers’ needs. Respite providers have important roles to play, sharing information about respite services and providers, advocating for caregiver eligibility to receive services, and participating in training paid and volunteer providers.

Development of statewide geriatric patients trauma triage criteria.

Science.gov (United States)

Werman, Howard A; Erskine, Timothy; Caterino, Jeffrey; Riebe, Jane F; Valasek, Tricia

2011-06-01

The geriatric population is unique in the type of traumatic injuries sustained, physiological responses to those injuries, and an overall higher mortality when compared to younger adults. No published, evidence-based, geriatric-specific field destination criteria exist as part of a statewide trauma system. The Trauma Committee of the Ohio Emergency Medical Services (EMS) Board sought to develop specific criteria for geriatric trauma victims. A literature search was conducted for all relevant literature to determine potential, geriatric-specific, field-destination criteria. Data from the Ohio Trauma Registry were used to compare elderly patients, defined as age >70 years, to all patients between the ages of 16 to 69 years with regards to mortality risk in the following areas: (1) Glasgow Coma Scale (GCS) score; (2) systolic blood pressure (SBP); (3) falls associated with head, chest, abdominal or spinal injury; (4) mechanism of injury; (5) involvement of more than one body system as defined in the Barell matrix; and (6) co-morbidities and motor vehicle collision with one or more long bone fracture. For GCS score and SBP, those cut-off points with equal or greater risk of mortality as compared to current values were chosen as proposed triage criteria. For other measures, any criterion demonstrating a statistically significant increase in mortality risk was included in the proposed criteria. The following criteria were identified as geriatric-specific criteria: (1) GCS score trauma; (2) SBP trauma. In addition, these data suggested that elderly patients with specific co-morbidities be given strong consideration for evaluation in a trauma center. The state of Ohio is the first state to develop evidence-based geriatric-specific field-destination criteria using data from its state-mandated trauma registry. Further analysis of these criteria will help determine their effects on over-triage and under-triage of geriatric victims of traumatic injuries and the impact on the

The Effect of a Statewide Mandatory Prescription Drug Monitoring Program on Opioid Prescribing by Emergency Medicine Providers Across 15 Hospitals in a Single Health System.

Science.gov (United States)

Suffoletto, Brian; Lynch, Michael; Pacella, Charissa B; Yealy, Donald M; Callaway, Clifton W

2018-04-01

Prescription drug monitoring programs (PDMPs) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the effect of a state-mandated PDMP on opioid prescribing by emergency medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 emergency departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law-mandated PDMP use on August 25, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% confidence interval [CI], 10.8%-14.1%) to 10.2% (95% CI, 8.8%-11.8%). For each month between September 2016 to March 2017, there was a mean decline of .46% (95% CI, -.38% to -.53%) in the percentage of patients discharged with an opioid prescription. There was heterogeneity in opioid prescribing across hospitals as well as according to patient diagnosis. This study examined the effect of a state-mandated PDMP on opioid prescribing among emergency medicine providers from 15 different hospitals in a single health system. Findings support current PDMP mandates in reducing opioid prescriptions, which could curb the prescription opioid epidemic and may ultimately reduce abuse, misuse, and overdose death. Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

Socioeconomic and travel demand forecasts for Virginia and potential policy responses : a report for VTrans2035 : Virginia's statewide multimodal transportation plan.

Science.gov (United States)

2009-01-01

VTrans2035, Virginia's statewide multimodal transportation plan, requires 25-year forecasts of socioeconomic and travel activity. Between 2010 and 2035, daily vehicle miles traveled (DVMT) will increase between 35% and 45%, accompanied by increases i...

45 CFR 1355.52 - Funding authority for statewide automated child welfare information systems (SACWIS).

Science.gov (United States)

2010-10-01

... welfare information systems (SACWIS). 1355.52 Section 1355.52 Public Welfare Regulations Relating to... welfare information systems (SACWIS). (a) States may receive Federal reimbursement at the 75 percent match... information system, to the extent such system: (1) Provides for the State to collect and electronically report...

Monitoring soil carbon will prepare growers for a carbon trading system

Directory of Open Access Journals (Sweden)

Emma C. Suddick

2013-07-01

Full Text Available California growers could reap financial benefits from the low-carbon economy and cap-and-trade system envisioned by the state's AB 32 law, which seeks to lower greenhouse gas emissions statewide. Growers could gain carbon credits by reducing greenhouse gas emissions and sequestering carbon through reduced tillage and increased biomass residue incorporation. First, however, baseline stocks of soil carbon need to be assessed for various cropping systems and management practices. We designed and set up a pilot soil carbon and land-use monitoring network at several perennial cropping systems in Northern California. We compared soil carbon content in two vineyards and two orchards (walnut and almond, looking at conventional and conservation management practices, as well as in native grassland and oak woodland. We then calculated baseline estimates of the total carbon in almond, wine grape and walnut acreages statewide. The organic walnut orchard had the highest total soil carbon, and no-till vineyards had 27% more carbon in the surface soil than tilled vineyards. We estimated wine grape vineyards are storing significantly more soil carbon per acre than almond and walnut orchards. The data can be used to provide accurate information about soil carbon stocks in perennial cropping systems for a future carbon trading system.

EMSC program manager survey on education of prehospital providers.

Science.gov (United States)

Ngo, Thuy L; Belli, Karen; Shah, Manish I

2014-01-01

Although pediatric-specific objectives for the initial education of prehospital providers have been established, uniform implementation of these objectives and guidelines for hours of required pediatric continuing education (CE) for prehospital providers have not been established. To examine the content and number of hours of pediatric-specific education that prehospital providers receive during initial certification and recertification. Second, to identify barriers to implementing specific requirements for pediatric education of prehospital providers. Electronic surveys were sent to 55 EMS for Children (EMSC) State Partnership grantee program managers inquiring about the certification and recertification processes of prehospital providers and barriers to receiving pediatric training in each jurisdiction. We had a 91% response rate for our survey. Specified pediatric education hours exist in more states and territories for recertification (63-67%) than initial certification (41%). Limitations in funding, time, instructors, and accessibility are barriers to enhancing pediatric education. Modifying statewide policies on prehospital education and increasing hands-on training may overcome identified barriers.

Results from a Multi-Modal Program Evaluation of a Four Year Statewide Juvenile Sex Offender Treatment and Reentry Program

Science.gov (United States)

Underwood, Lee A.; Dailey, Frances L. L.; Merino, Carrie; Crump, Yolanda

2015-01-01

The results of the Program Evaluation show the OJJ Statewide Sex Offender Treatment program is exceptionally productive in meeting over 90% of its established performance markers. These markers included successful screening and assessment of risk and psychosocial needs, completion of initial and master treatment plans, establishment of sex…

Statewide Groundwater Recharge Modeling in New Mexico

Science.gov (United States)

Xu, F.; Cadol, D.; Newton, B. T.; Phillips, F. M.

2017-12-01

It is crucial to understand the rate and distribution of groundwater recharge in New Mexico because it not only largely defines a limit for water availability in this semi-arid state, but also is the least understood aspect of the state's water budget. With the goal of estimating groundwater recharge statewide, we are developing the Evapotranspiration and Recharge Model (ETRM), which uses existing spatial datasets to model the daily soil water balance over the state at a resolution of 250 m cell. The input datasets includes PRISM precipitation data, MODIS Normalized Difference Vegetation Index (NDVI), NRCS soils data, state geology data and reference ET estimates produced by Gridded Atmospheric Data downscalinG and Evapotranspiration Tools (GADGET). The current estimated recharge presents diffuse recharge only, not focused recharge as in channels or playas. Direct recharge measurements are challenging and rare, therefore we estimate diffuse recharge using a water balance approach. The ETRM simulated runoff amount was compared with USGS gauged discharge in four selected ephemeral channels: Mogollon Creek, Zuni River, the Rio Puerco above Bernardo, and the Rio Puerco above Arroyo Chico. Result showed that focused recharge is important, and basin characteristics can be linked with watershed hydrological response. As the sparse instruments in NM provide limited help in improving estimation of focused recharge by linking basin characteristics, the Walnut Gulch Experimental Watershed, which is one of the most densely gauged and monitored semiarid rangeland watershed for hydrology research purpose, is now being modeled with ETRM. Higher spatial resolution of field data is expected to enable detailed comparison of model recharge results with measured transmission losses in ephemeral channels. The final ETRM product will establish an algorithm to estimate the groundwater recharge as a water budget component of the entire state of New Mexico. Reference ET estimated by GADGET

Changes in Obesity Awareness, Obesity Identification, and Self-Assessment of Health: Results from a Statewide Public Education Campaign

Science.gov (United States)

Tsai, Adam G.; Boyle, Tracy F.; Hill, James O.; Lindley, Corina; Weiss, Karl

2014-01-01

Background: Due to the high prevalence of obesity, individuals may be desensitized to weight as a personal health concern. Purpose: To evaluate changes in obesity awareness associated with a statewide public education campaign in Colorado. Methods: Cross-sectional random digit dial telephone surveys (n = 1,107 pre, n = 1101 post) were conducted…

Effect Of A “No Superuser Opioid Prescription” Policy On ED Visits And Statewide Opioid Prescription

Directory of Open Access Journals (Sweden)

Zachary P. Kahler

2017-07-01

Full Text Available Introduction: The U.S. opioid epidemic has highlighted the need to identify patients at risk of opioid abuse and overdose. We initiated a novel emergency department- (ED based interventional protocol to transition our superuser patients from the ED to an outpatient chronic pain program. The objective was to evaluate the protocol’s effect on superusers’ annual ED visits. Secondary outcomes included a quantitative evaluation of statewide opioid prescriptions for these patients, unique prescribers of controlled substances, and ancillary testing. Methods: Patients were referred to the program with the following inclusion criteria: ≥ 6 visits per year to the ED; at least one visit identified by the attending physician as primarily driven by opioid-seeking behavior; and a review by a committee comprising ED administration and case management. Patients were referred to a pain management clinic and informed that they would no longer receive opioid prescriptions from visits to the ED for chronic pain complaints. Electronic medical record (EMR alerts notified ED providers of the patient’s referral at subsequent visits. We analyzed one year of data pre- and post-referral. Results: A total of 243 patients had one year of data post-referral for analysis. Median annual ED visits decreased from 14 to 4 (58% decrease, 95% CI [50 to 66]. We also found statistically significant decreases for these patients’ state prescription drug monitoring program (PDMP opioid prescriptions (21 to 13, total unique controlled-substance prescribers (11 to 7, computed tomography imaging (2 to 0, radiographs (5 to 1, electrocardiograms (12 to 4, and labs run (47 to 13. Conclusion: This program and the EMR-based alerts were successful at decreasing local ED visits, annual opioid prescriptions, and hospital resource allocation for this population of patients. There is no evidence that these patients diverted their visits to neighboring EDs after being informed that they

A correction factor for estimating statewide agricultural injuries from ambulance reports.

Science.gov (United States)

Scott, Erika E; Earle-Richardson, Giulia; Krupa, Nicole; Jenkins, Paul

2011-10-01

Agriculture ranks as one of the most hazardous industries in the nation. Agricultural injury surveillance is critical to identifying and reducing major injury hazards. Currently, there is no comprehensive system of identifying and characterizing fatal and serious non-fatal agricultural injuries. Researchers sought to calculate a multiplier for estimating the number of agricultural injury cases based on the number of times the farm box indicator was checked on the ambulance report. Farm injuries from 2007 that used ambulance transport were ascertained for 10 New York counties using two methods: (1) ambulance reports including hand-entered free text; and (2) community surveillance. The resulting multiplier that was developed from contrasting these two methods was then applied to the statewide Emergency Medical Services database to estimate the total number of agricultural injuries for New York state. There were 25,735 unique ambulance runs due to injuries in the 10 counties in 2007. Among these, the farm box was checked a total of 90 times. Of these 90, 63 (70%) were determined to be agricultural. Among injury runs where the farm box was not checked, an additional 59 cases were identified from the free text. Among these 122 cases (63 + 59), four were duplicates. Twenty-four additional unique cases were identified from the community surveillance for a total of 142. This yielded a multiplier of 142/90 = 1.578 for estimating all agricultural injuries from the farm box indicator. Sensitivity and specificity of the ambulance report method were 53.4% and 99.9%, respectively. This method provides a cost-effective way to estimate the total number of agricultural injuries for the state. However, it would not eliminate the more labor intensive methods that are required to identify of the actual individual case records. Incorporating an independent source of case ascertainment (community surveillance) increased the multiplier by 17%. Copyright © 2011 Elsevier Inc. All rights

Staff turnover in statewide implementation of ACT: relationship with ACT fidelity and other team characteristics

OpenAIRE

Rollins, Angela L.; Salyers, Michelle P.; Tsai, Jack; Lydick, Jennifer M.

2010-01-01

Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover ...

Hawaii DAR Dealer Reporting System Data

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — In 2000 January, the Hawaii Division of Aquatic Resources (DAR) implemented a computerized data processing system for fish dealer data collected state-wide. Hawaii...

Validation of a risk stratification tool for fall-related injury in a state-wide cohort.

Science.gov (United States)

McCoy, Thomas H; Castro, Victor M; Cagan, Andrew; Roberson, Ashlee M; Perlis, Roy H

2017-02-06

A major preventable contributor to healthcare costs among older individuals is fall-related injury. We sought to validate a tool to stratify such risk based on readily available clinical data, including projected medication adverse effects, using state-wide medical claims data. Sociodemographic and clinical features were drawn from health claims paid in the state of Massachusetts for individuals aged 35-65 with a hospital admission for a period spanning January-December 2012. Previously developed logistic regression models of hospital readmission for fall-related injury were refit in a testing set including a randomly selected 70% of individuals, and examined in a training set comprised of the remaining 30%. Medications at admission were summarised based on reported adverse effect frequencies in published medication labelling. The Massachusetts health system. A total of 68 764 hospitalised individuals aged 35-65 years. Hospital readmission for fall-related injury defined by claims code. A total of 2052 individuals (3.0%) were hospitalised for fall-related injury within 90 days of discharge, and 3391 (4.9%) within 180 days. After recalibrating the model in a training data set comprised of 48 136 individuals (70%), model discrimination in the remaining 30% test set yielded an area under the receiver operating characteristic curve (AUC) of 0.74 (95% CI 0.72 to 0.76). AUCs were similar across age decades (0.71 to 0.78) and sex (0.72 male, 0.76 female), and across most common diagnostic categories other than psychiatry. For individuals in the highest risk quartile, 11.4% experienced fall within 180 days versus 1.2% in the lowest risk quartile; 57.6% of falls occurred in the highest risk quartile. This analysis of state-wide claims data demonstrates the feasibility of predicting fall-related injury requiring hospitalisation using readily available sociodemographic and clinical details. This translatable approach to stratification allows for identification of

Sandia National Laboratories, California sewer system management plan.

Energy Technology Data Exchange (ETDEWEB)

Holland, Robert C.

2010-02-01

A Sewer System Management Plan (SSMP) is required by the State Water Resources Control Board (SWRCB) Order No. 2006-0003-DWQ Statewide General Waste Discharge Requirements (WDR) for Sanitary Sewer Systems (General Permit). DOE, National Nuclear Security Administration (NNSA), Sandia Site Office has filed a Notice of Intent to be covered under this General Permit. The General Permit requires a proactive approach to reduce the number and frequency of sanitary sewer overflows (SSOs) within the State. SSMPs must include provisions to provide proper and efficient management, operation, and maintenance of sanitary sewer systems and must contain a spill response plan. Elements of this Plan are under development in accordance with the SWRCB's schedule.

Developing and maintaining state-wide adolescent pregnancy prevention coalitions: a preliminary investigation.

Science.gov (United States)

Nezlek, J B; Galano, J

1993-09-01

This paper presents the results of a study of state-wide adolescent pregnancy prevention coalitions. Key informants in five states throughout the southern United States were given semi-structured interviews regarding the adolescent pregnancy prevention coalitions in their states. From these interviews and other documents, conclusions were drawn regarding the nature and importance of the environments within which these coalitions operate, the universe of activities in which coalitions engage, and the stages of development of these coalitions. Katz and Kahn's model of social organizations served as the basis for understanding coalitions in terms of these three considerations. Future research should consider the utility of organizational models that can explain more fully the organization--committee hybrid structure that tends to characterize these coalitions.

Stuck in Neutral: Stalled Progress in Statewide Comprehensive Smoke-Free Laws and Cigarette Excise Taxes, United States, 2000–2014

Science.gov (United States)

King, Brian A.; Babb, Stephen D.

2016-01-01

Introduction Increasing tobacco excise taxes and implementing comprehensive smoke-free laws are two of the most effective population-level strategies to reduce tobacco use, prevent tobacco use initiation, and protect nonsmokers from secondhand smoke. We examined state laws related to smoke-free buildings and to cigarette excise taxes from 2000 through 2014 to see how implementation of these laws from 2000 through 2009 differs from implementation in more recent years (2010–2014). Methods We used legislative data from LexisNexis, an online legal research database, to examine changes in statewide smoke-free laws and cigarette excise taxes in effect from January 1, 2000, through December 31, 2014. A comprehensive smoke-free law was defined as a statewide law prohibiting smoking in all indoor areas of private work sites, restaurants, and bars. Results From 2000 through 2009, 21 states and the District of Columbia implemented comprehensive smoke-free laws prohibiting smoking in work sites, restaurants, and bars. In 2010, 4 states implemented comprehensive smoke-free laws. The last state to implement a comprehensive smoke-free law was North Dakota in 2012, bringing the total number to 26 states and the District of Columbia. From 2000 through 2009, 46 states and the District of Columbia implemented laws increasing their cigarette excise tax, which increased the national average state excise tax rate by $0.92. However, from 2010 through 2014, only 14 states and the District of Columbia increased their excise tax, which increased the national average state excise tax rate by $0.20. Conclusion The recent stall in progress in enacting and implementing statewide comprehensive smoke-free laws and increasing cigarette excise taxes may undermine tobacco prevention and control efforts in the United States, undercutting efforts to reduce tobacco use, exposure to secondhand smoke, health disparities, and tobacco-related illness and death. PMID:27309417

How a College System Joined a TV Network

Science.gov (United States)

McAuliffe, Daniel G.

1978-01-01

Describes the evolution of a state-wide "TV College" system in Connecticut, including centralized administrative development, course selection and evaluation, scheduling, promotion and advertising, fee structures, and budgeting processes. (RT)

Computerized provider order entry systems.

Science.gov (United States)

2001-01-01

Computerized provider order entry (CPOE) systems are designed to replace a hospital's paper-based ordering system. They allow users to electronically write the full range of orders, maintain an online medication administration record, and review changes made to an order by successive personnel. They also offer safety alerts that are triggered when an unsafe order (such as for a duplicate drug therapy) is entered, as well as clinical decision support to guide caregivers to less expensive alternatives or to choices that better fit established hospital protocols. CPOE systems can, when correctly configured, markedly increase efficiency and improve patient safety and patient care. However, facilities need to recognize that currently available CPOE systems require a tremendous amount of time and effort to be spent in customization before their safety and clinical support features can be effectively implemented. What's more, even after they've been customized, the systems may still allow certain unsafe orders to be entered. Thus, CPOE systems are not currently a quick or easy remedy for medical errors. ECRI's Evaluation of CPOE systems--conducted in collaboration with the Institute for Safe Medication Practices (ISMP)--discusses these and other related issues. It also examines and compares CPOE systems from three suppliers: Eclipsys Corp., IDX Systems Corp., and Siemens Medical Solutions Health Services Corp. Our testing focuses primarily on the systems' interfacing capabilities, patient safeguards, and ease of use.

The Michigan Spine Surgery Improvement Collaborative: a statewide Collaborative Quality Initiative.

Science.gov (United States)

Chang, Victor; Schwalb, Jason M; Nerenz, David R; Pietrantoni, Lisa; Jones, Sharon; Jankowski, Michelle; Oja-Tebbe, Nancy; Bartol, Stephen; Abdulhak, Muwaffak

2015-12-01

have been entered into the registry. This number reflects 4824 eligible cases with confirmed surgery dates. Of these 4824 eligible cases, 3338 cases went beyond the 120-day window and were considered eligible for the extraction of surgical details, 90-day outcomes, and adverse events. Among these 3338 patients, there are a total of 2469 lumbar cases, 862 cervical cases, and 7 combined procedures that were entered into the registry. CONCLUSIONS In addition to functioning as a registry, MSSIC is also meant to be a platform for quality improvement with the potential for future initiatives and best practices to be implemented statewide in order to improve quality and lower costs. With its current rate of recruitment and expansion, MSSIC will provide a robust platform as a regional prospective registry. Its unique funding model, which is supported by BCBSM/BCN, will help ensure its longevity and viability, as has been observed in other CQIs that have been active for several years.

Michigan Pharmacists Transforming Care and Quality: Developing a Statewide Collaborative of Physician Organizations and Pharmacists to Improve Quality of Care and Reduce Costs.

Science.gov (United States)

Choe, Hae Mi; Lin, Alexandra Tungol; Kobernik, Kathleen; Cohen, Marc; Wesolowicz, Laurie; Qureshi, Nabeel; Leyden, Tom; Share, David A; Darland, Rozanne; Spahlinger, David A

2018-04-01

Inappropriate drug use, increasing complexity of drug regimens, continued pressure to control costs, and focus on shared accountability for clinical measures drive the need to leverage the medication expertise of pharmacists in direct patient care. A statewide strategy based on the collaboration of pharmacists and physicians regarding patient care was developed to improve disease state management and medication-related outcomes. Blue Cross Blue Shield of Michigan (BCBSM) partnered with Michigan Medicine to develop and implement a statewide provider-payer program called Michigan Pharmacists Transforming Care and Quality (MPTCQ), which integrates pharmacists within physician practices throughout the state of Michigan. As the MPTCQ Coordinating Center, Michigan Medicine established an infrastructure integrating clinical pharmacists into direct patient care within patient-centered medical home (PCMH) practices and provides direction and guidance for quality and process improvement across physician organizations (POs) and their affiliated physician practices. The primary goal of MPTCQ is to improve patient care and outcomes related to Medicare star ratings and HEDIS measures through integration of clinical pharmacists into direct patient care. The short-term goal is to adopt and modify Michigan Medicine's integrated pharmacist practice model at participating POs, with the long-term goal of developing a sustainable model of pharmacist integration at each PO to improve patient care and outcomes. Initially, pharmacists are delivering disease management (diabetes, hypertension, and hyperlipidemia) and comprehensive medication review services with future plans to expand clinical services. In 2015, 10 POs participated in year 1 of the program. In collaboration with the MPTCQ Coordinating Center, each PO identified 1 "pharmacist transformation champion" (PTC). The PTC implemented the integrated pharmacist model at 2 or 3 practice sites with at least 2 practicing physicians per

Developing a statewide public health initiative to reduce infant mortality in Oklahoma.

Science.gov (United States)

Dooley, Suzanna; Patrick, Paul; Lincoln, Alicia; Cline, Janette

2014-01-01

The Preparing for a Lifetime, It's Everyone's Responsibility initiative was developed to improve the health and well- being of Oklahoma's mothers and infants. The development phase included systematic data collection, extensive data analysis, and multi-disciplinary partnership development. In total, seven issues (preconception/interconception health, tobacco use, postpartum depression, breastfeeding, infant safe sleep, preterm birth, and infant injury prevention) were identified as crucial to addressing infant mortality in Oklahoma. Workgroups were created to focus on each issue. Data and media communications workgroups were added to further partner commitment and support for policy and programmatic changes across multiple agencies and programs. Leadership support, partnership, evaluation, and celebrating small successes were important factors that lead to large scale adoption and support for the state-wide initiative to reduce infant mortality.

Addressing College Drinking as a Statewide Public Health Problem: Key Findings From the Maryland Collaborative.

Science.gov (United States)

Arria, Amelia M; Jernigan, David H

2018-03-01

Excessive drinking among college students is a serious and pervasive public health problem. Although much research attention has focused on developing and evaluating evidence-based practices to address college drinking, adoption has been slow. The Maryland Collaborative to Reduce College Drinking and Related Problems was established in 2012 to bring together a network of institutions of higher education in Maryland to collectively address college drinking by using both individual-level and environmental-level evidence-based approaches. In this article, the authors describe the findings of this multilevel, multicomponent statewide initiative. To date, the Maryland Collaborative has succeeded in providing a forum for colleges to share knowledge and experiences, strengthen existing strategies, and engage in a variety of new activities. Administration of an annual student survey has been useful for guiding interventions as well as evaluating progress toward the Maryland Collaborative's goal to measurably reduce high-risk drinking and its radiating consequences on student health, safety, and academic performance and on the communities surrounding college campuses. The experiences of the Maryland Collaborative exemplify real-world implementation of evidence-based approaches to reduce this serious public health problem.

Under Pressure: Financial Effect of the Hospital-Acquired Conditions Initiative-A Statewide Analysis of Pressure Ulcer Development and Payment.

Science.gov (United States)

Meddings, Jennifer; Reichert, Heidi; Rogers, Mary A M; Hofer, Timothy P; McMahon, Laurence F; Grazier, Kyle L

2015-07-01

To assess the financial effect of the 2008 Hospital-Acquired Conditions Initiative (HACI) pressure ulcer payment changes on Medicare, other payers, and hospitals. Retrospective before-and-after study of all-payer statewide administrative data for more than 2.4 million annual adult discharges in 2007 and 2009 using the Healthcare Cost and Utilization Project State Inpatient Datasets for California. How often and by how much the 2008 payment changes for pressure ulcers affected hospital payment was assessed. Nonfederal acute care California hospitals (N = 311). Adults discharged from acute-care hospitals. Pressure ulcer rates and hospital payment changes. Hospital-acquired pressure ulcer rates were low in 2007 (0.28%) and 2009 (0.27%); present-on-admission pressure ulcer rates increased from 2.3% in 2007 to 3.0% in 2009. According to clinical stage of pressure ulcer (available in 2009), hospital-acquired Stage III and IV ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for Stage III and IV hospital-acquired ulcers reduced payment in 75 (0.003%) discharges, for a statewide payment decrease of $310,444 (0.001%) for all payers and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital-Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present-on-admission ulcers), reducing statewide payment by $62,538,586 (0.21%) for all payers and $47,237,984 (0.32%) for Medicare. The total financial effect of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than Stages III and IV. The removal of payment for hospital-acquired Stage III and IV ulcers by implementation of the HACI policy was 1/200th that of the removal of payment for other types of pressure ulcers that occurred in implementation of the

A narrative account of implementation lessons learnt from the dissemination of an up-scaled state-wide child obesity management program in Australia: PEACH™ (Parenting, Eating and Activity for Child Health) Queensland.

Science.gov (United States)

Croyden, Debbie L; Vidgen, Helen A; Esdaile, Emma; Hernandez, Emely; Magarey, Anthea; Moores, Carly J; Daniels, Lynne

2018-03-13

PEACH™QLD translated the PEACH™ Program, designed to manage overweight/obesity in primary school-aged children, from efficacious RCT and small scale community trial to a larger state-wide program. This paper describes the lessons learnt when upscaling to universal health coverage. The 6-month, family-focussed program was delivered in Queensland, Australia from 2013 to 2016. Its implementation was planned by researchers who developed the program and conducted the RCT, and experienced project managers and practitioners across the health continuum. The intervention targeted parents as the agents of change and was delivered via parent-only group sessions. Concurrently, children attended fun, non-competitive activity sessions. Sessions were delivered by facilitators who received standardised training and were employed by a range of service providers. Participants were referred by health professionals or self-referred in response to extensive promotion and marketing. A pilot phase and a quality improvement framework were planned to respond to emerging challenges. Implementation challenges included engagement of the health system; participant recruitment; and engagement. A total of 1513 children (1216 families) enrolled, with 1122 children (919 families) in the face-to-face program (105 groups in 50 unique venues) and 391 children (297 families) in PEACH™ Online. Self-referral generated 68% of enrolments. Unexpected, concurrent and, far-reaching public health system changes contributed to poor program uptake by the sector (only 56 [53%] groups delivered by publicly-funded health organisations) requiring substantial modification of the original implementation plan. Process evaluation during the pilot phase and an ongoing quality improvement framework informed program adaptations that included changing from fortnightly to weekly sessions aligned with school terms, revision of parent materials, modification of eligibility criteria to include healthy weight children and

Statewide dissemination of a rural, non-chain restaurant intervention: adoption, implementation and maintenance

Science.gov (United States)

Nothwehr, F.; Haines, H.; Chrisman, M.; Schultz, U.

2014-01-01

The obesity epidemic calls for greater dissemination of nutrition-related programs, yet there remain few studies of the dissemination process. This study, guided by elements of the RE-AIM model, describes the statewide dissemination of a simple, point-of-purchase restaurant intervention. Conducted in rural counties of the Midwest, United States, the study targeted randomly selected, non-chain, family-style restaurants. Owners were recruited through mail, then telephone follow-up. Data were collected through telephone at baseline, and 3, 6, 12 and 18 months post-adoption. Using mixed methods, measures captured the program adoption rate, characteristics of adopters and non-adopters, program implementation and maintenance issues, and owner and customer satisfaction. Analyses involved descriptive statistics and summaries of qualitative data. The program adoption rate was 28%. Adopters were similar to responding non-adopters demographically, but varied in attitudes. The majority of restaurants maintained the program for at least 12 months. Adopters and their customers expressed satisfaction with the program. With some adjustments, the RE-AIM model was helpful in guiding evaluation of this process. Results provide implications for future dissemination of this and other programs with regard to research procedures and potential barriers that may be encountered. Research on alternative strategies for widespread dissemination of such programs is needed in this and other settings. PMID:24650944

SYSTEM ORGANIZATION OF MATERIAL PROVIDING OF BUILDING

Directory of Open Access Journals (Sweden)

A. V. Rаdkеvich

2014-04-01

Full Text Available Purpose. Development of scientific-methodical bases to the design of rational management of material streams in the field of building providing taking into account intersystem connections with the enterprises of building industry. Methodology. The analysis of last few years of functioning of building industry in Ukraine allows distinguishing a number of problems that negatively influence the steady development of building, as the component of the state economics system. Therefore the research of existent organization methods of the system of building objects providing with material resources is extremely necessary. In connection with this the article justifies the use of method of hierarchies analysis (Saati method for finding the optimal task solution of fixing the enterprises of building industry after building objects. Findings. Results give an opportunity to guidance of building organization to estimate and choose advantageous suppliers - enterprises of building industry, to conduct their rating, estimation taking into account basic descriptions, such as: quality, price, reliability of deliveries, specialization, financial status etc. Originality. On the basis of Saati method the methodologies of organization are improved, planning and managements of the reliable system of providing of building necessary material resources that meet the technological requirements of implementation of building and installation works. Practical value. Contribution to the decisions of many intricate organizational problems that are accompanied by the problems of development of building, provided due to organization of the reliable system of purchase of material resources.

The rare and undiagnosed diseases diagnostic service - application of massively parallel sequencing in a state-wide clinical service.

Science.gov (United States)

Baynam, Gareth; Pachter, Nicholas; McKenzie, Fiona; Townshend, Sharon; Slee, Jennie; Kiraly-Borri, Cathy; Vasudevan, Anand; Hawkins, Anne; Broley, Stephanie; Schofield, Lyn; Verhoef, Hedwig; Walker, Caroline E; Molster, Caron; Blackwell, Jenefer M; Jamieson, Sarra; Tang, Dave; Lassmann, Timo; Mina, Kym; Beilby, John; Davis, Mark; Laing, Nigel; Murphy, Lesley; Weeramanthri, Tarun; Dawkins, Hugh; Goldblatt, Jack

2016-06-11

The Rare and Undiagnosed Diseases Diagnostic Service (RUDDS) refers to a genomic diagnostic platform operating within the Western Australian Government clinical services delivered through Genetic Services of Western Australia (GSWA). GSWA has provided a state-wide service for clinical genetic care for 28 years and it serves a population of 2.5 million people across a geographical area of 2.5milion Km(2). Within this context, GSWA has established a clinically integrated genomic diagnostic platform in partnership with other public health system managers and service providers, including but not limited to the Office of Population Health Genomics, Diagnostic Genomics (PathWest Laboratories) and with executive level support from the Department of Health. Herein we describe report presents the components of this service that are most relevant to the heterogeneity of paediatric clinical genetic care. Briefly the platform : i) offers multiple options including non-genetic testing; monogenic and genomic (targeted in silico filtered and whole exome) analysis; and matchmaking; ii) is delivered in a patient-centric manner that is resonant with the patient journey, it has multiple points for entry, exit and re-entry to allow people access to information they can use, when they want to receive it; iii) is synchronous with precision phenotyping methods; iv) captures new knowledge, including multiple expert review; v) is integrated with current translational genomic research activities and best practice; and vi) is designed for flexibility for interactive generation of, and integration with, clinical research for diagnostics, community engagement, policy and models of care. The RUDDS has been established as part of routine clinical genetic services and is thus sustainable, equitably managed and seeks to translate new knowledge into efficient diagnostics and improved health for the whole community.

Using Logistic Regression for Validating or Invalidating Initial Statewide Cut-Off Scores on Basic Skills Placement Tests at the Community College Level

Science.gov (United States)

Secolsky, Charles; Krishnan, Sathasivam; Judd, Thomas P.

2013-01-01

The community colleges in the state of New Jersey went through a process of establishing statewide cut-off scores for English and mathematics placement tests. The colleges wanted to communicate to secondary schools a consistent preparation that would be necessary for enrolling in Freshman Composition and College Algebra at the community college…

Medical Providers' Oral Health Knowledgeability, Attitudes, and Practice Behaviors: An Opportunity for Interprofessional Collaboration.

Science.gov (United States)

Shimpi, Neel; Schroeder, Dixie; Kilsdonk, Joseph; Chyou, Po-Huang; Glurich, Ingrid; Penniman, Eric; Acharya, Amit

2016-03-01

Evaluation of current knowledgeability, attitudes, and practice behaviors of medical providers from a large health care system toward oral health was undertaken as a pilot effort to better understand and integrate oral health into the overall health care delivery. Invitations to complete a 28-question survey, designed in a web-based platform (SurveyMonkey(®)), were emailed to 1407 medical multispecialty physicians, residents, and nurses within the health system. The questionnaire included sections on provider demographics, oral health knowledgeability and attitudes, and current practice conducting oral health screenings. A 14% (n = 199/1407) response rate was achieved for survey completion. There were 16% who reported good coverage of oral/dental health topics in their medical training curriculum. Competency level was practice, while >80% answered knowledge-based questions correctly. Frequency rates for dental referral by the medical providers were 32% 'frequently' and 68% 'infrequently.' Perceptions of optimal frequency for conducting oral health assessment in their professional practices ranged from 69% indicating 'frequently' to 25% indicating 'infrequently.' Overall, positive attitudes were observed toward incorporation of oral health examination into medical practice. The study identified lack of oral health treatment and infrequent referral by medical providers to dental providers. Results support likelihood for acceptance of care models that incorporate a medical/dental team-based approach complemented by oral health training for medical providers to enhance holistic health care delivery. Limitations of this pilot study include potential selection bias and lack of generalizability beyond our institution; further studies are planned in additional settings statewide to validate findings. Copyright © 2016 Elsevier Inc. All rights reserved.

Portable traffic management system smart work zone application : operational test evaluation report

Science.gov (United States)

1997-05-01

As part of its statewide Intelligent Transportation System (ITS), The Minnesota Department of Transportation (Mn/DOT) sponsored an operational test of the Portable Traffic Management System (PTMS) in a work zone application in cooperation with its pr...

Perceptions of electronic health record implementation: a statewide survey of physicians in Rhode Island.

Science.gov (United States)

Wylie, Matthew C; Baier, Rosa R; Gardner, Rebekah L

2014-10-01

Although electronic health record use improves healthcare delivery, adoption into clinical practice is incomplete. We sought to identify the extent of adoption in Rhode Island and the characteristics of physicians and electronic health records associated with positive experience. We performed a cross-sectional study of data collected by the Rhode Island Department of Health for the Health Information Technology Survey 2009 to 2013. Survey questions included provider and practice demographics, health record information, and Likert-type scaled questions regarding how electronic health record use affected clinical practice. The survey response rate ranged from 50% to 65%, with 62% in 2013. Increasing numbers of physicians in Rhode Island use an electronic health record. In 2013, 81% of physicians used one, and adoption varied by clinical subspecialty. Most providers think that electronic health record use improves billing and quality improvement but has not improved job satisfaction. Physicians with longer and more sophisticated electronic health record use report positive effects of introduction on all aspects of practice examined (P electronic health record introduction (P electronic health record vendors most frequently used in Rhode Island, 5 were associated with improved job satisfaction. We report the largest statewide study of electronic health record adoption to date. We found increasing physician use in Rhode Island, and the extent of adoption varies by subspecialty. Although older physicians are less likely to be positive about electronic health record adoption, longer and more sophisticated use are associated with more positive opinions, suggesting acceptance will grow over time. Copyright © 2014 Elsevier Inc. All rights reserved.

Staff turnover in statewide implementation of ACT: relationship with ACT fidelity and other team characteristics.

Science.gov (United States)

Rollins, Angela L; Salyers, Michelle P; Tsai, Jack; Lydick, Jennifer M

2010-09-01

Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover rates did not change over time. Most ACT staff turnover rates were comparable or better than other turnover rates reported in the mental health and substance abuse literature.

Electronic consultation system demonstrates educational benefit for primary care providers.

Science.gov (United States)

Kwok, Jonas; Olayiwola, J Nwando; Knox, Margae; Murphy, Elizabeth J; Tuot, Delphine S

2017-01-01

Background Electronic consultation systems allow primary care providers to receive timely speciality expertise via iterative electronic communication. The use of such systems is expanding across the USA with well-documented high levels of user satisfaction. We characterise the educational impact for primary care providers of a long-standing integrated electronic consultation and referral system. Methods Primary care providers' perceptions of the educational value inherent to electronic consultation system communication and the impact on their ability to manage common speciality clinical conditions and questions were examined by electronic survey using five-point Likert scales. Differences in primary care providers' perceptions were examined overall and by primary care providers' speciality, provider type and years of experience. Results Among 221 primary care provider participants (35% response rate), 83.9% agreed or strongly agreed that the integrated electronic consultation and referral system provided educational value. There were no significant differences in educational value reported by provider type (attending physician, mid-level provider, or trainee physician), primary care providers' speciality, or years of experience. Perceived benefit of the electronic consultation and referral system in clinical management appeared stronger for laboratory-based conditions (i.e. subclinical hypothyroidism) than more diffuse conditions (i.e. abdominal pain). Nurse practitioners/physician assistants and trainee physicians were more likely to report improved abilities to manage specific clinical conditions when using the electronic consultation and/or referral system than were attending physicians, as were primary care providers with ≤10 years experience, versus those with >20 years of experience. Conclusions Primary care providers report overwhelmingly positive perceptions of the educational value of an integrated electronic consultation and referral system. Nurse

Undergraduate Research and Economic Development: A Systems Approach in Wisconsin

Science.gov (United States)

Van Galen, Dean; Schneider-Rebozo, Lissa; Havholm, Karen; Andrews, Kris

2015-01-01

This chapter presents the state of Wisconsin and the University of Wisconsin System as an ongoing case study for best practices in systematic, intentional, statewide programming and initiatives connecting undergraduate research and economic development.

INTEGRATED INFORMATION SYSTEM ARCHITECTURE PROVIDING BEHAVIORAL FEATURE

Directory of Open Access Journals (Sweden)

Vladimir N. Shvedenko

2016-11-01

Full Text Available The paper deals with creation of integrated information system architecture capable of supporting management decisions using behavioral features. The paper considers the architecture of information decision support system for production system management. The behavioral feature is given to an information system, and it ensures extraction, processing of information, management decision-making with both automated and automatic modes of decision-making subsystem being permitted. Practical implementation of information system with behavior is based on service-oriented architecture: there is a set of independent services in the information system that provides data of its subsystems or data processing by separate application under the chosen variant of the problematic situation settlement. For creation of integrated information system with behavior we propose architecture including the following subsystems: data bus, subsystem for interaction with the integrated applications based on metadata, business process management subsystem, subsystem for the current state analysis of the enterprise and management decision-making, behavior training subsystem. For each problematic situation a separate logical layer service is created in Unified Service Bus handling problematic situations. This architecture reduces system information complexity due to the fact that with a constant amount of system elements the number of links decreases, since each layer provides communication center of responsibility for the resource with the services of corresponding applications. If a similar problematic situation occurs, its resolution is automatically removed from problem situation metamodel repository and business process metamodel of its settlement. In the business process performance commands are generated to the corresponding centers of responsibility to settle a problematic situation.

Effectiveness of a Statewide Abusive Head Trauma Prevention Program in North Carolina.

Science.gov (United States)

Zolotor, Adam J; Runyan, Desmond K; Shanahan, Meghan; Durrance, Christine Piette; Nocera, Maryalice; Sullivan, Kelly; Klevens, Joanne; Murphy, Robert; Barr, Marilyn; Barr, Ronald G

2015-12-01

Abusive head trauma (AHT) is a serious condition, with an incidence of approximately 30 cases per 100,000 person-years in the first year of life. To assess the effectiveness of a statewide universal AHT prevention program. In total, 88.29% of parents of newborns (n = 405 060) in North Carolina received the intervention (June 1, 2009, to September 30, 2012). A comparison of preintervention and postintervention was performed using nurse advice line telephone calls regarding infant crying (January 1, 2005, to December 31, 2010). A difference-in-difference analysis compared AHT rates in the prevention program state with those of other states before and after the implementation of the program (January 1, 2000, to December 31, 2011). The Period of PURPLE Crying intervention, developed by the National Center on Shaken Baby Syndrome, was delivered by nurse-provided education, a DVD, and a booklet, with reinforcement by primary care practices and a media campaign. Changes in proportions of telephone calls for crying concerns to a nurse advice line and in AHT rates per 100,000 infants after the intervention (June 1, 2009, to September 30, 2011) in the first year of life using hospital discharge data for January 1, 2000, to December 31, 2011. In the 2 years after implementation of the intervention, parental telephone calls to the nurse advice line for crying declined by 20% for children younger than 3 months (rate ratio, 0.80; 95% CI, 0.73-0.87; P programmatic efforts and evaluation are needed to demonstrate an effect on AHT rates.

Damage Detection/Locating System Providing Thermal Protection

Science.gov (United States)

Woodard, Stanley E. (Inventor); Jones, Thomas W. (Inventor); Taylor, Bryant D. (Inventor); Qamar, A. Shams (Inventor)

2010-01-01

A damage locating system also provides thermal protection. An array of sensors substantially tiles an area of interest. Each sensor is a reflective-surface conductor having operatively coupled inductance and capacitance. A magnetic field response recorder is provided to interrogate each sensor before and after a damage condition. Changes in response are indicative of damage and a corresponding location thereof.

Measurement of fine particles and smoking activity in a statewide survey of 36 California Indian casinos

Science.gov (United States)

Jiang, Ru O-Ting; Cheng, Ka I-Chung; Acevedo-Bolton, Viviana; Klepeis, Neil E; Repace, James L; Ott, Wayne R; Hildemann, Lynn M

2011-01-01

Despite California's 1994 statewide smoking ban, exposure to secondhand smoke (SHS) continues in California's Indian casinos. Few data are available on exposure to airborne fine particles (PM2.5) in casinos, especially on a statewide basis. We sought to measure PM2.5 concentrations in Indian casinos widely distributed across California, exploring differences due to casino size, separation of smoking and non-smoking areas, and area smoker density. A selection of 36 out of the 58 Indian casinos throughout California were each visited for 1–3 h on weekend or holiday evenings, using two or more concealed monitors to measure PM2.5 concentrations every 10 s. For each casino, the physical dimensions and the number of patrons and smokers were estimated. As a preliminary assessment of representativeness, we also measured eight casinos in Reno, NV. The average PM2.5 concentration for the smoking slot machine areas (63 μg/m3) was nine times as high as outdoors (7 μg/m3), whereas casino non-smoking restaurants (29 μg/m3) were four times as high. Levels in non-smoking slot machine areas varied: complete physical separation reduced concentrations almost to outdoor levels, but two other separation types had mean levels that were 13 and 29 μg/m3, respectively, higher than outdoors. Elevated PM2.5 concentrations in casinos can be attributed primarily to SHS. Average PM2.5 concentrations during 0.5–1 h visits to smoking areas exceeded 35 μg/m3 for 90% of the casino visits. PMID:20160761

Statewide Policy Change in Pediatric Dental Care, and the Impact on Pediatric Dental and Physician Visits.

Science.gov (United States)

Zlotnick, Cheryl; Tam, Tammy; Ye, Yu

2017-10-01

Introduction In 2007, the California signed legislation mandating a dental visit for all children entering kindergarten or first grade; no such mandate was made for physician visits. This study examines the impact of this policy change on the risk factors associated with obtaining pediatric dental and physician health care visits. Methods Every 2 years, California Health Interview Survey conducts a statewide survey on a representative community sample. This cross-sectional study took advantage of these data to conduct a "natural experiment" assessing the impact of this policy change on both pediatric physician and dental care visits in the past year. Samples included surveys of adults and children (ages 5-11) on years 2005 (n = 5096), 2007 (n = 4324) and 2009 (n = 4100). Results Although few changes in risk factors were noted in pediatric physician visits, a gradual decrease in risk factors was found in pediatric dental visits from 2005 to 2009. Report of no dental visit was less likely for: younger children (OR -0.81, CI 0.75-0.88), insured children (OR 0.34, CI 0.22-0.53), and children who had a physician's visit last year (OR 0.37, CI 0.25-0.53) in 2005. By 2007, absence of insurance was the only risk factor related to having no dental visit (OR 0.34, CI 0.19-0.61). By 2009, no a priori measured risk factors were associated with not having a dental visit for children aged 5-11 years. Conclusions A statewide policy mandating pediatric dental visits appears to have reduced disparities. A policy for medical care may contribute to similar benefits.

Variation in the use of advanced imaging at the time of breast cancer diagnosis in a statewide registry.

Science.gov (United States)

Henry, N Lynn; Braun, Thomas M; Breslin, Tara M; Gorski, David H; Silver, Samuel M; Griggs, Jennifer J

2017-08-01

Although national guidelines do not recommend extent of disease imaging for patients with newly diagnosed early stage breast cancer given that the harm outweighs the benefits, high rates of testing have been documented. The 2012 Choosing Wisely guidelines specifically addressed this issue. We examined the change over time in imaging use across a statewide collaborative, as well as the reasons for performing imaging and the impact on cost of care. Clinicopathologic data and use of advanced imaging tests (positron emission tomography, computed tomography, and bone scan) were abstracted from the medical records of patients treated at 25 participating sites in the Michigan Breast Oncology Quality Initiative (MiBOQI). For patients diagnosed in 2014 and 2015, reasons for testing were abstracted from the medical record. Of the 34,078 patients diagnosed with stage 0-II breast cancer between 2008 and 2015 in MiBOQI, 6853 (20.1%) underwent testing with at least 1 imaging modality in the 90 days after diagnosis. There was considerable variability in rates of testing across the 25 sites for all stages of disease. Between 2008 and 2015, testing decreased over time for patients with stage 0-IIA disease (all P diagnosis decreased over time in a large statewide collaborative. Additional interventions are warranted to further reduce rates of unnecessary imaging to improve quality of care for patients with breast cancer. Cancer 2017;123:2975-83. © 2017 American Cancer Society. © 2017 American Cancer Society.

Variation in patient-provider communication by patient's race and ethnicity, provider type, and continuity in and site of care: An analysis of data from the Connecticut Health Care Survey.

Science.gov (United States)

Aseltine, Robert H; Sabina, Alyse; Barclay, Gillian; Graham, Garth

2016-01-01

The purpose of this study is to examine the quality of patient-reported communication with their health care providers using data from a large, statewide survey of patients. We examine the relationship between patient's race and ethnicity, type of health care provider, site of and continuity in care, and the quality of patient-provider communication. We analyze data from the Connecticut Health Care Survey, a representative telephone survey of 4608 Connecticut residents conducted between June 2012 and February 2013. Eight measures of patient-provider communication were analyzed using weighted general linear and logistic regression models. Patients' assessments of the quality of communication with their health care providers were generally positive. Hispanic patients, those who received care in a clinic or hospital setting, and those who did not consistently see the same provider reported significantly poorer communication with their providers. Our data suggest that improving patient-provider communication for Hispanic patients may be a critical step in achieving health equity. However, increased access to health care delivered outside of physician offices where there may not be consistency in providers across encounters may pose challenges to effective health communication.

Strategic information systems planning for health service providers.

Science.gov (United States)

Moriarty, D D

1992-01-01

There is significant opportunity for health service providers to gain competitive advantage through the innovative use of strategic information systems. This analysis presents some key strategic information systems issues that will enable managers to identify opportunities within their organizations.

Employee motivation in Product-Service-System providers

DEFF Research Database (Denmark)

Kreye, Melanie

2016-01-01

This research investigates how intrinsic and extrinsic motivation factors contribute to employee motivation in providers of Product-Service Systems (PSS). Employee motivation determines the quality of the delivered service and is thus an area of great importance for PSS providers. We present rich...... case-based data collected through semi-structured interviews, a survey and secondary sources. The analysis showed the particularly high importance of intrinsic and individual motivation factors such as the fulfilling nature of the work and skill development showing the ownership and pride service...... employees took in their work. Further, the organisation needs to set the context of high employee motivation by enabling flexibility and performance feedback. Our research contributes to the literature by providing a first empirical study of employee motivation in PSS providers and thus providing important...

Florida specific NTCIP MIB development for actuated signal controller (ASC), closed-circuit television (CCTV), and center-to-center (C2C) communications with SunGuideSM software and ITS device test procedure development : summary of final report.

Science.gov (United States)

2009-06-01

To provide hardware, software, network, systems research, and testing for multi-million dollar traffic : operations, Intelligent Transportation Systems (ITS), and statewide communications investments, the : Traffic Engineering and Operations Office h...

Florida specific NTCIP MIB development for actuated signal controller (ASC), closed-circuit television (CCTV), and center-to-center (C2C) communications with SunGuideSM software and ITS device test procedure development : executive summary.

Science.gov (United States)

2009-06-01

To provide hardware, software, network, systems research, and testing for multi-million : dollar traffic operations, Intelligent Transportation Systems (ITS), and statewide : communications investments, the Traffic Engineering and Operations Office h...

Variation in patient–provider communication by patient’s race and ethnicity, provider type, and continuity in and site of care: An analysis of data from the Connecticut Health Care Survey

Directory of Open Access Journals (Sweden)

Robert H Aseltine

2016-01-01

Full Text Available Objectives: The purpose of this study is to examine the quality of patient-reported communication with their health care providers using data from a large, statewide survey of patients. We examine the relationship between patient’s race and ethnicity, type of health care provider, site of and continuity in care, and the quality of patient–provider communication. Methods: We analyze data from the Connecticut Health Care Survey, a representative telephone survey of 4608 Connecticut residents conducted between June 2012 and February 2013. Eight measures of patient–provider communication were analyzed using weighted general linear and logistic regression models. Results: Patients’ assessments of the quality of communication with their health care providers were generally positive. Hispanic patients, those who received care in a clinic or hospital setting, and those who did not consistently see the same provider reported significantly poorer communication with their providers. Conclusion: Our data suggest that improving patient–provider communication for Hispanic patients may be a critical step in achieving health equity. However, increased access to health care delivered outside of physician offices where there may not be consistency in providers across encounters may pose challenges to effective health communication.

A Statistical Graphical Model of the California Reservoir System

Science.gov (United States)

Taeb, A.; Reager, J. T.; Turmon, M.; Chandrasekaran, V.

2017-11-01

The recent California drought has highlighted the potential vulnerability of the state's water management infrastructure to multiyear dry intervals. Due to the high complexity of the network, dynamic storage changes in California reservoirs on a state-wide scale have previously been difficult to model using either traditional statistical or physical approaches. Indeed, although there is a significant line of research on exploring models for single (or a small number of) reservoirs, these approaches are not amenable to a system-wide modeling of the California reservoir network due to the spatial and hydrological heterogeneities of the system. In this work, we develop a state-wide statistical graphical model to characterize the dependencies among a collection of 55 major California reservoirs across the state; this model is defined with respect to a graph in which the nodes index reservoirs and the edges specify the relationships or dependencies between reservoirs. We obtain and validate this model in a data-driven manner based on reservoir volumes over the period 2003-2016. A key feature of our framework is a quantification of the effects of external phenomena that influence the entire reservoir network. We further characterize the degree to which physical factors (e.g., state-wide Palmer Drought Severity Index (PDSI), average temperature, snow pack) and economic factors (e.g., consumer price index, number of agricultural workers) explain these external influences. As a consequence of this analysis, we obtain a system-wide health diagnosis of the reservoir network as a function of PDSI.

Barriers to Providing the Sexuality Education That Teachers Believe Students Need

Science.gov (United States)

Eisenberg, Marla E.; Madsen, Nikki; Oliphant, Jennifer A.; Sieving, Renee E.

2013-01-01

Background: Sexuality education teachers' perspectives are important to gain a full understanding of the issues surrounding teaching this subject. This study uses a statewide sample of public school teachers to examine what sexuality education content is taught, what barriers teachers face, and which barriers are associated with teaching specific…

Peer Crowd Identification and Adolescent Health Behaviors: Results From a Statewide Representative Study.

Science.gov (United States)

Jordan, Jeffrey W; Stalgaitis, Carolyn A; Charles, John; Madden, Patrick A; Radhakrishnan, Anjana G; Saggese, Daniel

2018-02-01

Peer crowds are macro-level subcultures that share similarities across geographic areas. Over the past decade, dozens of studies have explored the association between adolescent peer crowds and risk behaviors, and how they can inform public health efforts. However, despite the interest, researchers have not yet reported on crowd size and risk levels from a representative sample, making it difficult for practitioners to apply peer crowd science to interventions. The current study reports findings from the first statewide representative sample of adolescent peer crowd identification and health behaviors. Weighted data were analyzed from the 2015 Virginia Youth Survey of Health Behaviors ( n = 4,367). Peer crowds were measured via the I-Base Survey™, a photo-based peer crowd survey instrument. Frequencies and confidence intervals of select behaviors including tobacco use, substance use, nutrition, physical activity, and violence were examined to identify high- and low-risk crowds. Logistic regression was used to calculate adjusted odds ratios for each crowd and behavior. Risky behaviors clustered in two peer crowds. Hip Hop crowd identification was associated with substance use, violence, and some depression and suicidal behaviors. Alternative crowd identification was associated with increased risk for some substance use behaviors, depression and suicide, bullying, physical inactivity, and obesity. Mainstream and, to a lesser extent, Popular, identities were associated with decreased risk for most behaviors. Findings from the first representative study of peer crowds and adolescent behavior identify two high-risk groups, providing critical insights for practitioners seeking to maximize public health interventions by targeting high-risk crowds.

Method and Apparatus Providing Deception and/or Altered Operation in an Information System Operating System

Science.gov (United States)

Cohen, Fred; Rogers, Deanna T.; Neagoe, Vicentiu

2008-10-14

A method and/or system and/or apparatus providing deception and/or execution alteration in an information system. In specific embodiments, deceptions and/or protections are provided by intercepting and/or modifying operation of one or more system calls of an operating system.

Evaluating RITES, a Statewide Math and Science Partnership Program

Science.gov (United States)

Murray, D. P.; Caulkins, J. L.; Burns, A. L.; de Oliveira, G.; Dooley, H.; Brand, S.; Veeger, A.

2013-12-01

The Rhode Island Technology-Enhanced Science project (RITES) is a NSF-MSP Program that seeks to improve science education by providing professional development to science teachers at the 5th through 12th grade levels. At it's heart, RITES is a complex, multifaceted project that is challenging to evaluate because of the nature of its goal: the development of a large, statewide partnership between higher education and K12 public school districts during a time when science education strategies and leadership are in flux. As a result, these difficulties often require flexibility and creativity regarding evaluation, study design and data collection. In addition, the research agenda of the project often overlaps with the evaluator's agenda, making collaboration and communication a crucial component of the project's success. In it's 5th year, RITES and it's evaluators have developed a large number of instruments, both qualitative and quantitative, to provide direction and feedback on the effectiveness of the project's activities. RITES personnel work closely with evaluators and researchers to obtain a measure of how RITES' 'theory-of-action' affects both student outcomes and teacher practice. Here we discuss measures of teacher and student content gains, student inquiry gains, and teacher implementation surveys. Using content questions based on AAAS and MOSART databases, teachers in the short courses and students in classrooms showed significant normalized learning gains with averages generally above 0.3. Students of RITES-trained teachers also outperformed their non-RITES peers on the inquiry-section of the NECAP test, and The results show, after controlling for race and economic status, a small but statistically significant increase in test scores for RITES students. Technology use in the classroom significantly increased for teachers who were 'expected implementers' where 'expected implementers' are those teachers who implemented RITES as the project was designed. This

Forging successful academic-community partnerships with community health centers: the California statewide Area Health Education Center (AHEC) experience.

Science.gov (United States)

Fowkes, Virginia; Blossom, H John; Mitchell, Brenda; Herrera-Mata, Lydia

2014-01-01

Increased access to insurance under the Affordable Care Act will increase demands for clinical services in community health centers (CHCs). CHCs also have an increasingly important educational role to train clinicians who will remain to practice in community clinics. CHCs and Area Health Education Centers (AHECs) are logical partners to prepare the health workforce for the future. Both are sponsored by the Health Resources and Services Administration, and they share a mission to improve quality of care in medically underserved communities. AHECs emphasize the educational side of the mission, and CHCs the service side. Building stronger partnerships between them can facilitate a balance between education and service needs.From 2004 to 2011, the California Statewide AHEC program and its 12 community AHECs (centers) reorganized to align training with CHC workforce priorities. Eight centers merged into CHC consortia; others established close partnerships with CHCs in their respective regions. The authors discuss issues considered and approaches taken to make these changes. Collaborative innovative processes with program leadership, staff, and center directors revised the program mission, developed common training objectives with an evaluation plan, and defined organizational, functional, and impact characteristics for successful AHECs in California. During this planning, centers gained confidence as educational arms for the safety net and began collaborations with statewide programs as well as among themselves. The AHEC reorganization and the processes used to develop, strengthen, and identify standards for centers forged the development of new partnerships and established academic-community trust in planning and implementing programs with CHCs.

Outcomes of a statewide anti-tobacco industry youth organizing movement.

Science.gov (United States)

Dunn, Caroline L; Pirie, Phyllis L; Oakes, J Michael

2004-01-01

To outline the design and present select findings from an evaluation of a statewide anti-tobacco industry youth organizing movement. A telephone survey was administered to teenagers to assess associations between exposure to anti-industry youth organizing activities and tobacco-related attitudes and behaviors. A group-level comparison between areas high and low in youth organizing activities was planned. Methodological obstacles necessitated a subject-level analytic approach, with comparisons being made between youth at higher and lower levels of exposure. Six rural areas (comprising 13 counties) and two urban regions of Minnesota were selected for survey. The study comprised 852 youth, aged 15 to 17 years old, randomly selected from county-specific sampling frames constructed from a marketing research database. Exposure index scores were developed for two types of activities designed to involve youth in the anti-industry program: branding (creating awareness of the movement in general) and messaging (informing about the movement's main messages). Attitudinal outcomes measured attitudes about the tobacco industry and the effectiveness of youth action. Behavioral outcomes included taking action to get involved in the organization, spreading an anti-industry message, and smoking susceptibility. Branding index scores were significantly correlated with taking action to get involved (p strategy for involving youth in tobacco prevention and generating negative attitudes about the industry.

The Critical Role of a Well-Articulated, Coherent Design in Professional Development: An Evaluation of a State-Wide Two-Week Program for Mathematics and Science Teachers

Science.gov (United States)

Saderholm, Jon; Ronau, Robert N.; Rakes, Christopher R.; Bush, Sarah B.; Mohr-Schroeder, Margaret

2017-01-01

This evaluation study examined a state-wide professional development program composed of two institutes, one for mathematics teachers and one for science teachers, each spanning two weeks. The program was designed to help teachers transform their practice to align with Common Core State Standards for Mathematics and Next Generation Science…

Costs and effects of a state-wide health promotion program in primary schools in Germany - the Baden-Württemberg Study: A cluster-randomized, controlled trial.

Directory of Open Access Journals (Sweden)

Dorothea Kesztyüs

Full Text Available To evaluate the cost-effectiveness of the state-wide implementation of the health promotion program "Join the Healthy Boat" in primary schools in Germany.Cluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER to identify the costs per case of averted abdominal obesity were calculated.The final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]. The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group.This study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases.German Clinical Trials Register (DRKS, Freiburg University, Germany, DRKS-ID: DRKS00000494.

Using Chronic Absence in a Multi-Metric Accountability System. Policy Memo 16-1

Science.gov (United States)

Hough, Heather

2016-01-01

With the passage of the Every Student Succeeds Act (ESSA) of 2015, California must integrate additional measures of student and school performance into the state-wide accountability system. To support the conversation as policymakers consider if/how to include chronic absenteeism data in the state's accountability system, PACE has conducted an…

A statewide review of postnatal care in private hospitals in Victoria, Australia

Directory of Open Access Journals (Sweden)

Forster Della A

2010-05-01

Full Text Available Abstract Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19 and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11. Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and

California drug courts: outcomes, costs and promising practices: an overview of Phase II in a statewide study.

Science.gov (United States)

Carey, Shannon M; Finigan, Michael; Crumpton, Dave; Waller, Mark

2006-11-01

The rapid expansion of drug courts in California and the state's uncertain fiscal climate highlighted the need for definitive cost information on drug court programs. This study focused on creating a research design that can be utilized for statewide and national cost-assessment of drug courts by conducting in-depth case studies of the costs and benefits in nine adult drug courts in California. A Transactional Institutional Costs Analysis (TICA) approach was used, allowing researchers to calculate costs based on every individual's transactions within the drug court or the traditional criminal justice system. This methodology also allows the calculation of costs and benefits by agency (e.g., Public Defender's office, court, District Attorney). Results in the nine sites showed that the majority of agencies save money in processing an offender though drug court. Overall, for these nine study sites, participation in drug court saved the state over 9 million dollars in criminal justice and treatment costs due to lower recidivism in drug court participants. Based on the lessons learned in Phases I and II, Phase III of this study focuses on the creation of a web-based drug court cost self-evaluation tool (DC-CSET) that drug courts can use to determine their own costs and benefits.

A concept of customer–provider relation monitoring system solution

Directory of Open Access Journals (Sweden)

Naděžda Chalupová

2008-01-01

Full Text Available The contribution deals with design of customer–provider relationship monitoring system solution with regard to needs of business managers and analytics and to possibilities of contemporaneous information and communication technologies.The attention is followed to targeted modelling, what brings possibilities of acquisition of bigger overview about things taking place in the relation. In consequence it describes the functionality of analytical systems producing these very strategically valuable models – to so-called business intelligence tools. Onward it deals with modern technologies conductive to above mentioned system implementation – with Ajax concept and with some XML applications: PMML for analytical models manipulation, XSLT for XML data transformations to various formats, SVG for representing pictures of statistical graphs etc. and MathML for description of mathematical formulas created in analytical systems.Following these basis it suggests technological solution of some parts of client–provider relationship watching and evaluating system and it discusses its potential advantages and problems, which can occur.

Moving science into state child and adolescent mental health systems: Illinois' evidence-informed practice initiative.

Science.gov (United States)

Starin, Amy C; Atkins, Marc S; Wehrmann, Kathryn C; Mehta, Tara; Hesson-McInnis, Matthew S; Marinez-Lora, A; Mehlinger, Renee

2014-01-01

In 2005, the Illinois State Mental Health Authority embarked on an initiative to close the gap between research and practice in the children's mental health system. A stakeholder advisory council developed a plan to advance evidence informed practice through policy and program initiatives. A multilevel approach was developed to achieve this objective, which included policy change, stakeholder education, and clinician training. This article focuses on the evidence-informed training process designed following review of implementation research. The training involved in-person didactic sessions and twice-monthly telephone supervision across 6 cohorts of community based clinicians, each receiving 12 months of training. Training content initially included cognitive behavioral therapy and behavioral parent training and was adapted over the years to a practice model based on common element concepts. Evaluation based on provider and parent report indicated children treated by training clinicians generally showed superior outcomes versus both a treatment-as-usual comparison group for Cohorts 1 to 4 and the statewide child population as a whole after 90 days of care for Cohorts 5 to 6. The results indicated primarily moderate to strong effects for the evidence-based training groups. Moving a large public statewide child mental health system toward more effective services is a complex and lengthy process. These results indicate training of community mental health providers in Illinois in evidence-informed practice was moderately successful in positively impacting child-level functional outcomes. These findings also influenced state policy in committing resources to continuing the initiative, even in difficult economic times.

Costs and effects of a state-wide health promotion program in primary schools in Germany – the Baden-Württemberg Study: A cluster-randomized, controlled trial

Science.gov (United States)

Kesztyüs, Tibor; Kilian, Reinhold; Steinacker, Jürgen M

2017-01-01

Aim To evaluate the cost-effectiveness of the state-wide implementation of the health promotion program “Join the Healthy Boat” in primary schools in Germany. Methods Cluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years) were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR) ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER) to identify the costs per case of averted abdominal obesity were calculated. Results The final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]). The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group. Conclusion This study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases. Trial registration German Clinical Trials Register (DRKS), Freiburg University, Germany

Tanggung Jawab Hukum Penyelenggara Sistem Elektronik (Law Responsibility of the Electronic System Providers

Directory of Open Access Journals (Sweden)

Abdul Salam

2011-09-01

Full Text Available Reviewing Edmon Makarim’s book which is about Law Responsibility of the Electronic System Providers, remind us that easiness and availability of electronic system in electronic transaction in private or public happen because the role of electronic system providers. Behind the important and central role, there is big responsibility for electronic system providers. But because of wide of definition of provision of electronic system and so many people who involve in electronic system providers, there is a question in our mind, how is the shape of responsibility of the electronic system providers if the electronic system which is held is broken and / or not in operation as it has to and bring loss to users. Which one from the electronic system providers should take the responsibility in law?

Trends in hospitalization for community-associated methicillin-resistant Staphylococcus aureus in New York City, 1997-2006: data from New York State's Statewide Planning and Research Cooperative System.

Science.gov (United States)

Farr, Amanda M; Aden, Brandon; Weiss, Don; Nash, Denis; Marx, Melissa A

2012-07-01

To describe trends in hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in New York City over 10 years and to explore the demographics and comorbidities of patients hospitalized with CA-MRSA infections. Retrospective analysis of hospital discharges from New York State's Statewide Planning and Research Cooperative System database from 1997 to 2006. All patients greater than 1 year of age admitted to New York hospitals with diagnosis codes indicating MRSA who met the criteria for CA-MRSA on the basis of admission information and comorbidities. We determined hospitalization rates and compared demographics and comorbidities of patients hospitalized with CA-MRSA versus those hospitalized with all other non-MRSA diagnoses by multivariable logistic regression. Of 18,226 hospitalizations with an MRSA diagnosis over 10 years, 3,579 (20%) were classified as community-associated. The CA-MRSA hospitalization rate increased from 1.47 to 10.65 per 100,000 people overall from 1997 to 2006. Relative to non-MRSA hospitalizations, men, children, Bronx and Manhattan residents, the homeless, patients with human immunodeficiency virus (HIV) infection, and persons with diabetes had higher adjusted odds of CA-MRSA hospitalization. The CA-MRSA hospitalization rate appeared to increase between 1997 and 2006 in New York City, with residents of the Bronx and Manhattan, men, and persons with HIV infection or diabetes at increased odds of hospitalization with CA-MRSA. Further studies are needed to explore how changes in MRSA incidence, access to care, and other factors may have impacted these rates.

Embedding EfS in Teacher Education through a Multi-Level Systems Approach: Lessons from Queensland

Science.gov (United States)

Evans, Neus; Ferreira, Jo-Anne; Davis, Julie; Stevenson, Robert B.

2016-01-01

This article reports on the fourth stage of an evolving study to develop a systems model for embedding education for sustainability (EfS) into preservice teacher education. The fourth stage trialled the extension of the model to a comprehensive state-wide systems approach involving representatives from all eight Queensland teacher education…

Statewide prevalence of school children at risk of anaphylaxis and rate of adrenaline autoinjector activation in Victorian government schools, Australia.

Science.gov (United States)

Loke, Paxton; Koplin, Jennifer; Beck, Cara; Field, Michael; Dharmage, Shyamali C; Tang, Mimi L K; Allen, Katrina J

2016-08-01

The prevalence of school students at risk of anaphylaxis in Victoria is unknown and has not been previously studied. Similarly, rates of adrenaline autoinjector usage in the school environment have yet to be determined given increasing prescription rates. We sought to determine time trends in prevalence of school children at risk of anaphylaxis across all year levels and the annual usage rate of adrenaline autoinjectors in the school setting relative to the number of students at risk of anaphylaxis. Statewide surveys from more than 1,500 government schools including more than 550,000 students were used and prevalence rates (%) with 95% CIs were calculated. The overall prevalence of students at risk of anaphylaxis has increased 41% from 0.98% (95% CI, 0.95-1.01) in 2009 to 1.38% (95% CI, 1.35-1.41) in 2014. There was a significant drop in reporting of anaphylaxis risk with transition from the final year of primary school to the first year of secondary school, suggesting a change in parental reporting of anaphylaxis risk among secondary school students. The number of adrenaline autoinjectors activated per 1000 students at risk of anaphylaxis ranged from 6 to 8 per year, with consistently higher activation use in secondary school students than in primary school students. Statewide prevalence of anaphylaxis risk has increased in children attending Victorian government schools. However, adrenaline autoinjector activation has remained fairly stable despite known increase in the rates of prescription. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

On providing the fault-tolerant operation of information systems based on open content management systems

Science.gov (United States)

Kratov, Sergey

2018-01-01

Modern information systems designed to service a wide range of users, regardless of their subject area, are increasingly based on Web technologies and are available to users via Internet. The article discusses the issues of providing the fault-tolerant operation of such information systems, based on free and open source content management systems. The toolkit available to administrators of similar systems is shown; the scenarios for using these tools are described. Options for organizing backups and restoring the operability of systems after failures are suggested. Application of the proposed methods and approaches allows providing continuous monitoring of the state of systems, timely response to the emergence of possible problems and their prompt solution.

The Impact of the State-Wide and District Dropout Prevention Plans on the Dropout Rates, Graduation Rates, GED Completions, and Truancy Rates of High School Teens in Mississippi

Science.gov (United States)

Spencer, Amanda Jean Martin

2011-01-01

In 2006, as part of the compliance with the No Child Left Behind Act of 2001, Mississippi implemented a state-wide dropout prevention plan. The Mississippi Department of Education through the Office of Dropout Prevention supplied a skeletal format to serve as a guideline for all 152 individual school districts within the state. The school…

System and Method for Providing a Climate Data Persistence Service

Science.gov (United States)

Schnase, John L. (Inventor); Ripley, III, William David (Inventor); Duffy, Daniel Q. (Inventor); Thompson, John H. (Inventor); Strong, Savannah L. (Inventor); McInerney, Mark (Inventor); Sinno, Scott (Inventor); Tamkin, Glenn S. (Inventor); Nadeau, Denis (Inventor)

2018-01-01

A system, method and computer-readable storage devices for providing a climate data persistence service. A system configured to provide the service can include a climate data server that performs data and metadata storage and management functions for climate data objects, a compute-storage platform that provides the resources needed to support a climate data server, provisioning software that allows climate data server instances to be deployed as virtual climate data servers in a cloud computing environment, and a service interface, wherein persistence service capabilities are invoked by software applications running on a client device. The climate data objects can be in various formats, such as International Organization for Standards (ISO) Open Archival Information System (OAIS) Reference Model Submission Information Packages, Archive Information Packages, and Dissemination Information Packages. The climate data server can enable scalable, federated storage, management, discovery, and access, and can be tailored for particular use cases.

Evaluation of a statewide science inservice and outreach program: Teacher and student outcomes

Science.gov (United States)

Lott, Kimberly Hardiman

Alabama Science in Motion (ASIM) is a statewide in-service and outreach program designed to provide in-service training for teachers in technology and content knowledge. ASIM is also designed to increase student interest in science and future science careers. The goals of ASIM include: to complement, enhance and facilitate implementation of the Alabama Course of Study: Science, to increase student interest in science and scientific careers, and to provide high school science teachers with curriculum development and staff development opportunities that will enhance their subject-content expertise, technology background, and instructional skills. This study was conducted to evaluate the goals and other measurable outcomes of the chemistry component of ASIM. Data were collected from 19 chemistry teachers and 182 students that participated in ASIM and 6 chemistry teachers and 42 students that do not participate in ASIM using both surveys and student records. Pre-treatment Chi-Square tests revealed that the teachers did not differ in years of chemistry teaching experience, major in college, and number of classes other than chemistry taught. Pre-treatment Chi-Square tests revealed that the students did not differ in age, ethnicity, school classification, or school type. The teacher survey used measured attitudes towards inquiry-based teaching, frequency of technology used by teacher self-report and perceived teaching ability of chemistry topics from the Alabama Course of Study-Science. The student surveys used were the Test of Science Related Attitudes (TOSRA) and a modified version of the Test of Integrated Process Skills (TIPS). The students' science scores from the Stanford Achievement Test (SAT-9) were also obtained from student records. Analysis of teacher data using a MANOVA design revealed that participation in ASIM had a significantly positive effect on teacher attitude towards inquiry-based teaching and the frequency of technology used; however, there was no

A method of providing a barrier in a fracture-containing system

DEFF Research Database (Denmark)

2014-01-01

The present invention relates to a method of providing a barrier in a fracture-containing system, comprising: i) Providing a treatment fluid comprising: a) a base fluid; b) an elastomeric material, wherein said elastomeric material comprises at least one polymer capable of crosslinking into an el......The present invention relates to a method of providing a barrier in a fracture-containing system, comprising: i) Providing a treatment fluid comprising: a) a base fluid; b) an elastomeric material, wherein said elastomeric material comprises at least one polymer capable of crosslinking...... into an elastomer, and c) at least one crosslinking agent; ii) Placing the treatment fluid in a fracture-containing system; iii) Allowing the elastomeric material to crosslink with itself to form a barrier in said fracture-containing system; wherein the elastomeric material and/or the crosslinking agent...... are of neutral buoyancy with regard to the base fluid. The invention is contemplated to having utility not only in the oil-drilling industry but also in the plugging of fractures in sewer drains, pipelines etc....

Mapping one strong 'Ohana: using network analysis and GIS to enhance the effectiveness of a statewide coalition to prevent child abuse and neglect.

Science.gov (United States)

Cardazone, Gina; U Sy, Angela; Chik, Ivan; Corlew, Laura Kate

2014-06-01

Network analysis and GIS enable the presentation of meaningful data about organizational relationships and community characteristics, respectively. Together, these tools can provide a concrete representation of the ecological context in which coalitions operate, and may help coalitions identify opportunities for growth and enhanced effectiveness. This study uses network analysis and GIS mapping as part of an evaluation of the One Strong 'Ohana (OSO) campaign. The OSO campaign was launched in 2012 via a partnership between the Hawai'i Children's Trust Fund (HCTF) and the Joyful Heart Foundation. The OSO campaign uses a collaborative approach aimed at increasing public awareness of child maltreatment and protective factors that can prevent maltreatment, as well as enhancing the effectiveness of the HCTF Coalition. This study focuses on three elements of the OSO campaign evaluation: (1) Network analysis exploring the relationships between 24 active Coalition member organizations, (2) GIS mapping of responses to a randomized statewide phone survey (n = 1,450) assessing awareness of factors contributing to child maltreatment, and (3) Combined GIS maps and network data, illustrating opportunities for geographically-targeted coalition building and public awareness activities.

Provider and systems factors in diabetes quality of care.

Science.gov (United States)

Ghaznavi, Kimia; Malik, Shaista

2012-02-01

A gap exists in knowledge and the observed frequency with which patients with diabetes actually receive treatment for optimal cardiovascular risk reduction. Many interventions to improve quality of care have been targeted at the health systems level and provider organizations. Changes in several domains of care and investment in quality by organizational leaders are needed to make long-lasting improvements. In the studies reviewed, the most effective strategies often have multiple components, whereas the use of one single strategy, such as reminders only or an educational intervention, is less effective. More studies are needed to examine the effect of several care management strategies simultaneously, such as use of clinical information systems, provider financial incentives, and organizational model on processes of care and outcomes.

Internet-based information system of digital geological data providing

Science.gov (United States)

Yuon, Egor; Soukhanov, Mikhail; Markov, Kirill

2015-04-01

One of the Russian Federal аgency of mineral resources problems is to provide the geological information which was delivered during the field operation for the means of federal budget. This information should be present in the current, conditional form. Before, the leading way of presenting geological information were paper geological maps, slices, borehole diagrams reports etc. Technologies of database construction, including distributed databases, technologies of construction of distributed information-analytical systems and Internet-technologies are intensively developing nowadays. Most of geological organizations create their own information systems without any possibility of integration into other systems of the same orientation. In 2012, specialists of VNIIgeosystem together with specialists of VSEGEI started the large project - creating the system of providing digital geological materials with using modern and perspective internet-technologies. The system is based on the web-server and the set of special programs, which allows users to efficiently get rasterized and vectorised geological materials. These materials are: geological maps of scale 1:1M, geological maps of scale 1:200 000 and 1:2 500 000, the fragments of seamless geological 1:1M maps, structural zoning maps inside the seamless fragments, the legends for State geological maps 1:200 000 and 1:1 000 000, full author's set of maps and also current materials for international projects «Atlas of geological maps for Circumpolar Arctic scale 1:5 000 000» and «Atlas of Geologic maps of central Asia and adjacent areas scale 1:2 500 000». The most interesting and functional block of the system - is the block of providing structured and well-formalized geological vector materials, based on Gosgeolkart database (NGKIS), managed by Oracle and the Internet-access is supported by web-subsystem NGKIS, which is currently based on MGS-Framework platform, developed by VNIIgeosystem. One of the leading elements

A Statewide Examiniation of Mental Health Courts in Illinois: Program Characteristics and Operations

Directory of Open Access Journals (Sweden)

Arthur J. Lurigio

2015-07-01

Full Text Available This study represents the only broad-based, statewide evaluation of mental health courts (MHCs conducted to date.  Data were collected from 2010 to 2013 at each of the nine active MHC programs operating in Illinois at the start of the study. The purpose of the study was to compare and contrast the adjudicatory and supervisory models of each established Illinois MHC program by utilizing a variety of research methodologies. A four-year recidivism analysis of case-level data from three Illinois MHCs was also conducted. Illinois MHCs were largely characterized by the '10 essential elements of an MHC', such as voluntary participation, informed choice and hybrid team approaches to case manage clients. Results of the recidivism analysis suggest that MHCs compare favorably to other types of probation. Overall, findings revealed that Illinois MHCs are delivering services effectively and efficiently in a well-coordinated, client-centered team approach. Differences found among the MHCs are not evidence of significant variance from the model, and instead represent responsiveness to the unique culture of the court, the niche-filling character of the program, the expectations of the program stakeholders and the nature and extent of the local service environment.

0-6672 : ITS strategic plan for Texas : project summary.

Science.gov (United States)

2013-08-01

The purpose of this research was to provide a : framework to guide the development and : deployment of an integrated statewide program for : intelligent transportation systems (ITS).ITS is a : critical component of the transportation : infrastructure...

Providing Access to Library Automation Systems for Students with Disabilities.

Science.gov (United States)

California Community Colleges, Sacramento. High-Tech Center for the Disabled.

This document provides information on the integration of assistive computer technologies and library automation systems at California Community Colleges in order to ensure access for students with disabilities. Topics covered include planning, upgrading, purchasing, implementing and using these technologies with library systems. As information…

Special Education Electronic Individualized Education Program (IEP) System. Fiscal Year 2016 Report to the Legislature. As Required by Minnesota Statutes, Section 125A.085

Science.gov (United States)

Minnesota Department of Education, 2016

2016-01-01

In 2013, the Minnesota Legislature appropriated $1.763M for Fiscal Year 2014 to create a statewide system for special education paperwork. In 2014, the Legislature greatly expanded the requirements of the system but did not appropriate additional resources to maintain ongoing operation of the system. The 2014 legislation codified the system in…

Empowering High School Students in Scientific Careers: Developing Statewide Partnerships

Science.gov (United States)

Aguilar, C.; Swartz, D.

2008-05-01

Center for Multiscale Modeling of Atmospheric Processes (CMMAP) is a National Science Foundation Science and Technology Center focused on improving the representation of cloud processes in climate models. The Center is divided into three sections including Knowledge Transfer, Research, and Education and Diversity. The Science Education and Diversity mission is to educate and train people with diverse backgrounds in Climate and Earth System Science by enhancing teaching and learning and disseminating science results through multiple media. CMMAP is partnering with two local school districts to host an annual global climate conferences for high school students. The 2008 Colorado Global Climate Conference seeks "To educate students on global and local climate issues and empower them to se their knowledge." The conference is sponsored by CMMAP, The Governor's Energy Office, Poudre School District, Thompson School District, Clif Bar, and Ben and Jerry's Scoop Shop of Fort Collins. The conference seeks to inspire students to pursue future education and careers in science fields. Following an opening welcome from the Governor's Energy Office, Keynote Piers Sellers will discuss his experiences as an atmospheric scientist and NASA astronaut. Students will then attend 3 out of 16 breakout sessions including such sessions as "Hot poems, Cool Paintings, and the treasures of Antiquity of Climate Change", "Mitigation vs Adaptation", "Bigfoot Walks(What Size is our carbon footprint?)" "The Wedges: Reduc ing Carbon Emissions", and "We the People: Climate and Culture of Climate Change" to name a few. Using The Governor's High School Conference on the Environment sponsored by the Wisconsin Center for Environmental Education as a model we are developing statewide partnerships to bring high school students together to look at global climate issues that will impact their future and of which they can be part of the solution through their education and career paths. In addition to

Authentication of an operator-provided containment and surveillance (C and S) system

International Nuclear Information System (INIS)

Watkins, L.M.; Rundquist, D.E.

1987-01-01

Large multicomponent Operator-provided C and S systems with computer control, such as the pioneering Japanese Fast Critical Assembly Portal Monitor (FCA P/M), can efficiently meet evolving IAEA C and S requirements but they present substantial challenges to the IAEA's need to authenticate the data produced. To authenticate such systems by traditional IAEA methods would require a prohibitive expenditure of resources to ensure that each individual component is provided with credible tamper indication and that the control and interpretation of the data is appropriate. Consequently, in parallel with the FCA P/M field trial currently underway in Japan, the IAEA has initiated a programme aimed at producing resource-efficient and credible authentication of the system. Although initially focused on the P/M system, the methods under consideration are applicable to other similar Operator-provided systems

Employee Assistance Program Cost Containment through the Utilization of Community-Based, Social Model Treatment Providers.

Science.gov (United States)

de Miranda, John; Lampe, Marc

Statewide efforts by the California Department of Alcohol and Drug Programs to secure third-party payments for nonhospital alcoholism services gradually dissolved due to changes in political administration and overall priorities. San Mateo County, however, served as a demonstration county for the effort and has continued to explore third-party…

Statewide Quality Improvement Initiative to Reduce Early Elective Deliveries and Improve Birth Registry Accuracy.

Science.gov (United States)

Kaplan, Heather C; King, Eileen; White, Beth E; Ford, Susan E; Fuller, Sandra; Krew, Michael A; Marcotte, Michael P; Iams, Jay D; Bailit, Jennifer L; Bouchard, Jo M; Friar, Kelly; Lannon, Carole M

2018-04-01

To evaluate the success of a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data accuracy rapidly and at scale in Ohio. Between February 2013 and March 2014, participating hospitals were involved in a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data. This initiative was designed as a learning collaborative model (group webinars and a single face-to-face meeting) and included individual quality improvement coaching. It was implemented using a stepped wedge design with hospitals divided into three balanced groups (waves) participating in the initiative sequentially. Birth registry data were used to assess hospital rates of nonmedically indicated inductions at less than 39 weeks of gestation. Comparisons were made between groups participating and those not participating in the initiative at two time points. To measure birth registry accuracy, hospitals conducted monthly audits comparing birth registry data with the medical record. Associations were assessed using generalized linear repeated measures models accounting for time effects. Seventy of 72 (97%) eligible hospitals participated. Based on birth registry data, nonmedically indicated inductions at less than 39 weeks of gestation declined in all groups with implementation (wave 1: 6.2-3.2%, Pinitiative, they saw significant decreases in rates of early elective deliveries as compared with wave 3 (control; P=.018). All waves had significant improvement in birth registry accuracy (wave 1: 80-90%, P=.017; wave 2: 80-100%, P=.002; wave 3: 75-100%, Pinitiative enabled statewide spread of change strategies to decrease early elective deliveries and improve birth registry accuracy over 14 months and could be used for rapid dissemination of other evidence-based obstetric care practices across states or hospital systems.

Development of a computer-based training (CBT) course for the FSUTMS comprehensive modeling workshop.

Science.gov (United States)

2008-09-01

FSUTMS training is a major activity of the Systems Planning Office of the Florida Department of : Transportation (FDOT). The training aims to establish and maintain quality assurance for consistent : statewide modeling standards and provide up-to-dat...

Less Is More: Results of a Statewide Analysis of the Impact of Blood Transfusion on Coronary Artery Bypass Grafting Outcomes.

Science.gov (United States)

Crawford, Todd C; Magruder, J Trent; Fraser, Charles; Suarez-Pierre, Alejandro; Alejo, Diane; Bobbitt, Jennifer; Fonner, Clifford E; Canner, Joseph K; Horvath, Keith; Wehberg, Kurt; Taylor, Bradley; Kwon, Christopher; Whitman, Glenn J; Conte, John V; Salenger, Rawn

2018-01-01

Debate persists over the association between blood transfusions, especially those considered discretionary, and outcomes after cardiac operations. Using data from the Maryland Cardiac Surgery Quality Initiative, we sought to determine whether outcomes differed among coronary artery bypass grafting (CABG) patients receiving 1 U of red blood cells (RBCs) vs none. We used a statewide database to review patients who underwent isolated CABG from July 1, 2011, to June 30, 2016, across 10 Maryland cardiac surgery centers. We included patients who received 1 U or fewer of RBCs from the time of the operation through discharge. Propensity scoring, using 20 variables to control for treatment effect, was performed among patients who did and did not receive a transfusion. These two groups were matched 1:1 to assess for differences in our primary outcomes: operative death, prolonged postoperative length of stay (>14 days), and a composite postoperative respiratory complication of pneumonia or reintubation, or both. Of 10,877 patients who underwent CABG, 6,124 (56%) received no RBCs (group 1) during their operative hospitalization, and 981 (9.0%) received 1 U of RBCs (group 2), including 345 of 981 patients (35%) who received a transfusion intraoperatively. Propensity score matching generated 937 well-matched pairs. Compared with group 2, propensity-matched analysis revealed significantly greater 30-day survival in group 1 (99% vs 98%, p = 0.02) and reduced incidence of prolonged length of stay (3.7% vs 4.0%, p < 0.01). Our collaborative statewide analysis demonstrated that even 1 unit of blood was associated with significantly worse survival and longer length of stay after CABG. Multiinstitutional quality initiatives may seek to address discretionary transfusions and possess the potential to improve patient outcomes. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Quality assurance systems – the difficulties in providing a global unified system for Surveyors

OpenAIRE

Goodhead, Tim

2012-01-01

This paper will analyse the difficulties in providing a global quality assurance system for Surveyors. Using case studies from the United Kingdom and elsewhere opportunities for harmonising Quality Assurance systems will be explored. The difficulties in moving towards common quality assurance systems will be analysed. Possible alternatives in the form of the development a knowledge bank of mutual agreements and top up qualifications will be investigated. The paper also looks at the role of FI...

Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

Science.gov (United States)

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

Enhancing Clinical Content and Race/Ethnicity Data in Statewide Hospital Administrative Databases: Obstacles Encountered, Strategies Adopted, and Lessons Learned.

Science.gov (United States)

Pine, Michael; Kowlessar, Niranjana M; Salemi, Jason L; Miyamura, Jill; Zingmond, David S; Katz, Nicole E; Schindler, Joe

2015-08-01

Eight grant teams used Agency for Healthcare Research and Quality infrastructure development research grants to enhance the clinical content of and improve race/ethnicity identifiers in statewide all-payer hospital administrative databases. Grantees faced common challenges, including recruiting data partners and ensuring their continued effective participation, acquiring and validating the accuracy and utility of new data elements, and linking data from multiple sources to create internally consistent enhanced administrative databases. Successful strategies to overcome these challenges included aggressively engaging with providers of critical sources of data, emphasizing potential benefits to participants, revising requirements to lessen burdens associated with participation, maintaining continuous communication with participants, being flexible when responding to participants' difficulties in meeting program requirements, and paying scrupulous attention to preparing data specifications and creating and implementing protocols for data auditing, validation, cleaning, editing, and linking. In addition to common challenges, grantees also had to contend with unique challenges from local environmental factors that shaped the strategies they adopted. The creation of enhanced administrative databases to support comparative effectiveness research is difficult, particularly in the face of numerous challenges with recruiting data partners such as competing demands on information technology resources. Excellent communication, flexibility, and attention to detail are essential ingredients in accomplishing this task. Additional research is needed to develop strategies for maintaining these databases when initial funding is exhausted. © Health Research and Educational Trust.

Health information exchange implementation: lessons learned and critical success factors from a case study.

Science.gov (United States)

Feldman, Sue S; Schooley, Benjamin L; Bhavsar, Grishma P

2014-08-15

Much attention has been given to the proposition that the exchange of health information as an act, and health information exchange (HIE), as an entity, are critical components of a framework for health care change, yet little has been studied to understand the value proposition of implementing HIE with a statewide HIE. Such an organization facilitates the exchange of health information across disparate systems, thus following patients as they move across different care settings and encounters, whether or not they share an organizational affiliation. A sociotechnical systems approach and an interorganizational systems framework were used to examine implementation of a health system electronic medical record (EMR) system onto a statewide HIE, under a cooperative agreement with the Office of the National Coordinator for Health Information Technology, and its collaborating organizations. The objective of the study was to focus on the implementation of a health system onto a statewide HIE; provide insight into the technical, organizational, and governance aspects of a large private health system and the Virginia statewide HIE (organizations with the shared goal of exchanging health information); and to understand the organizational motivations and value propositions apparent during HIE implementation. We used a formative evaluation methodology to investigate the first implementation of a health system onto the statewide HIE. Qualitative methods (direct observation, 36 hours), informal information gathering, semistructured interviews (N=12), and document analysis were used to gather data between August 12, 2012 and June 24, 2013. Derived from sociotechnical concepts, a Blended Value Collaboration Enactment Framework guided the data gathering and analysis to understand organizational stakeholders' perspectives across technical, organizational, and governance dimensions. Several challenges, successes, and lessons learned during the implementation of a health system to the

Genome Structural Diversity among 31 Bordetella pertussis Isolates from Two Recent U.S. Whooping Cough Statewide Epidemics.

Science.gov (United States)

Bowden, Katherine E; Weigand, Michael R; Peng, Yanhui; Cassiday, Pamela K; Sammons, Scott; Knipe, Kristen; Rowe, Lori A; Loparev, Vladimir; Sheth, Mili; Weening, Keeley; Tondella, M Lucia; Williams, Margaret M

2016-01-01

During 2010 and 2012, California and Vermont, respectively, experienced statewide epidemics of pertussis with differences seen in the demographic affected, case clinical presentation, and molecular epidemiology of the circulating strains. To overcome limitations of the current molecular typing methods for pertussis, we utilized whole-genome sequencing to gain a broader understanding of how current circulating strains are causing large epidemics. Through the use of combined next-generation sequencing technologies, this study compared de novo, single-contig genome assemblies from 31 out of 33 Bordetella pertussis isolates collected during two separate pertussis statewide epidemics and 2 resequenced vaccine strains. Final genome architecture assemblies were verified with whole-genome optical mapping. Sixteen distinct genome rearrangement profiles were observed in epidemic isolate genomes, all of which were distinct from the genome structures of the two resequenced vaccine strains. These rearrangements appear to be mediated by repetitive sequence elements, such as high-copy-number mobile genetic elements and rRNA operons. Additionally, novel and previously identified single nucleotide polymorphisms were detected in 10 virulence-related genes in the epidemic isolates. Whole-genome variation analysis identified state-specific variants, and coding regions bearing nonsynonymous mutations were classified into functional annotated orthologous groups. Comprehensive studies on whole genomes are needed to understand the resurgence of pertussis and develop novel tools to better characterize the molecular epidemiology of evolving B. pertussis populations. IMPORTANCE Pertussis, or whooping cough, is the most poorly controlled vaccine-preventable bacterial disease in the United States, which has experienced a resurgence for more than a decade. Once viewed as a monomorphic pathogen, B. pertussis strains circulating during epidemics exhibit diversity visible on a genome structural

System and Method for Providing a Climate Data Analytic Services Application Programming Interface Distribution Package

Science.gov (United States)

Schnase, John L. (Inventor); Duffy, Daniel Q. (Inventor); Tamkin, Glenn S. (Inventor)

2016-01-01

A system, method and computer-readable storage devices for providing a climate data analytic services application programming interface distribution package. The example system can provide various components. The system provides a climate data analytic services application programming interface library that enables software applications running on a client device to invoke the capabilities of a climate data analytic service. The system provides a command-line interface that provides a means of interacting with a climate data analytic service by issuing commands directly to the system's server interface. The system provides sample programs that call on the capabilities of the application programming interface library and can be used as templates for the construction of new client applications. The system can also provide test utilities, build utilities, service integration utilities, and documentation.

Analyzing the Measurement Equivalence of a Translated Test in a Statewide Assessment Program

Directory of Open Access Journals (Sweden)

Jorge Carvajal-Espinoza

2016-09-01

Full Text Available When tests are translated into one or more languages, the question of the equivalence of items across language forms arises. This equivalence can be assessed at the scale level by means of a multiple group confirmatory factor analysis (CFA in the context of structural equation modeling. This study examined the measurement equivalence of a Spanish translated version of a statewide Mathematics test originally constructed in English by using a multi-group CFA approach. The study used samples of native speakers of the target language of the translation taking the test in both the source and target language, specifically Hispanics taking the test in English and Spanish. Test items were grouped in twelve facet-representative parcels. The parceling was accomplished by grouping items that corresponded to similar content and computing an average for each parcel. Four models were fitted to examine the equivalence of the test across groups. The multi-group CFA fixed factor loadings across groups and results supported the equivalence of the two language versions (English and Spanish of the test. The statistical techniques implemented in this study can also be used to address the performance on a test based on dichotomous or dichotomized variables such as gender, socioeconomic status, geographic location and other variables of interest.

Electronic health systems: challenges faced by hospital-based providers.

Science.gov (United States)

Agno, Christina Farala; Guo, Kristina L

2013-01-01

The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed.

Electricity decision-making: New techniques for calculating statewide economic impacts from new power supply and demand-side management programs

Science.gov (United States)

Tegen, Suzanne Isabel Helmholz

This dissertation introduces new techniques for calculating and comparing statewide economic impacts from new coal, natural gas and wind power plants, as well as from demand-side management programs. The impetus for this work was two-fold. First, reviews of current literature and projects revealed that there was no standard way to estimate statewide economic impacts from new supply- and demand-side electricity options. Second, decision-makers who were interviewed stated that they were overwhelmed with data in general, but also lacked enough specific information about economic development impacts to their states from electricity, to make informed choices. This dissertation includes chapters on electricity decision-making and on economic impacts from supply and demand. The supply chapter compares different electricity options in three states which vary in natural resource content: Arizona, Colorado and Michigan. To account for differing capacity factors, resources are compared on a per-megawatt-hour basis. The calculations of economic impacts from new supply include: materials and labor for construction, operations, maintenance, fuel extraction, fuel transport, as well as property tax, financing and landowner revenues. The demand-side chapter compares residential, commercial and industrial programs in Iowa. Impact calculations include: incremental labor and materials for program planning, installation and operations, as well as sales taxes and electricity saved. Results from supply-side calculations in the three states analyzed indicate that adding new wind power can have a greater impact to a state's economy than adding new gas or coal power due to resource location, taxes and infrastructure. Additionally, demand-side management programs have a higher relative percentage of in-state dollar flow than supply-side solutions, though demand-side programs typically involve fewer MWh and dollars than supply-side generation. Methods for this dissertation include researching

Development of a system to provide diagnostics-while-drilling.

Energy Technology Data Exchange (ETDEWEB)

Wise, Jack LeRoy; Jacobson, Ronald David; Finger, John Travis; Mansure, Arthur James; Knudsen, Steven Dell

2003-06-01

This report describes development of a system that provides high-speed, real-time downhole data while drilling. Background of the project, its benefits, major technical challenges, test planning, and test results are covered by relatively brief descriptions in the body of the report, with some topics presented in more detail in the attached appendices.

Health care quality measures for children and adolescents in Foster Care: feasibility testing in electronic records.

Science.gov (United States)

Deans, Katherine J; Minneci, Peter C; Nacion, Kristine M; Leonhart, Karen; Cooper, Jennifer N; Scholle, Sarah Hudson; Kelleher, Kelly J

2018-02-22

Preventive quality measures for the foster care population are largely untested. The objective of the study is to identify healthcare quality measures for young children and adolescents in foster care and to test whether the data required to calculate these measures can be feasibly extracted and interpreted within an electronic health records or within the Statewide Automated Child Welfare Information System. The AAP Recommendations for Preventive Pediatric Health Care served as the guideline for determining quality measures. Quality measures related to well child visits, developmental screenings, immunizations, trauma-related care, BMI measurements, sexually transmitted infections and depression were defined. Retrospective chart reviews were performed on a cohort of children in foster care from a single large pediatric institution and related county. Data available in the Ohio Statewide Automated Child Welfare Information System was compared to the same population studied in the electronic health record review. Quality measures were calculated as observed (received) to expected (recommended) ratios (O/E ratios) to describe the actual quantity of recommended health care that was received by individual children. Electronic health records and the Statewide Automated Child Welfare Information System data frequently lacked important information on foster care youth essential for calculating the measures. Although electronic health records were rich in encounter specific clinical data, they often lacked custodial information such as the dates of entry into and exit from foster care. In contrast, Statewide Automated Child Welfare Information System included robust data on custodial arrangements, but lacked detailed medical information. Despite these limitations, several quality measures were devised that attempted to accommodate these limitations. In this feasibility testing, neither the electronic health records at a single institution nor the county level Statewide

Receiving recommendations and providing feedback : the user-experience of a recommender system

NARCIS (Netherlands)

Knijnenburg, B.P.; Willemsen, M.C.; Hirtbach, S.; Buccafurri, F.; Semeraro, G.

2010-01-01

This paper systematically evaluates the user experience of a recommender system. Using both behavioral data and subjective measures of user experience, we demonstrate that choice satisfaction and system effectiveness increase when a system provides personalized recommendations (compared to the same

Quantifying the Lateral Bracing Provided by Standing Steam Roof Systems

OpenAIRE

Sorensen, Taylor J.

2016-01-01

One of the major challenges of engineering is finding the proper balance between economical and safe. Currently engineers at Nucor Corporation have ignored the additional lateral bracing provided by standing seam roofing systems to joists because of the lack of methods available to quantify the amount of bracing provided. Based on the results of testing performed herein, this bracing is significant, potentially resulting in excessively conservative designs and unnecessary costs. This proje...

A Statewide Private Microwave Wide Area Network for Real-time Natural Hazard Monitoring

Science.gov (United States)

Williams, M. C.; Kent, G.; Smith, K. D.; Plank, G.; Slater, D.; Torrisi, J.; Presser, R.; Straley, K.

2013-12-01

The Nevada Seismological Laboratory (NSL) at the University of Nevada, Reno, operates the Nevada Seismic Network, a collection of ground motion instruments installed throughout Nevada and California, for the purposes of detecting, locating, and notifying the public of earthquakes in the state. To perform these tasks effectively, NSL has designed and built a statewide wireless microwave wide-area network (WAN) in order to receive ground motion data in near real-time. This network consists of radio access points, backhauls, and backbone communication sites transmitting time-series, images, and datalogger diagnostics to our data center servers in Reno. This privately managed communication network greatly reduces the dependence on third-party infrastructure (e.g. commercial cellular networks), and is vital for emergency management response and system uptime. Any individual seismograph or data collection device is networked through a wireless point-to-multipoint connection to a remote access point (AP) using a low-cost radio/routerboard combination. Additional point-to-point connections from AP's to radio backhauls and/or mountaintop backbone sites allow the Data Center in Reno to communicate with and receive data directly from each datalogger. Dataloggers, radios, and routers can be configured using tablets on-site, or via desktop computers at the Data Center. Redundant mountaintop links can be added to the network and facilitate the re-routing of data (similar to a meshed network) in the event of a faulty, failing, or noisy communication site. All routers, radios, and servers, including those at the Data Center, have redundant power and can operate independently in the event of a grid power or public Internet outage. A managed server room at the Data Center processes earthquake data for notifications and acts as a data source for remote users. Consisting of about 500 hosts, and spanning hundreds of miles, this WAN provides network operators access to each router and

A comparison of the efficiency of health systems in providing life expectancy

DEFF Research Database (Denmark)

Lenart, Adam; Zarulli, Virginia

The role of the national health systems is to provide health for their citizens but each country achieves it up to a different degree. The health systems are heterogeneous not only in their efficiency but in their funding, organization and management too. As it is difficult to measure...... their efficiency in absolute terms, the countries can be compared with each other. The relative efficiency of health systems can be measured by the life expectancy that they provide by taking education level and their funding structure into account. Based on data coming from the HMD, GGS, OECD and WHO, data...

Performance Measurement and Target-Setting in California's Safety Net Health Systems.

Science.gov (United States)

Hemmat, Shirin; Schillinger, Dean; Lyles, Courtney; Ackerman, Sara; Gourley, Gato; Vittinghoff, Eric; Handley, Margaret; Sarkar, Urmimala

Health policies encourage implementing quality measurement with performance targets. The 2010-2015 California Medicaid waiver mandated quality measurement and reporting. In 2013, California safety net hospitals participating in the waiver set a voluntary performance target (the 90th percentile for Medicare preferred provider organization plans) for mammography screening and cholesterol control in diabetes. They did not reach the target, and the difference-in-differences analysis suggested that there was no difference for mammography ( P = .39) and low-density lipoprotein control ( P = .11) performance compared to measures for which no statewide quality improvement initiative existed. California's Medicaid waiver was associated with improved performance on a number of metrics, but this performance was not attributable to target setting on specific health conditions. Performance may have improved because of secular trends or systems improvements related to waiver funding. Relying on condition-specific targets to measure performance may underestimate improvements and disadvantage certain health systems. Achieving ambitious targets likely requires sustained fiscal, management, and workforce investments.

Optimizing the Use of Storage Systems Provided by Cloud Computing Environments

Science.gov (United States)

Gallagher, J. H.; Potter, N.; Byrne, D. A.; Ogata, J.; Relph, J.

2013-12-01

Cloud computing systems present a set of features that include familiar computing resources (albeit augmented to support dynamic scaling of processing power) bundled with a mix of conventional and unconventional storage systems. The linux base on which many Cloud environments (e.g., Amazon) are based make it tempting to assume that any Unix software will run efficiently in this environment efficiently without change. OPeNDAP and NODC collaborated on a short project to explore how the S3 and Glacier storage systems provided by the Amazon Cloud Computing infrastructure could be used with a data server developed primarily to access data stored in a traditional Unix file system. Our work used the Amazon cloud system, but we strived for designs that could be adapted easily to other systems like OpenStack. Lastly, we evaluated different architectures from a computer security perspective. We found that there are considerable issues associated with treating S3 as if it is a traditional file system, even though doing so is conceptually simple. These issues include performance penalties because using a software tool that emulates a traditional file system to store data in S3 performs poorly when compared to a storing data directly in S3. We also found there are important benefits beyond performance to ensuring that data written to S3 can directly accessed without relying on a specific software tool. To provide a hierarchical organization to the data stored in S3, we wrote 'catalog' files, using XML. These catalog files map discrete files to S3 access keys. Like a traditional file system's directories, the catalogs can also contain references to other catalogs, providing a simple but effective hierarchy overlaid on top of S3's flat storage space. An added benefit to these catalogs is that they can be viewed in a web browser; our storage scheme provides both efficient access for the data server and access via a web browser. We also looked at the Glacier storage system and

Systems and methods for providing power to a load based upon a control strategy

Science.gov (United States)

Perisic, Milun; Kajouke, Lateef A; Ransom, Ray M

2013-12-24

Systems and methods are provided for an electrical system. The electrical system includes a load, an interface configured to receive a voltage from a voltage source, and a controller configured to receive the voltage from the voltage source through the interface and to provide a voltage and current to the load. Wherein, when the controller is in a constant voltage mode, the controller provides a constant voltage to the load, when the controller is in a constant current mode, the controller provides a constant current to the load, and when the controller is in a constant power mode, the controller provides a constant power to the load.

Status of and changes in water quality monitored for the Idaho statewide surface-water-quality network, 1989—2002

Science.gov (United States)

Hardy, Mark A.; Parliman, Deborah J.; O'Dell, Ivalou

2005-01-01

The Idaho statewide surface-water-quality monitoring network consists of 56 sites that have been monitored from 1989 through 2002 to provide data to document status and changes in the quality of Idaho streams. Sampling at 33 sites has covered a wide range of flows and seasons that describe water-quality variations representing both natural conditions and human influences. Targeting additional high- or low-flow sampling would better describe conditions at 20 sites during hydrologic extremes. At the three spring site types, sampling covered the range of flow conditions from 1989 through 2002 well. However, high flows at these sites since 1989 were lower than historical high flows as a result of declining ground-water levels in the Snake River Plain. Summertime stream temperatures at 45 sites commonly exceeded 19 and 22 degrees Celsius, the Idaho maximum daily mean and daily maximum criteria, respectively, for the protection of coldwater aquatic life. Criteria exceedances in stream basins with minimal development suggest that such high temperatures may occur naturally in many Idaho streams. Suspended-sediment concentrations were generally higher in southern Idaho than in central and northern Idaho, and network data suggest that the turbidity criteria are most likely to be exceeded at sites in southern Idaho and other sections of the Columbia Plateaus geomorphic province. This is probably because this province has more fine-grained soils that are subject to erosion and disturbance by land uses than the Northern Rocky Mountains province of northern and central

How Californians View Education Standards, Testing and Accountability: Results from the Third PACE/USC Rossier Poll

Science.gov (United States)

Plank, David N.; Brewer, Dominic J.; Polikoff, Morgan; Hall, Michelle

2013-01-01

California is in the midst of sweeping education changes. The state is rolling out the Common Core State Standards (CCSS) and a new system of assessments. Voters approved a temporary statewide tax increase that will provide additional funding to schools after years of spending cuts. The Legislature adopted a new system for funding schools (the…

Public Health Approaches and Barriers to Educating Providers about Hereditary Breast and Ovarian Cancer Syndrome

Directory of Open Access Journals (Sweden)

Angela M. Trepanier

2016-03-01

Full Text Available The Michigan Department of Health and Human Services implemented and evaluated two initiatives designed to enhance provider knowledge of patients appropriate for breast and/or ovarian cancer genetic risk assessment and hereditary breast and ovarian cancer (HBOC syndrome testing. The first initiative targeted select providers who had diagnosed patients meeting HBOC risk criteria. Specifically, the initiative used 2008–2009 state cancer registry data to identify all providers who had diagnosed breast cancers in women ≤50 years of age, male breast cancers, and ovarian cancers in four health systems with newly established cancer genetics clinics. Using a method coined bidirectional reporting (BDR, reports highlighting how many of these cases each provider had seen were generated and mailed. Reports on 475 cancers (9.5% of the 5005 cases statewide meeting criteria were sent to 69 providers with information about how and why to refer such patients for genetic counseling. Providers who received a report were contacted to assess whether the reports increased awareness or resulted in action (genetic counseling/referral. Based on the few responses received, despite multiple attempts to contact, and attrition rate, it is not possible to ascertain the impact of this initiative on providers. However the project resulted in the MDHHS identifying which providers see the largest proportion of at-risk patients, creating an opportunity to target those providers with HBOC education efforts. The second initiative involved creating and broadly disseminating an online, interactive case-based educational module to increase awareness and referral decisions for HBOC using high- and low-risk patient scenarios. A total of 1835 unique users accessed the module in a one year. Collectively the users viewed topic pages 2724 times and the interactive case studies 1369 times. Point of care tools (fact sheets were viewed 1624 times and downloaded 764 times. Satisfaction

The Use of Nuclear Generation to Provide Power System Stability

OpenAIRE

Heather Wyman-Pain; Yuankai Bian; Furong Li

2016-01-01

The decreasing use of fossil fuel power stations has a negative effect on the stability of the electricity systems in many countries. Nuclear power stations have traditionally provided minimal ancillary services to support the system but this must change in the future as they replace fossil fuel generators. This paper explains the development of the four most popular reactor types still in regular operation across the world which have formed the basis for most reactor dev...

Swarm Intelligence: New Techniques for Adaptive Systems to Provide Learning Support

Science.gov (United States)

Wong, Lung-Hsiang; Looi, Chee-Kit

2012-01-01

The notion of a system adapting itself to provide support for learning has always been an important issue of research for technology-enabled learning. One approach to provide adaptivity is to use social navigation approaches and techniques which involve analysing data of what was previously selected by a cluster of users or what worked for…

Preventing Elder Abuse: The Texas Plan for a Coordinated Service Delivery System. Collaborative Elder Abuse Prevention Project.

Science.gov (United States)

McDaniel, Garry L.

The Texas Department of Human Services, in collaboration with 13 other public and private organizations, co-sponsored a statewide Collaborative Elder Abuse Prevention project. The goal of this project is to develop a comprehensive, long-range plan for the prevention of elder abuse, a method for achieving a coordinated service delivery system for…

A Multilevel, Statewide Investigation of School District Anti-Bullying Policy Quality and Student Bullying Involvement.

Science.gov (United States)

Gower, Amy L; Cousin, Molly; Borowsky, Iris W

2017-03-01

Although nearly all states in the United States require school districts to adopt anti-bullying policies, little research examines the effect of these policies on student bullying and health. Using a statewide sample, we investigated associations between the quality of school district anti-bullying policies and student bullying involvement and adjustment. School district anti-bullying policies (N = 208) were coded for their quality based on established criteria. District-level data were combined with student reports of bullying involvement, emotional distress, and school connectedness from a state surveillance survey of 6th, 9th, and 12th grade students (N = 93,437). Results indicated that policy quality was positively related to bullying victimization. Furthermore, students reporting frequent perpetration/victimization who also attended districts with high-quality policies reported more emotional distress and less school connectedness compared with students attending districts with low quality policies. Although statistically significant, the magnitude of these associations was small. Having a high-quality school district anti-bullying policy is not sufficient to reduce bullying and protect bullying-involved young people. Future studies examining policy implementation will inform best practices in bullying prevention. © 2017, American School Health Association.

Learning Analytics across a Statewide System

Science.gov (United States)

Buyarski, Catherine; Murray, Jim; Torstrick, Rebecca

2017-01-01

This chapter explores lessons learned from two different learning analytics efforts at a large, public, multicampus university--one internally developed and one vended platform. It raises questions about how to best use analytics to support students while keeping students responsible for their own learning and success.

Office-based preventive dental program and statewide trends in dental caries.

Science.gov (United States)

Achembong, Leo N; Kranz, Ashley M; Rozier, R Gary

2014-04-01

To evaluate the impact of a North Carolina Medicaid preventive dentistry program in primary care medical offices (Into the Mouths of Babes Program [IMBP]) on decayed, missing, and filled teeth (dmft) of kindergarten students statewide and in schools with a large proportion of students from low-income families. An ecologic study using panel data of 920,505 kindergarten students with 11,694 school-year observations examined the effect of the IMBP on dmft scores from 1998 to 2009. Ordinary least squares regression with fixed effects determined the association between IMBP visits per child 0 to 4 years of age per county and mean dmft scores per kindergarten student per school, controlling for school-level poverty and ethnicity, county-level Medicaid enrollment, and supply of dentists and physicians. Mean dmft per kindergarten student per school increased from 1.53 in 1998 to 1.84 in 2004, then decreased to 1.59 in 2009. The mean number of IMBP visits per child 0 to 4 years of age per county increased from 0.01 in 2000 to 0.22 in 2009. A 1-unit increase in IMBP visits per county was associated with a 0.248 (95% confidence interval, -0.40 to -0.10) decrease in dmft per kindergarten student per school. For schools with more students at high risk for dental disease, a 1-unit increase in IMBP visits was associated with a 0.320 (95% confidence interval, -0.55 to -0.09) decrease in dmft. IMBP reduced dental caries among targeted vulnerable children, which helped reduce oral health disparities among preschool-aged children in North Carolina.

Harmful Algal Bloom-Associated Illnesses in Humans and Dogs Identified Through a Pilot Surveillance System - New York, 2015.

Science.gov (United States)

Figgatt, Mary; Hyde, James; Dziewulski, David; Wiegert, Eric; Kishbaugh, Scott; Zelin, Grant; Wilson, Lloyd

2017-11-03

Cyanobacteria, also known as blue-green algae, are photosynthetic, aquatic organisms found in fresh, brackish, and marine water around the world (1). Rapid proliferation and accumulation of potentially toxin-producing cyanobacteria characterize one type of harmful algal bloom (HAB). HABs have the potential to cause illness in humans and animals (2,3); however, the epidemiology of these illnesses has not been well characterized. Statewide in 2015, a total of 139 HABs were identified in New York, 97 (70%) of which were confirmed through laboratory analysis; 77 independent beach closures were ordered at 37 beaches on 20 different bodies of water. To better characterize HAB-associated illnesses, during June-September 2015, the New York State Department of Health (NYSDOH) implemented a pilot surveillance system in 16 New York counties. Activities included the collection of data from environmental HAB reports, illness reports, poison control centers, and syndromic surveillance, and increased outreach to the public, health care providers, and veterinarians. During June-September, 51 HAB-associated illnesses were reported, including 35 that met the CDC case definitions*; 32 of the cases occurred in humans and three in dogs. In previous years, New York never had more than 10 HAB-associated illnesses reported statewide. The pilot surveillance results from 16 counties during a 4-month period suggest that HAB-associated illnesses might be more common than previously reported.

Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems.

Science.gov (United States)

Meyerhoefer, Chad D; Sherer, Susan A; Deily, Mary E; Chou, Shin-Yi; Guo, Xiaohui; Chen, Jie; Sheinberg, Michael; Levick, Donald

2018-05-16

The installation of EHR systems can disrupt operations at clinical practice sites, but also lead to improvements in information availability. We examined how the installation of an ambulatory EHR at OB/GYN practices and its subsequent interface with an inpatient perinatal EHR affected providers' satisfaction with the transmission of clinical information and patients' ratings of their care experience. We collected data on provider satisfaction through 4 survey rounds during the phased implementation of the EHR. Data on patient satisfaction were drawn from Press Ganey surveys issued by the healthcare network through a standard process. Using multivariable models, we determined how provider satisfaction with information transmission and patient satisfaction with their care experience changed as the EHR system allowed greater information flow between OB/GYN practices and the hospital. Outpatient OB/GYN providers became more satisfied with their access to information from the inpatient perinatal triage unit once system capabilities included automatic data flow from triage back to the OB/GYN offices. Yet physicians were generally less satisfied with how the EHR affected their work processes than other clinical and non-clinical staff. Patient satisfaction dropped after initial EHR installation, and we find no evidence of increased satisfaction linked to system integration. Dissatisfaction of providers with an EHR system and difficulties incorporating EHR technology into patient care may negatively impact patient satisfaction. Care must be taken during EHR implementations to maintain good communication with patients while satisfying documentation requirements.

Vehicle Tracking System, Vehicle Infrastructure Provided with Vehicle Tracking System and Method for Tracking

NARCIS (Netherlands)

Papp, Z.; Doodeman, G.J.N.; Nelisse, M.W.; Sijs, J.; Theeuwes, J.A.C.; Driessen, B.J.F.

2010-01-01

A vehicle tracking system is described comprising - a plurality of sensor nodes (10) that each provide a message (D) indicative for an occupancy status of a detection area of an vehicle infrastructure monitored by said sensor node, said sensor nodes (10) being arranged in the vehicle infrastructure

Criteria for the evaluation of a cloud-based hospital information system outsourcing provider.

Science.gov (United States)

Low, Chinyao; Hsueh Chen, Ya

2012-12-01

As cloud computing technology has proliferated rapidly worldwide, there has been a trend toward adopting cloud-based hospital information systems (CHISs). This study examines the critical criteria for selecting the CHISs outsourcing provider. The fuzzy Delphi method (FDM) is used to evaluate the primary indicator collected from 188 useable responses at a working hospital in Taiwan. Moreover, the fuzzy analytic hierarchy process (FAHP) is employed to calculate the weights of these criteria and establish a fuzzy multi-criteria model of CHISs outsourcing provider selection from 42 experts. The results indicate that the five most critical criteria related to CHISs outsourcing provider selection are (1) system function, (2) service quality, (3) integration, (4) professionalism, and (5) economics. This study may contribute to understanding how cloud-based hospital systems can reinforce content design and offer a way to compete in the field by developing more appropriate systems.

Arizona TeleMedicine Network: Engineering Master Plan.

Science.gov (United States)

Atlantic Research Corp., Alexandria, VA.

As the planning document for establishing a statewide health communications system initially servicing the Papago, San Carlos and White Mountain Apache, Navajo, and Hopi reservations, this document prescribes the communications services to be provided by the Arizona TeleMedicine Network. Specifications include: (1) communications services for each…

Improving Interdisciplinary Provider Communication Through a Unified Paging System.

Science.gov (United States)

Heidemann, Lauren; Petrilli, Christopher; Gupta, Ashwin; Campbell, Ian; Thompson, Maureen; Cinti, Sandro; Stewart, David A

2016-06-01

Interdisciplinary communication at a Veterans Affairs (VA) academic teaching hospital is largely dependent on alphanumeric paging, which has limitations as a result of one-way communication and lack of reliable physician identification. Adverse patient outcomes related to difficulty contacting the correct consulting provider in a timely manner have been reported. House officers were surveyed on the level of satisfaction with the current VA communication system and the rate of perceived adverse patient outcomes caused by potential delays within this system. Respondents were then asked to identify the ideal paging system. These results were used to develop and deploy a new Web site. A postimplementation survey was repeated 1 year later. This study was conducted as a quality improvement project. House officer satisfaction with the preintervention system was 3%. The majority used more than four modalities to identify consultants, with 59% stating that word of mouth was a typical source. The preferred mode of paging was the university hospital paging system, a Web-based program that is used at the partnering academic institution. Following integration of VA consulting services within the university hospital paging system, the level of satisfaction improved to 87%. Significant decreases were seen in perceived adverse patient outcomes (from 16% to 2%), delays in patient care (from 90% to 16%), and extended hospitalizations (from 46% to 4%). Our study demonstrates significant improvement in physician satisfaction with a newly implemented paging system that was associated with a decreased perceived number of adverse patient events and delays in care.

Proposed plan for public benefit programs funded by System Benefits Charge

International Nuclear Information System (INIS)

1998-01-01

As the electric industry in New York State moves through deregulation toward retail competition, it will be important to ensure the vital public benefit programs of energy efficiency, research and development, low income services, and environmental protection. The Public Service Commission's (PSC) Opinion No. 98-3, effective January 30, 1998, established a system for funding such programs with a non-passable System Benefits Charge (SBC) and designated the New York State Energy Research and Development Authority (NYSERDA) as the administrator of the statewide SBC-funded public benefit programs

Providing Survivable Real-Time Communication Service for Distributed Mission Critical Systems

National Research Council Canada - National Science Library

Zhao, Wei; Bettati, Riccardo; Vaidya, Nitin

2005-01-01

This document is the final report for Providing Survivable Real-Time Communication Service for Distributed Mission Critical Systems, a Texas A AND M project funded through the DARPA Fault Tolerant Networks Program...

Provider Profiling: A Population Health Improvement Tool for the Southeast Military Health System

National Research Council Canada - National Science Library

Pemberton, Phillip

1999-01-01

...). Profiling with Provider Perspectives, a Primary Care Management Tool, provides the SEMHS with a standardized performance measurement system that offers feedback in a user friendly and non-threatening format...

A state-wide assessment of the association between epidural analgesia, maternal fever and neonatal antibiotics in Colorado, 2007-2012.

Science.gov (United States)

White, Alice; Olson, Daniel; Messacar, Kevin

2017-03-01

To determine if an association exists between epidural analgesia, maternal fever and neonatal antibiotic exposure in a state-wide birth cohort. We performed a retrospective cohort study of the population-based Colorado Department of Public Health and Environment birth certificate database. Data included all reported births in the state of Colorado between 2007 and 2012. Live, non-preterm, vaginal, singleton, in-hospital births were included in analysis. Maternal epidural analgesia and maternal fever. Neonatal antibiotic treatment for suspected sepsis. A stratified analysis was conducted to evaluate whether epidural use was an effect modifier of the association between maternal fever and neonatal antibiotic treatment. The final cohort included 261 457 births. 2.2% of women who received an epidural had a fever, as compared with 0.4% of women who did not receive an epidural (OR: 5.4; 95% CI 4.9 to 6.0), and neonates born to women who received an epidural had 1.26 times increased odds of antibiotic treatment (95% CI 1.1 to 1.4). Stratification by epidural use did not alter the association between maternal fever and neonatal antibiotic treatment. Colorado providers treat neonates born to mothers with maternal fever without respect to whether the mother had an epidural. Further research into improved criteria for neonatal sepsis evaluation that accounts for the contribution of maternal epidural fever should be developed to decrease unnecessary neonatal antibiotic exposure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Arizona TeleMedicine Project.

Science.gov (United States)

Arizona Univ., Tucson. Coll. of Medicine.

Designed to provide health services for American Indians living on rurally isolated reservations, the Arizona TeleMedicine Project proposes to link Phoenix and Tucson medical centers, via a statewide telecommunications system, with the Hopi, San Carlos Apache, Papago, Navajo, and White Mountain Apache reservations. Advisory boards are being…

Methicillin-resistant Staphylococcus aureus in Saarland, Germany: a statewide admission prevalence screening study.

Directory of Open Access Journals (Sweden)

Mathias Herrmann

Full Text Available BACKGROUND: The screening of hospital admission patients for methicillin resistant Staphylococcus aureus (MRSA is of undisputed value in controlling and reducing the overall MRSA burden; yet, a concerted parallel universal screening intervention throughout all hospitals of an entire German Federal State has not yet been performed. METHODOLOGY/PRINCIPAL FINDINGS: During a four-week period, all 24 acute care hospitals of the State of Saarland participated in admission prevalence screening. Overall, 436/20,027 screened patients revealed MRSA carrier status (prevalence, 2.2/100 patients with geriatrics and intensive care departments associated with highest prevalence (7.6/100 and 6.3/100, respectively. Risk factor analysis among 17,975 admission patients yielded MRSA history (OR, 4.3; CI₉₅ 2.7-6.8, a skin condition (OR, 3.2; CI₉₅ 2.1-5.0, and/or an indwelling catheter (OR, 2.2; CI₉₅ 1.4-3.5 among the leading risks. Hierarchical risk factor ascertainment of the six risk factors associated with highest odd's ratios would require 31% of patients to be laboratory screened to allow for detection of 67% of all MRSA positive admission patients in the State. CONCLUSIONS/SIGNIFICANCE: State-wide admission prevalence screening in conjunction with risk factor ascertainment yields important information on the distribution of the MRSA burden for hospitals, and allows for data-based decisions on local or institutional MRSA screening policies considering risk factor prevalence and expected MRSA identification rates.

Impact of Maine's statewide nutrition policy on high school food environments.

Science.gov (United States)

Whatley Blum, Janet E; Beaudoin, Christina M; O'Brien, Liam M; Polacsek, Michele; Harris, David E; O'Rourke, Karen A

2011-01-01

We assessed the effect on the food environments of public high schools of Maine's statewide nutrition policy (Chapter 51), which banned "foods of minimal nutritional value" (FMNV) in public high schools that participated in federally funded meal programs. We documented allowable exceptions to the policy and describe the school food environments. We mailed surveys to 89 high school food-service directors to assess availability pre-Chapter 51 and post-Chapter 51 of soda, other sugar-sweetened beverages, and junk food. Frequency data were tabulated pre-Chapter 51 and post-Chapter 51, and Fisher exact test was used to assess significance in changes. We conducted food and beverage inventories at 11 high schools. The survey return rate was 61% (N = 54). Availability of soda in student vending significantly decreased pre-Chapter 51 versus post-Chapter 51 (P = .04). No significant changes were found for other sugar-sweetened beverages and junk food. Exceptions to Chapter 51 were permitted to staff (67%), to the public (86%), and in career and technical education programs (31%). Inventories in a subset of schools found no availability of soda for students, whereas other sugar-sweetened beverages and junk food were widely available in à la carte, vending machines, and school stores. Candy, considered a FMNV, was freely available. Soda advertisement on school grounds was common. Student vending choices improved after the implementation of Chapter 51; however, use of FMNV as the policy standard may be limiting, as availability of other sugar-sweetened beverages and junk food was pervasive. School environments were not necessarily supportive of the policy, as advertisement of soda was common and some FMNV were available. Furthermore, local exceptions to Chapter 51 likely reduced the overall effect of the policy.

Impact of Provider Characteristics on Outcomes of Carotid Endarterectomy for Asymptomatic Carotid Stenosis in New York State.

Science.gov (United States)

Meltzer, Andrew J; Agrusa, Christopher; Connolly, Peter H; Schneider, Darren B; Sedrakyan, Art

2017-11-01

The purpose of this study is to explore the impact of surgeon characteristics (including annual volume, specialty, and years in practice) on outcomes of carotid endarterectomy (CEA) for asymptomatic carotid atherosclerosis in New York State. The New York Statewide Planning and Cooperation System database was utilized to identify patients undergoing CEA from 2004 to 2011. Provider characteristics were determined by linkage to the New York Office of Professions and National Provider Identification databases. Provider-level factors were characterized by defining 5 quintiles of equal size for each factor. Hierarchical logistic regression models were created to evaluate the impact of provider characteristics on outcome. In total, 36,495 patients underwent CEA for asymptomatic disease performed by vascular (75.7%), general (16.1%), cardiac (6%), and neuro (2.1%) surgeons. Outcomes of interest included in-hospital mortality (0.26%), stroke (0.45%), and the composite end point of mortality, stroke, or cardiac complication (2.2%). Unadjusted outcomes improved with increasing surgeon annual CEA volume. Mid-career surgeons had lower mortality and stroke rates than early or late-career surgeons. Odds of mortality were increased when surgery was performed by the lowest volume providers (quintile 1; 0-11 CEA/year) (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.3-5.28) or a nonspecialty trained (general) surgeon (OR 1.64, 95% 1.01-2.67). After adjustment for all patient-level factors, provider volume remained an independent predictor of outcome, with significantly increased odds of mortality for volume quintile 1 (OR 2.57, 95% CI 1.27-5.23) and quintile 2 (12-22 CEA/year) (0.30%; OR 2.07, 95% CI 1-4.27) surgeons. Adverse events after CEA for asymptomatic disease are comparatively rare. However, surgeon characteristics impact outcome, with the best results offered by high-volume, mid-career, specialty-trained surgeons. Efforts to define the optimal treatment of asymptomatic

Elder Abuse Identification in the Prehospital Setting: An Examination of State Emergency Medical Services Protocols.

Science.gov (United States)

Namboodri, Brooke L; Rosen, Tony; Dayaa, Joseph A; Bischof, Jason J; Ramadan, Nadeem; Patel, Mehul D; Grover, Joseph; Brice, Jane H; Platts-Mills, Timothy F

2018-03-22

To describe statewide emergency medical service (EMS) protocols relating to identification, management, and reporting of elder abuse in the prehospital setting. Cross-sectional analysis. Statewide EMS protocols in the United States. Publicly available statewide EMS protocols identified from published literature, http://EMSprotocols.org, and each state's public health website. Protocols were reviewed to determine whether elder abuse was mentioned, elder abuse was defined, potential indicators of elder abuse were listed, management of older adults experiencing abuse was described, and instructions regarding reporting were provided. EMS protocols for child abuse were reviewed in the same manner for the purpose of comparison. Of the 35 publicly available statewide EMS protocols, only 14 (40.0%) mention elder abuse. Of protocols that mention elder abuse, 6 (42.9%) define elder abuse, 10 (71.4%) describe indicators of elder abuse, 8 (57.1%) provide instruction regarding management, and 12 (85.7%) provide instruction regarding reporting. Almost twice as many states met each of these metrics for child abuse. Statewide EMS protocols for elder abuse vary in regard to identification, management, and reporting, with the majority of states having no content on this subject. Expansion and standardization of protocols may increase the identification of elder abuse. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

System and Method for Providing Vertical Profile Measurements of Atmospheric Gases

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — A system and method for using an air collection device to collect a continuous air sample as the device descends through the atmosphere are provided. The air...

An Intelligent Virtual Human System For Providing Healthcare Information And Support

Science.gov (United States)

2011-01-01

healthcare system, and also to other SMs and Veterans by way of a variety of social networking tools (e.g., 2nd Life, Facebook, etc.). The user can progress... CyberPsychology and Behavior 8, 3 (2005), 187-211. [2] T. Parsons & A.A. Rizzo, Affective Outcomes of Virtual Reality Exposure Therapy for Anxiety...VH System for Providing Healthcare Information and Support508 [4] G. Riva, Virtual Reality in Psychotherapy: Review, CyberPsychology and Behavior 8

Adding evidence-based behavioral weight loss strategies to a statewide wellness campaign: a randomized clinical trial.

Science.gov (United States)

Leahey, Tricia M; Thomas, Graham; Fava, Joseph L; Subak, Leslee L; Schembri, Michael; Krupel, Katie; Kumar, Rajiv; Weinberg, Brad; Wing, Rena R

2014-07-01

We determined the efficacy and cost-effectiveness of adding an evidence-based Internet behavioral weight loss intervention alone or combined with optional group sessions to ShapeUp Rhode Island 2011 (SURI), a 3-month statewide wellness campaign. We randomized participants (n = 230; body mass index = 34.3 ±6.8 kg/m(2); 84% female) to the standard SURI program (S) or to 1 of 2 enhanced programs: SURI plus Internet behavioral program (SI) or SI plus optional group sessions (SIG). The primary outcome was weight loss at the end of the 3-month program. Weight losses differed among all 3 conditions (S: 1.1% ±0.9%; SI: 4.2% ±0.6%; SIG: 6.1% ±0.6%; Ps ≤ .04). Both SI and SIG increased the percentage of individuals who achieved a 5% weight loss (SI: 42%; SIG: 54%; S: 7%; Ps < .001). Cost per kilogram of weight loss was similar for S ($39) and SI ($35); both were lower than SIG ($114). Although weight losses were greatest at the end of SURI with optional group sessions, the addition of an Internet behavioral program was the most cost-effective method to enhance weight losses.

Information Management System for the California State Water Resources Control Board (SWRCB)

Science.gov (United States)

Heald, T. C.; Redmann, G. H.

1973-01-01

A study was made to establish the requirements for an integrated state-wide information management system for water quality control and water quality rights for the State of California. The data sources and end requirements were analyzed for the data collected and used by the numerous agencies, both State and Federal, as well as the nine Regional Boards under the jurisdiction of the State Board. The report details the data interfaces and outlines the system design. A program plan and statement of work for implementation of the project is included.

Commercial thermal distribution systems, Final report for CIEE/CEC

Energy Technology Data Exchange (ETDEWEB)

Xu, Tengfang; Bechu, Olivier; Carrie, Remi; Dickerhoff, Darryl; Fisk, William; Franconi, Ellen; Kristiansen, Oyvind; Levinson, Ronnen; McWilliams, Jennifer; Wang, Duo; Modera, Mark; Webster, Tom; Ring, Erik; Zhang, Qiang; Huizenga, Charlie; Bauman, Fred; Arens, Ed

1999-12-01

According to the California Energy Commission (CEC 1998a), California commercial buildings account for 35% of statewide electricity consumption, and 16% of statewide gas consumption. Space conditioning accounts for roughly 16,000 GWh of electricity and 800 million therms of natural gas annually, and the vast majority of this space conditioning energy passes through thermal distribution systems in these buildings. In addition, 8600 GWh per year is consumed by fans and pumps in commercial buildings, most of which is used to move the thermal energy through these systems. Research work at Lawrence Berkeley National Laboratory (LBNL) has been ongoing over the past five years to investigate the energy efficiency of these thermal distribution systems, and to explore possibilities for improving that energy efficiency. Based upon that work, annual savings estimates of 1 kWh/ft{sup 2} for light commercial buildings, and 1-2 kWh/ft{sup 2} in large commercial buildings have been developed for the particular aspects of thermal distribution system performance being addressed by this project. Those savings estimates, combined with a distribution of the building stock based upon an extensive stock characterization study (Modera et al. 1999a), and technical penetration estimates, translate into statewide saving potentials of 2000 GWh/year and 75 million thermal/year, as well as an electricity peak reduction potential of 0.7 GW. The overall goal of this research program is to provide new technology and application knowledge that will allow the design, construction, and energy services industries to reduce the energy waste associated with thermal distribution systems in California commercial buildings. The specific goals of the LBNL efforts over the past year were: (1) to advance the state of knowledge about system performance and energy losses in commercial-building thermal distribution systems; (2) to evaluate the potential of reducing thermal losses through duct sealing, duct

Establishing a Peer Client-Server Internet Architecture for Virginia's Schools.

Science.gov (United States)

Bull, Glen; And Others

1996-01-01

Virginia's Public Education Network (PEN) was one of the first statewide public school Internet systems. PEN began as a regional pilot that led to the establishment of a regional prototype, Teacher-LINK. Teacher-LINK in turn became the basis for the statewide K-12 Internet system. Topics include PEN's educational content, Internet services, and…

Family-friendliness in Medical Studies in Baden-Württemberg. Results of a state-wide study.

Science.gov (United States)

Niehues, Johanna; Prospero, Katrin; Fegert, Jörg M; Liebhardt, Hubert

2012-01-01

This paper describes the results of the study on "Family-friendliness of the Medical Studies in Baden-Württemberg" carried out in 2009-2011 by the working group "Family, Time policy and E-Learning" of the University Hospital of Ulm, supported by the Ministry of Science, Research and the Arts of Baden-Württemberg. This state-wide survey of the studying conditions and personal circumstances of medical students with children at the five medical schools in Baden-Württemberg aims to describe existing and necessary factors of family-friendliness. A total of 238 students with children participated in the quantitative online survey conducted during the summer semester 2010 which was based on topics from previous qualitative interviews with student parents.The data shows that even though founding a family while at university is usually planned, student parents are faced with significant compatibility issues, demonstrating the need for additional measures to individualise course organisation and to make the curriculum more flexible. At the same time, the need to significantly increase information and advisory services alongside the establishment of additional support services for student parents is discernable. The study contributes to the debate on the family-friendliness of universities and university hospitals and adds practice-oriented approaches to solutions.

a Cultural Landscape Information System Developed with Open Source Tools

Science.gov (United States)

Chudyk, C.; Müller, H.; Uhler, M.; Würriehausen, F.

2013-07-01

Since 2010, the state of Rhineland-Palatinate in Germany has developed a cultural landscape information system as a process to secure and further enrich aggregate data about its cultural assets. In an open dialogue between governing authorities and citizens, the intention of the project is an active cooperation of public and private actors. A cultural landscape information system called KuLIS was designed as a web platform, combining semantic wiki software with a geographic information system. Based on data sets from public administrations, the information about cultural assets can be extended and enhanced by interested participants. The developed infrastructure facilitates local information accumulation through a crowdsourcing approach. This capability offers new possibilities for e-governance and open data developments. The collaborative approach allows governing authorities to manage and supervise official data, while public participation enables affordable information acquisition. Gathered cultural heritage information can provide incentives for touristic valorisation of communities or concepts for strengthening regional identification. It can also influence political decisions in defining significant cultural regions worth of protecting from industrial influences. The presented cultural landscape information allows citizens to influence the statewide development of cultural landscapes in a democratic way.

Configurable memory system and method for providing atomic counting operations in a memory device

Science.gov (United States)

Bellofatto, Ralph E.; Gara, Alan G.; Giampapa, Mark E.; Ohmacht, Martin

2010-09-14

A memory system and method for providing atomic memory-based counter operations to operating systems and applications that make most efficient use of counter-backing memory and virtual and physical address space, while simplifying operating system memory management, and enabling the counter-backing memory to be used for purposes other than counter-backing storage when desired. The encoding and address decoding enabled by the invention provides all this functionality through a combination of software and hardware.

Effects of a Statewide Protocol for the Management of Peritoneal Dialysis-Related Peritonitis on Microbial Profiles and Antimicrobial Susceptibilities: A Retrospective Five-Year Review.

Science.gov (United States)

McGuire, Amanda L; Carson, Christine F; Inglis, Timothy J J; Chakera, Aron

2015-12-01

♦ Peritonitis is a major complication of peritoneal dialysis (PD) and is associated with significant morbidity and mortality. Early empirical antibiotic therapy is recommended, with the choice of agents guided by local resistance patterns. As routine use of specific antimicrobial agents can drive resistance, regular assessment of causative organisms and their susceptibility to empirical therapy is essential. ♦ We conducted a retrospective review of all PD peritonitis cases and positive PD fluid cultures obtained over a 5-year period in Western Australia following the introduction of a statewide protocol for the initial management of PD peritonitis with intraperitoneal vancomycin and gentamicin. ♦ The incidence of PD peritonitis decreased from 1 in 16 patient months (0.75/year at risk) to 1 in 29 patient months (0.41/year at risk) over the 5 years. There were 1,319 culture-positive samples and 1,069 unique isolates identified. Gram-positive bacteria accounted for 69.9% of positive cultures, with vancomycin resistance averaging 2% over the study period. Gram-negative bacteria accounted for 25.4% of positive cultures, with gentamicin resistance identified in an average of 8% of organisms. No increase in antimicrobial resistance to vancomycin or gentamicin occurred over the 5 years and there was no change in the proportion of gram-positive (69.9%), gram-negative (25.4%) or fungal (4.4%) organisms causing PD peritonitis. ♦ Over time, the peritonitis rates have dramatically improved although the profile of causative organisms remains similar. Empirical treatment of PD peritonitis with intraperitoneal vancomycin and gentamicin remains efficacious, with high levels of susceptibility and no evidence that the introduction of this statewide empirical PD peritonitis treatment protocol is driving resistance to these agents. Copyright © 2015 International Society for Peritoneal Dialysis.

Geographic Information Systems-Transportation ISTEA management systems server-net prototype pooled fund study: Phase B summary

Energy Technology Data Exchange (ETDEWEB)

Espinoza, J. Jr.; Dean, C.D.; Armstrong, H.M. [and others

1997-06-01

The Geographic Information System-Transportation (GIS-T) ISTEA Management Systems Server Net Prototype Pooled Fund Study represents the first national cooperative effort in the transportation industry to address the management and monitoring systems as well as the statewide and metropolitan transportation planning requirements of the Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA). The Study was initiated in November 1993 through the Alliance for Transportation Research and under the leadership of the New Mexico State Highway and Transportation Department. Sandia National Laboratories, an Alliance partner, and Geographic Paradigm Computing. Inc. provided technical leadership for the project. In 1992, the Alliance for Transportation Research, the New Mexico State Highway and Transportation Department, Sandia National Laboratories, and Geographic Paradigm Computing, Inc., proposed a comprehensive research agenda for GIS-T. That program outlined a national effort to synthesize new transportation policy initiatives (e.g., management systems and Intelligent Transportation Systems) with the GIS-T server net ideas contained in the NCHRP project {open_quotes}Adaptation of GIS to Transportation{close_quotes}. After much consultation with state, federal, and private interests, a project proposal based on this agenda was prepared and resulted in this Study. The general objective of the Study was to develop GIS-T server net prototypes supporting the ISTEA requirements for transportation planning and management and monitoring systems. This objective can be further qualified to: (1) Create integrated information system architectures and design requirements encompassing transportation planning activities and data. (2) Encourage the development of functional GIS-T server net prototypes. (3) Demonstrate multiple information systems implemented in a server net environment.

Charter Schools Indicators: A Report from the Center on Educational Governance University of Southern California. CSI-USC 2010

Science.gov (United States)

Center on Educational Governance, 2010

2010-01-01

CSI-USC continues to make sense of what the California statewide data system provides. This fourth annual report gauges multiple measures of academic and financial performance, probing well beyond mere test scores. Ratings in familiar green, yellow, and red cover four areas: financial resources and investment, school quality, student performance…

75 FR 3939 - Merit Systems Protection Board (MSPB) Provides Notice of Opportunity To File Amicus Briefs

Science.gov (United States)

2010-01-25

... MERIT SYSTEMS PROTECTION BOARD Merit Systems Protection Board (MSPB) Provides Notice of Opportunity To File Amicus Briefs AGENCY: Merit Systems Protection Board. ACTION: Notice. SUMMARY: Pursuant to 5 U.S.C. 7521 and 5 CFR 1201.131, the Merit Systems Protection Board (MSPB) is providing notice of...

Market competition, ownership, payment systems and the performance of health care providers - a panel study among Finnish occupational health services providers.

Science.gov (United States)

Kankaanpää, Eila; Linnosmaa, Ismo; Valtonen, Hannu

2013-10-01

Many health care reforms rely on competition although health care differs in many respects from the assumptions of perfect competition. Finnish occupational health services provide an opportunity to study empirically competition, ownership and payment systems and the performance of providers. In these markets employers (purchasers) choose the provider and prices are market determined. The price regulation of public providers was abolished in 1995. We had data on providers from 1992, 1995, 1997, 2000 and 2004. The unbalanced panel consisted of 1145 providers and 4059 observations. Our results show that in more competitive markets providers in general offered a higher share of medical care compared to preventive services. The association between unit prices and revenues and market environment varied according to the provider type. For-profit providers had lower prices and revenues in markets with numerous providers. The public providers in more competitive regions were more sensitive to react to the abolishment of their price regulation by raising their prices. Employer governed providers had weaker association between unit prices or revenues and competition. The market share of for-profit providers was negatively associated with productivity, which was the only sign of market spillovers we found in our study.

34 CFR 361.23 - Requirements related to the statewide workforce investment system.

Science.gov (United States)

2010-07-01

... technology for individuals with disabilities; (ii) The use of information and financial management systems... resources and specification of the financial responsibility of each partner of the One-Stop service delivery... the Act, this part, other Federal requirements, and State law; and (vi) The specification of...

Iraqi primary care system in Kurdistan region: providers' perspectives on problems and opportunities for improvement.

Science.gov (United States)

Shabila, Nazar P; Al-Tawil, Namir G; Al-Hadithi, Tariq S; Sondorp, Egbert; Vaughan, Kelsey

2012-09-27

As part of a comprehensive study on the primary health care system in Iraq, we sought to explore primary care providers' perspectives about the main problems influencing the provision of primary care services and opportunities to improve the system. A qualitative study based on four focus groups involving 40 primary care providers from 12 primary health care centres was conducted in Erbil governorate in the Iraqi Kurdistan region between July and October 2010. A topic guide was used to lead discussions and covered questions on positive aspects of and current problems with the primary care system in addition to the priority needs for its improvement. The discussions were fully transcribed and the qualitative data was analyzed by content analysis, followed by a thematic analysis. Problems facing the primary care system included inappropriate health service delivery (irrational use of health services, irrational treatment, poor referral system, poor infrastructure and poor hygiene), health workforce challenges (high number of specialists, uneven distribution of the health workforce, rapid turnover, lack of training and educational opportunities and discrepancies in the salary system), shortage in resources (shortage and low quality of medical supplies and shortage in financing), poor information technology and poor leadership/governance. The greatest emphasis was placed on poor organization of health services delivery, particularly the irrational use of health services and the related overcrowding and overload on primary care providers and health facilities. Suggestions for improving the system included application of a family medicine approach and ensuring effective planning and monitoring. This study has provided a comprehensive understanding of the factors that negatively affect the primary care system in Iraq's Kurdistan region from the perspective of primary care providers. From their experience, primary care providers have a role in informing the community and

Motion systems providing three or four degrees of freedom

Science.gov (United States)

Chou, Richard C. (Inventor)

1982-01-01

A motion system is provided by a platform generally parallel to a base and connected thereto by a column and powered and controlled extensible members, at least three of which are connected between distributed points around the column. In a three degree of freedom device, the column is conical, rigidly supported at its base with a universal joint at its top. The points of attachment define triangles in the base and in the platform surrounding the column with one extensible member connected between each. In the four degree of freedom version, the column is modified by making it effectively a column which is pivoted or guided at the base or contains an extensible member, preferably retains its triangular shape and its universal joint connection to the platform at its apex. For stability four powered and controlled extensible members are provided between points in the base and platform distributed around the column, a preferred pattern of arrangement being a square with the column at the center.

Facilitators and Barriers of Implementing a Measurement Feedback System in Public Youth Mental Health.

Science.gov (United States)

Kotte, Amelia; Hill, Kaitlin A; Mah, Albert C; Korathu-Larson, Priya A; Au, Janelle R; Izmirian, Sonia; Keir, Scott S; Nakamura, Brad J; Higa-McMillan, Charmaine K

2016-11-01

This study examines implementation facilitators and barriers of a statewide roll-out of a measurement feedback system (MFS) in a youth public mental health system. 76 % of all state care coordinators (N = 47) completed interviews, which were coded via content analysis until saturation. Facilitators (e.g., recognition of the MFS's clinical utility) and barriers (e.g., MFS's reliability and validity) emerged paralleling the Exploration, Adoption/Preparation, Implementation, and Sustainment framework outlined by Aarons et al. (Adm Policy Mental Health Mental Health Serv Res, 38:4-23, 2011). Sustainment efforts may leverage innovation fit, individual adopter, and system related facilitators.

Technoeconomics analysis of a photovoltaic system to provide electricity for a household in Malaysia

International Nuclear Information System (INIS)

Alamsyah, T.M.I.; Kamaruzzaman Sopian; Shahrir, A

2006-01-01

Malaysia is very fortunate because located in the tropical region where the used of solar energy is one of the most promising renewable energy sources in the country. This paper is a study on a photovoltaic (Pv) system to provide the electricity for a single residential household. The effect of solar intensity and surface temperature variation on the amount of power provided by PV panels in selected location in Malaysia is determined in this study. The Life cycle cost analysis is conducted to compare electricity price with other energy sources in this country. It is found that providing electricity for a household by using PV system seems to be beneficial and competitive for long term investment, especially if the price of the system is decrease and the efficiency is increase

Benefits to the Europa Clipper Mission Provided by the Space Launch System

Science.gov (United States)

Creech, Stephen D.; Patel, Keyur

2013-01-01

The National Aeronautics and Space Administration's (NASA's) proposed Europa Clipper mission would provide an unprecedented look at the icy Jovian moon, and investigate its environment to determine the possibility that it hosts life. Focused on exploring the water, chemistry, and energy conditions on the moon, the spacecraft would examine Europa's ocean, ice shell, composition and geology by performing 32 low-altitude flybys of Europa from Jupiter orbit over 2.3 years, allowing detailed investigations of globally distributed regions of Europa. In hopes of expediting the scientific program, mission planners at NASA's Jet Propulsion Laboratory are working with the Space Launch System (SLS) program, managed at Marshall Space Flight Center. Designed to be the most powerful launch vehicle ever flown, SLS is making progress toward delivering a new capability for exploration beyond Earth orbit. The SLS rocket will offer an initial low-Earth-orbit lift capability of 70 metric tons (t) beginning with a first launch in 2017 and will then evolve into a 130 t Block 2 version. While the primary focus of the development of the initial version of SLS is on enabling human exploration missions beyond low Earth orbit using the Orion Multi-Purpose Crew Vehicle, the rocket offers unique benefits to robotic planetary exploration missions, thanks to the high characteristic energy it provides. This paper will provide an overview of both the proposed Europa Clipper mission and the Space Launch System vehicle, and explore options provided to the Europa Clipper mission for a launch within a decade by a 70 t version of SLS with a commercially available 5-meter payload fairing, through comparison with a baseline of current Evolved Expendable Launch Vehicle (EELV) capabilities. Compared to that baseline, a mission to the Jovian system could reduce transit times to less than half, or increase mass to more than double, among other benefits. In addition to these primary benefits, the paper will

An Enterprise System and a Business Simulation Provide Many Opportunities for Interdisciplinary Teaching

Science.gov (United States)

Kreie, Jennifer; Shannon, James; Mora-Monge, Carlo A.

2011-01-01

Enterprise systems provide companies with centralized data management, business process support and integrated data flow between functional areas. Thanks to academic alliances offered by companies such as SAP, Oracle, Microsoft and others, universities can also take advantage of the integrated features of enterprise system to give business…

A Statewide Collaboration: Ohio Level III Trauma Centers' Approach to the Development of a Benchmarking System.

Science.gov (United States)

Lang, Carrie L; Simon, Diane; Kilgore, Jane

The American College of Surgeons Committee on Trauma revised the Resources for Optimal Care of the Injured Patient to include the criteria for trauma centers to participate in a risk-adjusted benchmarking system. Trauma Quality Improvement Program is currently the risk-adjusted benchmarking program sponsored by the American College of Surgeons, which will be required of all trauma centers to participate in early 2017. Prior to this, there were no risk-adjusted programs for Level III verified trauma centers. The Ohio Society of Trauma Nurse Leaders is a collaborative group made up of trauma program managers, coordinators, and other trauma leaders who meet 6 times a year. Within this group, a Level III Subcommittee was formed initially to provide a place for the Level III centers to discuss issues specific to the Level III centers. When the new requirement regarding risk-adjustment became official, the subcommittee agreed to begin reporting simple data points with the idea to risk adjust in the future.

Automated Vehicle Location (AVL) for Road Condition Reporting

OpenAIRE

McCullouch, Bob G.; Leung, Michelle; Kang, Wonjin

2009-01-01

This project developed an AVL system for INDOT that utilized the statewide wireless network, SAFE-T. This option was chosen after doing a cost analysis of commercial AVL systems that use cellular data communications. The system developed provides real time information collected during snow and ice removal. Information includes weather and road conditions, truck speed, amount of chemicals spread, time, location, plow position, and road temperature. This information is displayed on INDOT GIS ma...

Timber resource statistics for the north interior resource area of California.

Science.gov (United States)

Karen L. Waddell; Patricia M. Bassett

1997-01-01

This report is a summary of timber resource statistics for the North Interior Resource Area of California, which includes Lassen, Modoc, Shasta, Siskiyou, and Trinity Counties. Data were collected as part of a statewide multiresource inventory. The inventory sampled private and public lands except reserved areas and National Forests. The National Forest System provided...

Seroprevalence of HCV and HIV infection among clients of the nation's longest-standing statewide syringe exchange program: A cross-sectional study of Community Health Outreach Work to Prevent AIDS (CHOW).

Science.gov (United States)

Salek, Thomas P; Katz, Alan R; Lenze, Stacy M; Lusk, Heather M; Li, Dongmei; Des Jarlais, Don C

2017-10-01

The Community Health Outreach Work to Prevent AIDS (CHOW) Project is the first and longest-standing statewide integrated and funded needle and syringe exchange program (SEP) in the US. Initiated on O'ahu in 1990, CHOW expanded statewide in 1993. The purpose of this study is to estimate the prevalences of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, and to characterize risk behaviors associated with infection among clients of a long-standing SEP through the analysis of the 2012 CHOW evaluation data. A cross-sectional sample of 130 CHOW Project clients was selected from January 1, 2012 through December 31, 2012. Questionnaires captured self-reported exposure information. HIV and HCV antibodies were detected via rapid, point-of-care FDA-approved tests. Log-binomial regressions were used to estimate prevalence proportion ratios (PPRs). A piecewise linear log-binomial regression model containing 1 spline knot was used to fit the age-HCV relationship. The estimated seroprevalence of HCV was 67.7% (95% confidence interval [CI]=59.5-75.8%). HIV seroprevalence was 2.3% (95% CI=0-4.9%). Anti-HCV prevalence demonstrated age-specific patterns, ranging from 31.6% through 90.9% in people who inject drugs (PWID) HIV prevalence compared with HCV prevalence reflects differences in transmissibility of these 2 blood-borne pathogens and suggests much greater efficacy of SEP for HIV prevention. Copyright © 2017 Elsevier B.V. All rights reserved.

Outcome of the 'Drip-and-Ship' Paradigm among Patients with Acute Ischemic Stroke: Results of a Statewide Study.

Science.gov (United States)

Qureshi, Adnan I; Chaudhry, Saqib A; Rodriguez, Gustavo J; Suri, M Fareed K; Lakshminarayan, Kamakshi; Ezzeddine, Mustapha A

2012-01-01

BACKGROUND: The 'drip-and-ship' paradigm denotes a treatment regimen in patients in whom intravenous (IV) recombinant tissue plasminogen activator (rt-PA) is initiated at the emergency department (ED) of a community hospital, followed by transfer within 24 h to a comprehensive stroke center. Although the drip-and-ship paradigm has the potential to increase the number of patients who receive IV rt-PA, comparative outcomes have not been assessed at a population-based level. METHODS: Statewide estimates of thrombolysis, associated in-hospital outcomes, and hospitalization charges were obtained from 2008-2009 Minnesota Hospital Association data for all patients hospitalized with a primary diagnosis of ischemic stroke. Patients who were assigned the drip-and-ship code [International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) V45.88] were classified under the drip-and-ship paradigm. Patients who underwent thrombolysis (ICD-9-CM code 99.10) without drip-and-ship code were classified as primary ED arrival. Patient outcomes were analyzed after stratification into patients treated with IV rt-PA through primary ED arrival or drip-and-ship paradigm. RESULTS: Of the 21,024 admissions, 602 (2.86%) received IV rt-PA either through primary ED arrival (n = 473) or the drip-and-ship paradigm (n = 129). IV rt-PA was administered in 30 hospitals, of which 13 hospitals used the drip-and-ship paradigm; the number of patients treated with the drip-and-ship paradigm varied from 1 to 40 between the 13 hospitals. The rates of secondary intracerebral or subarachnoid hemorrhage were higher in patients treated with IV rt-PA through primary ED arrival compared with those treated with the drip-and-ship paradigm (8.5 vs. 3.1%, respectively; p = 0.038). The in-hospital mortality rate was similar among ischemic stroke patients receiving IV rt-PA through primary ED arrival or the drip-and-ship paradigm (5.9 vs. 7.0%, respectively). The mean hospital charges were USD

The influence of system quality characteristics on health care providers' performance: Empirical evidence from Malaysia.

Science.gov (United States)

Mohd Salleh, Mohd Idzwan; Zakaria, Nasriah; Abdullah, Rosni

The Ministry of Health Malaysia initiated the total hospital information system (THIS) as the first national electronic health record system for use in selected public hospitals across the country. Since its implementation 15 years ago, there has been the critical requirement for a systematic evaluation to assess its effectiveness in coping with the current system, task complexity, and rapid technological changes. The study aims to assess system quality factors to predict the performance of electronic health in a single public hospital in Malaysia. Non-probability sampling was employed for data collection among selected providers in a single hospital for two months. Data cleaning and bias checking were performed before final analysis in partial least squares-structural equation modeling. Convergent and discriminant validity assessments were satisfied the required criterions in the reflective measurement model. The structural model output revealed that the proposed adequate infrastructure, system interoperability, security control, and system compatibility were the significant predictors, where system compatibility became the most critical characteristic to influence an individual health care provider's performance. The previous DeLone and McLean information system success models should be extended to incorporate these technological factors in the medical system research domain to examine the effectiveness of modern electronic health record systems. In this study, care providers' performance was expected when the system usage fits with patients' needs that eventually increased their productivity. Copyright © 2016 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Wyoming's "Education Reform & Cost Study."

Science.gov (United States)

Meyer, Joseph B.

A history of education in the state of Wyoming, along with a description of recent legislative initiatives, are presented in this paper. It opens with statewide reorganizations begun in the 1960s that unified school districts and equalized property valuation. A decade later a court order ruled the system inequitable and new laws provided for a…

Development of a statewide transportation data warehousing and mining system under the Louisiana Transportation Information System (LATIS) Program.

Science.gov (United States)

2009-04-01

The objectives of this study are to assess whether introducing a data warehousing/data mining system in Louisiana would be feasible and beneficial. The study sets out to identify the features of the most suitable system for the state as well as to ou...

Enhancing the functionality of reactor protection systems to provide diagnostic and monitoring information: The ISATTM approach

International Nuclear Information System (INIS)

Baldwin, J.A.; Rowe, B.J.; Jones, C.D.

1996-01-01

The ISAT TM architecture has been successfully implemented as the Single Channel Trip System (SCTS), part of the primary protection system of Nuclear Electric's Dungeness 'B' Advanced Gas-Cooled Reactors. The system is the first computer-based protection system licensed on a UK civil nuclear reactor. The system provides protection against single channel faults resulting in high coolant gas outlet temperature. The SCTS was designed to output data at several points in the system to an Ethernet to allow checks to be made on the operation of parts of the protection system and the system as a whole. In order to monitor the performance of this shutdown system a PC based monitoring system was developed to take input as data from the Ethernet, check its integrity and then analyze the data to provide information of the state of the system and subsystems. The SCTS monitor was basically intended to alert the operator to any fault on the safety system and indicate its source, provide a diagnosis of the cause of any trip initiated by the safety system, and log the occurrences of these incidents for later inspection. The intention was also to provide accurate real-time information on the thermocouple readings and to decrease the effort required to maintain the safety system. This paper will describe briefly the development of the ISAT TM monitoring system: how its requirements were arrived at, and how the design, code and testing were carried out to ensure approval for this application. It will then go on to report how the ISAT TM monitor has performed during its time in service: how more functionality has been added over and above its original requirements. Features of additional monitors for the SCTS and other ISAT TM systems will also be described. (author). 2 refs, 5 figs

A Framework for Statewide Analysis of Site Suitability, Energy Estimation, Life Cycle Costs, Financial Feasibility and Environmental Assessment of Wind Farms: A Case Study of Indiana

Science.gov (United States)

Kumar, Indraneel

In the last decade, Midwestern states including Indiana have experienced an unprecedented growth in utility scale wind energy farms. For example, by end of 2013, Indiana had 1.5 GW of wind turbines installed, which could provide electrical energy for as many as half-a-million homes. However, there is no statewide systematic framework available for the evaluation of wind farm impacts on endangered species, required necessary setbacks and proximity standards to infrastructure, and life cycle costs. This research is guided to fill that gap and it addresses the following questions. How much land is suitable for wind farm siting in Indiana given the constraints of environmental, ecological, cultural, settlement, physical infrastructure and wind resource parameters? How much wind energy can be obtained? What are the life cycle costs and economic and financial feasibility? Is wind energy production and development in a state an emission free undertaking? The framework developed in the study is applied to a case study of Indiana. A fuzzy logic based AHP (Analytic Hierarchy Process) spatial site suitability analysis for wind energy is formulated. The magnitude of wind energy that could be sited and installed comprises input for economic and financial feasibility analysis for 20-25 years life cycle of wind turbines in Indiana. Monte Carlo simulation is used to account for uncertainty and nonlinearity in various costs and price parameters. Impacts of incentives and cost variables such as production tax credits, costs of capital, and economies of scale are assessed. Further, an economic input-output (IO) based environmental assessment model is developed for wind energy, where costs from financial feasibility analysis constitute the final demand vectors. This customized model for Indiana is used to assess emissions for criteria air pollutants, hazardous air pollutants and greenhouse gases (GHG) across life cycle events of wind turbines. The findings of the case study include

Statewide Inferior Vena Cava Filter Placement, Complications, and Retrievals: Epidemiology and Recent Trends.

Science.gov (United States)

Charalel, Resmi A; Durack, Jeremy C; Mao, Jialin; Ross, Joseph S; Meltzer, Andrew J; Sedrakyan, Art

2018-03-01

Public awareness of inferior vena cava (IVC) filter-related controversies has been elevated by the Food and Drug Administration (FDA) safety communication in 2010. To examine population level trends in IVC filter utilization, complications, retrieval rates, and subsequent pulmonary embolism (PE) risk. A retrospective cohort study. Patients receiving IVC filters during 2005-2014 in New York State. IVC filter-specific complications, new PE occurrences and IVC filter retrievals were evaluated as time-to-event data using Kaplan-Meier analysis. Estimated cumulative risks were obtained at various timepoints during follow-up. There were 91,873 patients receiving IVC filters between 2005 and 2014 in New York State included in the study. The average patient age was 67 years and 46.6% were male. Age-adjusted rates of IVC filter placement increased from 48 cases/100,000 in 2005 to 52 cases/100,000 in 2009, and decreased afterwards to 36 cases/100,000 in 2014. The estimated risks of having an IVC filter-related complication and filter retrieval within 1 year was 1.5% [95% confidence interval (CI), 1.4%-1.6%] and 3.5% (95% CI, 3.4%-3.6%). One-year retrieval rate was higher post-2010 when compared with pre-2010 years (hazard ratio, 2.70; 95% CI, 2.50-2.91). Among the 58,176 patients who did not have PE events before or at the time of IVC filter placement, the estimated risk of developing subsequent PE at 1 year was 2.0% (95% CI, 1.9%-2.1%). Our findings suggest that FDA communications may be effective in modifying statewide clinical practices. Given the 2% observed PE rate following prophylactic IVC filter placement, large scale pragmatic studies are needed to determine contemporary safety and effectiveness of IVC filters.

"AfterZone:" Outcomes for Youth Participating in Providence's Citywide After-School System. Executive Summary

Science.gov (United States)

Kauh, Tina J.

2011-01-01

This executive summary highlights the main findings from our participation and outcomes analysis of the "AfterZone" initiative--a citywide system-building effort in Providence, Rhode Island, that aims to provide high-quality, accessible out-of-school-time services to middle school youth. The summary briefly defines the AfterZone's unique…

Differences in Readiness between Rural Hospitals and Primary Care Providers for Telemedicine Adoption and Implementation: Findings from a Statewide Telemedicine Survey

Science.gov (United States)

Martin, Amy Brock; Probst, Janice C.; Shah, Kyle; Chen, Zhimin; Garr, David

2012-01-01

Purpose: Published advantages of and challenges with telemedicine led us to examine the scope of telemedicine adoption, implementation readiness, and barriers in a southern state where adoption has been historically low. We hypothesized that rural hospitals and primary care providers (RPCPs) differ on adoption, readiness, and implementation…

A System to Provide Real-Time Collaborative Situational Awareness by Web Enabling a Distributed Sensor Network

Science.gov (United States)

Panangadan, Anand; Monacos, Steve; Burleigh, Scott; Joswig, Joseph; James, Mark; Chow, Edward

2012-01-01

In this paper, we describe the architecture of both the PATS and SAP systems and how these two systems interoperate with each other forming a unified capability for deploying intelligence in hostile environments with the objective of providing actionable situational awareness of individuals. The SAP system works in concert with the UICDS information sharing middleware to provide data fusion from multiple sources. UICDS can then publish the sensor data using the OGC's Web Mapping Service, Web Feature Service, and Sensor Observation Service standards. The system described in the paper is able to integrate a spatially distributed sensor system, operating without the benefit of the Web infrastructure, with a remote monitoring and control system that is equipped to take advantage of SWE.

Using hydropower to complement wind energy: a hybrid system to provide firm power

Energy Technology Data Exchange (ETDEWEB)

Jaramillo, O.A.; Borja, M.A.; Huacuz, J.M. [Instituto de Investigaciones Electricas, Morelos (Mexico). Energias No Convencionales

2004-09-01

This paper presents a theoretical study of how wind power can be complemented by hydropower. A conceptual framework is provided for a hybrid power station that produces constant power output without the intermittent fluctuations inherent when using wind power. Two hypothetical facilities are considered as case studies. One of them is a hydropower plant located on the ''Presidente Benito Juarez'' dam in Jalapa del Marques, Oaxaca, Mexico. The other hypothetical facility is a wind farm located near ''La Venta's', an area in Juchitan, Oaxaca, Mexico. The wind-hydro-power system is a combined wind and hydro power plant in a region that is rich in both resources. The model shows that the hybrid plant could provide close to 20 MW of firm power to the electrical distribution system. On a techno-economic basis, we obtain the levelized production cost of the hybrid system. Taking into account two different discount rates of 7% and 10%, figures for levelized production cost are developed. (author)

Low carbon technologies as providers of operational flexibility in future power systems

International Nuclear Information System (INIS)

Pavić, Ivan; Capuder, Tomislav; Kuzle, Igor

2016-01-01

Highlights: • Mixed integer linear programming model for provision of multiple services from EV. • EV energy and reserve services provision effects on power system operation. • Impacts of conventional unit’s decommission on system’s operation and flexibility. • Assessment of power system’s flexibility under different wind generation polices. - Abstract: The paper presents a unit commitment model, based on mixed integer linear programming, capable of assessing the impact of electric vehicles (EV) on provision of ancillary services in power systems with high share of renewable energy sources (RES). The analyses show how role of different conventional units changes with integration of variable and uncertain RES and how introducing a flexible sources on the demand side, in this case EV, impact the traditional provision of spinning/contingency reserve services. In addition, technical constraints of conventional units, such as nuclear, gas or coal, limit the inherit flexibility of the system which results in curtailing clean renewable sources and inefficient operation. Following on that, sensitivity analyses of operational cost and wind curtailment shows which techno-economic constraints impact the flexibility of the high RES systems the most and how integration of more flexible units or decommission of conventional nuclear, coal and gas driven power plants would impact the system’s operation. Finally, two different wind generation polices (wind penalization and wind turbines as reserve providers) have been analysed in terms of operational flexibility through different stages of conventional unit’s decommission and compared with the same analyses when EV were used as reserve providers.

Fundamentals of Using Battery Energy Storage Systems to Provide Primary Control Reserves in Germany

Directory of Open Access Journals (Sweden)

Alexander Zeh

2016-09-01

Full Text Available The application of stationary battery storage systems to German electrical grids can help with various storage services. This application requires controlling the charge and discharge power of such a system. For example, photovoltaic (PV home storage, uninterruptible power supply, and storage systems for providing ancillary services such as primary control reserves (PCRs represent battery applications with positive profitability. Because PCRs are essential for stabilizing grid frequency and maintaining a robust electrical grid, German transmission system operators (TSOs released strict regulations in August 2015 for providing PCRs with battery storage systems as part of regulating the International Grid Control Cooperation (IGCC region in Europe. These regulations focused on the permissible state of charge (SoC of the battery during nominal and extreme conditions. The concomitant increased capacity demand oversizing may result in a significant profitability reduction, which can be attenuated only by using an optimal parameterization of the control algorithm for energy management of the storage systems. In this paper, the sizing optimization is achieved and a recommendation for a control algorithm that includes the appropriate parameters for the requirements in the German market is given. Furthermore, the storage cost is estimated, including battery aging simulations for different aging parameter sets to allow for a realistic profitability calculation.

Systemic racism moderates effects of provider racial biases on adherence to hypertension treatment for African Americans.

Science.gov (United States)

Greer, Tawanda M; Brondolo, Elizabeth; Brown, Porschia

2014-01-01

The purpose of the current study was to examine perceived exposure to systemic racism as a moderator of the effects of perceived exposure to provider racial biases on treatment adherence and mistrust of health care for a sample of African American hypertensive patients. We hypothesized that patients who endorsed high levels of systemic racism would exhibit poor adherence to hypertension treatment and increased mistrust in health care in relation to perceptions of exposure to provider racial biases. The sample consisted of 100 African American patients who ranged in age from 24 to 82 years. All were diagnosed with hypertension and were recruited from an outpatient clinic located in the Southeastern region of the United States. Moderated regression analyses were performed to test the study hypotheses. Findings revealed a positive, significant main effect for perceived provider racial biases in predicting mistrust of care. This finding suggested that an increase in mistrust of health care was associated with increased perceptions of provider biases. In predicting treatment adherence, a significant interaction revealed that patients who endorsed low and moderate degrees of exposure to systemic racism displayed poor adherence to treatment in relation to greater perceptions of provider racial biases. The overall findings suggest that patients who perceive themselves as infrequently exposed to systemic racism possess the greatest risk for nonadherence to hypertension treatment in relation to increased perceptions of provider racial biases. Implications of the findings are discussed. 2014 APA, all rights reserved

Challenges and opportunities in providing a digital protection system for the PBMR - HTR2008-58173

International Nuclear Information System (INIS)

Marais, J.; Ridolfo, C. F.

2008-01-01

The Republic of South Africa is currently developing the Pebble Bed Modular Reactor (PBMR); an advanced, fourth-generation reactor that incorporates inherent safety features, which require no human intervention and which provide an unprecedented level of nuclear safety. In addition to electrical power generation, the reactor is uniquely suited for a variety of non-traditional nuclear applications including oil sands extraction, desalination, and hydrogen production. A state-of-the-art digital Protection System for the PBMR is currently being developed in conjunction with Westinghouse Electric Company (WEC). The Protection System provides for: reactor shutdown using two different reactor trip methodologies (dropping of the control rods and insertion of Small Absorber Spheres (SASs) which are composed of boron carbide); post-event monitoring; and manual reactor shutdown, which is independent of software-based systems. The reactor shutdown and post-event instrumentation monitoring components of the Protection System are being implemented utilizing the WEC 'Common Q' platform, which is comprised of 'commercially dedicated' Programmable Logic Controllers (PLCs), colour-graphic Flat Panel Displays (FPDs) with integral touch screens, and high-speed data communication links. High reliability and availability are achieved through component redundancy, continuous automatic self-testing which is run online in a background mode, and implementation of a multi-channel system design which is tolerant to failures. The Protection System is also designed to support periodic surveillance testing through a suite of built- in computer-aided test facilities that are accessible via an FPD interface. These allow various system surveillance requirements to be readily performed in a convenient and systematic manner. This paper discusses the following topics with regard to the PBMR Protection System: development strategy, functional requirements, selection of applicable Codes and Standards

Geomorphic Identification and Verification of Recent Sedimentation Patterns in the Woonasquatucket River, North Providence, Rhode Island

Science.gov (United States)

2007-03-01

1954 52.0 465 Diane 8/19/1955 Tropical Storm 29 1965 35.4 438 1963-1967 (Statewide) Alma 6/14/1966 Extratropical 30 1996 42.4 438 10/20/1996...1960 9/12/1960 Extratropical Tropical Storm Hurricane (Cat 2) 34 1990 48.1 402 Bob 8/19/1991 Hurricane (Cat 2) 35 1964 29.2 401 1963-1967...Island to use the Scotch loom, a reproduction of a power loom used in Europe , and was also the first mill in the United States to produce worsteds

System and method of providing quick thermal comfort with reduced energy by using directed spot conditioning

Science.gov (United States)

Wang, Mingyu; Kadle, Prasad S.; Ghosh, Debashis; Zima, Mark J.; Wolfe, IV, Edward; Craig, Timothy D

2016-10-04

A heating, ventilation, and air conditioning (HVAC) system and a method of controlling a HVAC system that is configured to provide a perceived comfortable ambient environment to an occupant seated in a vehicle cabin. The system includes a nozzle configured to direct an air stream from the HVAC system to the location of a thermally sensitive portion of the body of the occupant. The system also includes a controller configured to determine an air stream temperature and an air stream flow rate necessary to establish the desired heat supply rate for the sensitive portion and provide a comfortable thermal environment by thermally isolating the occupant from the ambient vehicle cabin temperature. The system may include a sensor to determine the location of the sensitive portion. The nozzle may include a thermoelectric device to heat or cool the air stream.

Improved fixation quality provided by a Bessel beacon in an adaptive optics system.

Science.gov (United States)

Lambert, Andrew J; Daly, Elizabeth M; Dainty, Christopher J

2013-07-01

We investigate whether a structured probe beam that creates the beacon for use in a retinal imaging adaptive optics system can provide useful side effects. In particular we investigate whether a Bessel beam that is seen by the subject as a set of concentric rings has a dampening effect on fixation variations of the subject under observation. This calming effect would allow longer periods of observation, particularly for patients with abnormal fixation. An experimental adaptive optics system developed for retinal imaging is used to monitor the fluctuations in aberrations for artificial and human subjects. The probe beam is alternated between a traditional beacon and one provided by a Bessel beam created by SLM. Time-frequency analysis is used to indicate the differences in power and time variation during fixation depending on whether the Bessel beam or the traditional beacon is employed. Comparison is made with the response for an artificial eye to discount systemic variations. Significant evidence is accrued to indicate the reduced fluctuations in fixation when the Bessel beam is employed to create the beacon. © 2013 The Authors Ophthalmic & Physiological Optics © 2013 The College of Optometrists.

Creating a smart application system to provide a beneficial maintenance service for elderly drivers

Directory of Open Access Journals (Sweden)

Jung Sebin

2017-01-01

Full Text Available As overall population ages, elderly drivers have become a larger percentage of the driving population. With this trend, a lot of vehicle systems have been improved for elderly’s safety and convenience using different advanced technologies. However, elderly drivers have often paid more money than other drivers in a car-repair shop due to their lack of knowledge about vehicle systems with modern technologies. Given this fact, developing a tool to diminish this disadvantage and to help elderly drivers maintain their cars with confidence and with minimal cost is necessary. Therefore, this research work mainly focuses on suggesting a system concept on user-interface application, which is connected to a smart phone or a tablet to provide beneficial services anywhere. For the research outcome, diverse research activities – surveys, interviews with small focus groups, observations of the focus groups, and discussions – has been conducted to understand the elderly driver’s difficulties and behaviours regarding vehicle maintenance, to investigate what specific problems make them uncomfortable in repair shops, and to demonstrate how new system-concepts could be developed for the elderly. Furthermore, we conclude that adequate system-concepts for the elderly would offer elderly drivers convenient vehicle repair and maintenance and provide them a confident driving experience.

Measuring and improving quality of care in an academic medical center.

Science.gov (United States)

Blayney, Douglas W

2013-05-01

The Donabedian definition of quality—structure, process, and outcome—provides a useful framework. A relentless focus on measuring process adherence and outcome is critical. Systemic improvements usually require teams to plan and to implement them. The lean or Toyota production system for process improvement is one useful method of organizing work, although different approaches are often necessary at the physician, practice unit, and statewide level. Challenges include scalability of the change (ie, rolling them out across the institution or system), tailoring the information technology tools, and building systems for sustainability.

DJFS: Providing Highly Reliable and High‐Performance File System with Small‐Sized

Directory of Open Access Journals (Sweden)

Junghoon Kim

2017-11-01

Full Text Available File systems and applications try to implement their own update protocols to guarantee data consistency, which is one of the most crucial aspects of computing systems. However, we found that the storage devices are substantially under‐utilized when preserving data consistency because they generate massive storage write traffic with many disk cache flush operations and force‐unit‐access (FUA commands. In this paper, we present DJFS (Delta‐Journaling File System that provides both a high level of performance and data consistency for different applications. We made three technical contributions to achieve our goal. First, to remove all storage accesses with disk cache flush operations and FUA commands, DJFS uses small‐sized NVRAM for a file system journal. Second, to reduce the access latency and space requirements of NVRAM, DJFS attempts to journal compress the differences in the modified blocks. Finally, to relieve explicit checkpointing overhead, DJFS aggressively reflects the checkpoint transactions to file system area in the unit of the specified region. Our evaluation on TPC‐C SQLite benchmark shows that, using our novel optimization schemes, DJFS outperforms Ext4 by up to 64.2 times with only 128 MB of NVRAM.

Providers' Access of Imaging Versus Only Reports: A System Log File Analysis.

Science.gov (United States)

Jung, Hye-Young; Gichoya, Judy Wawira; Vest, Joshua R

2017-02-01

An increasing number of technologies allow providers to access the results of imaging studies. This study examined differences in access of radiology images compared with text-only reports through a health information exchange system by health care professionals. The study sample included 157,256 historical sessions from a health information exchange system that enabled 1,670 physicians and non-physicians to access text-based reports and imaging over the period 2013 to 2014. The primary outcome was an indicator of access of an imaging study instead of access of a text-only report. Multilevel mixed-effects regression models were used to estimate the association between provider and session characteristics and access of images compared with text-only reports. Compared with primary care physicians, specialists had an 18% higher probability of accessing actual images instead of text-only reports (β = 0.18; P < .001). Compared with primary care practice settings, the probability of accessing images was 4% higher for specialty care practices (P < .05) and 8% lower for emergency departments (P < .05). Radiologists, orthopedists, and neurologists accounted for 79% of all the sessions with actual images accessed. Orthopedists, radiologists, surgeons, and pulmonary disease specialists accessed imaging more often than text-based reports only. Consideration for differences in the need to access images compared with text-only reports based on the type of provider and setting of care are needed to maximize the benefits of image sharing for patient care. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Health insurance system and provider payment reform in the Republic of Macedonia

Directory of Open Access Journals (Sweden)

Doncho M. Donev

2009-03-01

Full Text Available This article gives an insight to the current health insurance system in the Republic of Macedonia. Special emphasis is given to the specificities and practice of both obligatory and voluntary health insurance, to the scope of the insured persons and their benefits and obligations, the way of calculating and payment of the contributions and the other sources of revenues for health insurance, user participation in health care expenses, payment to the health care providers and some other aspects of realization of health insurance in practice. According to the Health Insurance Law, which was adopted in March 2000, a person can become an insured to the Health Insurance Fund on various modalities. More than 90% of the citizens are eligible to the obligatory health insurance, which provides a broad scope of basic health care benefits. Till end of 2008 payroll contributions were equal to 9.2%, and from January 1st, 2009 are equal to 7.5% of gross earned wages and almost 60% of health sector revenues are derived from them. Within the autonomy and scope of activities of the Health Insurance Fund the structures of the revenues and expenditures are presented. Health financing and reform of the payment to health care providers are of high importance within the ongoing health care reform in Macedonia. It is expected that the newly introduced methods of payments at the primary health care level (capitation and at the hospital sector (global budgeting, DRGs will lead to increased equity, efficiency and quality of health care in hospitals and overall system

Assessment of systems for paying health care providers in Vietnam: implications for equity, efficiency and expanding effective health coverage.

Science.gov (United States)

Phuong, Nguyen Khanh; Oanh, Tran Thi Mai; Phuong, Hoang Thi; Tien, Tran Van; Cashin, Cheryl

2015-01-01

Provider payment arrangements are currently a core concern for Vietnam's health sector and a key lever for expanding effective coverage and improving the efficiency and equity of the health system. This study describes how different provider payment systems are designed and implemented in practice across a sample of provinces and districts in Vietnam. Key informant interviews were conducted with over 100 health policy-makers, purchasers and providers using a structured interview guide. The results of the different payment methods were scored by respondents and assessed against a set of health system performance criteria. Overall, the public health insurance agency, Vietnam Social Security (VSS), is focused on managing expenditures through a complicated set of reimbursement policies and caps, but the incentives for providers are unclear and do not consistently support Vietnam's health system objectives. The results of this study are being used by the Ministry of Health and VSS to reform the provider payment systems to be more consistent with international definitions and good practices and to better support Vietnam's health system objectives.

Enhancing the functionality of reactor protection systems to provide diagnostic and monitoring information: The ISAT{sup TM} approach

Energy Technology Data Exchange (ETDEWEB)

Baldwin, J A; Rowe, B J [AEA Technology, Winfrith (United Kingdom); Jones, C D [Nuclear Electric Ltd., Kent (United Kingdom). Dungeness ` B` Power Station

1997-12-31

The ISAT{sup TM} architecture has been successfully implemented as the Single Channel Trip System (SCTS), part of the primary protection system of Nuclear Electric`s Dungeness `B` Advanced Gas-Cooled Reactors. The system is the first computer-based protection system licensed on a UK civil nuclear reactor. The system provides protection against single channel faults resulting in high coolant gas outlet temperature. The SCTS was designed to output data at several points in the system to an Ethernet to allow checks to be made on the operation of parts of the protection system and the system as a whole. In order to monitor the performance of this shutdown system a PC based monitoring system was developed to take input as data from the Ethernet, check its integrity and then analyze the data to provide information of the state of the system and subsystems. The SCTS monitor was basically intended to alert the operator to any fault on the safety system and indicate its source, provide a diagnosis of the cause of any trip initiated by the safety system, and log the occurrences of these incidents for later inspection. The intention was also to provide accurate real-time information on the thermocouple readings and to decrease the effort required to maintain the safety system. This paper will describe briefly the development of the ISAT{sup TM} monitoring system: how its requirements were arrived at, and how the design, code and testing were carried out to ensure approval for this application. It will then go on to report how the ISAT{sup TM} monitor has performed during its time in service: how more functionality has been added over and above its original requirements. Features of additional monitors for the SCTS and other ISAT{sup TM} systems will also be described. (author). 2 refs, 5 figs.

45 CFR 205.38 - Federal financial participation (FFP) for establishing a statewide mechanized system.

Science.gov (United States)

2010-10-01

... software or modifications thereof and associated documentation designed or developed with 90 percent FFP... system planned, designed, developed, installed, and hardware acquired, with FFP under these regulations... are being met and to determine its efficiency, economy and effectiveness. (c) If ACF suspends approval...

Texting While Driving: Does the New Law Work Among Healthcare Providers?

Directory of Open Access Journals (Sweden)

Anitha E. Mathew

2014-08-01

Full Text Available Introduction: This study assessed whether Georgia Senate Bill 360, a statewide law passed in August 2010, that prohibits text messaging while driving, resulted in a decrease in this behavior among emergency medicine (EM and general surgery (GS healthcare providers. Methods: Using SurveyMonkey, we created a web-based survey containing up to 28 multiple choice and free-text questions about driving behaviors. EM and GS healthcare providers at a southeastern medical school and its affiliate county hospital received an email inviting them to complete this survey in February 2011. We conducted all analyses in SPSS (version 19.0, Chicago, IL, 2010, using chisquared tests and logistic regression models. The primary outcome of interest was a change in participant texting or emailing while driving after passage of the texting ban in Georgia. Results: Two hundred and twenty-six providers completed the entire survey (response rate 46.8%. Participants ranged in age from 23 to 71 years, with an average age of 38 (SD¼10.2; median¼35. Only three-quarters of providers (n¼173, 76.6% were aware of a texting ban in the state. Out of these, 60 providers (36.6% reported never or rarely sending texts while driving (0 to 2 times per year, and 30 engaged in this behavior almost daily (18.9%. Almost two-thirds of this group reported no change in texting while driving following passage of the texting ban (n¼110, 68%, while 53 respondents texted less (31.8%. Respondents younger than 40 were more than twice as likely to report no change in texting post-ban compared to older participants (OR¼2.31, p¼0.014. Providers who had been pulled over for speeding in the previous 5 years were about 2.5 times as likely to not change their texting while-driving behavior following legislation passage compared to those without a history of police stops for speeding (OR¼2.55, p¼0.011. Each additional ticket received in the past 5 years for a moving violation lessened the odds of

The applicability of constructivist user studies: how can constructivist inquiry inform service providers and systems designers? Constructivist inquiry, Case study, Systems design, User behaviour

Directory of Open Access Journals (Sweden)

Alison Pickard

2004-01-01

Full Text Available This paper has attempted to clarify the ways in which individual, holistic case studies, produced via the process of constructivist inquiry, can be tested for trustworthiness and applied to other, similar situations. Service providers and systems designers need contextual information concerning their users in order to design and provide systems and services that will function effectively and efficiently within those contexts. Abstract models can only provide abstract insight into human behaviour and this is rarely sufficient detail upon which to base the planning and delivery of a service. The methodological issues which surround the applicability of individual, holistic case studies are discussed, explaining the concept of 'contextual applicability.' The relevance and usefulness of in-depth case study research to systems designers and service providers is highlighted.

A Recommender System for an IPTV Service Provider: a Real Large-Scale Production Environment

Science.gov (United States)

Bambini, Riccardo; Cremonesi, Paolo; Turrin, Roberto

In this chapter we describe the integration of a recommender system into the production environment of Fastweb, one of the largest European IP Television (IPTV) providers. The recommender system implements both collaborative and content-based techniques, suitable tailored to the specific requirements of an IPTV architecture, such as the limited screen definition, the reduced navigation capabilities, and the strict time constraints. The algorithms are extensively analyzed by means of off-line and on-line tests, showing the effectiveness of the recommender systems: up to 30% of the recommendations are followed by a purchase, with an estimated lift factor (increase in sales) of 15%.

Staffing in postnatal units: is it adequate for the provision of quality care? Staff perspectives from a state-wide review of postnatal care in Victoria, Australia

Directory of Open Access Journals (Sweden)

Lumley Judith

2006-07-01

Full Text Available Abstract Background State-wide surveys of recent mothers conducted over the past decade in Victoria, one state of Australia, have identified that women are consistently less satisfied with the care they received in hospital following birth compared with other aspects of maternity care. Little is known of caregivers' perspectives on the provision ofhospital postnatal care: how care is organised and provided in different hospitals; what constrains the provision of postnatal care (apart from funding and what initiatives are being undertaken to improve service delivery. A state-widereview of organisational structures and processes in relation to the provision of hospital postnatal care in Victoria was undertaken. This paper focuses on the impact of staffing issues on the provision of quality postnatal care from the perspective of care providers. Methods A study of care providers from Victorian public hospitals that provide maternity services was undertaken. Datawere collected in two stages. Stage one: a structured questionnaire was sent to all public hospitals in Victoria that provided postnatal care (n = 73, exploring the structure and organisation of care (e.g. staffing, routine observations, policy framework and discharge planning. Stage two: 14 maternity units were selected and invited to participate in a more in-depth exploration of postnatal care. Thirty-eight key informant interviews were undertaken with midwives (including unit managers, associate unit managers and clinical midwives and a medical practitioner from eachselected hospital. Results Staffing was highlighted as a major factor impacting on the provision of quality postnatal care. There were significant issues associated with inadequate staff/patient ratios; staffing mix; patient mix; prioritisation of birth suites over postnatal units; and the use of non-permanent staff. Forty-three percent of hospitals reported having only midwives (i.e. no non-midwives providing postnatal care

System Statement of Tasks of Calculating and Providing the Reliability of Heating Cogeneration Plants in Power Systems

Science.gov (United States)

Biryuk, V. V.; Tsapkova, A. B.; Larin, E. A.; Livshiz, M. Y.; Sheludko, L. P.

2018-01-01

A set of mathematical models for calculating the reliability indexes of structurally complex multifunctional combined installations in heat and power supply systems was developed. Reliability of energy supply is considered as required condition for the creation and operation of heat and power supply systems. The optimal value of the power supply system coefficient F is based on an economic assessment of the consumers’ loss caused by the under-supply of electric power and additional system expences for the creation and operation of an emergency capacity reserve. Rationing of RI of the industrial heat supply is based on the use of concept of technological margin of safety of technological processes. The definition of rationed RI values of heat supply of communal consumers is based on the air temperature level iside the heated premises. The complex allows solving a number of practical tasks for providing reliability of heat supply for consumers. A probabilistic model is developed for calculating the reliability indexes of combined multipurpose heat and power plants in heat-and-power supply systems. The complex of models and calculation programs can be used to solve a wide range of specific tasks of optimization of schemes and parameters of combined heat and power plants and systems, as well as determining the efficiency of various redundance methods to ensure specified reliability of power supply.

44 CFR 65.14 - Remapping of areas for which local flood protection systems no longer provide base flood protection.

Science.gov (United States)

2010-10-01

... local flood protection systems no longer provide base flood protection. 65.14 Section 65.14 Emergency... § 65.14 Remapping of areas for which local flood protection systems no longer provide base flood... process of restoring a flood protection system that was: (i) Constructed using Federal funds; (ii...

“Take in two parks and call me in the morning” – Perception of parks as an essential component of our healthcare system

Directory of Open Access Journals (Sweden)

A.J. Mowen

2017-06-01

Full Text Available As a feature of the built neighborhood environment, parks have been associated with a range of positive health outcomes. Recognition of these contributions has prompted advocates to suggest parks are a part of our healthcare system. Despite these developments, park investments have declined over the past decade nationally, lagging behind expenditures on other community services such as health. Perhaps the idea of parks as a solution to the nation's health concerns has not diffused across the population. To date, however, public perception of parks' role in healthcare has not been documented. This study responds to this gap by assessing whether parks are perceived as an essential part of the healthcare system. Self-administered surveys were completed by a statewide sample of Pennsylvania adults (2014 and by a sample of primary care clinic visitors in Hershey, Pennsylvania (2015. Participants from both studies were asked the extent they agreed with the following statement: Parks, trails, and open space are an essential component of our healthcare system. Response was also compared across demographic characteristics to assess whether this belief was universally held. Findings indicate 73% of the statewide sample and 68% of the clinical sample agreed parks, trails, and open space are an essential element of the healthcare system. Males, those with lower levels of educational attainment, and rural residents were statistically less likely to agree with this statement. Results indicate widespread belief in parks as an essential part of the healthcare system, suggesting consideration of health-sector investments in these settings.

Prevalence of Self-Reported Lifetime History of Traumatic Brain Injury and Associated Disability: A Statewide Population-Based Survey.

Science.gov (United States)

Whiteneck, Gale G; Cuthbert, Jeffrey P; Corrigan, John D; Bogner, Jennifer A

2016-01-01

To investigate the prevalence of all severities of traumatic brain injury (TBI), regardless of treatment setting, and their associated negative outcomes. A total of 2701 adult Coloradoans. A statewide, population-based, random digit-dialed telephone survey. The lifetime history of TBI was assessed by a modification of the Ohio State University TBI Identification Method; activity limitation and life satisfaction were also assessed. The distribution of self-reported lifetime injury was as follows: 19.8%, no injury; 37.7%, injury but no TBI; 36.4%, mild TBI; and 6.0%, moderate-severe TBI. Of those reporting a TBI, 23.1% were hospitalized, 38.5% were treated in an emergency department, 9.8% were treated in a physician's office, and 27.5% did not seek medical care. A clear gradient of activity limitations and low life satisfaction was seen, with the highest proportions of these negative outcomes occurring in people reporting more severe TBI and the lowest proportions in those not reporting a TBI. Approximately twice as many people reported activity limitations and low life satisfaction after nonhospitalized TBI compared with hospitalized TBI. This investigation highlights the seriousness of TBI as a public health problem and the importance of including all severities of TBI, no matter where, or if treated, in estimating the prevalence of disability co-occurring with TBI.

Application of Evolutionary Mechanisms of Enhancers for Development Effective Artificial Intelligence Systems for Providing Data Security

Directory of Open Access Journals (Sweden)

M. L. Garanina

2010-06-01

Full Text Available This article describes the base approaches of the methods of evolutionary mechanisms (special type of genes — enhancers for parameterizations of AI systems genotype. This method can help in increasing adaptability of AI systems for providing data security.

Performance evaluation of cable median barrier systems in Texas.

Science.gov (United States)

2009-08-01

Since 2003, the Texas Department of Transportation (TxDOT) has embarked on an aggressive campaign to install : median barriers to prevent cross-median crashes on freeway facilities statewide. In the few years prior to 2003, : virtually all fatalities...

Ancillary Services Provided from DER

Energy Technology Data Exchange (ETDEWEB)

Campbell, J.B.

2005-12-21

Distributed energy resources (DER) are quickly making their way to industry primarily as backup generation. They are effective at starting and then producing full-load power within a few seconds. The distribution system is aging and transmission system development has not kept up with the growth in load and generation. The nation's transmission system is stressed with heavy power flows over long distances, and many areas are experiencing problems in providing the power quality needed to satisfy customers. Thus, a new market for DER is beginning to emerge. DER can alleviate the burden on the distribution system by providing ancillary services while providing a cost adjustment for the DER owner. This report describes 10 types of ancillary services that distributed generation (DG) can provide to the distribution system. Of these 10 services the feasibility, control strategy, effectiveness, and cost benefits are all analyzed as in the context of a future utility-power market. In this market, services will be provided at a local level that will benefit the customer, the distribution utility, and the transmission company.

Of Needles and Haystacks: Building an Accurate Statewide Dropout Early Warning System in Wisconsin

Science.gov (United States)

Knowles, Jared E.

2015-01-01

The state of Wisconsin has one of the highest four year graduation rates in the nation, but deep disparities among student subgroups remain. To address this the state has created the Wisconsin Dropout Early Warning System (DEWS), a predictive model of student dropout risk for students in grades six through nine. The Wisconsin DEWS is in use…

Incentives and provider payment methods.

Science.gov (United States)

Barnum, H; Kutzin, J; Saxenian, H

1995-01-01

The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

VOLTTRON-Based System for Providing Ancillary Services with Residential Building Loads

Energy Technology Data Exchange (ETDEWEB)

Jin, Xin

2016-07-01

Ancillary services entail controlled modulation of building equipment to maintain a stable balance of generation and load in the power system. Ancillary services include frequency regulation and contingency reserves, whose acting time ranges from several seconds to several minutes. Many pilot studies have been implemented to use industrial loads to provide ancillary services, and some have explored services from commercial building loads or electric vehicle charging loads. Residential loads, such as space conditioning and water heating, represent a largely untapped resource for providing ancillary services. The residential building sector accounts for a significant fraction of the total electricity use in the United States. Many loads in residential buildings are flexible and could potentially be curtailed or shifted at the request of the grid. However, there are many barriers that prevent residential loads being widely used for ancillary services. One of the major technical barriers is the lack of communication capabilities between end-use devices and the grid. End-use devices need to be able to receive the automatic generation control (AGC) signal from the grid operator and supply certain types of telemetry to verify response. With the advance of consumer electronics, communication-enabled, or 'connected,' residential equipment has emerged to overcome the communication barrier. However, these end-use devices have introduced a new interoperability challenge due to the existence of numerous standards and communication protocols among different end devices. In this paper, we present a VOLTTRON-based system that overcomes these technical challenges and provides ancillary services with residential loads. VOLTTRON is an open-source control and sensing platform for building energy management, facilitating interoperability solutions for end devices. We have developed drivers to communicate and control different types of end devices through standard

Biota: Providing often-overlooked connections among freshwater systems

Science.gov (United States)

Mushet, David M.; Christensen, Jay R.; Bennett, Michah; Alexander, Laurie C.

2017-01-01

When we think about connections in and among aquatic systems, we typically envision clear headwater streams flowing into downstream rivers, river floodwaters spilling out onto adjacent floodplains, or groundwater connecting wetlands to lakes and streams. However, there is another layer of connectivity moving materials among freshwater systems, one with connections that are not always tied to downgradient flows of surface waters and groundwater. These movements are those of organisms, key components of virtually every freshwater system on the planet. In their movements across the landscape, biota connect aquatic systems in often-overlooked ways.

Decision support system of e-book provider selection for library using Simple Additive Weighting

Science.gov (United States)

Ciptayani, P. I.; Dewi, K. C.

2018-01-01

Each library has its own criteria and differences in the importance of each criterion in choosing an e-book provider for them. The large number of providers and the different importance levels of each criterion make the problem of determining the e-book provider to be complex and take a considerable time in decision making. The aim of this study was to implement Decision support system (DSS) to assist the library in selecting the best e-book provider based on their preferences. The way of DSS works is by comparing the importance of each criterion and the condition of each alternative decision. SAW is one of DSS method that is quite simple, fast and widely used. This study used 9 criteria and 18 provider to demonstrate how SAW work in this study. With the DSS, then the decision-making time can be shortened and the calculation results can be more accurate than manual calculations.

Development and Implementation of a Novel Prehospital Care System in the State of Kerala, India.

Science.gov (United States)

Brown, Heather A; Douglass, Katherine A; Ejas, Shafi; Poovathumparambil, Venugopalan

2016-12-01

Most low- and middle-income countries (LMICs) have struggled to find a system for prehospital care that can provide adequate patient care and geographical coverage while maintaining a feasible price tag. The emergency medical systems of the Western world are not necessarily relevant in developing economic systems, given the lack of strict legislation, the scarcity of resources, and the limited number of trained personnel. Meanwhile, most efforts to provide prehospital care in India have taken the form of adapting Western models to the Indian context with limited success. Described here is a novel approach to prehospital care designed for and implemented in the State of Kerala, India. The Active Network Group of Emergency Life Savers (ANGELS) was launched in 2011 in Calicut City, the third largest city in the Indian State of Kerala. The ANGELS integrated an existing fleet of private and state-owned ambulances into a single network utilizing Global Positioning System (GPS) technology and a single statewide call number. A total of 85 volunteer emergency medical certified technicians (EMCTs) were trained in basic first aid and trauma care principles. Public awareness campaigns accompanied all activities to raise awareness amongst community members. Funding was provided via public-private partnership, aimed to minimize costs to patients for service utilization. Over a two-year period from March 2011 to April 2013, 8,336 calls were recorded, of which 54.8% (4,569) were converted into actual ambulance run sheets. The majority of calls were for medical emergencies and most patients were transported to Medical College Hospital in Calicut. This unique public-private partnership has been responsive to the needs of the population while sustaining low operational costs. This system may provide a relevant template for Emergency Medical Services (EMS) development in other resource-limited settings. Brown HA , Douglass KA , Ejas S , Poovathumparambil V . Development and

Maternal symptoms of stress, depression, and anxiety are related to nonresponsive feeding styles in a statewide sample of WIC participants.

Science.gov (United States)

Hurley, Kristen M; Black, Maureen M; Papas, Mia A; Caulfield, Laura E; Caufield, Laura E

2008-04-01

Parenting, including nonresponsive feeding styles, has been related to under- or overweight among young children. The relationship between maternal mental health and feeding styles has not been examined. We hypothesized that mothers who report more symptoms of stress, depression, or anxiety report less responsive (e.g. more controlling, indulgent, and uninvolved) feeding styles than mothers who report fewer symptoms of stress, depression, or anxiety. Our analyses included 702 mother-infant pairs from a statewide sample of Special Supplemental Nutrition Program for Women, Infants, and Children mothers. We assessed maternal mental health and feeding styles by a telephone survey. After adjusting for potential confounding variables, maternal stress symptomatology was significantly associated with forceful (beta = 0.03; 95% CI = 0.02, 0.05) and uninvolved (OR = 1.4; 95% CI = 1.1, 1.7) feeding style scores, maternal depression symptomatology was significantly associated with forceful (beta = 0.03; 95% CI = 0.004, 0.05), indulgent (beta = 0.03; 95% CI = 0.004, 0.06), and uninvolved (OR = 1.5; 95% CI = 1.001, 2.2) feeding styles scores, and maternal anxiety symptomatology was significantly related to restrictive (beta = 0.11; 95% CI = 0.01, 0.21), forceful (beta = 0.04; 95% CI = 0.02, 0.06), and uninvolved (OR = 1.4; 95% CI = 1.01, 1.9) feeding style scores. Among mothers who perceived their infant as temperamentally fussy, there was a significant positive relationship between restrictive feeding styles scores and 3 indices of maternal mental health (stress, beta = 0.18; 95% CI = 0.07, 0.28; depression, beta = 0.21; 95% CI = 0.04, 0.38; and cumulative mental health symptomatology, beta = 0.29; 95% CI = 0.10, 0.48). Mothers who report stress, depression, or anxiety symptoms are at risk for nonresponsive feeding styles. These findings provide support for broadening the focus of existing child nutrition programs to include strategies that recognize how issues of maternal

Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG)

Data.gov (United States)

U.S. Department of Health & Human Services — A provider level summary of Inpatient Prospective Payment System (IPPS) discharges, average charges and average Medicare payments for the Top 100 Diagnosis-Related...

Transaction of long-term power purchasing contract by independent power providers in wholesale and retail competitive system

Energy Technology Data Exchange (ETDEWEB)

Lee, Seung Hoon [Korea Energy Economics Institute, Euiwang (Korea)

1998-12-01

In general, the restructuring starts with separation and division of power sector from the existing monopolist as the cases of Thailand and Malaysia. When the power provider is separated and divided, it becomes an independent power provider. The existing regional electricity provider carries out the supplying function to end-users buying electricity from several separated and divided providers. Therefore, the existing regional electricity providers give up the power generation business but become a demand monopolist in wholesale market. The competition system capable of applying during the separation period is the Generation Pool. With the Generation Pool, it is able to promote competition of power generation sector effectively and there is no need to have an extra step such as long-term power purchasing contract. In fact, Latin America and Chile have been managed the power market for more than 10 years with the competition system by the Generation Pool. 9 refs.

Environmental and economic evaluation of the Massachusetts Smoke-Free Workplace Law.

Science.gov (United States)

Alpert, Hillel R; Carpenter, Carrie M; Travers, Mark J; Connolly, Gregory N

2007-08-01

An environmental and economic evaluation of the smoke-free law in Massachusetts provides a broad appreciation of how a state-wide smoking ban affects the health of patrons and workers as well as the industries that are commonly concerned about the effects of smoking bans on business. The aim of this study is to evaluate environmental and economic effects of the statewide Massachusetts statewide Smoke-Free Workplace Law. Before and after the smoking ban, air quality testing was conducted in a sample (n = 27) of hospitality venues and state-wide economic changes were assessed. Compliance, in terms of patronage was measured by person-counts. Environmental outcomes were respirable suspended particles (RSP) less than 2.5 microns in diameter (PM2.5). Economic outcomes were meals tax collections, employment in the food services and drinking places and accommodations industries. On average, levels of respirable suspended particles (RSPs) less than 2.5 microns in diameter (PM2.5) decreased 93% in these venues after the Massachusetts Smoke-free Workplace Law went into effect. No statistically significant changes were observed among the economic indicators. This evaluation demonstrates that the state-wide Massachusetts law has effectively improved indoor air quality in a sample of Massachusetts venues and has not negatively affected several economic indicators.

Development of guidelines for cable median barrier systems in Texas.

Science.gov (United States)

2009-12-01

Since 2003, the Texas Department of Transportation (TxDOT) has embarked on an aggressive campaign to install : median barriers to prevent cross-median crashes on freeway facilities statewide. In the few years prior to 2003, : virtually all fatalities...

Workshop for coordinating South Carolina`s pre-college systemic initiatives

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-03-26

The goal of the South Carolina Statewide Systemic Initiative (SC SSI) is to provide quality and effective learning experiences in science and mathematics to all people of South Carolina by affecting systemic change. To accomplish this goal, South Carolina must: (1) coordinate actions among many partners for science and mathematics change; (2) place the instruments of change into the hands of the effectors of change - teachers and schools; and (3) galvanize the support of policy makers, parents, and local communities for change. The SC SSI proposes to establish a network of 13 regional mathematics and science HUBs. The central idea of this plan is the accumulation of Teacher Leaders at each HUB who are prepared in special Curriculum Leadership Institutes to assist other teachers and schools. The HUB becomes a regional nexus for delivering services to schools who request assistance by matching schools with Teacher Leaders. Other initiatives such as the use of new student performance assessments, the integration of instructional technologies into the curriculum, a pilot preservice program, and Family Math and Family Science will be bundled together through the Teacher Leaders in the HUBs. Concurrent policy changes at the state level in teacher and administrator certification and recertification requirements, school regulations and accountability, and the student performance assessment system will enable teachers and schools to support instructional practices that model South Carolina`s new state Curriculum Frameworks in Mathematics and Science.

Water and sludge treatment device provided with a system for irradiating by accelerated charged particles

International Nuclear Information System (INIS)

Azam, Guy; Bensussan, Andre; Levaillant, Claude; Huber, Harry; Mevel, Emile; Tronc, Dominique.

1977-01-01

Treatment system for a fluid made up of water and sludge, provided with a system for irradiating the fluid by a beam of accelerated charged particles comprising means for obtaining a constant flow of the fluid to be treated, facilities for monitoring this flow, an irradiation channel located on the path of the beam, in which the fluid to be treated can flow, a portion of this channel having at least one window transparent to the beam of accelerated particles. A safety system associated with the system for monitoring the characteristics of the beam and with the system for monitoring the flow of the fluid to be treated, stops the flow of the fluid and the recycling of the fluid defectively treated [fr

Stepping up to the challenge: the development, implementation, and assessment of a statewide, regional, leadership program for school nutrition directors.

Science.gov (United States)

Bergman, Jacqueline J; Briggs, Marilyn M; Beall, Deborah L; Curwood, Sandy; Gray, Pilar; Soiseth, Scott; Taylor, Rodney K; Zidenberg-Cherr, Sheri

2015-01-01

A statewide professional development program was developed and implemented throughout California for school nutrition directors with the goal of creating healthy school environments and regional networks for collaboration and healthy school environment sustainability. Needs of school nutrition directors were identified through a needs assessment questionnaire. Results of the needs assessment questionnaire (n = 256) identified (a) planning cost-effective menus; (b) reducing calories, sodium, saturated fat, and trans fat in menus; and (c) using U.S. Department of Agriculture foods cost-effectively as the most useful topics. Highest rated topics informed the content of the professional development program. A post-professional development questionnaire identified key "insights, inspirations, and strategies" as (a) marketing of school foods program, (b) expansion of salad bars, and (c) collaboration with community partners. A 6-month follow-up questionnaire identified that 86% of participants made progress toward implementing at least one of their five insights, inspirations, and strategies in their school districts. Most common areas that were implemented were marketing and branding (32%), revamping salad bars (18%), and motivating staff (16%). School and Community Actions for Nutrition survey analysis showed a significant increase in the use of marketing methods in school nutrition programs from baseline to 6-month post-program implementation (p = .024). © 2014 Society for Public Health Education.

Advancing LGBT Elder Policy and Support Services: The Massachusetts Model.

Science.gov (United States)

Krinsky, Lisa; Cahill, Sean R

2017-12-01

The Massachusetts-based LGBT Aging Project has trained elder service providers in affirming and culturally competent care for LGBT older adults, supported development of LGBT-friendly meal programs, and advanced LGBT equality under aging policy. Working across sectors, this innovative model launched the country's first statewide Legislative Commission on Lesbian, Gay, Bisexual, and Transgender Aging. Advocates are working with policymakers to implement key recommendations, including cultural competency training and data collection in statewide networks of elder services. The LGBT Aging Project's success provides a template for improving services and policy for LGBT older adults throughout the country.

A telecommunications journey rural health network.

Science.gov (United States)

Moore, Joe

2012-01-01

Utilizing a multi-gigabit statewide fiber healthcare network, Radiology Consultants of Iowa (RCI) set out to provide instantaneous service to their rural, critical access, hospital partners. RCIs idea was to assemble a collection of technologies and services that would even out workflow, reduce time on the road, and provide superior service. These technologies included PACS, voice recognition enabled dictation, HL7 interface technology, an imaging system for digitizing paper and prior films, and modern communication networks. The Iowa Rural Health Telecommunication Project was undertaken to form a system that all critical access hospitals would participate in, allowing RCI radiologists the efficiency of "any image, anywhere, anytime".

SU-D-BRF-05: A Novel System to Provide Real-Time Image-Guidance for Intrauterine Tandem Insertion and Placement

Energy Technology Data Exchange (ETDEWEB)

Price, M; Fontenot, J [pF Biomedical Solutions LLC, Baton Rouge, LA (United States)

2014-06-01

Purpose: To develop a system that provides real-time image-guidance for intrauterine tandem insertion and placement for brachytherapy. Methods: The conceptualized system consists of an intrauterine tandem with a transparent, lensed tip, a flexible miniature fiber optic scope, light source and interface for CCD coupling. The tandem tip was designed to act as a lens providing a wide field-of-view (FOV) with minimal image distortion and focus length appropriate for the application. The system is designed so that once inserted, the image-guidance component of the system can be removed and brachytherapy can be administered without interfering with source transport or disturbing tandem placement. Proof-of-principle studies were conducted to assess the conceptualized system's (1) lens functionality (clarity, focus and FOV) (2) and ability to visualize the cervical os of a female placed in the lithotomy position. Results: A prototype of this device was constructed using a commercial tandem modified to incorporate a transparent tip that internally coupled with a 1.9mm diameter fiber optic cable. The 900mm-long cable terminated at an interface that provided illumination as well as facilitated visualization of patient anatomy on a computer. The system provided a 23mm FOV with a focal length of 1cm and provided clear visualization of the cervix, cervical fornix and cervical os. The optical components of the system are easily removed without perturbing the position of a tandem placed in a common fixation clamp. Conclusion: Clinicians frequently encounter difficulty inserting an intrauterine tandem through the cervical os, circumventing fibrotic tissue or masses within the uterus, and positioning the tandem without perforating the uterus. To mitigate these challenges, we have designed and conducted proof-of- principle studies to discern the utility of a prototype device that provides real-time image-guidance for intrauterine tandem placement using fiber optic components.

Alternate performance standard project: Interpreting the post-construction test

International Nuclear Information System (INIS)

Williamson, A.D.; McDonough, S.E.

1993-01-01

The paper describes the results of a project commissioned by the State of Florida, in cooperation with the US Environmental Protection Agency, as one portion of the Florida Radon Research Program (FRRP). The purpose of the FRRP is to provide technical support for a statewide Building Standard for Radon-Resistant Construction currently in the rulemaking process. In this case the information provides technical background for a post-construction radon test specified as a performance element of the code which accompanies the prescriptive alternative that does not incorporate active radon reduction systems

Factors Predicting Oncology Care Providers' Behavioral Intention to Adopt Clinical Decision Support Systems

Science.gov (United States)

Wolfenden, Andrew

2012-01-01

The purpose of this quantitative correlation study was to examine the predictors of user behavioral intention on the decision of oncology care providers to adopt or reject the clinical decision support system. The Unified Theory of Acceptance and Use of Technology (UTAUT) formed the foundation of the research model and survey instrument. The…

Effects of statewide health promotion in primary schools on children's sick days, visits to a physician and parental absence from work: a cluster-randomized trial.

Science.gov (United States)

Kesztyüs, Dorothea; Lauer, Romy; Traub, Meike; Kesztyüs, Tibor; Steinacker, Jürgen Michael

2016-12-12

Based on the World Health Organization's global school health initiative we investigate intervention effects of statewide health promotion in schools on the numbers of children's sick days and visits to a physician, and parental days off work due to child illness. Cluster-randomized trial with 1-year follow-up in primary schools in the state of Baden-Württemberg, Germany. Anthropometric measurements of first and second grade school children were taken by trained staff. Parents filled in questionnaires for information about socio-demographics, health-related variables, numbers of children's sick days, visits to a physician, and days parents had to stay off work to care for a sick child. Longitudinal differences in the outcome variables were calculated between baseline and follow-up. Intraclass correlation coefficients were determined to quantify a possible clustering of data in schools. Accordingly, linear models and linear mixed models were applied to identify relationships and ascertain significances. Data from 1943 children (1 st grade n = 1024, 6.6 ± 0.4 years old; 2 nd grade n = 919, 7.6 ± 0.4 years old) were available at baseline. Unadjusted differences regarding both grades were found between mean longitudinal changes in intervention and control group in children's sick days (-3.2 ± 7.1 vs. -2.3 ± 5.6, p = 0.013), and maternal days off work (-0.9 ± 2.4 vs. -0.5 ± 2.8, p = 0.019). The intervention effect on sick days was adjusted in a linear regression for baseline values, gender and migration background and confirmed for first grade children (B = -0.83, p = 0.003). The intervention effect on maternal days off work lost its significance after adjusting for baseline values. No significant differences were detected in the numbers of children's visits to a physician and paternal days off work. School-based health promotion slightly reduces sick days in first grade children. Subsequently, parents may not

Father participation with mothers in the Signposts program: an initial investigation.

Science.gov (United States)

May, Fiona S; McLean, Louise A; Anderson, Angelika; Hudson, Alan; Cameron, Christine; Matthews, Jan

2013-03-01

The Signposts program is an evidence-based intervention system for parents of children with intellectual disability and problem behaviours. This study provided an initial investigation of the outcomes for mothers associated with father participation in Signposts, using data collected from the Signposts Statewide project, conducted in Victoria, Australia. Data from Signposts Statewide were analysed, with the effect size Cohen's d and 95% confidence interval around d calculated for pre- to post-program changes for 134 mothers who participated in Signposts with fathers and 483 mothers who participated without fathers. Although mothers in both groups benefitted from the program, as evidenced by pre- to post-program improvements across all measures, the mean effect size was notably larger for mothers who participated in Signposts with fathers. These results highlight possible further program benefits for mothers who participate in Signposts with fathers, and are of particular significance in light of research describing the increased stress experienced by mothers of children with a disability.

Core to College Evaluation: Statewide Networks. Connecting Education Systems and Stakeholders to Support College Readiness

Science.gov (United States)

Bracco, Kathy Reeves; Klarin, Becca; Broek, Marie; Austin, Kim; Finkelstein, Neal; Bugler, Daniel; Mundry, Susan

2014-01-01

The Core to College initiative aims to facilitate greater coordination between K-12 and postsecondary education systems around implementation of the Common Core State Standards and aligned assessments. Core to College grants have been awarded to teams in Colorado, Florida, Hawaii, Kentucky, Louisiana, Massachusetts, North Carolina, Oregon,…

75 FR 6728 - The Merit Systems Protection Board (MSPB) is Providing Notice of the Opportunity to File Amicus...

Science.gov (United States)

2010-02-10

... MERIT SYSTEMS PROTECTION BOARD The Merit Systems Protection Board (MSPB) is Providing Notice of the Opportunity to File Amicus Briefs in the Matters of Conyers v. Department of Defense, Docket No...: Merit Systems Protection Board. ACTION: Notice. SUMMARY: On January 25, 2010, the MSPB published in the...

The Drupal Environmental Information Management System Provides Standardization, Flexibility and a Platform for Collaboration

Science.gov (United States)

Gries, C.; Vanderbilt, K.; Reid, D.; Melendez-Colom, E.; San Gil, I.

2013-12-01

Over the last five years several Long-Term Ecological Research (LTER) sites have collaboratively developed a standardized yet flexible approach to ecological information management based on the open source Drupal content management system. These LTER sites adopted a common data model for basic metadata necessary to describe data sets, but also used for site management and web presence. Drupal core functionality provides web forms for easy management of information stored in this data model. Custom Drupal extensions were developed to generate XML files conforming to the Ecological Metadata Language (EML) for contribution to the LTER Network Information System (NIS) and other data archives. Each LTER site then took advantage of the flexibility Drupal provides to develop its unique web presence, choosing different themes and adding additional content to the websites. By nature, information presented is highly interlinked which can easily be modeled in Drupal entities and is further supported by a sophisticated tagging system (Fig. 1). Therefore, it is possible to provide the visitor with many different entry points to the site specific information presented. For example, publications and datasets may be grouped for each scientist, for each research project, for each major research theme at the site, making the information presented more accessible for different visitors. Experience gained during the early years was recently used to launch a complete re-write for upgrading to Drupal 7. LTER sites from multiple academic institutions pooled resources in order to partner with professional Drupal developers. Highlights of the new developments are streamlined data entry, improved EML output and integrity, support of IM workflows, a faceted data set search, a highly configurable data exploration tool with intelligent filtering and data download, and, for the mobile age, a responsive web design theme. Seven custom modules and a specific installation profile were developed

Evaluation of a Statewide HIV-HCV-STD Online Clinical Education Program by Healthcare Providers - A Comparison of Nursing and Other Disciplines.

Science.gov (United States)

Wang, Dongwen; Luque, Amneris E

2016-01-01

The New York State HIV-HCV-STD Clinical Education Initiative (CEI) has developed a large repository of online resources and disseminated them to a wide range of healthcare providers. To evaluate the CEI online education program and in particular to compare the self-reported measures by clinicians from different disciplines, we analyzed the data from 1,558 course completions in a study period of three months. The results have shown that the overall evaluations by the clinicians were very positive. Meanwhile, there were significant differences across the clinical disciplines. In particular, physicians and nurse practitioners were the most satisfied. In contrast, pharmacists and case/care managers recorded lower than average responses. Nurses and counselors had mixed results. Nurse practitioners' responses were very similar to physicians on most measures, but significantly different from nurses in many aspects. For more effective knowledge dissemination, online education programs should consider the unique needs by clinicians from specific disciplines.

75 FR 25885 - The Merit Systems Protection Board (MSPB) is Providing Notice of the Opportunity to File Amicus...

Science.gov (United States)

2010-05-10

... MERIT SYSTEMS PROTECTION BOARD The Merit Systems Protection Board (MSPB) is Providing Notice of the Opportunity to File Amicus Briefs in the Matter of Larry L. Evans v. Department of Veterans Affairs, MSPB Docket Number AT-3330-09-0953- I-1. AGENCY: Merit Systems Protection Board. ACTION: Notice...

75 FR 20007 - The Merit Systems Protection Board (MSPB) Is Providing Notice of the Opportunity To File Amicus...

Science.gov (United States)

2010-04-16

... MERIT SYSTEMS PROTECTION BOARD The Merit Systems Protection Board (MSPB) Is Providing Notice of the Opportunity To File Amicus Briefs in the Matter of Hyginus U. Aguzie v. Office of Personnel Management, MSPB Docket Number DC-0731- 09-0261-R-1 AGENCY: Merit Systems Protection Board. ACTION: Notice...

Dare to Dialogue: Engaging Parents in System Change

Science.gov (United States)

Graham, Patrick; Kennedy, Sara; Lynch, Johanna

2016-01-01

Determined parents are powerful advocates at all levels of our society. Parents can move mountains for their child, and they often do. State teams that actively collaborate with parents gain new perspectives, ideas, and energy. Statewide transition planning teams welcomed the authors--three parents who are also professionals active in the deaf…

An open source hydroeconomic model for California's water supply system: PyVIN

Science.gov (United States)

Dogan, M. S.; White, E.; Herman, J. D.; Hart, Q.; Merz, J.; Medellin-Azuara, J.; Lund, J. R.

2016-12-01

Models help operators and decision makers explore and compare different management and policy alternatives, better allocate scarce resources, and predict the future behavior of existing or proposed water systems. Hydroeconomic models are useful tools to increase benefits or decrease costs of managing water. Bringing hydrology and economics together, these models provide a framework for different disciplines that share similar objectives. This work proposes a new model to evaluate operation and adaptation strategies under existing and future hydrologic conditions for California's interconnected water system. This model combines the network structure of CALVIN, a statewide optimization model for California's water infrastructure, along with an open source solver written in the Python programming language. With the flexibilities of the model, reservoir operations, including water supply and hydropower, groundwater pumping, and the Delta water operations and requirements can now be better represented. Given time series of hydrologic inputs to the model, typical outputs include urban, agricultural and wildlife refuge water deliveries and shortage costs, conjunctive use of surface and groundwater systems, and insights into policy and management decisions, such as capacity expansion and groundwater management policies. Water market operations also represented in the model, allocating water from lower-valued users to higher-valued users. PyVIN serves as a cross-platform, extensible model to evaluate systemwide water operations. PyVIN separates data from the model structure, enabling model to be easily applied to other parts of the world where water is a scarce resource.

Selecting healthcare information systems provided by third-party vendors: a mind map beyond the manuals.

Science.gov (United States)

Gortzis, Lefteris G

2010-01-01

The selection of a new healthcare information system (HIS) has always been a daunting process for clinicians, health care providers and policy makers. The objective of this study is to present the lessons learned and the main findings from several relevant case studies to support this process. Data were collected by retrospectively reviewing the summative results of three well-established systems, acquiring feedback from two E.U. projects, and conducting semi-structured interviews with a number of collaborators involved in electronic healthcare interventions. Selection issues were identified and classified into the following five categories: (i) data creation, (ii) data management, (iii) data sharing, (iv) data presentation and (v) modules management. A mind map was also structured to provide a more manageable list of issues concerning the most common electronic clinical technologies (e-CT). The vendor manual is intended as an overview of the merchandise e-CT and therefore has limited potential in supporting effectively the selection process of a new HIS. The present classification and the mind map - based on lessons learned - provide a ready-to-use toolkit for supporting the HIS selection process when healthcare organisations are unable to employ research development groups to lay the groundwork for building a new HIS from scratch.

Anthropogenic hydrological cycle disturbance at a regional scale: State-wide evapotranspiration trends (1979-2015) across Nebraska, USA

Science.gov (United States)

Szilagyi, Jozsef

2018-02-01

Trends in monthly evapotranspiration (ET) rates across Nebraska, the most intensely irrigated state within the US, were calculated by the calibration-free version of the nonlinear complementary relationship of evaporation over the 1979-2015 period utilizing North American Regional Reanalysis (NARR) net radiation, 10-m wind velocity, as well as Parameter Regression Independent Slope Model (PRISM) air- and dew-point temperature data. State-averaged modeled ET rates rose by 5.5 mm decade-1 due to the presence of wide-spread large-scale irrigation projects in accordance with a 2.4 mm decade-1 increase in PRISM precipitation (P) and a simultaneous -2.8 mm decade-1 drop in United States Geological Survey's state-averaged annual streamflow rates, raising the state-wide ET to P ratio from 0.89 to 0.91 over the modeled time-period. ET rates over irrigated crops increased by 7 mm decade-1 despite a -4.4 mm decade-1 drop in precipitation rates. A similar increase in ET rates (6 mm decade-1) required 8.1 mm decade-1 increase in precipitation rates across the non-irrigated Sand Hills of Nebraska. Published NARR ET rates are unable to pick up this unusual regional trend. Since an increase in precipitation rates should normally decrease the ET ratio, as predicted by the Budyko curve, this study yields evidence on how dramatically sustained large-scale irrigation can alter the regional hydrologic cycle not only through a) trivially depleting streamflow rates and/or lowering groundwater table levels; b) suppressing precipitation locally (while enhancing it a long distance downwind), but also; c) reversing the trajectory of the regional ET ratio under generally increasing trends of precipitation.

Statewide ban on recreational fires resulted in a significant decrease in campfire-related summer burn center admissions.

Science.gov (United States)

Hoang, David Manh; Reid, Dixie; Lentz, Christopher William

2013-01-01

Every summer, there is an increase in the number of burn injuries caused by accidents around campfires. Because of the prevalence of drought, high winds, and uncontrolled wild fires, a statewide ban on recreational fires was instituted in New Mexico from June to July 2011. We hypothesized that this legislation would have a significant impact on burn admissions caused by campfire-related injuries. A retrospective review of summer admissions to a state burn center was conducted to assess the effect of this ban on recreational fire injuries, and these data were compared with that of the previous summer when no ban was in effect. All burn admissions to a state burn center were reviewed from Memorial Day to Labor Day in 2010 and 2011. Data collected included cause, % TBSA, age, days of hospitalization, intensive care unit days, and total surface area grafted. Nonparametric statistical analysis was performed with Fisher exact test for dichotomous data and Mann-Whitney test for continuous data with significance at P fires during the study period (n = 14 [17%] in 2010 and 4 [5%] in 2011; P = .02). This resulted in a decrease in the number of patient-days from 91 in 2010 to 25 in 2011. Half of the camp fire admissions required skin grafts to definitively close the wounds (6/14 in 2010 and 2/4 in 2011). Recreational fire bans targeted at controlling wildfires during conditions favoring rapid spread were associated with a 3- to 4-fold decrease in campfire-related burn admissions. Compared with a summer when no fire ban was in effect, the number of patient-days decreased from 91 to 25.

Nuclear Facility Isotopic Content (NFIC) Waste Management System to provide input for safety envelope definition

International Nuclear Information System (INIS)

Genser, J.R.

1992-01-01

The Westinghouse Savannah River Company (WSRC) is aggressively applying environmental remediation and radioactive waste management activities at the US Department of Energy's Savannah River Site (SRS) to ensure compliance with today's challenging governmental laws and regulatory requirements. This report discusses a computer-based Nuclear Facility Isotopic Content (NFIC) Waste Management System developed to provide input for the safety envelope definition and assessment of site-wide facilities. Information was formulated describing the SRS ''Nuclear Facilities'' and their respective bounding inventories of nuclear materials and radioactive waste using the NFIC Waste Management System

Providing Cardiology Care in Rural Areas Through Visiting Consultant Clinics.

Science.gov (United States)

Gruca, Thomas S; Pyo, Tae-Hyung; Nelson, Gregory C

2016-06-30

Workforce experts predict a future shortage of cardiologists that is expected to impact rural areas more severely than urban areas. However, there is little research on how rural patients are currently served through clinical outreach. This study examines the impact of cardiology outreach in Iowa, a state with a large rural population, on participating cardiologists and on patient access. Outreach clinics are tracked annually in the Office of Statewide Clinical Education Programs Visiting Medical Consultant Database (University of Iowa Carver College of Medicine). Data from 2014 were analyzed. In 2014, an estimated 5460 visiting consultant clinic days were provided in 96 predominantly rural cities by 167 cardiologists from Iowa and adjoining states. Forty-five percent of Iowa cardiologists participated in rural outreach. Visiting cardiologists from Iowa and adjoining states drive an estimated 45 000 miles per month. Because of monthly outreach clinics, the average driving time to the nearest cardiologist falls from 42.2±20.0 to 14.7±11.0 minutes for rural Iowans. Cardiology outreach improves geographic access to office-based cardiology care for more than 1 million Iowans out of a total population of 3 million. Direct travel costs and opportunity costs associated with physician travel are estimated to be more than $2.1 million per year. Cardiologists in Iowa and adjoining states have expanded access to office-based cardiology care from 18 to 89 of the 99 counties in Iowa. In these 71 counties without a full-time cardiologist, visiting consultant clinics can accommodate more than 50% of office visits in the patients' home county. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

A microbial clock provides an accurate estimate of the postmortem interval in a mouse model system

Science.gov (United States)

Metcalf, Jessica L; Wegener Parfrey, Laura; Gonzalez, Antonio; Lauber, Christian L; Knights, Dan; Ackermann, Gail; Humphrey, Gregory C; Gebert, Matthew J; Van Treuren, Will; Berg-Lyons, Donna; Keepers, Kyle; Guo, Yan; Bullard, James; Fierer, Noah; Carter, David O; Knight, Rob

2013-01-01

Establishing the time since death is critical in every death investigation, yet existing techniques are susceptible to a range of errors and biases. For example, forensic entomology is widely used to assess the postmortem interval (PMI), but errors can range from days to months. Microbes may provide a novel method for estimating PMI that avoids many of these limitations. Here we show that postmortem microbial community changes are dramatic, measurable, and repeatable in a mouse model system, allowing PMI to be estimated within approximately 3 days over 48 days. Our results provide a detailed understanding of bacterial and microbial eukaryotic ecology within a decomposing corpse system and suggest that microbial community data can be developed into a forensic tool for estimating PMI. DOI: http://dx.doi.org/10.7554/eLife.01104.001 PMID:24137541

90-day Readmission After Lumbar Spinal Fusion Surgery in New York State Between 2005 and 2014: A 10-year Analysis of a Statewide Cohort.

Science.gov (United States)

Baaj, Ali A; Lang, Gernot; Hsu, Wei-Chun; Avila, Mauricio J; Mao, Jialin; Sedrakyan, Art

2017-11-15

MINI: We assessed 90-day readmission and evaluated risk factors associated with readmission after lumbar spinal fusion surgery in New York State. The overall 90-day readmission rate was 24.8%. Age, sex, race, insurance, procedure, number of operated spinal levels, health service area, and comorbidities are major risk factors for 90-day readmission. Retrospective cohort study. The aim of this study was to assess 90-day readmission and evaluate risk factors associated with readmission after lumbar fusion in New York State. Readmission is becoming an important metric for quality and efficiency of health care. Readmission and its predictors following spine surgery are overall poorly understood and limited evidence is available specifically in lumbar fusion. The New York Statewide Planning and Research Cooperative System (SPARCS) was utilized to capture patients undergoing lumbar fusion from 2005 to 2014. Temporal trend of 90-day readmission was assessed using Cochran-Armitage test. Logistic regression was used to examine predictors associated with 90-day readmission. There were 86,869 patients included in this cohort study. The overall 90-day readmission rate was 24.8%. On a multivariable analysis model, age (odds ratio [OR] comparing ≥75 versus New York-Pennsylvania border: 0.67, 95% CI: 0.61-0.73), and comorbidity, i.e., coronary artery disease (OR: 1.26, 95% CI: 1.19-1.33) were significantly associated with 90-day readmission. Directions of the odds ratios for these factors were consistent after stratification by procedure type. Age, sex, race, insurance, procedure, number of operated spinal levels, HSA, and comorbidities are major risk factors for 90-day readmission. Our study allows risk calculation to determine high-risk patients before undergoing spinal fusion surgery to prevent early readmission, improve quality of care, and reduce health care expenditures. 3.

Design and Implementation of a Centralized Model of Clinical Education Within a Statewide Health System.

Science.gov (United States)

Elzy, Pamela Smith

2016-01-01

Today's dynamic health care environment is exceedingly complex, and health care facilities across the United States are struggling to respond to changes in technology, health care reimbursement, the Affordable Care Act, and the much-anticipated nursing shortage. Mergers, acquisitions, and integrations are the current health care reality. These are proposed to increase efficiency, efficacy, quality, satisfaction, and safety while effectively reducing cost to the consumer and stabilizing the economy of the health care system. Many of these projects fail to achieve objectives, even years after the formal change in status. Clinical education departments in merged organizations are often operated in the single-facility mindset, or contain an element of the shared services model. They are not truly integrated. Development of skills in complex analysis of current state, identification of desired scope of service and expectations of performance, and articulation of the benefits of the desired future state are all essential to nursing executive practice. This article describes an experience integrating 3 legacy education departments across 21 facilities into a centralized education system. The complexity of integration activities is illustrated and outcome measures of success are discussed. Barriers, facilitators, and risks of the project are identified and evaluated.

Porous TiO₂-Based Gas Sensors for Cyber Chemical Systems to Provide Security and Medical Diagnosis.

Science.gov (United States)

Galstyan, Vardan

2017-12-19

Gas sensors play an important role in our life, providing control and security of technical processes, environment, transportation and healthcare. Consequently, the development of high performance gas sensor devices is the subject of intense research. TiO₂, with its excellent physical and chemical properties, is a very attractive material for the fabrication of chemical sensors. Meanwhile, the emerging technologies are focused on the fabrication of more flexible and smart systems for precise monitoring and diagnosis in real-time. The proposed cyber chemical systems in this paper are based on the integration of cyber elements with the chemical sensor devices. These systems may have a crucial effect on the environmental and industrial safety, control of carriage of dangerous goods and medicine. This review highlights the recent developments on fabrication of porous TiO₂-based chemical gas sensors for their application in cyber chemical system showing the convenience and feasibility of such a model to provide the security and to perform the diagnostics. The most of reports have demonstrated that the fabrication of doped, mixed and composite structures based on porous TiO₂ may drastically improve its sensing performance. In addition, each component has its unique effect on the sensing properties of material.

New approaches to provide ride-through for critical loads in electric power distribution systems

Science.gov (United States)

Montero-Hernandez, Oscar C.

2001-07-01

The extensive use of electronic circuits has enabled modernization, automation, miniaturization, high quality, low cost, and other achievements regarding electric loads in the last decades. However, modern electronic circuits and systems are extremely sensitive to disturbances from the electric power supply. In fact, the rate at which these disturbances happen is considerable as has been documented in recent years. In response to the power quality concerns presented previously, this dissertation is proposing new approaches to provide ride-through for critical loads during voltage disturbances with emphasis on voltage sags. In this dissertation, a new approach based on an AC-DC-AC system is proposed to provide ride-through for critical loads connected in buildings and/or an industrial system. In this approach, a three-phase IGBT inverter with a built in Dc-link voltage regulator is suitably controlled along with static by-pass switches to provide continuous power to critical loads. During a disturbance, the input utility source is disconnected and the power from the inverter is connected to the load. The remaining voltage in the AC supply is converted to DC and compensated before being applied to the inverter and the load. After detecting normal utility conditions, power from the utility is restored to the critical load. In order to achieve an extended ride-through capability a second approach is introduced. In this case, the Dc-link voltage regulator is performed by a DC-DC Buck-Boost converter. This new approach has the capability to mitigate voltage variations below and above the nominal value. In the third approach presented in this dissertation, a three-phase AC to AC boost converter is investigated. This converter provides a boosting action for the utility input voltages, right before they are applied to the load. The proposed Pulse Width Modulation (PWM) control strategy ensures independent control of each phase and compensates for both single-phase or poly

Comprehensive Statewide Plan for Postsecondary Education

Science.gov (United States)

Nebraska's Coordinating Commission for Postsecondary Education, 2016

2016-01-01

The constitution and statutes of Nebraska assign the Coordinating Commission for Postsecondary Education the responsibility for comprehensive planning for postsecondary education in Nebraska. The purpose of the "Comprehensive Plan for Postsecondary Education" is to provide direction for the future of postsecondary education in Nebraska.…

The GLOBE Program in Alabama: A Mentoring Approach to State-wide Implementation

Science.gov (United States)

Cox, G. N.

2003-12-01

Established in 1997, the GLOBE in Alabama (GIA) partnership has trained more than 1,000 teachers in almost 500 schools - over 25% of the total number of K-12 schools in Alabama. Over those five years, GIA has strived to achieve recognition of GLOBE as the "glue" to Alabama's new education program, the Alabama Math, Science and Technology Initiative (AMSTI). In 2003, GIA trained over 370 AMSTI K-8 teachers at two AMSTI hub sites in north Alabama. As the AMSTI program grows with the addition of future hub sites (eleven are planned), GIA must ready itself to train thousands of AMSTI teachers during the two-week summer professional development institutes that are part of AMSTI. A key component of AMSTI is a mentoring program conducted by math and science specialists - classroom educators loaned to the AMSTI hub sites by the school systems each hub site serves. The AMSTI mentoring program mirrors the GIA mentoring model begun in 1999 that originally funded regional GLOBE master teachers to provide technical assistance, feedback, and coaching for other GLOBE teachers. In schools where GIA mentor teachers were working, nearly a 100% increase in GLOBE student data reporting was noted. The GIA mentors now work within the hub site framework to ensure implementation of GLOBE as an integrated part of AMSTI. With the continued support of the State of Alabama, GIA will establish a network of mentors who work with the AMSTI hub site specialists in providing support for all AMSTI teachers. GIA is administered by the National Space Science and Technology Center, a partnership between NASA and the State of Alabama's seven research universities. Operational funding for GIA has been provided by the University of Alabama in Huntsville's Earth System Science Center, the NASA Marshall Space Flight Center, the Alabama Space Grant Consortium, The Alabama Department of Economic and Community Affairs, the Alabama State Department of Education, and Legacy. GIA has been able to build on these

Motivation and reward systems in service provision: exploring motivators for people providing engineering services

OpenAIRE

Kreye, Melanie; Nandrup-Bus, Troels

2015-01-01

It is becoming a distinctive feature for manufacturing firms to compete strategically through service provision. In relation to reward systems the aim of this thesis is to investigate what motivates employees of servitized manufacturing firms when providing engineering services and why. Through quantitative and qualitative data collection with an international company within the European healthcare sector, the findings show that key motivating factors were to “delight” the customer and being ...

[A web information system for enhancing management and improving special care services provided to dependent persons].

Science.gov (United States)

Alvarez-Bermejo, J A; Hernández-Capel, D M; Belmonte-Ureña, L J; Roca-Piera, J

2009-01-01

Ensuring the quality of services provided in centres where dependent persons are seen by specialist services, by improving and enhancing how information -salary, control of tasks, patients' records, etc.- is shared between staff and carers. A web information system has been developed and experimentally deployed to accomplish this. The accuracy of the system was evaluated by assessing how confident the employees were with it rather than relying on statistical data. It was experimentally deployed since January 2009 in Asociación de Personas con Discapacidad "El Saliente" that manages several day centres in Almeria, for dependent persons over 65 years old, particularly those affected by Alzheimer' disease. Incidence data was collected during the experimental period. A total of 84% of the employees thought that the system helped to manage documents, administrative duties, etc., and 92.4% said they could attend to really important tasks because the system was responsible for alerting them of every task, such as medication timetables, checking all patients were present (to prevent an Alzheimer affected person leaving the centre) etc. During this period the incidences reported were reduced by about a 30%, although data is still partially representative. As the life expectancy of the population gets longer, these centres will increase. Providing systems such as the one presented here would be of great help for administrative duties (sensitive data protection...) as well as ensuring high quality care and attention.

From Demonstration System to Prototype: ShakeAlert Beta Users Provide Feedback to Improve Alert Delivery

Science.gov (United States)

Strauss, J. A.; Vinci, M.; Steele, W. P.; Allen, R. M.; Hellweg, M.

2013-12-01

Earthquake Early Warning (EEW) is a system that can provide a few to tens of seconds to minutes of warning prior to ground shaking at a given location. The goal and purpose of such a system is to reduce the damage, costs, and casualties resulting from an earthquake. A prototype earthquake early warning system (ShakeAlert) is in development by the UC Berkeley Seismological Laboratory, Caltech, ETH Zurich, University of Washington, and the USGS. Events are published to the UserDisplay--ShakeAlert's Java based graphical interface, which is being tested by a small group of beta users throughout California. The beta users receive earthquake alerts in real-time and are providing feedback on their experiences. For early warning alerts to be useful, people, companies, and institutions must know beforehand what actions they will perform when they receive the information. Beta user interactions allow the ShakeAlert team to discern: which alert delivery options are most effective, what changes would make the UserDisplay more useful in a pre-disaster situation, and most importantly, what actions users plan to take for various scenarios. We also collect feedback detailing costs of implementing actions and challenges within the beta user organizations, as well as anticipated benefits and savings. Thus, creating a blueprint for a fully operational system that will meet the needs of the public. New California users as well as the first group of Pacific Northwest users are slated to join the ShakeAlert beta test group in the fall of 2013.

User-centered development and testing of a monitoring system that provides feedback regarding physical functioning to elderly people

Science.gov (United States)

Vermeulen, Joan; Neyens, Jacques CL; Spreeuwenberg, Marieke D; van Rossum, Erik; Sipers, Walther; Habets, Herbert; Hewson, David J; de Witte, Luc P

2013-01-01

Purpose To involve elderly people during the development of a mobile interface of a monitoring system that provides feedback to them regarding changes in physical functioning and to test the system in a pilot study. Methods and participants The iterative user-centered development process consisted of the following phases: (1) selection of user representatives; (2) analysis of users and their context; (3) identification of user requirements; (4) development of the interface; and (5) evaluation of the interface in the lab. Subsequently, the monitoring and feedback system was tested in a pilot study by five patients who were recruited via a geriatric outpatient clinic. Participants used a bathroom scale to monitor weight and balance, and a mobile phone to monitor physical activity on a daily basis for six weeks. Personalized feedback was provided via the interface of the mobile phone. Usability was evaluated on a scale from 1 to 7 using a modified version of the Post-Study System Usability Questionnaire (PSSUQ); higher scores indicated better usability. Interviews were conducted to gain insight into the experiences of the participants with the system. Results The developed interface uses colors, emoticons, and written and/or spoken text messages to provide daily feedback regarding (changes in) weight, balance, and physical activity. The participants rated the usability of the monitoring and feedback system with a mean score of 5.2 (standard deviation 0.90) on the modified PSSUQ. The interviews revealed that most participants liked using the system and appreciated that it signaled changes in their physical functioning. However, usability was negatively influenced by a few technical errors. Conclusion Involvement of elderly users during the development process resulted in an interface with good usability. However, the technical functioning of the monitoring system needs to be optimized before it can be used to support elderly people in their self-management. PMID

Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory.

Science.gov (United States)

Rahimi, Bahlol; Timpka, Toomas; Vimarlund, Vivian; Uppugunduri, Srinivas; Svensson, Mikael

2009-12-31

Computerized provider order entry (CPOE) systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0%) and 176 from 741 physicians (23.8%). Data were analyzed using descriptive-analytical statistical methods. More nurses (56.7%) than physicians (31.3%) stated that the CPOE system introduction had worked well in their clinical setting (P system not adapted to their specific professional practice (P = system (P = 0.041). We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance, we emphasize that CPOE system designers and healthcare decision-makers should continually collect users' feedback about the systems, while

Current status of system development to provide databases of nuclides migration

International Nuclear Information System (INIS)

Sasamoto, Hiroshi; Yoshida, Yasushi; Isogai, Takeshi; Suyama, Tadahiro; Shibata, Masahiro; Yui, Mikazu; Jintoku, Takashi

2005-01-01

JNC has developed databases of nuclides migration for safety assessment of high-level radioactive waste (HLW) repository, and they have been used in the second progress report to present the technical reliability of HLW geological disposal system in Japan. The technical level and applicability of databases have been highly evaluated even overseas. To provide the databases broadly over the world and to promote the use of the databases, we have performed the followings: 1) development of tools to convert the database format from geochemical code PHREEQE to PHREEQC, GWB and EQ3/6 and 2) set up a web site (http://migrationdb.jnc.go.jp) which enables the public to access to the databases. As a result, the number of database users has significantly increased. Additionally, a number of useful comments from the users can be applied to modification and/or update of databases. (author)

Providing Internet Access to the Ohio Career Information System for All Residents: A Feasibility Study.

Science.gov (United States)

Lewis, Morgan V.

Expanded Internet access to the Ohio Career Information System (OCIS) would provide adults in Ohio who need to or wish to make career changes with the best available information about occupations, education and training programs, and financial aid. In order to determine the feasibility of improving access without cost to users, an advisory group,…

COMFORT PROVIDING SYSTEMS IN SPACES WITH ACOUTIC INSULATION

Directory of Open Access Journals (Sweden)

Grzegorz KLEKOT

2014-12-01

Full Text Available High capacities of currently available devices for sound registering and processing have generated a need for sound insulated spaces dedicated to exchange of confidential information. In such spaces, preventing propagation of vibroacoustic signals both by the way of air and construction elements entails complete insulation of the room. In order to meet this requirement, proper chemical composition of air and stabilized temperature conditions have to be guaranteed. The paper discusses questions related to the process of solving the task of providing thermal comfort and satisfying air quality in a room for confidential discussions. It presents prototype solutions of installations dedicated to stabilize human-friendly conditions inside a modular chamber provided with acoustic insulation.

Physicians' and Nurses' Opinions about the Impact of a Computerized Provider Order Entry System on Their Workflow.

Science.gov (United States)

Ayatollahi, Haleh; Roozbehi, Masoud; Haghani, Hamid

2015-01-01

In clinical practices, the use of information technology, especially computerized provider order entry (CPOE) systems, has been found to be an effective strategy to improve patient care. This study aimed to compare physicians' and nurses' views about the impact of CPOE on their workflow. This case study was conducted in 2012. The potential participants included all physicians (n = 28) and nurses (n = 145) who worked in a teaching hospital. Data were collected using a five-point Likert-scale questionnaire and were analyzed using SPSS version 18.0. The results showed a significant difference between physicians' and nurses' views about the impact of the system on interorganizational workflow (p = .001) and working relationships between physicians and nurses (p = .017). Interorganizational workflow and working relationships between care providers are important issues that require more attention. Before a CPOE system is designed, it is necessary to identify workflow patterns and hidden structures to avoid compromising quality of care and patient safety.

Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region.

Science.gov (United States)

Barbarito, Fulvio; Pinciroli, Francesco; Mason, John; Marceglia, Sara; Mazzola, Luca; Bonacina, Stefano

2012-08-01

Information technologies (ITs) have now entered the everyday workflow in a variety of healthcare providers with a certain degree of independence. This independence may be the cause of difficulty in interoperability between information systems and it can be overcome through the implementation and adoption of standards. Here we present the case of the Lombardy Region, in Italy, that has been able, in the last 10 years, to set up the Regional Social and Healthcare Information System, connecting all the healthcare providers within the region, and providing full access to clinical and health-related documents independently from the healthcare organization that generated the document itself. This goal, in a region with almost 10 millions citizens, was achieved through a twofold approach: first, the political and operative push towards the adoption of the Health Level 7 (HL7) standard within single hospitals and, second, providing a technological infrastructure for data sharing based on interoperability specifications recognized at the regional level for messages transmitted from healthcare providers to the central domain. The adoption of such regional interoperability specifications enabled the communication among heterogeneous systems placed in different hospitals in Lombardy. Integrating the Healthcare Enterprise (IHE) integration profiles which refer to HL7 standards are adopted within hospitals for message exchange and for the definition of integration scenarios. The IHE patient administration management (PAM) profile with its different workflows is adopted for patient management, whereas the Scheduled Workflow (SWF), the Laboratory Testing Workflow (LTW), and the Ambulatory Testing Workflow (ATW) are adopted for order management. At present, the system manages 4,700,000 pharmacological e-prescriptions, and 1,700,000 e-prescriptions for laboratory exams per month. It produces, monthly, 490,000 laboratory medical reports, 180,000 radiology medical reports, 180

Organization-wide adoption of computerized provider order entry systems: a study based on diffusion of innovations theory

Directory of Open Access Journals (Sweden)

Timpka Toomas

2009-12-01

Full Text Available Abstract Background Computerized provider order entry (CPOE systems have been introduced to reduce medication errors, increase safety, improve work-flow efficiency, and increase medical service quality at the moment of prescription. Making the impact of CPOE systems more observable may facilitate their adoption by users. We set out to examine factors associated with the adoption of a CPOE system for inter-organizational and intra-organizational care. Methods The diffusion of innovation theory was used to understand physicians' and nurses' attitudes and thoughts about implementation and use of the CPOE system. Two online survey questionnaires were distributed to all physicians and nurses using a CPOE system in county-wide healthcare organizations. The number of complete questionnaires analyzed was 134 from 200 nurses (67.0% and 176 from 741 physicians (23.8%. Data were analyzed using descriptive-analytical statistical methods. Results More nurses (56.7% than physicians (31.3% stated that the CPOE system introduction had worked well in their clinical setting (P P = P = 0.041. We found that in particular the received relative advantages of the CPOE system were estimated to be significantly (P P Conclusions Qualifications for CPOE adoption as defined by three attributes of diffusion of innovation theory were not satisfied in the study setting. CPOE systems are introduced as a response to the present limitations in paper-based systems. In consequence, user expectations are often high on their relative advantages as well as on a low level of complexity. Building CPOE systems therefore requires designs that can provide rather important additional advantages, e.g. by preventing prescription errors and ultimately improving patient safety and safety of clinical work. The decision-making process leading to the implementation and use of CPOE systems in healthcare therefore has to be improved. As any change in health service settings usually faces resistance

Influencing Anesthesia Provider Behavior Using Anesthesia Information Management System Data for Near Real-Time Alerts and Post Hoc Reports.

Science.gov (United States)

Epstein, Richard H; Dexter, Franklin; Patel, Neil

2015-09-01

In this review article, we address issues related to using data from anesthesia information management systems (AIMS) to deliver near real-time alerts via AIMS workstation popups and/or alphanumeric pagers and post hoc reports via e-mail. We focus on reports and alerts for influencing the behavior of anesthesia providers (i.e., anesthesiologists, anesthesia residents, and nurse anesthetists). Multiple studies have shown that anesthesia clinical decision support (CDS) improves adherence to protocols and increases financial performance through facilitation of billing, regulatory, and compliance documentation; however, improved clinical outcomes have not been demonstrated. We inform developers and users of feedback systems about the multitude of concerns to consider during development and implementation of CDS to increase its effectiveness and to mitigate its potentially disruptive aspects. We discuss the timing and modalities used to deliver messages, implications of outlier-only versus individualized feedback, the need to consider possible unintended consequences of such feedback, regulations, sustainability, and portability among systems. We discuss statistical issues related to the appropriate evaluation of CDS efficacy. We provide a systematic review of the published literature (indexed in PubMed) of anesthesia CDS and offer 2 case studies of CDS interventions using AIMS data from our own institution illustrating the salient points. Because of the considerable expense and complexity of maintaining near real-time CDS systems, as compared with providing individual reports via e-mail after the fact, we suggest that if the same goal can be accomplished via delayed reporting versus immediate feedback, the former approach is preferable. Nevertheless, some processes require near real-time alerts to produce the desired improvement. Post hoc e-mail reporting from enterprise-wide electronic health record systems is straightforward and can be accomplished using system

Efficient transportation for Vermont : optimal statewide transit networks.

Science.gov (United States)

2011-01-01

"Public transit systems are receiving increased attention as viable solutions to problems with : transportation system robustness, energy-efficiency and equity. The over-reliance on a single : mode, the automobile, is a threat to system robustness. I...

Using Model-Based Systems Engineering To Provide Artifacts for NASA Project Life-Cycle and Technical Reviews

Science.gov (United States)

Parrott, Edith L.; Weiland, Karen J.

2017-01-01

The ability of systems engineers to use model-based systems engineering (MBSE) to generate self-consistent, up-to-date systems engineering products for project life-cycle and technical reviews is an important aspect for the continued and accelerated acceptance of MBSE. Currently, many review products are generated using labor-intensive, error-prone approaches based on documents, spreadsheets, and chart sets; a promised benefit of MBSE is that users will experience reductions in inconsistencies and errors. This work examines features of SysML that can be used to generate systems engineering products. Model elements, relationships, tables, and diagrams are identified for a large number of the typical systems engineering artifacts. A SysML system model can contain and generate most systems engineering products to a significant extent and this paper provides a guide on how to use MBSE to generate products for project life-cycle and technical reviews. The use of MBSE can reduce the schedule impact usually experienced for review preparation, as in many cases the review products can be auto-generated directly from the system model. These approaches are useful to systems engineers, project managers, review board members, and other key project stakeholders.

Validation of mean glandular dose values provided by a digital breast tomosynthesis system in Brazil

International Nuclear Information System (INIS)

Beraldo O, B.; Paixao, L.; Donato da S, S.; Araujo T, M. H.; Nogueira, M. S.

2014-08-01

Digital breast tomosynthesis (DBT) is an emerging imaging modality that provides quasi-three-dimensional structural information of the breast and has strong promise to improve the differentiation of normal tissue and suspicious masses reducing the tissue overlaps. DBT images are reconstructed from a sequence of low-dose X-ray projections of the breast acquired at a small number of angles over a limited angular range. The Ho logic Selen ia Dimensions system is equipped with an amorphous Selenium (a-Se) detector layer of 250 μm thickness and a 70 μm pixel pitch. Studies are needed to determine the radiation dose of patients that are undergoing this emerging procedure to compare with the results obtained in DBT images. The mean glandular dose (D G ) is the dosimetric quantity used in quality control of the mammographic systems. The aim of this work is to validate D G values for different breast thicknesses provided by a Ho logic Selen ia Dimensions system using a DBT mode in comparison with the same results obtained by a calibrated 90 X 5-6M-model Radcal ionization chamber. D G values were derived from the incident air kerma (K i ) measurements and tabulated conversion coefficients that are dependent on the half value layer (HVL) of the X-ray spectrum. Voltage and tube loading values were recorded in irradiations using W/Al anode/filter combination, automatic exposure control mode and polymethyl methacrylate (PMMA) slabs which simulate different breast thicknesses. For K i measurements, the ionization chamber was positioned at 655 mm from the focus and the same radiographic technique values were selected with the manual mode. D G values for a complete procedure ranged from 0.9 ± 0.1 to 3.7 ± 0.4 mGy. The results for different breast thicknesses are in accordance with values obtained by DBT images and with acceptable levels established by the Commission of the European Communities (Cec) and the International Atomic Energy Agency (IAEA). This work contributes to

Validation of mean glandular dose values provided by a digital breast tomosynthesis system in Brazil

Energy Technology Data Exchange (ETDEWEB)

Beraldo O, B.; Paixao, L.; Donato da S, S. [Centro de Desenvolvimento da Tecnologia Nuclear / CNEN, Post-graduation in Sciences and Technology of Radiations Minerals and Materials, Pte. Antonio Carlos 6627, 31270-901 Belo Horizonte (Brazil); Araujo T, M. H. [Dr Maria Helena Araujo Teixeira Clinic, Guajajaras 40, 30180-100 Belo Horizonte (Brazil); Nogueira, M. S., E-mail: bbo@cdtn.br [Centro de Desenvolvimento da Tecnologia Nuclear / CNEN, Pte. Antonio Carlos 6627, 31270-901 Belo Horizonte (Brazil)

2014-08-15

Digital breast tomosynthesis (DBT) is an emerging imaging modality that provides quasi-three-dimensional structural information of the breast and has strong promise to improve the differentiation of normal tissue and suspicious masses reducing the tissue overlaps. DBT images are reconstructed from a sequence of low-dose X-ray projections of the breast acquired at a small number of angles over a limited angular range. The Ho logic Selen ia Dimensions system is equipped with an amorphous Selenium (a-Se) detector layer of 250 μm thickness and a 70 μm pixel pitch. Studies are needed to determine the radiation dose of patients that are undergoing this emerging procedure to compare with the results obtained in DBT images. The mean glandular dose (D{sub G}) is the dosimetric quantity used in quality control of the mammographic systems. The aim of this work is to validate D{sub G} values for different breast thicknesses provided by a Ho logic Selen ia Dimensions system using a DBT mode in comparison with the same results obtained by a calibrated 90 X 5-6M-model Radcal ionization chamber. D{sub G} values were derived from the incident air kerma (K{sub i}) measurements and tabulated conversion coefficients that are dependent on the half value layer (HVL) of the X-ray spectrum. Voltage and tube loading values were recorded in irradiations using W/Al anode/filter combination, automatic exposure control mode and polymethyl methacrylate (PMMA) slabs which simulate different breast thicknesses. For K{sub i} measurements, the ionization chamber was positioned at 655 mm from the focus and the same radiographic technique values were selected with the manual mode. D{sub G} values for a complete procedure ranged from 0.9 ± 0.1 to 3.7 ± 0.4 mGy. The results for different breast thicknesses are in accordance with values obtained by DBT images and with acceptable levels established by the Commission of the European Communities (Cec) and the International Atomic Energy Agency (IAEA

State-of-the-art incore detector system provides operational and safety benefits: Example, Hanford N Reactor

International Nuclear Information System (INIS)

Toffer, H.

1988-08-01

A presentation on the operational and safety benefits that can be derived from a state-of-the-art incore neutron monitoring system has been prepared for the DOE/ANL training course on ''The Potential Safety Impact of New and Emerging Technologies on the Operation of DOE Nuclear Facilities.'' Advanced incore neutron flux monitoring systems have been installed in some commercial reactors and should be considered for any new reactor designs or as backfits to existing plants. The recent installation of such a system at the Hanford N Reactor is used as an example in this presentation. Unfortunately, N Reactor has been placed in a cold standby condition and the full core incore system has not been tested under power conditions. Nevertheless, the evaluations that preceded the installation of the full core system provide interesting insight into the operational and safety benefits that could be expected

VT Data - Parcels Available by Town

Data.gov (United States)

Vermont Center for Geographic Information — Vermont parcel data, downloadable by individual municipality. Includes:standardized parcel-data (where available), most of which is provided via the Statewide...

Census 2000 Places (cen00pl02)

Data.gov (United States)

California Natural Resource Agency — Census 2000 Place Names provides a seamless statewide GIS layer of places, including census designated places (CDP), consolidated cities, and incorporated places,...

Designated Places

Data.gov (United States)

California Natural Resource Agency — Census 2000 Place Names provides a seamless statewide GIS layer of places, including census designated places (CDP), consolidated cities, and incorporated places,...

Inactivated Influenza Vaccine That Provides Rapid, Innate-Immune-System-Mediated Protection and Subsequent Long-Term Adaptive Immunity.

Science.gov (United States)

Chua, Brendon Y; Wong, Chinn Yi; Mifsud, Edin J; Edenborough, Kathryn M; Sekiya, Toshiki; Tan, Amabel C L; Mercuri, Francesca; Rockman, Steve; Chen, Weisan; Turner, Stephen J; Doherty, Peter C; Kelso, Anne; Brown, Lorena E; Jackson, David C

2015-10-27

The continual threat to global health posed by influenza has led to increased efforts to improve the effectiveness of influenza vaccines for use in epidemics and pandemics. We show in this study that formulation of a low dose of inactivated detergent-split influenza vaccine with a Toll-like receptor 2 (TLR2) agonist-based lipopeptide adjuvant (R4Pam2Cys) provides (i) immediate, antigen-independent immunity mediated by the innate immune system and (ii) significant enhancement of antigen-dependent immunity which exhibits an increased breadth of effector function. Intranasal administration of mice with vaccine formulated with R4Pam2Cys but not vaccine alone provides protection against both homologous and serologically distinct (heterologous) viral strains within a day of administration. Vaccination in the presence of R4Pam2Cys subsequently also induces high levels of systemic IgM, IgG1, and IgG2b antibodies and pulmonary IgA antibodies that inhibit hemagglutination (HA) and neuraminidase (NA) activities of homologous but not heterologous virus. Improved primary virus nucleoprotein (NP)-specific CD8(+) T cell responses are also induced by the use of R4Pam2Cys and are associated with robust recall responses to provide heterologous protection. These protective effects are demonstrated in wild-type and antibody-deficient animals but not in those depleted of CD8(+) T cells. Using a contact-dependent virus transmission model, we also found that heterologous virus transmission from vaccinated mice to naive mice is significantly reduced. These results demonstrate the potential of adding a TLR2 agonist to an existing seasonal influenza vaccine to improve its utility by inducing immediate short-term nonspecific antiviral protection and also antigen-specific responses to provide homologous and heterologous immunity. The innate and adaptive immune systems differ in mechanisms, specificities, and times at which they take effect. The innate immune system responds within hours of

Trust and trust relations from the providers' perspective: the case of the healthcare system in India.

Science.gov (United States)

Kane, Sumit; Calnan, Michael; Radkar, Anjali

2015-01-01

Commentators suggest that there is an erosion of trust in the relations between different actors in the health system in India. This paper presents the results of an exploratory study of the situation of providers in an urban setting in western India, the nature of their relations in terms of trust and what influences these relations. The data on relationships of trust were collected through interviews and focus group discussions with key informants, including public and private providers, regulators, managers and societal actors, such as patients/citizens, politicians and the media.

Providers' perceptions of the implementation of a performance measurement system for substance abuse treatment: A process evaluation of the Service Quality Measures initiative.

Science.gov (United States)

Myers, Bronwyn; Williams, Petal Petersen; Johnson, Kim; Govender, Rajen; Manderscheid, Ron; Koch, J Randy

2016-02-22

In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measurement system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. To describe providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation. We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.

Immunization registries in the EMR Era

Science.gov (United States)

Stevens, Lindsay A.; Palma, Jonathan P.; Pandher, Kiran K.; Longhurst, Christopher A.

2013-01-01

Background: The CDC established a national objective to create population-based tracking of immunizations through regional and statewide registries nearly 2 decades ago, and these registries have increased coverage rates and reduced duplicate immunizations. With increased adoption of commercial electronic medical records (EMR), some institutions have used unidirectional links to send immunization data to designated registries. However, access to these registries within a vendor EMR has not been previously reported. Purpose: To develop a visually integrated interface between an EMR and a statewide immunization registry at a previously non-reporting hospital, and to assess subsequent changes in provider use and satisfaction. Methods: A group of healthcare providers were surveyed before and after implementation of the new interface. The surveys addressed access of the California Immunization Registry (CAIR), and satisfaction with the availability of immunization information. Information Technology (IT) teams developed a “smart-link” within the electronic patient chart that provides a single-click interface for visual integration of data within the CAIR database. Results: Use of the tool has increased in the months since its initiation, and over 20,000 new immunizations have been exported successfully to CAIR since the hospital began sharing data with the registry. Survey data suggest that providers find this tool improves workflow and overall satisfaction with availability of immunization data. (p=0.009). Conclusions: Visual integration of external registries into a vendor EMR system is feasible and improves provider satisfaction and registry reporting. PMID:23923096

Using Model-Based System Engineering to Provide Artifacts for NASA Project Life-Cycle and Technical Reviews Presentation

Science.gov (United States)

Parrott, Edith L.; Weiland, Karen J.

2017-01-01

This is the presentation for the AIAA Space conference in September 2017. It highlights key information from Using Model-Based Systems Engineering to Provide Artifacts for NASA Project Life-cycle and Technical Reviews paper.

POSSIBILITY OF IMPROVING EXISTING STANDARDS AND METHODOLOGIES FOR AUDITING INFORMATION SYSTEMS TO PROVIDE E-GOVERNMENT SERVICES

Directory of Open Access Journals (Sweden)

Евгений Геннадьевич Панкратов

2014-03-01

Full Text Available This article analyzes the existing methods of e-government systems audit, their shortcomings are examined.  The approaches to improve existing techniques and adapt them to the specific characteristics of e-government systems are suggested. The paper describes the methodology, providing possibilities of integrated assessment of information systems. This methodology uses systems maturity models and can be used in the construction of e-government rankings, as well as in the audit of their implementation process. Maturity models are based on COBIT, COSO methodologies and models of e-government, developed by the relevant committee of the UN. The methodology was tested during the audit of information systems involved in the payment of temporary disability benefits. The audit was carried out during analysis of the outcome of the pilot project for the abolition of the principle of crediting payments for disability benefits.DOI: http://dx.doi.org/10.12731/2218-7405-2014-2-5

Second California Assessment: Integrated climate change impacts assessment of natural and managed systems. Guest editorial

Science.gov (United States)

Franco, G.; Cayan, D.R.; Moser, S.; Hanemann, M.; Jones, M.A.

2011-01-01

Since 2006 the scientific community in California, in cooperation with resource managers, has been conducting periodic statewide studies about the potential impacts of climate change on natural and managed systems. This Special Issue is a compilation of revised papers that originate from the most recent assessment that concluded in 2009. As with the 2006 studies that influenced the passage of California's landmark Global Warming Solutions Act (AB32), these papers have informed policy formulation at the state level, helping bring climate adaptation as a complementary measure to mitigation. We provide here a brief introduction to the papers included in this Special Issue focusing on how they are coordinated and support each other. We describe the common set of downscaled climate and sea-level rise scenarios used in this assessment that came from six different global climate models (GCMs) run under two greenhouse gas emissions scenarios: B1 (low emissions) and A2 (a medium-high emissions). Recommendations for future state assessments, some of which are being implemented in an on-going new assessment that will be completed in 2012, are offered. ?? 2011 Springer Science+Business Media B.V.

Best practices: the Utah Youth Suicide Study: best practices for suicide prevention through the juvenile court system.

Science.gov (United States)

Gray, Doug; Dawson, Kristin L; Grey, Todd C; McMahon, William M

2011-12-01

Utah is among a group of Western Mountain states in which suicide rates among youths are consistently high. The Utah Youth Suicide Study incorporated data from every government agency in Utah, utilizing a statewide Office of the Medical Examiner. A key finding was that 63% of suicide decedents had contact with the juvenile courts. The group developed a best practices model within the juvenile court system for early mental health intervention. Significant cost savings were demonstrated. The model includes screening at-risk teenagers with the Youth Outcome Questionnaire. Treatment includes both psychiatric care and in-home behavioral intervention. Services were effectively delivered on a large scale.

Benefits of Demand Side Response in Providing Frequency Response Service in the Future GB Power System

Directory of Open Access Journals (Sweden)

Fei eTeng

2015-08-01

Full Text Available The demand for ancillary service is expected to increase significantly in the future GB electricity system due to high penetration of wind. In particular, the need for frequency response, required to deal with sudden frequency drops following a loss of generator, will increase because of the limited inertia capability of wind plants. This paper quantifies the requirements for primary frequency response and analyses the benefits of frequency response provision from DSR. The results show dramatic changes in frequency response requirements driven by high penetration of wind. Case studies carried out by using an advanced stochastic generation scheduling model suggest that the provision of frequency response from DSR could greatly reduce the system operation cost, wind curtailment and carbon emissions in the future GB system characterised by high penetration of wind. Furthermore, the results demonstrate that the benefit of DSR shows significant diurnal and seasonal variation, whereas an even more rapid (instant delivery of frequency response from DSR could provide significant additional value. Our studies also indicate that the competing technologies to DSR, namely battery storage and more flexible generation could potentially reduce its value by up to 35%, still leaving significant room to deploy DSR as frequency response provider.

Benefits of Demand-Side Response in Providing Frequency Response Service in the Future GB Power System

Energy Technology Data Exchange (ETDEWEB)

Teng, Fei, E-mail: fei.teng09@imperial.ac.uk; Aunedi, Marko; Pudjianto, Danny; Strbac, Goran [Department of Electrical and Electronic Engineering, Imperial College London, London (United Kingdom)

2015-08-18

The demand for ancillary service is expected to increase significantly in the future Great Britain (GB) electricity system due to high penetration of wind. In particular, the need for frequency response, required to deal with sudden frequency drops following a loss of generator, will increase because of the limited inertia capability of wind plants. This paper quantifies the requirements for primary frequency response and analyses the benefits of frequency response provision from demand-side response (DSR). The results show dramatic changes in frequency response requirements driven by high penetration of wind. Case studies carried out by using an advanced stochastic generation scheduling model suggest that the provision of frequency response from DSR could greatly reduce the system operation cost, wind curtailment, and carbon emissions in the future GB system characterized by high penetration of wind. Furthermore, the results demonstrate that the benefit of DSR shows significant diurnal and seasonal variation, whereas an even more rapid (instant) delivery of frequency response from DSR could provide significant additional value. Our studies also indicate that the competing technologies to DSR, namely battery storage, and more flexible generation could potentially reduce its value by up to 35%, still leaving significant room to deploy DSR as frequency response provider.

Benefits of Demand-Side Response in Providing Frequency Response Service in the Future GB Power System

International Nuclear Information System (INIS)

Teng, Fei; Aunedi, Marko; Pudjianto, Danny; Strbac, Goran

2015-01-01

The demand for ancillary service is expected to increase significantly in the future Great Britain (GB) electricity system due to high penetration of wind. In particular, the need for frequency response, required to deal with sudden frequency drops following a loss of generator, will increase because of the limited inertia capability of wind plants. This paper quantifies the requirements for primary frequency response and analyses the benefits of frequency response provision from demand-side response (DSR). The results show dramatic changes in frequency response requirements driven by high penetration of wind. Case studies carried out by using an advanced stochastic generation scheduling model suggest that the provision of frequency response from DSR could greatly reduce the system operation cost, wind curtailment, and carbon emissions in the future GB system characterized by high penetration of wind. Furthermore, the results demonstrate that the benefit of DSR shows significant diurnal and seasonal variation, whereas an even more rapid (instant) delivery of frequency response from DSR could provide significant additional value. Our studies also indicate that the competing technologies to DSR, namely battery storage, and more flexible generation could potentially reduce its value by up to 35%, still leaving significant room to deploy DSR as frequency response provider.

Healing or harming? Healthcare provider interactions with injured workers and insurers in workers' compensation systems.

Science.gov (United States)

Kilgour, Elizabeth; Kosny, Agnieszka; McKenzie, Donna; Collie, Alex

2015-03-01

Healthcare providers (HCPs) are influential in the injured worker's recovery process and fulfil many roles in the delivery of health services. Interactions between HCPs and insurers can also affect injured workers' engagement in rehabilitation and subsequently their recovery and return to work. Consideration of the injured workers' perceptions and experiences as consumers of medical and compensation services can provide vital information about the quality, efficacy and impact of such systems. The aim of this systematic review was to identify and synthesize published qualitative research that focused on the interactions between injured workers, HCPs and insurers in workers' compensation systems in order to identify processes or interactions which impact injured worker recovery. A search of six electronic databases for literature published between 1985 and 2012 revealed 1,006 articles. Screening for relevance identified 27 studies which were assessed for quality against set criteria. A final 13 articles of medium and high quality were retained for data extraction. Findings were synthesized using a meta-ethnographic approach. Injured workers reported that HCPs could play both healing and harming roles in their recovery. Supportive patient-centred interaction with HCPs is important for injured workers. Difficult interactions between HCPs and insurers were highlighted in themes of adversarial relations and organisational pressures. Insurer and compensation system processes exerted an influence on the therapeutic relationship. Recommendations to improve relationships included streamlining administrative demands and increasing education and communication between the parties. Injured workers with long term complex injuries experience difficulties with healthcare in the workers' compensation context. Changes in insurer administrative demands and compensation processes could increase HCP participation and job satisfaction. This in turn may improve injured worker recovery

Impact of Helmet Use on Injury and Financial Burden of Motorcycle and Moped Crashes in Hawai‘i: Analysis of a Linked Statewide Database

Science.gov (United States)

Castel, Nikki A; Wong, Linda L; Steinemann, Susan

2016-01-01

Helmet use reduces injury severity, disability, hospital length of stay, and hospital charges in motorcycle riders. The public absorbs billions of dollars annually in hospital charges for unhelmeted, uninsured motorcycle riders. We sought to quantify, on a statewide level, the healthcare burden of unhelmeted motorcycle and moped riders. We examined 1,965 emergency medical service (EMS) reports from motorcycle and moped crashes in Hawai‘i between 2007–2009. EMS records were linked to hospital medical records to assess associations between vehicle type, helmet use, medical charges, diagnoses, and final disposition. Unhelmeted riders of either type of vehicle suffered more head injuries, especially skull fractures (adjusted odds ratio (OR) of 4.48, P motorcycle and moped riders, with a significant (P = .006) difference between helmeted ($27,176) and unhelmeted ($40,217) motorcycle riders. Unhelmeted riders were twice as likely to self-pay (19.3%, versus 9.8% of helmeted riders), and more likely to have Medicaid or a similar income-qualifying insurance plan (13.5% versus 5.0%, respectively). Protective associations with helmet use are stronger among motorcyclists than moped riders, suggesting the protective effect is augmented in higher speed crashes. The public financial burden is higher from unhelmeted riders who sustain more severe injuries and are less likely to be insured. PMID:27980882

Role of Surgical Services in Profitability of Hospitals in California: An Analysis of Office of Statewide Health Planning and Development Annual Financial Data.

Science.gov (United States)

Moazzez, Ashkan; de Virgilio, Christian

2016-10-01

With constant changes in health-care laws and payment methods, profitability, and financial sustainability of hospitals are of utmost importance. The purpose of this study is to determine the relationship between surgical services and hospital profitability. The Office of Statewide Health Planning and Development annual financial databases for the years 2009 to 2011 were used for this study. The hospitals' characteristics and income statement elements were extracted for statistical analysis using bivariate and multivariate linear regression. A total of 989 financial records of 339 hospitals were included. On bivariate analysis, the number of inpatient and ambulatory operating rooms (ORs), the number of cases done both as inpatient and outpatient in each OR, and the average minutes used in inpatient ORs were significantly related with the net income of the hospital. On multivariate regression analysis, when controlling for hospitals' payer mix and the study year, only the number of inpatient cases done in the inpatient ORs (β = 832, P = 0.037), and the number of ambulatory ORs (β = 1,485, 466, P = 0.001) were significantly related with the net income of the hospital. These findings suggest that hospitals can maximize their profitability by diverting and allocating outpatient surgeries to ambulatory ORs, to allow for more inpatient surgeries.

Porous TiO2-Based Gas Sensors for Cyber Chemical Systems to Provide Security and Medical Diagnosis

Science.gov (United States)

2017-01-01

Gas sensors play an important role in our life, providing control and security of technical processes, environment, transportation and healthcare. Consequently, the development of high performance gas sensor devices is the subject of intense research. TiO2, with its excellent physical and chemical properties, is a very attractive material for the fabrication of chemical sensors. Meanwhile, the emerging technologies are focused on the fabrication of more flexible and smart systems for precise monitoring and diagnosis in real-time. The proposed cyber chemical systems in this paper are based on the integration of cyber elements with the chemical sensor devices. These systems may have a crucial effect on the environmental and industrial safety, control of carriage of dangerous goods and medicine. This review highlights the recent developments on fabrication of porous TiO2-based chemical gas sensors for their application in cyber chemical system showing the convenience and feasibility of such a model to provide the security and to perform the diagnostics. The most of reports have demonstrated that the fabrication of doped, mixed and composite structures based on porous TiO2 may drastically improve its sensing performance. In addition, each component has its unique effect on the sensing properties of material. PMID:29257076

Supercapacitor to Provide Ancillary Services: Preprint

Energy Technology Data Exchange (ETDEWEB)

Muljadi, Eduard [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Gevorgian, Vahan [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Luo, Yusheng [Idaho National Laboratory; Mohanpurkar, M. [Idaho National Laboratory; Hovsapian, R. [Idaho National Laboratory; Koritarov, V. [Argonne National Laboratory

2017-10-09

Supercapacitor technology has reached a level of maturity as a viable energy storage option available to support a modern electric power system grid; however, its application is still limited because of its energy capacity and the cost of the commercial product. In this paper, we demonstrate transient models of supercapacitor energy storage plants operating in coordination with run-of-the-river (ROR), doubly-fed induction generator hydropower plants (HPP) using a system control concept and architecture developed. A detailed transient model of a supercapacitor energy storage device is coupled with the grid via a three-phase inverter/rectifier and bidirectional DC-DC converter. In addition, we use a version of a 14-bus IEEE test case that includes the models of the supercapacitor energy storage device, ROR HPPs, and synchronous condensers that use the rotating synchronous generators of retired coal-powered plants. The purpose of the synchronous condensers is to enhance the system stability by providing voltage and reactive power control, provide power system oscillations damping, and maintain system inertia at secure levels. The control layer provides coordinated, decentralized operation of distributed ROR HPPs and energy storage as aggregate support to power system operations.

Maryland's Helicopter Emergency Medical Services Experience From 2001 to 2011: System Improvements and Patients' Outcomes.

Science.gov (United States)

Hirshon, Jon Mark; Galvagno, Samuel M; Comer, Angela; Millin, Michael G; Floccare, Douglas J; Alcorta, Richard L; Lawner, Benjamin J; Margolis, Asa M; Nable, Jose V; Bass, Robert R

2016-03-01

Helicopter emergency medical services (EMS) has become a well-established component of modern trauma systems. It is an expensive, limited resource with potential safety concerns. Helicopter EMS activation criteria intended to increase efficiency and reduce inappropriate use remain elusive and difficult to measure. This study evaluates the effect of statewide field trauma triage changes on helicopter EMS use and patient outcomes. Data were extracted from the helicopter EMS computer-aided dispatch database for in-state scene flights and from the state Trauma Registry for all trauma patients directly admitted from the scene or transferred to trauma centers from July 1, 2000, to June 30, 2011. Computer-aided dispatch flights were analyzed for periods corresponding to field triage protocol modifications intended to improve system efficiency. Outcomes were separately analyzed for trauma registry patients by mode of transport. The helicopter EMS computer-aided dispatch data set included 44,073 transports. There was a statewide decrease in helicopter EMS usage for trauma patients of 55.9%, differentially affecting counties closer to trauma centers. The Trauma Registry data set included 182,809 patients (37,407 helicopter transports, 128,129 ambulance transports, and 17,273 transfers). There was an increase of 21% in overall annual EMS scene trauma patients transported; ground transports increased by 33%, whereas helicopter EMS transports decreased by 49%. Helicopter EMS patient acuity increased, with an attendant increase in patient mortality. However, when standardized with W statistics, both helicopter EMS- and ground-transported trauma patients showed sustained improvement in mortality. Modifications to state protocols were associated with decreased helicopter EMS use and overall improved trauma patient outcomes. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Solar diffusion in California: a pilot study. Consultant report

Energy Technology Data Exchange (ETDEWEB)

Rogers, E.M.; Leonard-Barton, D.; Avi-Itzhak, T.; Rosa, E.; Adhikarya, R.

1979-10-01

Solar system owners and their neighbors in the San Francisco Bay Area were studied. The study determined the level of homeowner awareness about residential solar energy systems, described characteristics of consumers purchasing solar equipment (e.g. whether they represent identifiable market segments), identified major channels of communication through which solar information is effectively used, determined remaining barriers to solar use, identified needed incentives to accelerate commercialization, and assessed public attitudes toward various state and Federal government actions to increase the rate of solar energy use statewide. Issues and questions explored are being used in the development of a statewide survey of 700 homeowners in California to determine if these findings apply to residents throughout the state.

PACS-Graz, 1985-2000: from a scientific pilot to a state-wide multimedia radiological information system

Science.gov (United States)

Gell, Guenther

2000-05-01

1971/72 began the implementation of a computerized radiological documentation system as the Department of Radiology of the University of Graz, which developed over the years into a full RIS. 1985 started a scientific cooperation with SIEMENS to develop a PACS. The two systems were linked and evolved into a highly integrated RIS-PACS for the state wide hospital system in Styria. During its lifetime the RIS, originally implemented in FORTRAN on a UNIVAC 494 mainframe migrated to a PDP15, on to a PDP11, then VAX and Alphas. The flexible original record structure with variable length fields and the powerful retrieval language were retained. The data acquisition part with the user interface was rewritten several times and many service programs have been added. During our PACS cooperation many ideas like the folder concept or functionalities of the GUI have been designed and tested and were then implemented in the SIENET product. The actual RIS/PACS supports the whole workflow in the Radiology Department. It is installed in a 2.300 bed university hospital and the smaller hospitals of the State of Styria. Modalities from different vendors are connected via DICOM to the RIS (modality worklist) and to the PACS. PACSubsystems from other vendors have been integrated. Images are distributed to referring clinics and for teleconsultation and image processing and reports are available on line to all connected hospitals. We spent great efforts to guarantee optimal support of the workflow and to ensure an enhanced cost/benefit ratio for each user (class). Another special feature is selective image distribution. Using the high level retrieval language individual filters can be constructed easily to implement any image distribution policy agreed upon by radiologists and referring clinicians.

Motivation and reward systems in service provision: exploring motivators for people providing engineering services

DEFF Research Database (Denmark)

Kreye, Melanie; Nandrup-Bus, Troels

2015-01-01

It is becoming a distinctive feature for manufacturing firms to compete strategically through service provision. In relation to reward systems the aim of this thesis is to investigate what motivates employees of servitized manufacturing firms when providing engineering services and why. Through...... quantitative and qualitative data collection with an international company within the European healthcare sector, the findings show that key motivating factors were to “delight” the customer and being able to take responsibility and accountability for ones work. Service employees were found to feel proud...

Effects of statewide health promotion in primary schools on children’s sick days, visits to a physician and parental absence from work: a cluster-randomized trial

Directory of Open Access Journals (Sweden)

Dorothea Kesztyüs

2016-12-01

Full Text Available Abstract Background Based on the World Health Organization’s global school health initiative we investigate intervention effects of statewide health promotion in schools on the numbers of children’s sick days and visits to a physician, and parental days off work due to child illness. Methods Cluster-randomized trial with 1-year follow-up in primary schools in the state of Baden-Württemberg, Germany. Anthropometric measurements of first and second grade school children were taken by trained staff. Parents filled in questionnaires for information about socio-demographics, health-related variables, numbers of children’s sick days, visits to a physician, and days parents had to stay off work to care for a sick child. Longitudinal differences in the outcome variables were calculated between baseline and follow-up. Intraclass correlation coefficients were determined to quantify a possible clustering of data in schools. Accordingly, linear models and linear mixed models were applied to identify relationships and ascertain significances. Results Data from 1943 children (1st grade n = 1024, 6.6 ± 0.4 years old; 2nd grade n = 919, 7.6 ± 0.4 years old were available at baseline. Unadjusted differences regarding both grades were found between mean longitudinal changes in intervention and control group in children’s sick days (−3.2 ± 7.1 vs. -2.3 ± 5.6, p = 0.013, and maternal days off work (−0.9 ± 2.4 vs. -0.5 ± 2.8, p = 0.019. The intervention effect on sick days was adjusted in a linear regression for baseline values, gender and migration background and confirmed for first grade children (B = −0.83, p = 0.003. The intervention effect on maternal days off work lost its significance after adjusting for baseline values. No significant differences were detected in the numbers of children’s visits to a physician and paternal days off work. Conclusions School-based health promotion

Environmental Data Store: A Web-Based System Providing Management and Exploitation for Multi-Data-Type Environmental Data

Science.gov (United States)

Ji, P.; Piasecki, M.

2012-12-01

With the rapid growth in data volumes, data diversity and data demands from multi-disciplinary research effort, data management and exploitation are increasingly facing significant challenges for environmental scientific community. We describe Environmental data store (EDS), a system we are developing that is a web-based system following an open source implementation to manage and exploit multi-data-type environmental data. EDS provides repository services for the six fundamental data types, which meet the demands of multi-disciplinary environmental research. These data types are: a) Time Series Data, b) GeoSpatial data, c) Digital Data, d) Ex-Situ Sampling data, e) Modeling Data, f) Raster Data. Through data portal, EDS allows for efficient consuming these six types of data placed in data pool, which is made up of different data nodes corresponding to different data types, including iRODS, ODM, THREADS, ESSDB, GeoServer, etc.. EDS data portal offers unified submission interface for the above different data types; provides fully integrated, scalable search across content from the above different data systems; also features mapping, analysis, exporting and visualization, through integration with other software. EDS uses a number of developed systems, follows widely used data standards, and highlights the thematic, semantic, and syntactic support on the submission and search, in order to advance multi-disciplinary environmental research. This system will be installed and develop at the CrossRoads initiative at the City College of New York.

A statewide partnership for reducing readmissions.

Science.gov (United States)

Landman, James H

2013-06-01

Three core programs have heped reduce reedrmissions in Illinois hospitals: Projct BOOST (better Outcomem by Optimizing Safe Transitions), whih focuses on redesigning hospital discharge processes and improving transitions of care. HP3: Hospitalist Program Peak Performance which provides ducational resources, motivation, and a process improvement structure for hospitalist programs. Communications and Palliative Care, which teaches physicians and dclinicians how to work with paients to define their goal of care and identify options to improve their quality of life.

Neighborhood Stabilization Program Data NSP1 (Statewide)

Data.gov (United States)

Department of Housing and Urban Development — HUD's Neighborhood Stabilization Program (www.HUD.gov/nsp) provides emergency assistance to state and local governments to acquire and redevelop foreclosed...

How Statewide LGB Policies Go From “Under Our Skin” to “Into Our Hearts”: Fatherhood Aspirations and Psychological Well-Being Among Emerging Adult Sexual Minority Men

Science.gov (United States)

2013-01-01

Researchers have noted increasingly the public health importance of addressing discriminatory policies towards lesbian, gay, and bisexual (LGB) populations. At present, however, we know little about the mechanisms through which policies affect LGB populations’ psychological well-being; in other words, how do policies get under our skin? Using data from a study of sexual minority young men (N = 1,487; M = 20.80 (SD = 1.93); 65 % White; 92 % gay), we examined whether statewide bans (e.g., same-sex marriage, adoption) moderated the relationship between fatherhood aspirations and psychological well-being. Fatherhood aspirations were associated with lower depressive symptoms and higher self-esteem scores among participants living in states without discriminatory policies. In states with marriage equality bans, fatherhood aspirations were associated with higher depressive symptoms and lower self-esteem scores, respectively. Fatherhood aspirations were associated negatively with self-esteem in states banning same-sex and second parent adoptions, respectively. Our findings underscore the importance of recognizing how anti-equality LGB policies may influence the psychosocial development of sexual minority men. PMID:24233971

The Economic Potential of Three Nuclear-Renewable Hybrid Energy Systems Providing Thermal Energy to Industry

International Nuclear Information System (INIS)

Ruth, Mark; Cutler, Dylan; Flores-Espino, Francisco; Stark, Greg; Jenkin, Thomas

2016-01-01

This report is one of a series of reports that Idaho National Laboratory and National Renewable Energy Laboratory are producing to investigate the technical and economic aspects of nuclear-renewable hybrid energy systems (N-R HESs). Previous reports provided results of an analysis of two N-R HES scenarios. This report builds that analysis with a Texas-synthetic gasoline scenario providing the basis in which the N-R HES sells heat directly to an industrial customer. Subsystems were included that convert electricity to heat, thus allowing the renewable energy subsystem to generate heat and benefit from that revenue stream. Nuclear and renewable energy sources are important to consider in the energy sector's evolution because both are considered to be clean and non-carbon-emitting energy sources.

Use of electronic personal health record systems to encourage HIV screening: an exploratory study of patient and provider perspectives

Directory of Open Access Journals (Sweden)

McInnes D Keith

2011-08-01

Full Text Available Abstract Background When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA health care system. Findings We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory. Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising

A stochastic simulation model for reliable PV system sizing providing for solar radiation fluctuations

International Nuclear Information System (INIS)

Kaplani, E.; Kaplanis, S.

2012-01-01

Highlights: ► Solar radiation data for European cities follow the Extreme Value or Weibull distribution. ► Simulation model for the sizing of SAPV systems based on energy balance and stochastic analysis. ► Simulation of PV Generator-Loads-Battery Storage System performance for all months. ► Minimum peak power and battery capacity required for reliable SAPV sizing for various European cities. ► Peak power and battery capacity reduced by more than 30% for operation 95% success rate. -- Abstract: The large fluctuations observed in the daily solar radiation profiles affect highly the reliability of the PV system sizing. Increasing the reliability of the PV system requires higher installed peak power (P m ) and larger battery storage capacity (C L ). This leads to increased costs, and makes PV technology less competitive. This research paper presents a new stochastic simulation model for stand-alone PV systems, developed to determine the minimum installed P m and C L for the PV system to be energy independent. The stochastic simulation model developed, makes use of knowledge acquired from an in-depth statistical analysis of the solar radiation data for the site, and simulates the energy delivered, the excess energy burnt, the load profiles and the state of charge of the battery system for the month the sizing is applied, and the PV system performance for the entire year. The simulation model provides the user with values for the autonomy factor d, simulating PV performance in order to determine the minimum P m and C L depending on the requirements of the application, i.e. operation with critical or non-critical loads. The model makes use of NASA’s Surface meteorology and Solar Energy database for the years 1990–2004 for various cities in Europe with a different climate. The results obtained with this new methodology indicate a substantial reduction in installed peak power and battery capacity, both for critical and non-critical operation, when compared to

Consumer assessment of healthcare providers and systems surgical care survey: benefits and challenges.

Science.gov (United States)

Schulz, Kristine A; Rhee, John S; Brereton, Jean M; Zema, Carla L; Witsell, David L

2012-10-01

To describe the feasibility and initial results of the implementation of a continuous quality improvement project using the newly available Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS), in a small cohort of otolaryngology-head and neck surgery practices. Prospective observational study using a newly validated health care consumer survey. Two community-based and 2 university-based otolaryngology-head and neck surgery outpatient clinic practices. Fourteen board-certified otolaryngology, head and neck surgeons from 4 practice sites voluntarily participated in this project. All adult patients scheduled for surgery during a 12-month period were asked to complete the S-CAHPS survey through an electronic data capture (EDC) system 7 to 28 days after surgery. The surgeons were not directly involved in administration or collection of survey data. Three sites successfully implemented the S-CAHPS project. A 39.9% response rate was achieved for the cohort of surgical patients entered into the EDC system. While most patients rated their surgeons very high (mean of 9.5 or greater out of 10), subanalysis revealed there is variability among sites and surgeons in communication practices. From these data, a potential surgeon Quality Improvement report was developed that highlights priority areas to improve surgeon-patient rapport. The S-CAHPS survey can be successfully implemented in most otolaryngology practices, and our initial work holds promise for how the survey can be best deployed and analyzed for the betterment of both the surgeon and the patient.

Prehospital Providers' Perceptions on Providing Patient and Family Centered Care.

Science.gov (United States)

Ayub, Emily M; Sampayo, Esther M; Shah, Manish I; Doughty, Cara B

2017-01-01

A gap exists in understanding a provider's approach to delivering care that is mutually beneficial to patients, families, and other providers in the prehospital setting. The purpose of this study was to identify attitudes, beliefs, and perceived barriers to providing patient and family centered care (PFCC) in the prehospital setting and to describe potential solutions for improving PFCC during critical pediatric events. We conducted a qualitative, cross-sectional study of a purposive sample of Emergency Medical Technicians (EMTs) and paramedics from an urban, municipal, fire-based EMS system, who participated in the Pediatric Simulation Training for Emergency Prehospital Providers (PediSTEPPS) course. Two coders reviewed transcriptions of audio recordings from participants' first simulation scenario debriefings and performed constant comparison analysis to identify unifying themes. Themes were verified through member checking with two focus groups of prehospital providers. A total of 122 EMTs and paramedics participated in 16 audiotaped debriefing sessions and two focus groups. Four overarching themes emerged regarding the experience of PFCC by prehospital providers: (1) Perceived barriers included the prehospital environment, limited manpower, multi-tasking medical care, and concern for interference with patient care; (2) Providing emotional support comprised of empathetically comforting caregivers, maintaining a calm demeanor, and empowering families to feel involved; (3) Effective communication strategies consisted of designating a family point person, narration of actions, preempting the next steps, speaking in lay terms, summarizing during downtime, and conveying a positive first impression; (4) Tactics to overcome PFCC barriers were maintaining a line of sight, removing and returning a caregiver to and from the scene, and providing situational awareness. Based on debriefings from simulated scenarios, some prehospital providers identified the provision of

Applying a statewide geospatial leaching tool for assessing soil vulnerability ratings for agrochemicals across the contiguous United States.

Science.gov (United States)

Ki, Seo Jin; Ray, Chittaranjan; Hantush, Mohamed M

2015-06-15

A large-scale leaching assessment tool not only illustrates soil (or groundwater) vulnerability in unmonitored areas, but also can identify areas of potential concern for agrochemical contamination. This study describes the methodology of how the statewide leaching tool in Hawaii modified recently for use with pesticides and volatile organic compounds can be extended to the national assessment of soil vulnerability ratings. For this study, the tool was updated by extending the soil and recharge maps to cover the lower 48 states in the United States (US). In addition, digital maps of annual pesticide use (at a national scale) as well as detailed soil properties and monthly recharge rates (at high spatial and temporal resolutions) were used to examine variations in the leaching (loads) of pesticides for the upper soil horizons. Results showed that the extended tool successfully delineated areas of high to low vulnerability to selected pesticides. The leaching potential was high for picloram, medium for simazine, and low to negligible for 2,4-D and glyphosate. The mass loadings of picloram moving below 0.5 m depth increased greatly in northwestern and central US that recorded its extensive use in agricultural crops. However, in addition to the amount of pesticide used, annual leaching load of atrazine was also affected by other factors that determined the intrinsic aquifer vulnerability such as soil and recharge properties. Spatial and temporal resolutions of digital maps had a great effect on the leaching potential of pesticides, requiring a trade-off between data availability and accuracy. Potential applications of this tool include the rapid, large-scale vulnerability assessments for emerging contaminants which are hard to quantify directly through vadose zone models due to lack of full environmental data. Copyright © 2015 Elsevier Ltd. All rights reserved.

IEEE 802.15.4 Frame Aggregation Enhancement to Provide High Performance in Life-Critical Patient Monitoring Systems.

Science.gov (United States)

Akbar, Muhammad Sajjad; Yu, Hongnian; Cang, Shuang

2017-01-28

In wireless body area sensor networks (WBASNs), Quality of Service (QoS) provision for patient monitoring systems in terms of time-critical deadlines, high throughput and energy efficiency is a challenging task. The periodic data from these systems generates a large number of small packets in a short time period which needs an efficient channel access mechanism. The IEEE 802.15.4 standard is recommended for low power devices and widely used for many wireless sensor networks applications. It provides a hybrid channel access mechanism at the Media Access Control (MAC) layer which plays a key role in overall successful transmission in WBASNs. There are many WBASN's MAC protocols that use this hybrid channel access mechanism in variety of sensor applications. However, these protocols are less efficient for patient monitoring systems where life critical data requires limited delay, high throughput and energy efficient communication simultaneously. To address these issues, this paper proposes a frame aggregation scheme by using the aggregated-MAC protocol data unit (A-MPDU) which works with the IEEE 802.15.4 MAC layer. To implement the scheme accurately, we develop a traffic patterns analysis mechanism to understand the requirements of the sensor nodes in patient monitoring systems, then model the channel access to find the performance gap on the basis of obtained requirements, finally propose the design based on the needs of patient monitoring systems. The mechanism is initially verified using numerical modelling and then simulation is conducted using NS2.29, Castalia 3.2 and OMNeT++. The proposed scheme provides the optimal performance considering the required QoS.

Power system services provided by inverter connected distributed energy resources

DEFF Research Database (Denmark)

For the last few years there has been a significant increase of DER units in Denmark, of those units more and more are connected to the power system using inverters. These inverter connected units have the potential to support the electrical power system with various power system services. One...

The Challenge of Providing Safe Water with an Intermittently Supplied Piped Water Distribution System

Science.gov (United States)

Kumpel, E.; Nelson, K. L.

2012-12-01

An increasing number of urban residents in low- and middle-income countries have access to piped water; however, this water is often not available continuously. 84% of reporting utilities in low-income countries provide piped water for fewer than 24 hours per day (van den Berg and Danilenko, 2010), while no major city in India has continuous piped water supply. Intermittent water supply leaves pipes vulnerable to contamination and forces households to store water or rely on alternative unsafe sources, posing a health threat to consumers. In these systems, pipes are empty for long periods of time and experience low or negative pressure even when water is being supplied, leaving them susceptible to intrusion from sewage, soil, or groundwater. Households with a non-continuous supply must collect and store water, presenting more opportunities for recontamination. Upgrading to a continuous water supply, while an obvious solution to these challenges, is currently out of reach for many resource-constrained utilities. Despite its widespread prevalence, there are few data on the mechanisms causing contamination in an intermittent supply and the frequency with which it occurs. Understanding the impact of intermittent operation on water quality can lead to strategies to improve access to safe piped water for the millions of people currently served by these systems. We collected over 100 hours of continuous measurements of pressure and physico-chemical water quality indicators and tested over 1,000 grab samples for indicator bacteria over 14 months throughout the distribution system in Hubli-Dharwad, India. This data set is used to explore and explain the mechanisms influencing water quality when piped water is provided for a few hours every 3-5 days. These data indicate that contamination occurs along the distribution system as water travels from the treatment plant to reservoirs and through intermittently supplied pipes to household storage containers, while real

Effects of the DRG-based prospective payment system operated by the voluntarily participating providers on the cesarean section rates in Korea.

Science.gov (United States)

Lee, Kwangsoo; Lee, Sangil

2007-05-01

This study explored the effects of the diagnosis-related group (DRG)-based prospective payment system (PPS) operated by voluntarily participating organizations on the cesarean section (CS) rates, and analyzed whether the participating health care organizations had similar CS rates despite the varied participation periods. The study sample included delivery claims data from the Korean national health insurance program for the year 2003. Risk factors were identified and used in the adjustment model to distinguish the main reason for CS. Their risk-adjusted CS rates were compared by the reimbursement methods, and the organizations' internal and external environments were controlled. The final risk-adjustment model for the CS rates meets the criteria for an effective model. There were no significant differences of CS rates between providers in the DRG and fee-for-service system after controlling for organizational variables. The CS rates did not vary significantly depending on the providers' DRG participation periods. The results provide evidence that the DRG payment system operated by volunteering health care organizations had no impact on the CS rates, which can lower the quality of care. Although the providers joined the DRG system in different years, there were no differences in the CS rates among the DRG providers. These results support the future expansion of the DRG-based PPS plan to all health care services in Korea.

Core drilling provides information about Santa Fe Group aquifer system beneath Albuquerque's West Mesa

Science.gov (United States)

Allen, B.D.; Connell, S.D.; Hawley, J.W.; Stone, B.D.

1998-01-01

Core samples from the upper ???1500 ft of the Santa Fe Group in the Albuquerque West Mesa area provide a first-hand look at the sediments and at subsurface stratigraphic relationships in this important part of the basin-fill aquifer system. Two major hydrostratigraphic subunits consisting of a lower coarse-grained, sandy interval and an overlying fine-grained, interbedded silty sand and clay interval lie beneath the water table at the 98th St core hole. Borehole electrical conductivity measurements reproduce major textural changes observed in the recovered cores and support subsurface correlations of hydrostratigraphic units in the Santa Fe Group aquifer system based on geophysical logs. Comparison of electrical logs from the core hole and from nearby city wells reveals laterally consistent lithostratigraphic patterns over much of the metropolitan area west of the Rio Grande that may be used to delineate structural and related stratigraphic features that have a direct bearing on the availability of ground water.

AskFuse Origins: System Barriers to Providing the Research That Public Health Practice and Policy Partners Say They Need

Science.gov (United States)

Rushmer, Rosemary; Shucksmith, Janet

2018-01-01

In this paper the development of askFuse is used as a case study to illustrate contextual and system barriers to universities providing useful, usable and timely research evidence in response to local practice and policy partners' stated public health research needs. Entrenched systems (research excellence framework, academic career pathways,…

The Economic Potential of Three Nuclear-Renewable Hybrid Energy Systems Providing Thermal Energy to Industry

Energy Technology Data Exchange (ETDEWEB)

Ruth, Mark [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cutler, Dylan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Flores-Espino, Francisco [National Renewable Energy Lab. (NREL), Golden, CO (United States); Stark, Greg [National Renewable Energy Lab. (NREL), Golden, CO (United States); Jenkin, Thomas [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2016-12-01

This report is one of a series of reports that Idaho National Laboratory and National Renewable Energy Laboratory are producing to investigate the technical and economic aspects of nuclear-renewable hybrid energy systems (N-R HESs). Previous reports provided results of an analysis of two N-R HES scenarios. This report builds that analysis with a Texas-synthetic gasoline scenario providing the basis in which the N-R HES sells heat directly to an industrial customer. Subsystems were included that convert electricity to heat, thus allowing the renewable energy subsystem to generate heat and benefit from that revenue stream. Nuclear and renewable energy sources are important to consider in the energy sector's evolution because both are considered to be clean and non-carbon-emitting energy sources.

Critical care providers refer to information tools less during communication tasks after a critical care clinical information system introduction.

Science.gov (United States)

Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel

2011-01-01

Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.

A Similarity-Ranking Method on Semantic Computing for Providing Information-Services in Station-Concierge System

Directory of Open Access Journals (Sweden)

Motoki Yokoyama

2017-07-01

Full Text Available The prevalence of smartphones and wireless broadband networks have been progressing as a new Railway infomration environment.　According to the spread of such devices and information technology, various types of information can be obtained from databases connected to the Internet. One scenario of obtaining such a wide variety of information resources is in the phase of user’s transportation. This paper proposes an information provision system, named the Station Concierge System that matches the situation and intention of passengers. The purpose of this system is to estimate the needs of passengers like station staff or hotel concierge and to provide information resources that satisfy user’s expectations dynamically. The most important module of the system is constructed based on a new information ranking method for passenger intention prediction and service recommendation. This method has three main features, which are (1 projecting a user to semantic vector space by using her current context, (2 predicting the intention of a user based on selecting a semantic vector subspace, and (3 ranking the services by a descending order of relevant scores to the user’ intention. By comparing the predicted results of our method with those of two straightforward computation methods, the experimental studies show the effectiveness and efficiency of the proposed method. Using this system, users can obtain transit information and service map that dynamically matches their context.

Implementation of the Louisiana ADD Law.

Science.gov (United States)

Pounders, Mickey

Louisiana's state education agency (SEA) was mandated to provide appropriate services for children with attention deficit disorders, by developing statewide training for representatives from public school districts and by selecting and implementing four pilot programs. The SEA implemented the pilot programs, provided an informational training…

Water Resources Research Institute | Mississippi State University

Science.gov (United States)

Welcome The Mississippi Water Resources Research Institute provides a statewide center of expertise in water and associated land-use and serves as a repository of knowledge for use in education private interests in the conservation, development, and use of water resources; to provide training

Wildland Urban Interface

Data.gov (United States)

Earth Data Analysis Center, University of New Mexico — The USFS, Silvis Lab developed a statewide WUI layer (see metadata for more information). New Mexico State Forestry provided Community Wildfire Protection Plans,...

Patient and provider perspectives on quality and health system effectiveness in a transition economy: evidence from Ukraine.

Science.gov (United States)

Luck, J; Peabody, J W; DeMaria, L M; Alvarado, C S; Menon, R

2014-08-01

Facing a severe population health crisis due to noncommunicable diseases, Ukraine and other former Soviet republics and Eastern European countries have a pressing need for more effective health systems. Policies to enhance health system effectiveness should consider the perspectives of different stakeholder groups, including providers as well as patients. In addition, policies that directly target the quality of clinical care should be based on objective performance measures. In 2009 and 2010 we conducted a coordinated series of household and facility-level surveys to capture the perspectives of Ukrainian household members, outpatient clinic patients, and physicians regarding the country's health system overall, as well as the quality, access, and affordability of health care. We objectively measured the quality of care for heart failure and chronic obstructive pulmonary disease using CPV(®) vignettes. There was broad agreement among household respondents (79%) and physicians (95%) that Ukraine's health system should be reformed. CPV(®) results indicate that the quality of care for common noncommunicable diseases is poor in all regions of the country and in hospitals as well as polyclinics. However, perspectives about the quality of care differ, with household respondents seeing quality as a serious concern, clinic patients having more positive perceptions, and physicians not viewing quality as a reform priority. All stakeholder groups viewed affordability as a problem. These findings have several implications for policies to enhance health system effectiveness. The shared desire for health system reform among all stakeholder groups provides a basis for action in Ukraine. Improving quality, strengthening primary care, and enhancing affordability should be major goals of new health policies. Policies to improve quality directly, such as pay-for-performance, would be mutually reinforcing with purchasing reforms such as transparent payment mechanisms. Such policies

Oil Spill Incident Tracking [ds394

Data.gov (United States)

California Natural Resource Agency — The Office of Spill Prevention and Response (OSPR) Incident Tracking Database is a statewide oil spill tracking information system. The data are collected by OSPR...

User-centered development and testing of a monitoring system that provides feedback regarding physical functioning to elderly people

Directory of Open Access Journals (Sweden)

Vermeulen J

2013-08-01

Full Text Available Joan Vermeulen,1 Jacques CL Neyens,1 Marieke D Spreeuwenberg,1 Erik van Rossum,1,2 Walther Sipers,3 Herbert Habets,3 David J Hewson,4 Luc P de Witte1,2 1School for Public Health and Primary Care (CAPHRI, Maastricht University, Maastricht, The Netherlands; 2Research Center for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands; 3Expertise Center for Elderly Care, Orbis Medical Center, Sittard, The Netherlands; 4Institute Charles Delaunay, Université de Technologie de Troyes, Troyes, France Purpose: To involve elderly people during the development of a mobile interface of a monitoring system that provides feedback to them regarding changes in physical functioning and to test the system in a pilot study. Methods and participants: The iterative user-centered development process consisted of the following phases: (1 selection of user representatives; (2 analysis of users and their context; (3 identification of user requirements; (4 development of the interface; and (5 evaluation of the interface in the lab. Subsequently, the monitoring and feedback system was tested in a pilot study by five patients who were recruited via a geriatric outpatient clinic. Participants used a bathroom scale to monitor weight and balance, and a mobile phone to monitor physical activity on a daily basis for six weeks. Personalized feedback was provided via the interface of the mobile phone. Usability was evaluated on a scale from 1 to 7 using a modified version of the Post-Study System Usability Questionnaire (PSSUQ; higher scores indicated better usability. Interviews were conducted to gain insight into the experiences of the participants with the system. Results: The developed interface uses colors, emoticons, and written and/or spoken text messages to provide daily feedback regarding (changes in weight, balance, and physical activity. The participants rated the usability of the monitoring and feedback system with a mean score of 5

Cancer Data and Aboriginal Disparities (CanDAD)—developing an Advanced Cancer Data System for Aboriginal people in South Australia: a mixed methods research protocol

Science.gov (United States)

Yerrell, Paul Henry; Roder, David; Cargo, Margaret; Reilly, Rachel; Banham, David; Micklem, Jasmine May; Morey, Kim; Stewart, Harold Bundamurra; Stajic, Janet; Norris, Michael; Brown, Alex

2016-01-01

Introduction In Australia, Aboriginal and Torres Strait Islander People carry a greater burden of cancer-related mortality than non-Aboriginal Australians. The Cancer Data and Aboriginal Disparities Project aims to develop and test an integrated, comprehensive cancer monitoring and surveillance system capable of incorporating epidemiological and narrative data to address disparities and advocate for clinical system change. Methods and analysis The Advanced Cancer Data System will integrate routinely collected unit record data from the South Australian Population Cancer Registry and a range of other data sources for a retrospective cohort of indigenous people with cancers diagnosed from 1990 to 2010. A randomly drawn non-Aboriginal cohort will be matched by primary cancer site, sex, age and year at diagnosis. Cross-tabulations and regression analyses will examine the extent to which demographic attributes, cancer stage and survival vary between the cohorts. Narratives from Aboriginal people with cancer, their families, carers and service providers will be collected and analysed using patient pathway mapping and thematic analysis. Statements from the narratives will structure both a concept mapping process of rating, sorting and prioritising issues, focusing on issues of importance and feasibility, and the development of a real-time Aboriginal Cancer Measure of Experience for ongoing linkage with epidemiological data in the Advanced Cancer Data System. Aboriginal Community engagement underpins this Project. Ethics and dissemination The research has been approved by relevant local and national ethics committees. Findings will be disseminated in local and international peer-reviewed journals and conference presentations. In addition, the research will provide data for knowledge translation activities across the partner organisations and feed directly into the Statewide Cancer Control Plan. It will provide a mechanism for monitoring and evaluating the implementation of

Characteristics of electronic patient-provider messaging system utilisation in an urban health care organisation

Directory of Open Access Journals (Sweden)

Sean Patrick Mikles

2014-12-01

Full Text Available Introduction Research suggests that electronic messaging can improve patient engagement. Studies indicate that a ‘digital divide’ may exist, where certain patient populations may be using electronic messaging less frequently. This study aims to determine which patient characteristics are associated with different levels of usage of an electronic patient-provider messaging system in a diverse urban population.Methods Cross-sectional electronic health record data were extracted for patients 10 years of age or older who live in New York City and who visited a set of clinics between 1 July 2011 and 30 June 2012. Regression analyses determined which participant characteristics were associated with the sending of electronic messages.Results Older, female, English-speaking participants of white race who received more messages, had any diagnoses, more office visits and a provider who sent messages were more likely to send more messages. Non-Millennial, non-white participants who received fewer messages, had more office visits, any diagnoses, a provider who saw fewer patients with patient portal accounts, lived in a low socioeconomic status neighbourhood, and did not have private insurance were more likely to send zero messages.Conclusion This study found significant differences in electronic messaging usage based on demographic, socioeconomic and health-related patient characteristics. Future studies are needed to support these results and determine the causes of observed associations.

Towards the Use of Unmanned Aerial Systems for Providing Sustainable Services in Smart Cities.

Science.gov (United States)

Moguel, Enrique; Conejero, José M; Sánchez-Figueroa, Fernando; Hernández, Juan; Preciado, Juan C; Rodríguez-Echeverría, Roberto

2017-12-27

Sustainability is at the heart of many application fields where the use of Unmanned Aerial Systems (UAS) is becoming more and more important (e.g., agriculture, fire detection and prediction, environmental surveillance, mapping, etc.). However, their usage and evolution are highly conditioned by the specific application field they are designed for, and thus, they cannot be easily reused among different application fields. From this point of view, being that they are not multipurpose, we can say that they are not fully sustainable. Bearing this in mind, the objective of this paper is two-fold: on the one hand, to identify the whole set of features that must be provided by a UAS to be considered sustainable and to show that there is no UAS satisfying all these features; on the other hand, to present an open and sustainable UAS architecture that may be used to build UAS on demand to provide the features needed in each application field. Since this architecture is mainly based on software and hardware adaptability, it contributes to the technical sustainability of cities.

Towards the Use of Unmanned Aerial Systems for Providing Sustainable Services in Smart Cities

Directory of Open Access Journals (Sweden)

Enrique Moguel

2017-12-01

Full Text Available Sustainability is at the heart of many application fields where the use of Unmanned Aerial Systems (UAS is becoming more and more important (e.g., agriculture, fire detection and prediction, environmental surveillance, mapping, etc.. However, their usage and evolution are highly conditioned by the specific application field they are designed for, and thus, they cannot be easily reused among different application fields. From this point of view, being that they are not multipurpose, we can say that they are not fully sustainable. Bearing this in mind, the objective of this paper is two-fold: on the one hand, to identify the whole set of features that must be provided by a UAS to be considered sustainable and to show that there is no UAS satisfying all these features; on the other hand, to present an open and sustainable UAS architecture that may be used to build UAS on demand to provide the features needed in each application field. Since this architecture is mainly based on software and hardware adaptability, it contributes to the technical sustainability of cities.

Hospital Consumer Assessment of Healthcare Providers and Systems: An Ethical Leadership Dilemma to Satisfy Patients.

Science.gov (United States)

Piper, Llewellyn E; Tallman, Erin

2016-01-01

This article examines the parameters and the dynamics of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) that create an ethical leadership dilemma to satisfy patients in the hospital setting while still ensuring appropriate care for quality clinical outcomes. Under the Affordable Care Act, hospitals and health care systems are in a high-stakes struggle of winners and losers based on HCAHPS scores. This high-stakes struggle creates unintended consequences of an ethical dilemma of doing what is right for the patient versus doing whatever it takes to please the patient in order to achieve high scores of satisfaction that are tied to better reimbursements. This article also reports the results of a national survey of 500 chief executive officers by the authors about the attitudes and frustrations of chief executive officers confronting the wild unrest caused by HCAHPS.

Measuring trauma system performance: Right patient, right place-Mission accomplished?

Science.gov (United States)

Ciesla, David J; Pracht, Etienne E; Tepas, Joseph J; Namias, Nicholas; Moore, Frederick A; Cha, John Y; Kerwin, Andrew; Langland-Orban, Barbara

2015-08-01

A regional trauma system must establish and monitor acceptable overtriage and undertriage rates. Although diagnoses from discharge data sets can be used with mortality prediction models to define high-risk injury, retrospective analyses introduce methodological errors when evaluating real-time triage processes. The purpose of this study was to determine if major trauma patients identified using field criteria correlated with those retrospectively labeled high risk and to assess system performance by measuring triage accuracy and trauma center utilization. A statewide database was queried for all injury-related International Classification of Diseases, 9th Revision, code discharges from designated trauma centers and nontrauma centers for 2012. Children and burn patients were excluded. Patients assigned a trauma alert fee were considered field-triage(+). The International Classification Injury Severity Score methodology was used to estimate injury-related survival probabilities, with an International Classification Injury Severity Score less than 0.85 considered high risk. Triage rates were expressed relative to the total population; the proportion of low- and high-risk patients discharged from trauma centers defined trauma center utilization. There were 116,990 patients who met study criteria, including 11,368 (10%) high-risk, 70,741 field-triage(-) patients treated in nontrauma centers and 28,548 field-triage(-) and 17,791 field-triage(+) patients treated in trauma centers. Field triage was 86% accurate, with 10% overtriage and 4% undertriage. System triage was 66% accurate, with 32% overtriage and 2% undertriage. Overtriage patients more often, and undertriage patients less often, had severe injury characteristics than appropriately triaged patients. Trauma system performance assessed using retrospective administrative data provides a convenient measure of performance but must be used with caution. Residual mistriage can partly be attributed to error introduced by

CWHR - Amphibians [ds523

Data.gov (United States)

California Natural Resource Agency — This data set is an intersection of all 694 vector polygon ranges in the California Wildlife Habitat Relationships (CWHR) System with a statewide grid of 25 square...

Instructional Computing Project Uses "Multiplier Effect" to Train Florida Teachers.

Science.gov (United States)

Roblyer, M. D.; Castine, W. H.

1987-01-01

Reviews the efforts undertaken in the Florida Model Microcomputer Trainer Project (FMMTP) and its statewide impact. Outlines its procedural strategies, trainer curriculum, networking system, and the results of its multiplier effect. (ML)

CWHR - Birds (A - La) [ds524

Data.gov (United States)

California Natural Resource Agency — This data set is an intersection of all 694 vector polygon ranges in the California Wildlife Habitat Relationships (CWHR) System with a statewide grid of 25 square...

Measuring Learning, Supporting Teaching: Classroom Experts' Recommendations for an Effective Educator Evaluation System

Science.gov (United States)

Center for Teaching Quality, 2013

2013-01-01

The Illinois New Millennium Initiative (NMI) is a statewide team of accomplished, early-career teachers and educators focused on classroom- and community-based solutions to improve public schools. In virtual and face-to-face collaborations, the NMI works to connect research findings with its own teaching experiences in order to design policies and…

A method for calculating active feedback system to provide vertical

Indian Academy of Sciences (India)

The active feedback system is applied to control slow motions of plasma. The objective of the ... The other problem is connected with the control of plasma vertical position with active feedback system. Calculation of ... Current Issue Volume 90 ...

Research

African Journals Online (AJOL)

abp

2016-07-12

Jul 12, 2016 ... multiple risk factors provides support for multiple-behavior interventions as ... consumption) with smoking therefore needs further research. As such this study .... restaurants, in bars, and on a statewide basis. They preferred to.

Web-Based Self-Service Systems for Managed IT Support: Service Provider Perspectives of Stakeholder-Based Issues

Science.gov (United States)

Cooper, Vanessa A.; Lichtenstein, Sharman; Smith, Ross

This chapter explores the provision of after-sales information technology (IT) support services using Web-based self-service systems (WSSs) in a business-to-business (B2B) context. A recent study conducted at six large multi-national IT support organisations revealed a number of critical success factors (CSFs) and stakeholder-based issues. To better identify and understand these important enablers and barriers, we explain how WSSs should be considered within a complex network of service providers, business partners and customer firms. The CSFs and stakeholder-based issues are discussed. The chapter highlights that for more successful service provision using WSSs, IT service providers should collaborate more effectively with enterprise customers and business partners and should better integrate their WSSs.

The Agr communication system provides a benefit to the populations of Listeria monocytogenes in soil.

Science.gov (United States)

Vivant, Anne-Laure; Garmyn, Dominique; Gal, Laurent; Piveteau, Pascal

2014-01-01

In this study, we investigated whether the Agr communication system of the pathogenic bacterium Listeria monocytogenes was involved in adaptation and competitiveness in soil. Alteration of the ability to communicate, either by deletion of the gene coding the response regulator AgrA (response-negative mutant) or the signal pro-peptide AgrD (signal-negative mutant), did not affect population dynamics in soil that had been sterilized but survival was altered in biotic soil suggesting that the Agr system of L. monocytogenes was involved to face the complex soil biotic environment. This was confirmed by a set of co-incubation experiments. The fitness of the response-negative mutant was lower either in the presence or absence of the parental strain but the fitness of the signal-negative mutant depended on the strain with which it was co-incubated. The survival of the signal-negative mutant was higher when co-cultured with the parental strain than when co-cultured with the response-negative mutant. These results showed that the ability to respond to Agr communication provided a benefit to listerial cells to compete. These results might also indicate that in soil, the Agr system controls private goods rather than public goods.

Open access tools for quality-assured and efficient data entry in a large, state-wide tobacco survey in India.

Science.gov (United States)

Shewade, Hemant Deepak; Vidhubala, E; Subramani, Divyaraj Prabhakar; Lal, Pranay; Bhatt, Neelam; Sundaramoorthi, C; Singh, Rana J; Kumar, Ajay M V

2017-01-01

A large state-wide tobacco survey was conducted using modified version of pretested, globally validated Global Adult Tobacco Survey (GATS) questionnaire in 2015-22016 in Tamil Nadu, India. Due to resource constrains, data collection was carrid out using paper-based questionnaires (unlike the GATS-India, 2009-2010, which used hand-held computer devices) while data entry was done using open access tools. The objective of this paper is to describe the process of data entry and assess its quality assurance and efficiency. In EpiData language, a variable is referred to as 'field' and a questionnaire (set of fields) as 'record'. EpiData software was used for double data entry with adequate checks followed by validation. Teamviewer was used for remote training and trouble shooting. The EpiData databases (one each for each district and each zone in Chennai city) were housed in shared Dropbox folders, which enabled secure sharing of files and automatic back-up. Each database for a district/zone had separate file for data entry of household level and individual level questionnaire. Of 32,945 households, there were 111,363 individuals aged ≥15 years. The average proportion of records with data entry errors for a district/zone in household level and individual level file was 4% and 24%, respectively. These are the errors that would have gone unnoticed if single entry was used. The median (inter-quartile range) time taken for double data entry for a single household level and individual level questionnaire was 30 (24, 40) s and 86 (64, 126) s, respectively. Efficient and quality-assured near-real-time data entry in a large sub-national tobacco survey was performed using innovative, resource-efficient use of open access tools.

Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for hospital outpatient departments - Facility

Data.gov (United States)

U.S. Department of Health & Human Services — A list of hospital outpatient department ratings for the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS)...

The process of development of a prioritization tool for a clinical decision support build within a computerized provider order entry system: Experiences from St Luke's Health System.

Science.gov (United States)

Wolf, Matthew; Miller, Suzanne; DeJong, Doug; House, John A; Dirks, Carl; Beasley, Brent

2016-09-01

To establish a process for the development of a prioritization tool for a clinical decision support build within a computerized provider order entry system and concurrently to prioritize alerts for Saint Luke's Health System. The process of prioritizing clinical decision support alerts included (a) consensus sessions to establish a prioritization process and identify clinical decision support alerts through a modified Delphi process and (b) a clinical decision support survey to validate the results. All members of our health system's physician quality organization, Saint Luke's Care as well as clinicians, administrators, and pharmacy staff throughout Saint Luke's Health System, were invited to participate in this confidential survey. The consensus sessions yielded a prioritization process through alert contextualization and associated Likert-type scales. Utilizing this process, the clinical decision support survey polled the opinions of 850 clinicians with a 64.7 percent response rate. Three of the top rated alerts were approved for the pre-implementation build at Saint Luke's Health System: Acute Myocardial Infarction Core Measure Sets, Deep Vein Thrombosis Prophylaxis within 4 h, and Criteria for Sepsis. This study establishes a process for developing a prioritization tool for a clinical decision support build within a computerized provider order entry system that may be applicable to similar institutions. © The Author(s) 2015.

Ecolo Watt. Ecologic comparison of electricity providers

International Nuclear Information System (INIS)

2007-09-01

As consumers now can choose their electricity provider, Greenpeace proposes Ecolo Watt, a system which assesses the different providers, more particularly in terms of protection of the environment. This document first describes the electricity market liberalisation (principle, market opening process, a shake-up of the French electric landscape, obligations for the providers). It presents the green electricity market (original guarantees, the questionable system of green certificates, and the Eve label). It describes the methodology adopted for the Ecolo Watt comparative assessment: assessment criteria, final mark. It presents the ranking of electricity providers while analysing their energy mix, their energy policy, their energy service and sales policy, the quality and transparency of information). Detailed results are presented for each operator

Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence.

Science.gov (United States)

Javadi, D; Feldhaus, I; Mancuso, A; Ghaffar, A

2017-01-01

This paper seeks to review the available evidence to determine whether a systems approach is employed in the implementation and evaluation of task shifting for mental health using lay providers in low- and middle-income countries, and to highlight system-wide effects of task-shifting strategies in order to better inform efforts to strength community mental health systems. Pubmed, CINAHL, and Cochrane Library databases were searched. Articles were screened by two independent reviewers with a third reviewer resolving discrepancies. Two stages of screens were done to ensure sensitivity. Studies were analysed using the World Health Organization's building blocks framework with the addition of a community building block, and systems thinking characteristics to determine the extent to which system-wide effects had been considered. Thirty studies were included. Almost all studies displayed positive findings on mental health using task shifting. One study showed no effect. No studies explicitly employed systems thinking tools, but some demonstrated systems thinking characteristics, such as exploring various stakeholder perspectives, capturing unintended consequences, and looking across sectors for system-wide impact. Twenty-five of the 30 studies captured elements other than the most directly relevant building blocks of service delivery and health workforce. There is a lack of systematic approaches to exploring complexity in the evaluation of task-shifting interventions. Systems thinking tools should support evidence-informed decision making for a more complete understanding of community-based systems strengthening interventions for mental health.

Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for ambulatory surgical centers - Facility

Data.gov (United States)

U.S. Department of Health & Human Services — A list of ambulatory surgical center ratings for the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey....

Renaissance: A revolutionary approach for providing low-cost ground data systems

Science.gov (United States)

Butler, Madeline J.; Perkins, Dorothy C.; Zeigenfuss, Lawrence B.

1996-01-01

The NASA is changing its attention from large missions to a greater number of smaller missions with reduced development schedules and budgets. In relation to this, the Renaissance Mission Operations and Data Systems Directorate systems engineering process is presented. The aim of the Renaissance approach is to improve system performance, reduce cost and schedules and meet specific customer needs. The approach includes: the early involvement of the users to define the mission requirements and system architectures; the streamlining of management processes; the development of a flexible cost estimation capability, and the ability to insert technology. Renaissance-based systems demonstrate significant reuse of commercial off-the-shelf building blocks in an integrated system architecture.

Developing a database management system to support birth defects surveillance in Florida.

Science.gov (United States)

Salemi, Jason L; Hauser, Kimberlea W; Tanner, Jean Paul; Sampat, Diana; Correia, Jane A; Watkins, Sharon M; Kirby, Russell S

2010-01-01

The value of any public health surveillance program is derived from the ways in which data are managed and used to improve the public's health. Although birth defects surveillance programs vary in their case volume, budgets, staff, and objectives, the capacity to operate efficiently and maximize resources remains critical to long-term survival. The development of a fully-integrated relational database management system (DBMS) can enrich a surveillance program's data and improve efficiency. To build upon the Florida Birth Defects Registry--a statewide registry relying solely on linkage of administrative datasets and unconfirmed diagnosis codes-the Florida Department of Health provided funding to the University of South Florida to develop and pilot an enhanced surveillance system in targeted areas with a more comprehensive approach to case identification and diagnosis confirmation. To manage operational and administrative complexities, a DBMS was developed, capable of managing transmission of project data from multiple sources, tracking abstractor time during record reviews, offering tools for defect coding and case classification, and providing reports to DBMS users. Since its inception, the DBMS has been used as part of our surveillance projects to guide the receipt of over 200 case lists and review of 12,924 fetuses and infants (with associated maternal records) suspected of having selected birth defects in over 90 birthing and transfer facilities in Florida. The DBMS has provided both anticipated and unexpected benefits. Automation of the processes for managing incoming case lists has reduced clerical workload considerably, while improving accuracy of working lists for field abstraction. Data quality has improved through more effective use of internal edits and comparisons with values for other data elements, while simultaneously increasing abstractor efficiency in completion of case abstraction. We anticipate continual enhancement to the DBMS in the future

A new multiphasic buffer system for benzyldimethyl-n-hexadecylammonium chloride polyacrylamide gel electrophoresis of proteins providing efficient stacking.

Science.gov (United States)

Kramer, Michael L

2006-02-01

Acidic PAGE systems using cationic detergents such as benzyldimethyl-n-hexadecylammonium chloride (16-BAC) or CTAB have proven useful for the detection of methoxy esters sensitive to alkaline pH, resolving basic proteins such as histones and membrane proteins. However, the interesting phosphate-based system suffered from poor stacking, resulting in broadened bands and long running times. Therefore, a new 16-BAC PAGE system based on the theory of moving boundary electrophoresis with properties comparable to the classical SDS-PAGE system was designed. As a result a new multiphasic analytical 16-BAC PAGE system providing efficient stacking and significantly shorter running times is presented here. It is based on acetic acid and methoxyacetic acid as common ion constituents. This PAGE system takes advantage of the additional counter stacking effect due to a cross boundary electrophoresis system resulting from the selected buffer constituents. Furthermore, the concentration of 16-BAC was optimized by determining its previously unknown CMC. Due to efficient focusing of the introduced tracking dye, methyl green, termination of electrophoresis can now be more easily followed as compared to the Schlieren line.

Medicare Provider Data - Hospice Providers

Data.gov (United States)

U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...

32 CFR 231.9 - Definitions.

Science.gov (United States)

2010-07-01

... union facility. A facility employing a communications system with the parent credit union to conduct... requirements that cannot be resolved by the credit union or local command. (q) Geographic franchise... operations are thus differentiated from county-wide or state-wide branch systems consisting of a head office...

A method for calculating active feedback system to provide vertical ...

Indian Academy of Sciences (India)

Slow instabilities, development time of which is proportional to the .... where (w, I) denotes the scalar (inner or dot) product of vectors w and I. Solutions ... which the system of passive conductors must satisfy. ..... In this research, the active feedback system consisting of two coils with coordi- .... a new mode becomes dominant.

Athena: Providing Insight into the History of the Universe

Science.gov (United States)

Murphy, Gloria A.

2010-01-01

The American Institute for Aeronautics and Astronautics has provided a Request for Proposal which calls for a manned mission to a Near-Earth Object. It is the goal of Team COLBERT to respond to their request by providing a reusable system that can be implemented as a solid stepping stone for future manned trips to Mars and beyond. Despite Team COLBERT consisting of only students in Aerospace Engineering, in order to achieve this feat, the team must employ the use of Systems Engineering. Tools and processes from Systems Engineering will provide quantitative and semi-quantitative tools for making design decisions and evaluating items such as budgets and schedules. This paper will provide an in-depth look at some of the Systems Engineering processes employed and will step through the design process of a Human Asteroid Exploration System.

PROVIDING QUALITY OF ELECTRIC POWER IN ELECTRIC POWER SYSTEM IN PARALLEL OPERATION WITH WIND TURBINE

Directory of Open Access Journals (Sweden)

Yu. A. Rolik

2016-01-01

Full Text Available The problem of providing electric power quality in the electric power systems (EPS that are equipped with sufficiently long air or cable transmission lines is under consideration. This problem proved to be of particular relevance to the EPS in which a source of electrical energy is the generator of wind turbines since the wind itself is an instable primary energy source. Determination of the degree of automation of voltage regulation in the EPS is reduced to the choice of methods and means of regulation of power quality parameters. The concept of a voltage loss and the causes of the latter are explained by the simplest power system that is presented by a single-line diagram. It is suggested to regulate voltage by means of changing parameters of the network with the use of the method of reducing loss of line voltage by reducing its reactance. The latter is achieved by longitudinal capacitive compensation of the inductive reactance of the line. The effect is illustrated by vector diagrams of currents and voltages in the equivalent circuits of transmission lines with and without the use of longitudinal capacitive compensation. The analysis of adduced formulas demonstrated that the use of this method of regulation is useful only in the systems of power supply with a relatively low power factor (cosφ < 0.7 to 0.9. This power factor is typical for the situation of inclusion the wind turbine with asynchronous generator in the network since the speed of wind is instable. The voltage regulation fulfilled with the aid of the proposed method will make it possible to provide the required quality of the consumers’ busbars voltage in this situation. In is turn, it will make possible to create the necessary conditions for the economical transmission of electric power with the lowest outlay of reactive power and the lowest outlay of active power losses.

Florida maintenance rating program (MRP) assessment and enhancement : final report, May 28, 2008.

Science.gov (United States)

2008-05-28

The Maintenance Rating Program (MRP), developed in 1985 by FDOT, is a statewide maintenance system aimed : at evaluating the State highway maintenance conditions, and determining FDOT asset maintenance needs. In the : quest for continuous improvement...

Modeling truck traffic volume growth congestion.

Science.gov (United States)

2009-05-01

Modeling of the statewide transportation system is an important element in understanding issues and programming of funds to thwart potential congestion. As Alabama grows its manufacturing economy, the number of heavy vehicles traversing its highways ...

77 FR 27781 - Non-Competitive One-Year Extension With Funds for State Early Childhood Comprehensive Systems...

Science.gov (United States)

2012-05-11

... emotional development of children (birth to five years of age) by supporting statewide collaborations of... childhood initiatives under the Administration for Children and Families (ACF), the Substance Abuse and... children and their families. Each ECCS grantee is an active member, and in some cases these grantees hold a...

General Fund Enterprise Business System Did Not Provide Required Financial Information

Science.gov (United States)

2012-03-26

Management of the General Fund Enterprise Business System,” January 14, 2008 Army AAA Report No. A-2010-0187- FFM , “General Fund Enterprise Business System...A-2009-0232- FFM , “General Fund Enterprise Business System – Federal Financial Management Improvement Act Compliance, Examination of Releases...1.4.1, 1.4.2, 1.4.3, and 1.4.4 Requirements,” September 30, 2009 AAA Report No. A-2009-0231- FFM , “General Fund Enterprise Business System – Federal

On the assessment of performance and emissions characteristics of a SI engine provided with a laser ignition system

Science.gov (United States)

Birtas, A.; Boicea, N.; Draghici, F.; Chiriac, R.; Croitoru, G.; Dinca, M.; Dascalu, T.; Pavel, N.

2017-10-01

Performance and exhaust emissions of spark ignition engines are strongly dependent on the development of the combustion process. Controlling this process in order to improve the performance and to reduce emissions by ensuring rapid and robust combustion depends on how ignition stage is achieved. An ignition system that seems to be able for providing such an enhanced combustion process is that based on plasma generation using a Q-switched solid state laser that delivers pulses with high peak power (of MW-order level). The laser-spark devices used in the present investigations were realized using compact diffusion-bonded Nd:YAG/Cr4+:YAG ceramic media. The laser igniter was designed, integrated and built to resemble a classical spark plug and therefore it could be mounted directly on the cylinder head of a passenger car engine. In this study are reported the results obtained using such ignition system provided for a K7M 710 engine currently produced by Renault-Dacia, where the standard calibrations were changed towards the lean mixtures combustion zone. Results regarding the performance, the exhaust emissions and the combustion characteristics in optimized spark timing conditions, which demonstrate the potential of such an innovative ignition system, are presented.

Hanford statewide groundwater flow and transport model calibration report

International Nuclear Information System (INIS)

Law, A.; Panday, S.; Denslow, C.; Fecht, K.; Knepp, A.

1996-04-01

This report presents the results of the development and calibration of a three-dimensional, finite element model (VAM3DCG) for the unconfined groundwater flow system at the Hanford Site. This flow system is the largest radioactively contaminated groundwater system in the United States. Eleven groundwater plumes have been identified containing organics, inorganics, and radionuclides. Because groundwater from the unconfined groundwater system flows into the Columbia River, the development of a groundwater flow model is essential to the long-term management of these plumes. Cost effective decision making requires the capability to predict the effectiveness of various remediation approaches. Some of the alternatives available to remediate groundwater include: pumping contaminated water from the ground for treatment with reinjection or to other disposal facilities; containment of plumes by means of impermeable walls, physical barriers, and hydraulic control measures; and, in some cases, management of groundwater via planned recharge and withdrawals. Implementation of these methods requires a knowledge of the groundwater flow system and how it responds to remedial actions

Safe, Healthy and Ready to Succeed: Arizona School Readiness Key Performance Indicators

Science.gov (United States)

Migliore, Donna E.

2006-01-01

"Safe, Healthy and Ready to Succeed: Arizona School Readiness Key Performance Indicators" presents a set of baseline measurements that gauge how well a statewide system of school readiness supports is addressing issues that affect Arizona children's readiness for school. The Key Performance Indicators (KPIs) measure the system, rather…

Numerical modeling of the agricultural-hydrologic system in Punjab, India

Science.gov (United States)

Nyblade, M.; Russo, T. A.; Zikatanov, L.; Zipp, K.

2017-12-01

The goal of food security for India's growing population is threatened by the decline in freshwater resources due to unsustainable water use for irrigation. The issue is acute in parts of Punjab, India, where small landholders produce a major quantity of India's food with declining groundwater resources. To further complicate this problem, other regions of the state are experiencing groundwater logging and salinization, and are reliant on canal systems for fresh water delivery. Due to the lack of water use records, groundwater consumption for this study is estimated with available data on crop yields, climate, and total canal water delivery. The hydrologic and agricultural systems are modeled using appropriate numerical methods and software. This is a state-wide hydrologic numerical model of Punjab that accounts for multiple aquifer layers, agricultural water demands, and interactions between the surface canal system and groundwater. To more accurately represent the drivers of agricultural production and therefore water use, we couple an economic crop optimization model with the hydrologic model. These tools will be used to assess and optimize crop choice scenarios based on farmer income, food production, and hydrologic system constraints. The results of these combined models can be used to further understand the hydrologic system response to government crop procurement policies and climate change, and to assess the effectiveness of possible water conservation solutions.

Performance measures to characterize directional corridor travel time delay based on probe vehicle data : final report.

Science.gov (United States)

2015-10-01

Anonymous probe vehicle data are currently being collected on roadways throughout the United States. These data are being incorporated into local and statewide mobility reports to measure the performance of freeways and arterial systems. Predefined s...

Single Intravenous Dose of Novel Flurbiprofen-Loaded Proniosome Formulations Provides Prolonged Systemic Exposure and Anti-inflammatory Effect.

Science.gov (United States)

Verma, Preeti; Prajapati, Sunil K; Yadav, Rajbharan; Senyschyn, Danielle; Shea, Peter R; Trevaskis, Natalie L

2016-11-07

hydrated proniosomes can prolong systemic drug exposure over 3 days and provide a sustained therapeutic effect. The developed proniosomes represent a novel approach to treat acute pain and inflammation with the potential to be administered as a single intravenous dose by a clinician at the time of injury or surgery that provides adequate relief for several days and reduces fluctuations in therapy. Similar systems loaded with different drugs have potential for broader application in anesthesia, anti-infective, antiemetic, and cancer therapy.

The Leadville Mine Drainage Tunnel Catastrophe: A Case Study of How Isotope Geochemistry Provided Forensic Evidence to Inform Policy Decisions

Science.gov (United States)

Williams, M. W.; Wireman, M.; Liu, F.; Gertson, J.

2008-12-01

A state of emergency was declared in February 2008 because of fears that a blocked drainage tunnel in the Leadville mining district of Colorado could cause a catastrophic flood. An estimated 1 billion gallons of metals-laden water poses an eminent threat to the city of Leadville and the headwaters of the Arkansas river. Within days of the declaration of a state of emergency, Governor Ritter and Senator Salazer of Colorado, along with a host of other local and statewide politicians, visited the site and emphasized the need to develop a fast yet safe mitigation plan. Here we provide information from a case study that illustrates how a suite of isotopic and hydrologic tools enables identification of critical, site-specific variables essential in developing a science plan to guide targeted remediation of the Leadville drainage tunnel. The isotopic tools, including both stable and radiogenic isotopes, provided clear and compelling evidence of water sources and flowpaths in an area that has undergone extensive perturbations, including the drilling of more than 2,000 mine shafts. This forensic evidence was the key information in developing a plan to plug the drainage tunnel several hundred feet underground, divert a major source of polluted water from reaching the collapsed tunnel and piping it to an existing treatment plant, and guidance on where to place pumps in additional mine shafts, and the drilling of new wells to pump water in case the plugging of the tunnel caused water to pool up and raise the water table to dangerous heights. This particular case of forensic hydrology using isotopic tools not only provides the scientific basis for an operational plan to defuse a life- and property-threatening situation, it also provides the basis for decommissioning an existing water treatment plant, which will result in savings of over 1 million annually in operational costs. Decommissioning the existing water treatment plant will pay for the tunnel mitigation within several

A statewide model program to improve emergency department readiness for pediatric care.

Science.gov (United States)

Cichon, Mark E; Fuchs, Susan; Lyons, Evelyn; Leonard, Daniel

2009-08-01

Pediatric emergency patients have unique needs, requiring specialized personnel, training, equipment, supplies, and medications. Deficiencies in these areas have resulted in historically poorer outcomes for pediatric patients versus adults. Since 1985, federally funded Emergency Medical Services for Children (EMSC) programs in each state have been working to improve the quality of pediatric emergency care. The Health Resources and Services Administration now requires that all EMSC grantees report on specific performance measures. This includes implementation of a standardized system recognizing hospitals that are able to stabilize or manage pediatric medical emergencies and trauma cases. We describe the steps involved in implementing Illinois' 3-level facility recognition process to illustrate a model that other states might use to provide appropriate pediatric care and comply with new Health Resources and Services Administration performance measures.

An imaging informatics-based ePR (electronic patient record) system for providing decision support in evaluating dose optimization in stroke rehabilitation

Science.gov (United States)

Liu, Brent J.; Winstein, Carolee; Wang, Ximing; Konersman, Matt; Martinez, Clarisa; Schweighofer, Nicolas

2012-02-01

Stroke is one of the major causes of death and disability in America. After stroke, about 65% of survivors still suffer from severe paresis, while rehabilitation treatment strategy after stroke plays an essential role in recovery. Currently, there is a clinical trial (NIH award #HD065438) to determine the optimal dose of rehabilitation for persistent recovery of arm and hand paresis. For DOSE (Dose Optimization Stroke Evaluation), laboratory-based measurements, such as the Wolf Motor Function test, behavioral questionnaires (e.g. Motor Activity Log-MAL), and MR, DTI, and Transcranial Magnetic Stimulation (TMS) imaging studies are planned. Current data collection processes are tedious and reside in various standalone systems including hardcopy forms. In order to improve the efficiency of this clinical trial and facilitate decision support, a web-based imaging informatics system has been implemented together with utilizing mobile devices (eg, iPAD, tablet PC's, laptops) for collecting input data and integrating all multi-media data into a single system. The system aims to provide clinical imaging informatics management and a platform to develop tools to predict the treatment effect based on the imaging studies and the treatment dosage with mathematical models. Since there is a large amount of information to be recorded within the DOSE project, the system provides clinical data entry through mobile device applications thus allowing users to collect data at the point of patient interaction without typing into a desktop computer, which is inconvenient. Imaging analysis tools will also be developed for structural MRI, DTI, and TMS imaging studies that will be integrated within the system and correlated with the clinical and behavioral data. This system provides a research platform for future development of mathematical models to evaluate the differences between prediction and reality and thus improve and refine the models rapidly and efficiently.

Idaho Transportation Department 2009 customer satisfaction survey.

Science.gov (United States)

2010-02-01

In the summer and fall of 2009, the Idaho Transportation Department (ITD) commissioned a statewide customer satisfaction survey of Idaho residents in order to assess the overall level of satisfaction with several key areas of service provided by the ...

Comparing Intentions to Use University-Provided vs Vendor-Provided Multibiometric Authentication in Online Exams

Science.gov (United States)

Levy, Yair; Ramim, Michelle M.; Furnell, Steven M.; Clarke, Nathan L.

2011-01-01

Purpose: Concerns for information security in e-learning systems have been raised previously. In the pursuit for better authentication approaches, few schools have implemented students' authentication during online exams beyond passwords. This paper aims to assess e-learners' intention to provide multibiometric data and use of multibiometrics…

Subterranean systems provide a suitable overwintering habitat for Salamandra salamandra

Directory of Open Access Journals (Sweden)

Monika Balogová

2017-09-01

Full Text Available The fire salamander (Salamandra salamandra has been repeatedly noted to occur in natural and artificial subterranean systems. Despite the obvious connection of this species with underground shelters, their level of dependence and importance to the species is still not fully understood. In this study, we carried out long-term monitoring based on the capture-mark-recapture method in two wintering populations aggregated in extensive underground habitats. Using the POPAN model we found the population size in a natural shelter to be more than twice that of an artificial underground shelter. Survival and recapture probabilities calculated using the Cormack-Jolly-Seber model were very constant over time, with higher survival values in males than in females and juveniles, though in terms of recapture probability, the opposite situation was recorded. In addition, survival probability obtained from Cormack-Jolly-Seber model was higher than survival from POPAN model. The observed bigger population size and the lower recapture rate in the natural cave was probably a reflection of habitat complexity. Our study showed that regular visits are needed to detect the true significance of underground shelters for fire salamanders. The presence of larvae was recorded in both wintering sites, especially in bodies of water near the entrance. On the basis of previous and our observations we incline to the view, that karst areas can induce not only laying in underground shelters but also group wintering in this species. Our study highlights the strong connection of the life cycle of fire salamanders with underground shelters and their essential importance for the persistence of some populations during unfavourable conditions and breeding activity. In addition, the study introduces the POPAN and Cormac-Jolly-Seber models for estimating of population size, survival and recapture probability in wintering populations of the species, which could provide important information

State laws prohibiting sales to minors and indoor use of electronic nicotine delivery systems--United States, November 2014.

Science.gov (United States)

Marynak, Kristy; Holmes, Carissa Baker; King, Brian A; Promoff, Gabbi; Bunnell, Rebecca; McAfee, Timothy

2014-12-12

Electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigarettes) and other devices such as electronic hookahs, electronic cigars, and vape pens, are battery-powered devices capable of delivering aerosolized nicotine and additives to the user. Experimentation with and current use of e-cigarettes has risen sharply among youths and adults in the United States. Youth access to and use of ENDS is of particular concern given the potential adverse effects of nicotine on adolescent brain development. Additionally, ENDS use in public indoor areas might passively expose bystanders (e.g., children, pregnant women, and other nontobacco users) to nicotine and other potentially harmful constituents. ENDS use could have the potential to renormalize tobacco use and complicate enforcement of smoke-free policies. State governments can regulate the sales of ENDS and their use in indoor areas where nonusers might be involuntarily exposed to secondhand aerosol. To learn the current status of state laws regulating the sales and use of ENDS, CDC assessed state laws that prohibit ENDS sales to minors and laws that include ENDS use in conventional smoking prohibitions in indoor areas of private worksites, restaurants, and bars. Findings indicate that as of November 30, 2014, 40 states prohibited ENDS sales to minors, but only three states prohibited ENDS use in private worksites, restaurants, and bars. Of the 40 states that prohibited ENDS sales to minors, 21 did not prohibit ENDS use or conventional smoking in private worksites, restaurants, and bars. Three states had no statewide laws prohibiting ENDS sales to minors and no statewide laws prohibiting ENDS use or conventional smoking in private worksites, restaurants, and bars. According to the Surgeon General, ENDS have the potential for public health harm or public health benefit. The possibility of public health benefit from ENDS could arise only if 1) current smokers use these devices to switch completely

Computerized provider order entry in the clinical laboratory

Science.gov (United States)

Baron, Jason M.; Dighe, Anand S.

2011-01-01

Clinicians have traditionally ordered laboratory tests using paper-based orders and requisitions. However, paper orders are becoming increasingly incompatible with the complexities, challenges, and resource constraints of our modern healthcare systems and are being replaced by electronic order entry systems. Electronic systems that allow direct provider input of diagnostic testing or medication orders into a computer system are known as Computerized Provider Order Entry (CPOE) systems. Adoption of laboratory CPOE systems may offer institutions many benefits, including reduced test turnaround time, improved test utilization, and better adherence to practice guidelines. In this review, we outline the functionality of various CPOE implementations, review the reported benefits, and discuss strategies for using CPOE to improve the test ordering process. Further, we discuss barriers to the implementation of CPOE systems that have prevented their more widespread adoption. PMID:21886891

Computerized provider order entry in the clinical laboratory

Directory of Open Access Journals (Sweden)

Jason M Baron

2011-01-01

Full Text Available Clinicians have traditionally ordered laboratory tests using paper-based orders and requisitions. However, paper orders are becoming increasingly incompatible with the complexities, challenges, and resource constraints of our modern healthcare systems and are being replaced by electronic order entry systems. Electronic systems that allow direct provider input of diagnostic testing or medication orders into a computer system are known as Computerized Provider Order Entry (CPOE systems. Adoption of laboratory CPOE systems may offer institutions many benefits, including reduced test turnaround time, improved test utilization, and better adherence to practice guidelines. In this review, we outline the functionality of various CPOE implementations, review the reported benefits, and discuss strategies for using CPOE to improve the test ordering process. Further, we discuss barriers to the implementation of CPOE systems that have prevented their more widespread adoption.

Valuing the Resilience Provided by Solar and Battery Energy Storage Systems

Energy Technology Data Exchange (ETDEWEB)

McLaren, Joyce A [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Gagnon, Pieter J [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Mullendore, Seth [Clean Energy Group

2018-02-05

This paper explores the impact of valuing resilience on the economics of photovoltaics (PV) and storage systems for commercial buildings. The analysis presented here illustrates that accounting for the cost of grid power outages can change the breakeven point for PV and storage system investment, and increase the size of systems designed to deliver the greatest economic benefit over time. In other words, valuing resilience can make PV and storage systems economical in cases where they would not be otherwise. As storage costs decrease, and outages occur more frequently, PV and storage are likely to play a larger role in building design and management considerations.

The Impact of Performance Ratings on Job Satisfaction for Public School Teachers

Science.gov (United States)

Koedel, Cory; Li, Jiaxi; Springer, Matthew G.; Tan, Li

2017-01-01

Spurred by the federal Race to the Top competition, the state of Tennessee implemented a comprehensive statewide educator evaluation system in 2011. The new system is designed to increase the rigor of evaluations and better differentiate teachers based on performance. The use of more differentiated ratings represents a significant shift in…

Storm-Induced Slope Failure Susceptibility Mapping

Science.gov (United States)

2018-01-01

A pilot study was conducted to characterize and map the areas susceptible to slope failure using state-wide available data. The objective was to determine whether it would be possible to provide slope-failure susceptibility mapping that could be used...

Programs across the United States that aid motorists in the reporting of impaired drivers to law enforcement

Science.gov (United States)

2007-03-01

The objective of this project was to identify States that use a statewide cellular drunk driving reporting program which provides free airtime and allows motorists with cell phones to dial a special number (such as *DUI) to report suspected drunk dri...

Provider Payment Trends and Methods in the Massachusetts Health Care System

OpenAIRE

Allison Barrett; Timothy Lake

2010-01-01

This report investigates provider payment methods in Massachusetts. Payments include fee-for-service, the predominant model; global payments, which pay providers a single fee for all or most required services during a contract period; and pay-for-performance models, which layer quality incentives onto payments.

Development of GPS survey data management protocols/policy.

Science.gov (United States)

2010-08-01

This project developed a statewide policy and criteria for collecting, analyzing, and managing global position system (GPS) survey data. The research project determined the needs of the Department in adopting the GPS real time kinetic (GPS RTK) stake...

How statewide LGB policies go from ‘‘under our skin’’ to ‘‘into our hearts’’: fatherhood aspirations and psychological well-being among emerging adult sexual minority men.

Science.gov (United States)

Bauermeister, José A

2014-08-01

Researchers have noted increasingly the public health importance of addressing discriminatory policies towards lesbian, gay, and bisexual (LGB) populations. At present, however, we know little about the mechanisms through which policies affect LGB populations’ psychological well-being; in other words, how do policies get under our skin? Using data from a study of sexual minority young men (N = 1,487; M = 20.80 (SD = 1.93); 65% White; 92% gay), we examined whether statewide bans (e.g., same-sex marriage, adoption) moderated the relationship between fatherhood aspirations and psychological well-being. Fatherhood aspirations were associated with lower depressive symptoms and higher self-esteem scores among participants living in states without discriminatory policies. In states with marriage equality bans, fatherhood aspirations were associated with higher depressive symptoms and lower self-esteem scores, respectively. Fatherhood aspirations were associated negatively with self-esteem in states banning same-sex and second parent adoptions, respectively. Our findings underscore the importance of recognizing how anti-equality LGB policies may influence the psychosocial development of sexual minority men.

Beam shaping to provide round and square-shaped beams in optical systems of high-power lasers

Science.gov (United States)

Laskin, Alexander; Laskin, Vadim

2016-05-01

Optical systems of modern high-power lasers require control of irradiance distribution: round or square-shaped flat-top or super-Gaussian irradiance profiles are optimum for amplification in MOPA lasers and for thermal load management while pumping of crystals of solid-state ultra-short pulse lasers to control heat and minimize its impact on the laser power and beam quality while maximizing overall laser efficiency, variable profiles are also important in irradiating of photocathode of Free Electron lasers (FEL). It is suggested to solve the task of irradiance re-distribution using field mapping refractive beam shapers like piShaper. The operational principle of these devices presumes transformation of laser beam intensity from Gaussian to flat-top one with high flatness of output wavefront, saving of beam consistency, providing collimated output beam of low divergence, high transmittance, extended depth of field, negligible residual wave aberration, and achromatic design provides capability to work with ultra-short pulse lasers having broad spectrum. Using the same piShaper device it is possible to realize beams with flat-top, inverse Gauss or super Gauss irradiance distribution by simple variation of input beam diameter, and the beam shape can be round or square with soft edges. This paper will describe some design basics of refractive beam shapers of the field mapping type and optical layouts of their applying in optical systems of high-power lasers. Examples of real implementations and experimental results will be presented as well.

DESYCO: a Decision Support System to provide climate services for coastal stakeholders dealing with climate change impacts.

Science.gov (United States)

Torresan, S.; Gallina, V.; Giannini, V.; Rizzi, J.; Zabeo, A.; Critto, A.; Marcomini, A.

2012-04-01

At the international level climate services are recognized as innovative tools aimed at providing and distributing climate data and information according to the needs of end-users. Furthermore, needs-based climate services are extremely effective to manage climate risks and take advantage of the opportunities associated with climate change impacts. To date, climate services are mainly related to climate models that supply climate data (e.g. temperature, precipitations) at different spatial and time scales. However, there is a significant gap of tools aimed at providing information about risks and impacts induced by climate change and allowing non-expert stakeholders to use both climate-model and climate-impact data. DESYCO is a GIS-Decision Support System aimed at the integrated assessment of multiple climate change impacts on vulnerable coastal systems (e.g. beaches, river deltas, estuaries and lagoons, wetlands, agricultural and urban areas). It is an open source software that manages different input data (e.g. raster or shapefiles) coming from climate models (e.g. global and regional climate projections) and high resolution impact models (e.g. hydrodynamic, hydrological and biogeochemical simulations) in order to provide hazard, exposure, susceptibility, risk and damage maps for the identification and prioritization of hot-spot areas and to provide a basis for the definition of coastal adaptation and management strategies. Within the CLIM-RUN project (FP7) DESYCO is proposed as an helpful tool to bridge the gap between climate data and stakeholder needs and will be applied to the coastal area of the North Adriatic Sea (Italy) in order to provide climate services for local authorities involved in coastal zone management. Accordingly, a first workshop was held in Venice (Italy) with coastal authorities, climate experts and climate change risk experts, in order to start an iterative exchange of information about the knowledge related to climate change, climate

Study of nonpoint source nutrient loading in the Patuxent River basin, Maryland

Science.gov (United States)

Preston, S.D.

1997-01-01

Study of nonpoint-source (NPS) nutrient loading in Maryland has focused on the Patuxent watershed because of its importance and representativeness of conditions in the State. Evaluation of NPS nutrient loading has been comprehensive and has included long-term monitoring, detailed watershed modeling, and synoptic sampling studies. A large amount of information has been compiled for the watershed and that information is being used to identify primary controls and efficient management strategies for NPS nutrient loading. Results of the Patuxent NPS study have identified spatial trends in water quality that appear to be related to basin charcteristics such as land use, physiography, andgeology. Evaluation of the data compiled by the study components is continuing and is expected to provide more detailed assessments of the reasons for spatial trends. In particular, ongoing evaluation of the watershed model output is expected to provide detailed information on the relative importance of nutrient sources and transport pathways across the entire watershed. Planned future directions of NPS evaluation in the State of Maryland include continued study of water quality in the Patuxent watershed and a shift in emphasis to a statewide approach. Eventually, the statewide approach will become the primary approach usedby the State to evaluate NPS loading. The information gained in the Patuxent study and the tools developed will represent valuable assets indeveloping the statewide NPS assessment program.

The Role of Security Concerns in Determining Information Systems/Technology Activities Outsourced to Offshore Service Providers in India

Science.gov (United States)

Ocholi, Smart

2012-01-01

Based on research studies, the Information System/Technology (IS/T) outsourcing industry in India is reasoned to maintain the status quo of providing IS/T services at the lower level of the IS/T value chain. The 2006 study conducted by Walsh supported the 2001 findings by Arora, Arunachalam, Asundi, and Fernandes that India-based IS /T service…

Outpatient provider concentration and commercial colonoscopy prices.

Science.gov (United States)

Pozen, Alexis

2015-01-01

The objective was to evaluate the magnitude of various contributors to outpatient commercial colonoscopy prices, including market- and provider-level factors, especially market share. We used adjudicated fee-for-service facility claims from a large commercial insurer for colonoscopies occurring in hospital outpatient department or ambulatory surgery center from October 2005 to December 2012. Claims were matched to provider- and market-level data. Linear fixed effects regressions of negotiated colonoscopy price were run on provider, system, and market characteristics. Markets were defined as counties. There were 178,433 claims from 169 providers (104 systems). The mean system market share was 76% (SD = 0.34) and the mean real (deflated) price was US$1363 (SD = 374), ranging from US$169 to US$2748. For every percentage point increase in a system or individual facility's bed share, relative price increased by 2 to 4 percentage points; this result was stable across a number of specifications. Market population and price were also consistently positively related, though this relation was small in magnitude. No other factor explained price as strongly as market share. Price variation for colonoscopy was driven primarily by market share, of particular concern as the number of mergers increases in wake of the recession and the Affordable Care Act. Whether variation is justified by better quality care requires further research to determine whether quality is subsumed in prices. © The Author(s) 2015.

Development of a Geographic Information System (GIS) tool for the preliminary assessment of the effects of predicted sea level and tidal change on transportation infrastructure.

Science.gov (United States)

2013-09-01

In this project, researchers from the University of Florida developed a sketch planning tool that can be used to conduct statewide and regional assessments of transportation facilities potentially vulnerable to sea level change trends. Possible futur...

Type III CRISPR-Cas systems can provide redundancy to counteract viral escape from type I systems.

Science.gov (United States)

Silas, Sukrit; Lucas-Elio, Patricia; Jackson, Simon A; Aroca-Crevillén, Alejandra; Hansen, Loren L; Fineran, Peter C; Fire, Andrew Z; Sánchez-Amat, Antonio

2017-08-17

CRISPR-Cas-mediated defense utilizes information stored as spacers in CRISPR arrays to defend against genetic invaders. We define the mode of target interference and role in antiviral defense for two CRISPR-Cas systems in Marinomonas mediterranea . One system (type I-F) targets DNA. A second system (type III-B) is broadly capable of acquiring spacers in either orientation from RNA and DNA, and exhibits transcription-dependent DNA interference. Examining resistance to phages isolated from Mediterranean seagrass meadows, we found that the type III-B machinery co-opts type I-F CRISPR-RNAs. Sequencing and infectivity assessments of related bacterial and phage strains suggests an 'arms race' in which phage escape from the type I-F system can be overcome through use of type I-F spacers by a horizontally-acquired type III-B system. We propose that the phage-host arms race can drive selection for horizontal uptake and maintenance of promiscuous type III interference modules that supplement existing host type I CRISPR-Cas systems.

Factors Influencing Team Performance in a Continuous Quality Improvement Process in the Wisconsin Technical College System

Science.gov (United States)

Pietz, Victoria Lynn

2014-01-01

Continuous Quality Improvement (CQI) programs are growing in popularity in higher education settings and a key component is the use of work groups, which require active employee involvement. The problem addressed in this research was the lack of employee engagement in the Quality Review Process (QRP), which is a statewide CQI model developed by…

Providing Learning Computing Labs using Hosting and Virtualization Technologies

Directory of Open Access Journals (Sweden)

Armide González

2011-05-01

Full Text Available This paper presents a computing hosting system to provide virtual computing laboratories for learning activities. This system is based on hosting and virtualization technologies. All the components used in its development are free software tools. The computing lab model provided by the system is a more sustainable and scalable alternative than the traditional academic computing lab, and it requires lower costs of installation and operation.

77 FR 49856 - Environmental Impact Statement for the Salinas to San Luis Obispo Portion of the Coast Corridor...

Science.gov (United States)

2012-08-17

... intercity travel option. These improvements would provide additional capacity to relieve some of the... activity is expected to generate increased travel demand. By 2040, statewide population is expected to grow... continuing transportation challenges as evidenced by the following: Constrained Travel Options--While the...

Million Hearts 2022: Understanding the Links between Environmental Pollutant Exposure and Cardiovascular and Cerebrovascular Events - Justus-Warren Heart Disease and Stroke Prevention Task Force

Science.gov (United States)

The webinar was requested by the Justus-Warren Heart Disease and Stroke Prevention Task Force. From their website, “The task force was established in 1995 in North Carolina to provide statewide leadership for the prevention and management of cardiovascular disease. Meetings are...

GHG and black carbon emission inventories from Mezquital Valley: The main energy provider for Mexico Megacity.

Science.gov (United States)

Montelongo-Reyes, M M; Otazo-Sánchez, E M; Romo-Gómez, C; Gordillo-Martínez, A J; Galindo-Castillo, E

2015-09-15

The greenhouse gases and black carbon emission inventory from IPCC key category Energy was accomplished for the Mezquital Valley, one of the most polluted regions in Mexico, as the Mexico City wastewater have been continuously used in agricultural irrigation for more than a hundred years. In addition, thermoelectric, refinery, cement and chemistry industries are concentrated in the southern part of the valley, near Mexico City. Several studies have reported air, soil, and water pollution data and its main sources for the region. Paradoxically, these sources contaminate the valley, but boosted its economic development. Nevertheless, no research has been done concerning GHG emissions, or climate change assessment. This paper reports inventories performed by the 1996 IPCC methodology for the baseline year 2005. Fuel consumption data were derived from priority sectors such as electricity generation, refineries, manufacturing & cement industries, transportation, and residential use. The total CO2 emission result was 13,894.9 Gg, which constituted three-quarters of Hidalgo statewide energy category. The principal CO2 sources were energy transformation (69%) and manufacturing (19%). Total black carbon emissions were estimated by a bottom-up method at 0.66 Gg. The principal contributor was on-road transportation (37%), followed by firewood residential consumption (26%) and cocked brick manufactures (22%). Non-CO2 gas emissions were also significant, particularly SO2 (255.9 Gg), which accounts for 80% of the whole Hidalgo State emissions. Results demonstrated the negative environmental impact on Mezquital Valley, caused by its role as a Megacity secondary fuel and electricity provider, as well as by the presence of several cement industries. Copyright © 2015 Elsevier B.V. All rights reserved.

Using a computerized provider order entry system to meet the unique prescribing needs of children: description of an advanced dosing model

Directory of Open Access Journals (Sweden)

Schellenberger Patricia

2011-02-01

Full Text Available Abstract Background It is well known that the information requirements necessary to safely treat children with therapeutic medications cannot be met with the same approaches used in adults. Over a 1-year period, Duke University Hospital engaged in the challenging task of enhancing an established computerized provider order entry (CPOE system to address the unique medication dosing needs of pediatric patients. Methods An advanced dosing model (ADM was designed to interact with our existing CPOE application to provide decision support enabling complex pediatric dose calculations based on chronological age, gestational age, weight, care area in the hospital, indication, and level of renal impairment. Given that weight is a critical component of medication dosing that may change over time, alerting logic was added to guard against erroneous entry or outdated weight information. Results Pediatric CPOE was deployed in a staggered fashion across 6 care areas over a 14-month period. Safeguards to prevent miskeyed values became important in allowing providers the flexibility to override the ADM logic if desired. Methods to guard against over- and under-dosing were added. The modular nature of our model allows us to easily add new dosing scenarios for specialized populations as the pediatric population and formulary change over time. Conclusions The medical needs of pediatric patients vary greatly from those of adults, and the information systems that support those needs require tailored approaches to design and implementation. When a single CPOE system is used for both adults and pediatrics, safeguards such as redirection and suppression must be used to protect children from inappropriate adult medication dosing content. Unlike other pediatric dosing systems, our model provides active dosing assistance and dosing process management, not just static dosing advice.

Mitigating Provider Uncertainty in Service Provision Contracts

Science.gov (United States)

Smith, Chris; van Moorsel, Aad

Uncertainty is an inherent property of open, distributed and multiparty systems. The viability of the mutually beneficial relationships which motivate these systems relies on rational decision-making by each constituent party under uncertainty. Service provision in distributed systems is one such relationship. Uncertainty is experienced by the service provider in his ability to deliver a service with selected quality level guarantees due to inherent non-determinism, such as load fluctuations and hardware failures. Statistical estimators utilized to model this non-determinism introduce additional uncertainty through sampling error. Inability of the provider to accurately model and analyze uncertainty in the quality level guarantees can result in the formation of sub-optimal service provision contracts. Emblematic consequences include loss of revenue, inefficient resource utilization and erosion of reputation and consumer trust. We propose a utility model for contract-based service provision to provide a systematic approach to optimal service provision contract formation under uncertainty. Performance prediction methods to enable the derivation of statistical estimators for quality level are introduced, with analysis of their resultant accuracy and cost.

Enstore with Chimera namespace provider

International Nuclear Information System (INIS)

Litvintsev, Dmitry; Moibenko, Alexander; Oleynik, Gene; Zalokar, Michael

2012-01-01

Enstore is a mass storage system developed by Fermilab that provides distributed access and management of data stored on tapes. It uses a namespace service, PNFS, developed by DESY to provide a filesystem-like view of the stored data. PNFS is a legacy product and is being replaced by a new implementation, called Chimera, which is also developed by DESY. Chimera offers multiple advantages over PNFS in terms of performance and functionality. The Enstore client component, encp, has been modified to work with Chimera, as well as with any other namespace provider. We performed high load end-to-end acceptance test of Enstore with the Chimera namespace. This paper describes the modifications to Enstore, the test procedure and the results of the acceptance testing.