Sample records for staffed residential services

  1. Alternative staffing services. Contract transcription. (United States)

    Tessier, C


    Contract medical transcription services can be of great assistance in meeting the demands for transcription, without jeopardizing patient, physician, or institutional confidentiality. You simply must require the contract service to provide at least the same degree of protection and preservation of confidentiality that you should require inhouse. To achieve this you must make these requirements explicit, comprehensive, comprehensible, believable, and enforceable. Discuss the requirements with prospective contractors. Review them at least annually with existing contractors and when contracts are due for renewal. Be sure to specify the consequence of breaching confidentiality, and if there are breaches, enforce the terms of the contract. Consult your institution's legal counsel both in developing the contract and in enforcing its provisions. Take into consideration your department's and institution's policies, AHIMA's statement on confidentiality, as well as local, state, and federal laws. Above all, never lose sight of the patient. Ultimately, it is not patient information that you are obligated to protect. It is the patient.

  2. Pre-hospital critical care by anaesthesiologist-staffed pre-hospital services in Scandinavia

    DEFF Research Database (Denmark)

    Krüger, A J; Lossius, H M; Mikkelsen, S


    All Scandinavian countries provide anaesthesiologist-staffed pre-hospital services. Little is known of the incidence of critical illness or injury attended by these services. We aimed to investigate anaesthesiologist-staffed pre-hospital services in Scandinavia with special emphasis on incidence...

  3. Nursing home staffing requirements and input substitution: effects on housekeeping, food service, and activities staff. (United States)

    Bowblis, John R; Hyer, Kathryn


    To study the effect of minimum nurse staffing requirements on the subsequent employment of nursing home support staff. Nursing home data from the Online Survey Certification and Reporting (OSCAR) System merged with state nurse staffing requirements. Facility-level housekeeping, food service, and activities staff levels are regressed on nurse staffing requirements and other controls using fixed effect panel regression. OSCAR surveys from 1999 to 2004. Increases in state direct care and licensed nurse staffing requirements are associated with decreases in the staffing levels of all types of support staff. Increased nursing home nurse staffing requirements lead to input substitution in the form of reduced support staffing levels. © Health Research and Educational Trust.

  4. Longitudinal comparative evaluation of the equivalence of an integrated peer-support and clinical staffing model for residential mental health rehabilitation: a mixed methods protocol incorporating multiple stakeholder perspectives. (United States)

    Parker, Stephen; Dark, Frances; Newman, Ellie; Korman, Nicole; Meurk, Carla; Siskind, Dan; Harris, Meredith


    A novel staffing model integrating peer support workers and clinical staff within a unified team is being trialled at community based residential rehabilitation units in Australia. A mixed-methods protocol for the longitudinal evaluation of the outcomes, expectations and experiences of care by consumers and staff under this staffing model in two units will be compared to one unit operating a traditional clinical staffing. The study is unique with regards to the context, the longitudinal approach and consideration of multiple stakeholder perspectives. The longitudinal mixed methods design integrates a quantitative evaluation of the outcomes of care for consumers at three residential rehabilitation units with an applied qualitative research methodology. The quantitative component utilizes a prospective cohort design to explore whether equivalent outcomes are achieved through engagement at residential rehabilitation units operating integrated and clinical staffing models. Comparative data will be available from the time of admission, discharge and 12-month period post-discharge from the units. Additionally, retrospective data for the 12-month period prior to admission will be utilized to consider changes in functioning pre and post engagement with residential rehabilitation care. The primary outcome will be change in psychosocial functioning, assessed using the total score on the Health of the Nation Outcome Scales (HoNOS). Planned secondary outcomes will include changes in symptomatology, disability, recovery orientation, carer quality of life, emergency department presentations, psychiatric inpatient bed days, and psychological distress and wellbeing. Planned analyses will include: cohort description; hierarchical linear regression modelling of the predictors of change in HoNOS following CCU care; and descriptive comparisons of the costs associated with the two staffing models. The qualitative component utilizes a pragmatic approach to grounded theory, with

  5. Service Differentiation in Residential Broadband Networks

    DEFF Research Database (Denmark)

    Sigurdsson, Halldór Matthias


    As broadband gains widespread adoption with residential users, revenue generating voice- and video-services have not yet taken off. This slow uptake is often attributed to lack of Quality of Service management in residential broadband networks. To resolve this and induce service variety, network...... access providers are implementing service differentiation in their networks where voice and video gets prioritised before data. This paper discusses the role of network access providers in multipurpose packet based networks and the available migration strategies for supporting multimedia services...... in digital subscriber line (DSL) based residential broadband networks. Four possible implementation scenarios and their technical characteristics and effects are described. To conclude, the paper discusses how network access providers can be induced to open their networks for third party service providers....

  6. Implementing an inclusive staffing model for today's reference services a practical guide for librarians

    CERN Document Server

    Nims, Julia K; Stevens, Robert


    Reference service remains a core function of modern libraries. However, how and where we provide assistance has evolved with changing technologies and the shifting habits and preferences of our users. One way libraries can provide the on-demand, in-person assistance while managing and developing new services and resources that will benefit current and future users is to reconsider how their reference points and services are staffed and adopt a staff-based reference model. In Implementing an Inclusive Staffing Model for Today's Reference Services, Nims, Storm, and Stevens describe step-by-step

  7. Who Hires Social Workers? Structural and Contextual Determinants of Social Service Staffing in Nursing Homes. (United States)

    Roberts, Amy Restorick; Bowblis, John R


    Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines the structural characteristics of NHs and other macro-focused contextual factors that explain differences in social service staffing patterns using longitudinal national data (Certification and Survey Provider Enhanced Reports, 2009-2012). NHs have three patterns of staffing for social services, using qualified social workers (QSWs); paraprofessional social service staff; and interprofessional teams, consisting of both QSWs and paraprofessionals. Although most NHs employ a QSW (89 percent), nearly half provide social services through interprofessional teams, and 11 percent rely exclusively on paraprofessionals. Along with state and federal regulations that depend on facility size, other contextual and structural factors within NHs also influence staffing. NHs most likely to hire QSWs are large facilities in urban areas within a health care complex, owned by nonprofit organizations, with more payer mixes associated with more profitable reimbursement. QSWs are least likely to be hired in small facilities in rural areas. The influence of policy in supporting the professionalization of social service staff and the need for QSWs with expertise in gerontology, especially in rural NHs, are discussed. © 2016 National Association of Social Workers.

  8. New Perspectives on Child Welfare; Services, Staffing, Delivery System. (United States)

    Madison, Bernice Q.; Schapiro, Michael

    This is a report of a three-year demonstration and research project which addressed itself to three objectives: (1) To explore the need for planned, long-term foster family care for minority children as one of the services to be made available by a multiple child welfare services program in a public agency. (2) To assess the readiness of seniors…

  9. Counseling, Psychological, and Social Services Staffing: Policies in U.S. School Districts. (United States)

    Brener, Nancy; Demissie, Zewditu


    Schools are in a unique position to meet the mental and behavioral health needs of children and adolescents because approximately 95% of young people aged 7-17 years attend school. Little is known, however, about policies related to counseling, psychological, and social services staffing in school districts. This study analyzed the prevalence of such policies in public school districts in the U.S. Data from four cycles (2000, 2006, 2012, and 2016) of the School Health Policies and Practices Study, a national survey periodically conducted to assess policies and practices for ten components of school health, were analyzed in 2017. The survey collected data related to counseling, psychological, and social services among nationally representative samples of school districts using online or mailed questionnaires. Sampled districts identified respondents responsible for or most knowledgeable about the content of each questionnaire. The percentage of districts with a district-level counseling, psychological, and social services coordinator increased significantly from 62.6% in 2000 to 79.5% in 2016. In 2016, 56.3% of districts required each school to have someone to coordinate counseling, psychological, and social services at the school. Fewer districts required schools at each level to have a specified ratio of counselors to students (16.2% for elementary schools, 16.8% for middle schools, and 19.8% for high schools), and the percentage of districts with these requirements has decreased significantly since 2012. Increases in the prevalence of district-level staffing policies could help increase the quantity and quality of counseling, psychological, and social services staff in schools nationwide, which in turn could improve mental and behavioral health outcomes for students. This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration

  10. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services

    DEFF Research Database (Denmark)

    Kruger, Andreas J; Lockey, David; Kurola, Jouni


    -staffed pre-hospital services in Europe. METHODS: Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary...... have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care....

  11. Residential proximity to gasoline service stations and preterm birth. (United States)

    Huppé, Vicky; Kestens, Yan; Auger, Nathalie; Daniel, Mark; Smargiassi, Audrey


    Preterm birth (PTB) is a growing public health problem potentially associated with ambient air pollution. Gasoline service stations can emit atmospheric pollutants, including volatile organic compounds potentially implicated in PTB. The objective of this study was to evaluate the relationship between residential proximity to gasoline service stations and PTB. Singleton live births on the Island of Montreal from 1994 to 2006 were obtained (n=267,478). Gasoline service station locations, presence of heavy-traffic roads, and neighborhood socioeconomic status (SES) were determined using a geographic information system. Multivariable logistic regression was used to analyze the association between PTB and residential proximity to gasoline service stations (50, 100, 150, 200, 250, and 500 m), accounting for maternal covariates, neighborhood SES, and heavy-traffic roads. For all distance categories beyond 50 m, presence of service stations was associated with a greater odds of PTB. Associations were robust to adjustment for maternal covariates for distance categories of 150 and 200 m but were nullified when adjusting for neighborhood SES. In analyses accounting for the number of service stations, the likelihood of PTB within 250 m was statistically significant in unadjusted models. Associations were, however, nullified in models accounting for maternal covariates or neighborhood SES. Our results suggest that there is no clear association between residential proximity to gasoline service stations in Montreal and PTB. Given the correlation between proximity of gasoline service stations and SES, it is difficult to delineate the role of these factors in PTB.

  12. Implementing the psychosocial standards in pediatric cancer: Current staffing and services available. (United States)

    Scialla, Michele A; Canter, Kimberly S; Chen, Fang Fang; Kolb, E Anders; Sandler, Eric; Wiener, Lori; Kazak, Anne E


    Fifteen evidence-based Standards for Psychosocial Care for Children with Cancer and Their Families (Standards) were published in 2015. The Standards cover a broad range of topics and circumstances and require qualified multidisciplinary staff to be implemented. This paper presents data on the availability of psychosocial staff and existing practices at pediatric oncology programs in the United States, providing data that can be used to advocate for expanded services and prepare for implementation of the Standards. Up to three healthcare professionals from 144 programs (72% response rate) participated in an online survey conducted June-December 2016. There were 99 pediatric oncologists with clinical leadership responsibility (Medical Director/Clinical Director), 132 psychosocial leaders in pediatric oncology (Director of Psychosocial Services/Manager/most senior staff member), and 58 administrators in pediatric oncology (Administrative Director/Business Administrator/Director of Operations). The primary outcomes were number and type of psychosocial staff, psychosocial practices, and identified challenges in the delivery of psychosocial care. Over 90% of programs have social workers and child life specialists who provide care to children with cancer and their families. Fewer programs have psychologists (60%), neuropsychologists (31%), or psychiatrists (19%). Challenges in psychosocial care are primarily based on pragmatic issues related to funding and reimbursement. Most participating pediatric oncology programs appear to have at least the basic level of staffing necessary to implement of some of the Standards. However, the lack of a more comprehensive multidisciplinary team is a likely barrier in the implementation of the full set of Standards. © 2017 Wiley Periodicals, Inc.

  13. Factors Influencing Quality of Pain Management in a Physician Staffed Helicopter Emergency Medical Service. (United States)

    Oberholzer, Nicole; Kaserer, Alexander; Albrecht, Roland; Seifert, Burkhardt; Tissi, Mario; Spahn, Donat R; Maurer, Konrad; Stein, Philipp


    Pain is frequently encountered in the prehospital setting and needs to be treated quickly and sufficiently. However, incidences of insufficient analgesia after prehospital treatment by emergency medical services are reported to be as high as 43%. The purpose of this analysis was to identify modifiable factors in a specific emergency patient cohort that influence the pain suffered by patients when admitted to the hospital. For that purpose, this retrospective observational study included all patients with significant pain treated by a Swiss physician-staffed helicopter emergency service between April and October 2011 with the following characteristics to limit selection bias: Age > 15 years, numerical rating scale (NRS) for pain documented at the scene and at hospital admission, NRS > 3 at the scene, initial Glasgow coma scale > 12, and National Advisory Committee for Aeronautics score helicopter emergency service associated with insufficient pain management. A total of 778 patients were included in the analysis. Insufficient pain management (NRS > 3 at hospital admission) was identified in 298 patients (38%). Factors associated with insufficient pain management were higher National Advisory Committee for Aeronautics scores, high NRS at the scene, nontrauma patients, no analgesic administration, and treatment by a female physician. In 16% (128 patients), despite ongoing pain, no analgesics were administered. Factors associated with this untreated persisting pain were short time at the scene (below 10 minutes), secondary missions of helicopter emergency service, moderate pain at the scene, and nontrauma patients. Sufficient management of severe pain is significantly better if ketamine is combined with an opioid (65%), compared to a ketamine or opioid monotherapy (46%, P = .007). In the studied specific Swiss cohort, nontrauma patients, patients on secondary missions, patients treated only for a short time at the scene before transport, patients who receive no

  14. Successful Implementation of Six Sigma to Schedule Student Staffing for Circulation Service Desks (United States)

    Jankowski, Janiece


    In fall of 2011 the University at Buffalo Libraries circulation department undertook Six Sigma training for the purpose of overhauling its student scheduling process. The department was able to mitigate significant staffing budgetary reductions and resource reallocations and to overcome the unique challenges of scheduling student labor for a…

  15. 28 CFR 550.52 - Non-residential drug abuse treatment services. (United States)


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Non-residential drug abuse treatment... INSTITUTIONAL MANAGEMENT DRUG PROGRAMS Drug Abuse Treatment Program § 550.52 Non-residential drug abuse treatment services. All institutions must have non-residential drug abuse treatment services, provided...

  16. EnviroAtlas - Population and Residential Activity in the Conterminous U.S. Web Service (United States)

    U.S. Environmental Protection Agency — This EnviroAtlas web service includes maps that illustrate population and residential activity in each census block group as well as residential-location-based...

  17. Customer service in the residential property market of South Africa

    Directory of Open Access Journals (Sweden)

    S Rudansky-KlopperS


    Full Text Available An increasing number of estate agencies are entering the real estate market in South Africa and many are struggling to survive as competition grows stronger. Customer service has become of overriding importance to establish a differential advantage that will ensure long-term survival. This study investigates customer service by estate agencies in the residential property market of South Africa. The results indicate that estate agencies seem to be aware of the importance of providing good customer service and of being service-oriented, but they do not always seem to realise the need to conduct marketing research and test the actual satisfaction of customers with the services provided, leaving a potential gap between what the customer wants and what the estate agency provides.

  18. Short Paper: Frequency Regulation Services from Connected Residential Devices: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Baker, Kyri; Jin, Xin; Vaidhynathan, Deepthi; Jones, Wesley; Christensen, Dane; Sparn, Bethany; Woods, Jason; Sorensen, Harry; Lunacek, Monte


    In this paper, we demonstrate the potential benefits that residential buildings can provide for frequency regulation services in the electric power grid. In a hardware-in-the- loop (HIL) implementation, simulated homes along with a physical laboratory home are coordinated via a grid aggregator, and it is shown that their aggregate response has the potential to follow the regulation signal on a timescale of seconds. Connected (communication-enabled), devices in the National Renewable Energy Laboratory's (NREL's) Energy Systems Integration Facility (ESIF) received demand response (DR) requests from a grid aggregator, and the devices responded accordingly to meet the signal while satisfying user comfort bounds and physical hardware limitations. Future research will address the issues of cybersecurity threats, participation rates, and reducing equipment wear-and-tear while providing grid services.

  19. Costs, Staffing, and Services of Assisted Living in the United States: A Literature Review. (United States)

    Kisling-Rundgren, Amy; Paul, David P; Coustasse, Alberto


    Assisted-living facilities (ALFs), which provide a community for residents who require assistance throughout their day, are an important part of the long-term-care system in the United States. The costs of ALFs are paid either out of pocket, by Medicaid, or by long-term-care insurance. Monthly costs of ALFs have increased over the past 5 years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the United States to determine the impact of health care on costs. The methodology for this study was a literature review, and a total of 32 sources were referenced. Trends in monthly costs of ALFs have increased from 2004 to 2014. Within the past 5 years, there has been an increase on average of 4.1% in assisted-living costs. Medicaid is one payer for residents of ALFs, whereas another alternative is the use of long-term-care insurance. Unfortunately, Medicare does not pay for ALFs. Staffing concerns in ALFs are limited because of each state having different rules and regulations. Turnover and retention rates of nurses in ALFs are suggested to be high, whereas vacancy rate for nurses is suggested to be lower. The baby-boomer generation can be one contribution to the increase in costs. Over the years, there has been an increase in Alzheimer disease, which has had also an effect on cost in ALFs.

  20. Airway management by physician-staffed Helicopter Emergency Medical Services - a prospective, multicentre, observational study of 2,327 patients. (United States)

    Sunde, Geir Arne; Heltne, Jon-Kenneth; Lockey, David; Burns, Brian; Sandberg, Mårten; Fredriksen, Knut; Hufthammer, Karl Ove; Soti, Akos; Lyon, Richard; Jäntti, Helena; Kämäräinen, Antti; Reid, Bjørn Ole; Silfvast, Tom; Harm, Falko; Sollid, Stephen J M


    Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services. We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. A uniform Utstein-style airway template was used for collecting data. The participating services attended 14,703 patients on primary missions during the study period, and 2,327 (16 %) required advanced prehospital airway interventions. Of these, tracheal intubation was attempted in 92 % of the cases. The rest were managed with supraglottic airway devices (5 %), bag-valve-mask ventilation (2 %) or continuous positive airway pressure (0.2 %). Intubation failure rates were 14.5 % (first-attempt) and 1.2 % (overall). Cardiac arrest patients showed significantly higher first-attempt intubation failure rates (odds ratio: 2.0; 95 % CI: 1.5-2.6; p < 0.001) compared to non-cardiac arrest patients. Complications were recorded in 13 %, with recognised oesophageal intubation being the most frequent (25 % of all patients with complications). For non-cardiac arrest patients, important risk predictors for first-attempt failure were patient age (a non-linear association) and administration of sedatives (reduced failure risk). The patient's sex, provider's intubation experience, trauma type (patient category), indication for airway intervention and use of neuromuscular blocking agents were not risk factors for first-attempt intubation failure. Advanced airway management in physician-staffed prehospital services was performed frequently, with high intubation success rates and low complication rates overall. However, cardiac arrest patients showed significantly higher first-attempt failure rates compared to non-cardiac arrest patients. All

  1. Thermographic Inspections And The Residential Conservation Service Program (RCS) (United States)

    Ward, Ronald J.


    Rhode Islanders Saving Energy (RISE) is a non-profit corporation founded in 1977 to provide Rhode Island residents with a variety of energy conservation services. Since January of 1981, it has been performing energy audits in compliance with the Department of Energy's (DOE) Residential Conservation Service Program (RCS). One aspect of the RCS program is the performance of inspections on energy conservation activities completed according to RCS installation guidelines. This paper will describe both the use and results of thermographic inspections within the RISE program. The primary objective of these inspections has been to assure the quality of the building envelope after completion of retrofit measures. Thermal anamolies have been detected that vary in size, location and probable cause. Approximately 37% of all jobs performed through RISE in conjunction with the RCS program have required remedial work as a result of problems that were identi-fied during the thermographic inspection. This percentage was much higher when infra-red inspections were conducted on "Non-RCS" retrofits. Statistics will be presented that provide an interesting insight on the quality of retrofit work when performed in associa-tion with a constant inspection process.

  2. Improving the Quality of Services in Residential Treatment Facilities: A Strength-Based Consultative Review Process (United States)

    Pavkov, Thomas W.; Lourie, Ira S.; Hug, Richard W.; Negash, Sesen


    This descriptive case study reports on the positive impact of a consultative review methodology used to conduct quality assurance reviews as part of the Residential Treatment Center Evaluation Project. The study details improvement in the quality of services provided to youth in unmonitored residential treatment facilities. Improvements were…

  3. School Psychologists as Mental Health Providers: The Impact of Staffing Ratios and Medicaid on Service Provisions (United States)

    Eklund, Katie; Meyer, Lauren; Way, Samara; Mclean, Deija


    As one out of five children in the United States demonstrate some type of mental or behavioral health concern warranting additional intervention, federal policies have emphasized the need for school-based mental health (SBMH) services and an expansion of Medicaid reimbursement for eligible children and families. Most youth access mental health…

  4. Emergency residential care settings: A model for service assessment and design. (United States)

    Graça, João; Calheiros, Maria Manuela; Patrício, Joana Nunes; Magalhães, Eunice Vieira


    There have been calls for uncovering the "black box" of residential care services, with a particular need for research focusing on emergency care settings for children and youth in danger. In fact, the strikingly scant empirical attention that these settings have received so far contrasts with the role that they often play as gateway into the child welfare system. To answer these calls, this work presents and tests a framework for assessing a service model in residential emergency care. It comprises seven studies which address a set of different focal areas (e.g., service logic model; care experiences), informants (e.g., case records; staff; children/youth), and service components (e.g., case assessment/evaluation; intervention; placement/referral). Drawing on this process-consultation approach, the work proposes a set of key challenges for emergency residential care in terms of service improvement and development, and calls for further research targeting more care units and different types of residential care services. These findings offer a contribution to inform evidence-based practice and policy in service models of residential care. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Ecosystem services in managing residential landscapes: priorities, value dimensions, and cross-regional patterns (United States)

    K.L. Larson; K.C. Nelson; S.R. Samples; S.J. Hall; N. Bettez; J. Cavender-Bares; P.M. Groffman; M. Grove; J.B. Heffernan; S.E. Hobbie; J. Learned; J.L. Morse; C. Neill; L.A. Ogden; Jarlath O' Neil-Dunne; D.E. Pataki; C. Polsky; R. Roy Chowdhury; M. Steele; T.L.E. Trammell


    Although ecosystem services have been intensively examined in certain domains (e.g., forests and wetlands), little research has assessed ecosystem services for the most dominant landscape type in urban ecosystems—namely, residential yards. In this paper, we report findings of a cross-site survey of homeowners in six U.S. cities to 1) examine how residents subjectively...

  6. Older adults’ home- and community-based care service use and residential transitions: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Chen Ya-Mei


    Full Text Available Abstract Background As Home-and Community-Based Services (HCBS, such as skilled nursing services or personal care services, have become increasingly available, it has become clear that older adults transit through different residential statuses over time. Older adults may transit through different residential statuses as the various services meet their needs. The purpose of this exploratory study was to better understand the interplay between community-dwelling older adults’ use of home- and community-based services and their residential transitions. Methods The study compared HCBS service-use patterns and residential transitions of 3,085 older adults from the Second Longitudinal Study of Aging. Based on older adults’ residential status at the three follow-up interviews, four residential transitions were tracked: (1 Community-Community-Community (CCC: Resided in community during the entire study period; (2 Community-Institution-Community (CIC: Resided in community at T1, had lived in an institution at some time between T1 and T2, then had returned to community by T3; (3 Community-Community-Institution (CCI: Resided in community between at T1, and betweenT1 and T2, including at T2, but had used institutional services between T2 and T3; (4 Community-Institution-Institution (CII: Resided in community at T1 but in an institution at some time between T1 and T2, and at some time between T2 and T3.. Results Older adults’ use of nondiscretionary and discretionary services differed significantly among the four groups, and the patterns of HCBS use among these groups were also different. Older adults’ use of nondiscretionary services, such as skilled nursing care, may help them to return to communities from institutions. Personal care services (PCS and senior center services may be the key to either support elders to stay in communities longer or help elders to return to their communities from institutions. Different combinations of PCS with other

  7. Applying WHO's 'workforce indicators of staffing need' (WISN) method to calculate the health worker requirements for India's maternal and child health service guarantees in Orissa State. (United States)

    Hagopian, Amy; Mohanty, Manmath K; Das, Abhijit; House, Peter J


    In one district of Orissa state, we used the World Health Organization's Workforce Indicators of Staffing Need (WISN) method to calculate the number of health workers required to achieve the maternal and child health 'service guarantees' of India's National Rural Health Mission (NRHM). We measured the difference between this ideal number and current staffing levels. We collected census data, routine health information data and government reports to calculate demand for maternal and child health services. By conducting 54 interviews with physicians and midwives, and six focus groups, we were able to calculate the time required to perform necessary health care tasks. We also interviewed 10 new mothers to cross-check these estimates at a global level and get assessments of quality of care. For 18 service centres of Ganjam District, we found 357 health workers in our six cadre categories, to serve a population of 1.02 million. Total demand for the MCH services guaranteed under India's NRHM outpaced supply for every category of health worker but one. To properly serve the study population, the health workforce supply should be enhanced by 43 additional physicians, 15 nurses and 80 nurse midwives. Those numbers probably under-estimate the need, as they assume away geographic barriers. Our study established time standards in minutes for each MCH activity promised by the NRHM, which could be applied elsewhere in India by government planners and civil society advocates. Our calculations indicate significant numbers of new health workers are required to deliver the services promised by the NRHM.

  8. Infectious Intestinal Diseases and Residential Water Services in Mexico: a Spatial Analysis

    Directory of Open Access Journals (Sweden)

    Nicholas P. Sisto


    Full Text Available Infectious intestinal diseases (IID represent a widespread public health problem in Mexico. The country also faces major challenges with respect to the provision of residential water services (piped water and sewer—an essential input for hygiene and cleanliness in homes. This paper analyzes morbidity rates from several IID associated with unsanitary living conditions along with a series of residential water services indicators for Mexico’s 2,456 municipalities. With data obtained through a special request to the federal epidemiological authority as well as official census data for 2010, we find stark regional contrasts and identify interesting spatial structures for both IID morbidity and residential water services indicators. In particular, municipalities tend to present values similar to neighboring municipalities, forming clusters of relatively high-value (or low-value municipalities. Moreover we find that municipalities with a relatively high level of access to residential water services tend to present relatively low IID morbidity rates. These results have multiple public policy implications. In order to reduce the incidence of IID effectively and efficiently, interventions should explicitly consider the spatial structure of morbidity and target problem spots—which typically spill over state, municipal and other administrative boundaries. Moreover, improvements in the quality of access to piped water (for example, increasing the frequency of supply may be as important for reducing morbidity as the expansion of basic access to this service.

  9. Physician staffed helicopter emergency medical service dispatch via centralised control or directly by crew – case identification rates and effect on the Sydney paediatric trauma system

    Directory of Open Access Journals (Sweden)

    Garner Alan A


    Full Text Available Abstract Background Severe paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC. Parallel case identification systems utilising paramedics from a centralised dispatch centre versus the crew of a physician staffed Helicopter Emergency Medical Service (HEMS allowed comparison of the two systems for case identification rates and subsequent timeliness of direct transfer to a PTC. Methods Paediatric trauma patients over a two year period from the Sydney region with an Injury Severity Score (ISS > 15 were retrospectively identified from a state wide trauma registry. Overall paediatric trauma system performance was assessed by comparisons of the availability of the physician staffed HEMS for patient characteristics, transport mode (direct versus indirect and the times required for the patient to arrive at the paediatric trauma centre. The proportion of patients transported directly to a PTC was compared between the times that the HEMS service was available versus the time that it was unavailable to determine if the HEMS system altered the rate of direct transport to a PTC. Analysis of variance was used to compare the identifying systems for various patient characteristics when the HEMS was available. Results Ninety nine cases met the inclusion criteria, 44 when the HEMS system was operational. Patients identified for physician response by the HEMS system were significantly different to those that were not identified with higher median ISS (25 vs 18, p = 0.011, and shorter times to PTC (67 vs 261mins, p = 0.015 and length of intensive care unit stays (2 vs 0 days, p = 0.045. Of the 44 cases, 21 were not identified, 3 were identified by the paramedic system and 20 were identified by the HEMS system, (P  Conclusions Physician staffed HEMS crew dispatch is significantly more likely to identify cases of severe paediatric trauma and is associated with a greater proportion of transports

  10. Medical Service Utilization among Youth with School-Identified Disabilities in Residential Care (United States)

    Lambert, Matthew C.; Trout, Alexandra L.; Nelson, Timothy D.; Epstein, Michael H.; W. Thompson, Ronald


    Background: Behavioral, social, emotional, and educational risks among children and youth with school identified disabilities served in residential care have been well documented. However, the health care needs and medical service utilization of this high-risk population are less well known. Given the risks associated with children with…

  11. Integration of EEG lead placement templates into traditional technologist-based staffing models reduces costs in continuous video-EEG monitoring service. (United States)

    Kolls, Brad J; Lai, Amy H; Srinivas, Anang A; Reid, Robert R


    The purpose of this study was to determine the relative cost reductions within different staffing models for continuous video-electroencephalography (cvEEG) service by introducing a template system for 10/20 lead application. We compared six staffing models using decision tree modeling based on historical service line utilization data from the cvEEG service at our center. Templates were integrated into technologist-based service lines in six different ways. The six models studied were templates for all studies, templates for intensive care unit (ICU) studies, templates for on-call studies, templates for studies of ≤ 24-hour duration, technologists for on-call studies, and technologists for all studies. Cost was linearly related to the study volume for all models with the "templates for all" model incurring the lowest cost. The "technologists for all" model carried the greatest cost. Direct cost comparison shows that any introduction of templates results in cost savings, with the templates being used for patients located in the ICU being the second most cost efficient and the most practical of the combined models to implement. Cost difference between the highest and lowest cost models under the base case produced an annual estimated savings of $267,574. Implementation of the ICU template model at our institution under base case conditions would result in a $205,230 savings over our current "technologist for all" model. Any implementation of templates into a technologist-based cvEEG service line results in cost savings, with the most significant annual savings coming from using the templates for all studies, but the most practical implementation approach with the second highest cost reduction being the template used in the ICU. The lowered costs determined in this work suggest that a template-based cvEEG service could be supported at smaller centers with significantly reduced costs and could allow for broader use of cvEEG patient monitoring.

  12. Future Services for District Heating Solutions in Residential Districts

    Directory of Open Access Journals (Sweden)

    Hannele Ahvenniemi


    Full Text Available The underlying assumption of this study is that in order to retain the competitiveness while reaching for the EU targets regarding low-energy construction, district heating companies need to develop new business and service models. How district heating companies could broaden their perspective and switch to a more service-oriented way of thinking is a key interest of our research. The used methods in our study are house builder interviews and a questionnaire. With the help of these methods we discussed the potential interest in heating related services acquiring a comprehensive understanding of the customer needs. The results indicate the importance of certain criteria when choosing the heating system in households: easiness, comfort and affordability seem to dominate the house builders’ preferences. Also environmental awareness seems to be for many an important factor when making a decision about the heating of the house. Altogether, based on the results of this study, we suggest that the prospects of district heating could benefit from highlighting certain aspects and strengths in the future. District heating companies need to increase flexibility, readiness to adopt new services, to invest in new marketing strategies and improving the communication skills.

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

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Xin


    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

  14. Staffing in Radiotherapy: An Activity Based Approach

    International Nuclear Information System (INIS)


    Radiotherapy requires competent professional staff to ensure safe and effective patient treatment and management. There is a need to provide guidelines that recommend appropriate staffing levels to support the initiation of new services as well as the expansion or upgrade of existing services as even simple upgrades or replacement of existing equipment may have a significant impact on staffing needs. Similarly, the introduction of education and training programmes will require staffing adjustments. A calculation algorithm was developed to predict staffing levels based on the inputs that are known or can be easily estimated. This publication complements other IAEA publications used to support the initiation of basic radiation medicine services including Setting up a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects, published in 2008

  15. Physician staffed helicopter emergency medical service dispatch via centralised control or directly by crew - case identification rates and effect on the Sydney paediatric trauma system. (United States)

    Garner, Alan A; Lee, Anna; Weatherall, Andrew


    Severe paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC). Parallel case identification systems utilising paramedics from a centralised dispatch centre versus the crew of a physician staffed Helicopter Emergency Medical Service (HEMS) allowed comparison of the two systems for case identification rates and subsequent timeliness of direct transfer to a PTC. Paediatric trauma patients over a two year period from the Sydney region with an Injury Severity Score (ISS) > 15 were retrospectively identified from a state wide trauma registry. Overall paediatric trauma system performance was assessed by comparisons of the availability of the physician staffed HEMS for patient characteristics, transport mode (direct versus indirect) and the times required for the patient to arrive at the paediatric trauma centre. The proportion of patients transported directly to a PTC was compared between the times that the HEMS service was available versus the time that it was unavailable to determine if the HEMS system altered the rate of direct transport to a PTC. Analysis of variance was used to compare the identifying systems for various patient characteristics when the HEMS was available. Ninety nine cases met the inclusion criteria, 44 when the HEMS system was operational. Patients identified for physician response by the HEMS system were significantly different to those that were not identified with higher median ISS (25 vs 18, p = 0.011), and shorter times to PTC (67 vs 261mins, p = 0.015) and length of intensive care unit stays (2 vs 0 days, p = 0.045). Of the 44 cases, 21 were not identified, 3 were identified by the paramedic system and 20 were identified by the HEMS system, (P system was available (RR 1.81, 95% CI 1.20-2.73). The median time (minutes) to arrival at the PTC was shorter when HEMS available (HEMS available 92, IQR 50-261 versus HEMS unavailable 296, IQR 84-583, P < 0.01). Physician staffed

  16. Evaluation of a Residential Mental Health Recovery Service in North Queensland. (United States)

    Heyeres, Marion; Kinchin, Irina; Whatley, Elise; Brophy, Lisa; Jago, Jon; Wintzloff, Thomas; Morton, Steve; Mosby, Vinitta; Gopalkrishnan, Narayan; Tsey, Komla


    Evidence shows that subacute mental health recovery occurs best when a person remains active within the community and fulfils meaningful and satisfying roles of their choosing. Several residential care services that incorporate these values have been established in Australia and overseas. This study describes (a) the development of an evaluation framework for a new subacute residential mental health recovery service in regional Australia and (b) reports on the formative evaluation outcomes. Continuous quality improvement and participatory research approaches informed all stages of the development of the evaluation framework. A program logic was established and subsequently tested for practicability. The resultant logic utilizes the Scottish Recovery Indicator 2 (SRI 2) service development tool, Individual Recovery Plans (IRPs), and the impact assessment of the service on psychiatric inpatient admissions (reported separately). Service strengths included a recovery-focused practice that identifies and addresses the basic needs of residents (consumers). The consumers of the service were encouraged to develop their own goals and self-manage their recovery plans. The staff of the service were identified as working effectively in the context of the recovery process; the staff were seen as supported and valued. Areas for improvement included more opportunities for self-management for residents and more feedback from residents and carers.

  17. Evaluation of a Residential Mental Health Recovery Service in North Queensland

    Directory of Open Access Journals (Sweden)

    Marion Heyeres


    Full Text Available BackgroundEvidence shows that subacute mental health recovery occurs best when a person remains active within the community and fulfils meaningful and satisfying roles of their choosing. Several residential care services that incorporate these values have been established in Australia and overseas.AimsThis study describes (a the development of an evaluation framework for a new subacute residential mental health recovery service in regional Australia and (b reports on the formative evaluation outcomes.MethodsContinuous quality improvement and participatory research approaches informed all stages of the development of the evaluation framework. A program logic was established and subsequently tested for practicability. The resultant logic utilizes the Scottish Recovery Indicator 2 (SRI 2 service development tool, Individual Recovery Plans (IRPs, and the impact assessment of the service on psychiatric inpatient admissions (reported separately.ResultsService strengths included a recovery-focused practice that identifies and addresses the basic needs of residents (consumers. The consumers of the service were encouraged to develop their own goals and self-manage their recovery plans. The staff of the service were identified as working effectively in the context of the recovery process; the staff were seen as supported and valued. Areas for improvement included more opportunities for self-management for residents and more feedback from residents and carers.

  18. Market opportunities in Canada for multimedia residential services in rural and small urban areas (United States)

    Shariatmadar, Mehran; Narasimhan, Vasantha


    This paper reviews the studies which were undertaken jointly by Telesat and Industry Canada to provide an estimate of the market opportunities for residential multi-media services in the rural and small urban areas of Canada. This study is part of the Advanced Satcom program, a Ka-band satellite system proposal which is currently in the implementation proposal phase by the government and the Canadian space industry of which Telesat is an active member. Advanced Satcom extends the reach of terrestrial information highways to the remote and sparsely populated parts of the country in a cost-effective manner and thus provides a ubiquitous coverage of the information highways to all Canadians. Therefore, the rural and small urban markets are believed to be good opportunities for the Advanced Satcom. Although the results are primarily intended for fixed residential applications, they can also be used as input to market opportunity studies for wideband mobile applications.

  19. Second life battery energy storage system for residential demand response service

    DEFF Research Database (Denmark)

    Saez-de-Ibarra, Andoni; Martinez-Laserna, Egoitz; Koch-Ciobotaru, Cosmin


    vehicles, during their main first life application, for providing residential demand response service. The paper considers the decayed characteristics of these batteries and optimizes the rating of such a second life battery energy storage system (SLBESS) for maximizing the economic benefits of the user......The integration of renewable energies and the usage of battery energy storage systems (BESS) into the residential buildings opens the possibility for minimizing the electricity bill for the end-user. This paper proposes the use of batteries that have already been aged while powering electric......'s energy consumption during a period of one year. Furthermore, simulations were performed considering real data of PV generation, consumption, prices taken from the Spanish market and costs of battery and photovoltaic systems....

  20. Resource and revenue potential of California residential load participation in ancillary services

    International Nuclear Information System (INIS)

    Mathieu, Johanna L.; Dyson, Mark E.H.; Callaway, Duncan S.


    Increasing penetrations of intermittent renewable energy resources will require additional power system services. California recently adopted an energy storage mandate to support its renewable portfolio standard, which requires 33% of delivered energy from renewables by 2020. The objective of this paper is to estimate the amount of energy storage that could be provided by residential thermostatically controlled loads, such as refrigerators and air conditioners, and the amount of revenue that could be earned by loads participating in ancillary services markets. We model load aggregations as virtual energy storage, and use simple dynamical system models and publicly available data to generate our resource and revenue estimates. We find that the resource potential is large: 10–40 GW/8–12 GWh, which is significantly more than that required by the mandate. We also find that regulation and spinning/non-spinning reserve revenues vary significantly depending upon type of load and, for heat pumps and air conditioners, climate zone. For example, mean regulation revenues for refrigerators are $11/year, for electric water heaters are $24/year, for air conditioners are $0-32/year, and for heat pumps are $22–56/year. Both consumer choices, such as appliance settings, and policy, such as the design of ancillary service compensation and appliance standards, could increase revenue potentials. - Highlights: • California's energy storage mandate requires 1.325 GW of energy storage by 2020. • Residential loads such as refrigerators have thermal energy storage. • California's residential loads could provide 10-40 GW/8-12 GWh of storage. • Loads participating in ancillary services markets could earn up to $56/load/year. • Consumer choices and policy mechanisms could increase revenue potentials

  1. Regionalised tertiary psychiatric residential facilities. (United States)

    Lesage, Alain; Groden, David; Goldner, Elliot M; Gelinas, Daniel; Arnold, Leslie M


    Psychiatric hospitals remain the main venue for long-term mental health care and, despite widespread closures and downsizing, no country that built asylums in the last century has done away with them entirely--with the recent exception of Italy. Differentiated community-based residential alternatives have been developed over the past decades, with staffing levels that range from full-time professional, to daytime only, to part-time/on-call. This paper reviews the characteristics of community-based psychiatric residential care facilities as an alternative to long-term care in psychiatric hospitals. It describes five factors decision makers should consider: 1. number of residential places needed; 2. staffing levels; 3. physical setting; 4. programming; and 5. governance and financing. In Italy, facilities with full-time professional staff have been developed since the mid-1990s to accommodate the last cohorts of patients discharged from psychiatric hospitals. In the United Kingdom, experiments with hostel wards since the 1980s have shown that home-like, small-scale facilities with intensive treatment and rehabilitation programming can be effective for the most difficult-to-place patients. More recently in Australia, Community Care Units (CCUs) have been applying this concept. In the Canadian province of British Columbia (BC), Tertiary Psychiatric Residential Facilities (TPRFs) have been developed as part of an effort to regionalise health and social services and downsize and ultimately close its only psychiatric hospital. This type of service must be further developed in addition to the need for forensic, acute-care and intermediate-level beds, as well as for community-based care such as assertive community treatment and intensive case management. All these types of services, together with long-term community-based residential care, constitute the elements of a balanced mental health care system. As part of a region's balanced mental health care plan, these Tertiary

  2. Study of structural capacity and serviceability affecting the obstruction of residential door

    Directory of Open Access Journals (Sweden)

    Eric Forcael

    Full Text Available The last Chilean earthquake, occurred on February 27, 2010, allowed establishing important patterns of structural failures in reinforced concrete residential buildings; however, limited progress has been made in the study of basic standards of serviceability, such as obstruction of doors. Thus, this study focused on measuring the influence of design specifications and construction criteria of lintels and columns, in terms of obstruction of doors, considering capacity thresholds for certain levels of displacement. The study consisted of the design and construction of a full-scale prototype of a reinforced concrete frame, designed in accordance with all the ACI-318-08 requirements, taking into account typical aspects of geometry and materiality widely used by the real estate industry, for location and size of doors. In order to quantify the structural capacity of the prototype and to study the serviceability of the door, a quasi-static cyclic test was conducted, according to load and displacement protocols specified in FEMA 356 and FEMA 461, which was adjusted by using virtual models based on a static nonlinear analysis called "Pushover". This research verified that, for displacement levels even five times higher than those established by codes considered, the cracking degree was minimal and fully recoverable. It was also found the door evidenced malfunction when the displacements were greater than those specified by design only, validating a high degree of accomplishment of current codes, in terms of capacity and serviceability, when dealing with obstruction of residential doors.

  3. What do customers want from improved residential electricity services? Evidence from a choice experiment

    International Nuclear Information System (INIS)

    Huh, Sung-Yoon; Woo, JongRoul; Lim, Sesil; Lee, Yong-Gil; Kim, Chang Seob


    Improvements in customer satisfaction as well as product/service quality represent a common objective of all businesses, and electricity services are no exception. Using choice experiments and a mixed logit model, this study quantitatively analyzes customers' preferences and their marginal willingness to pay for improved residential electricity services. The study provides an ex ante evaluation of customers' acceptance of hypothetical electricity services. According to the results, customers consider the electricity bill and the electricity mix as the two most important attributes when choosing their electricity services. Customers are willing to pay 2.2% more in the average electricity bill (an additional monthly electricity bill of KRW 1,064; USD 0.96) for a significant increase in the share of renewable energy, which is far less than the actual cost of achieving this renewable target. Therefore, it is better to maintain the current electricity mix in principle, and the renewable share should be gradually expanded instead of making a sudden change in the electricity mix. In addition, customers are willing to pay KRW 6,793 (USD 6.15) more to reduce blackouts once in a year and KRW 64/year (USD 0.06/year) to reduce a minute of each blackout. -- Highlights: •Customers' preferences for improved residential electricity services are analyzed. •Empirical setting is a sample of residents in South Korea. •The electricity bills and electricity mix are important to customers. •Increase in electricity bill of different electricity mix is considered

  4. 42 CFR 9.9 - Facility staffing. (United States)


    ... 42 Public Health 1 2010-10-01 2010-10-01 false Facility staffing. 9.9 Section 9.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS STANDARDS OF CARE FOR... Biosafety Officer must have experience in developing and monitoring biohazards and dealing with biosafety...

  5. Development, Validation, and Implementation of a Clinic Nurse Staffing Guideline. (United States)

    Deeken, Debra Jean; Wakefield, Douglas; Kite, Cora; Linebaugh, Jeanette; Mitchell, Blair; Parkinson, Deidre; Misra, Madhukar


    Ensuring that the level of nurse staffing used to care for patients is appropriate to the setting and service intensity is essential for high-quality and cost-effective care. This article describes the development, validation, and implementation of the clinic technical skills permission list developed specifically to guide nurse staffing decisions in physician clinics of an academic medical center. Results and lessons learned in using this staffing guideline are presented.

  6. Mortality and health services utilisation among older people with advanced cognitive impairment living in residential care homes. (United States)

    Luk, James K H; Chan, W K; Ng, W C; Chiu, Patrick K C; Ho, Celina; Chan, T C; Chan, Felix H W


    To study the demography, clinical characteristics, service utilisation, mortality, and predictors of mortality in older residential care home residents with advanced cognitive impairment. Cohort longitudinal study. Residential care homes for the elderly in Hong Kong West. Residents of such homes aged 65 years or more with advanced cognitive impairment. In all, 312 such residential care home residents (71 men and 241 women) were studied. Their mean age was 88 (standard deviation, 8) years and their mean Barthel Index 20 score was 1.5 (standard deviation, 2.0). In all, 164 (53%) were receiving enteral feeding. Nearly all of them had urinary and bowel incontinence. Apart from Community Geriatric Assessment Team clinics, 119 (38%) of the residents attended other clinics outside their residential care homes. In all, 107 (34%) died within 1 year; those who died within 1 year used significantly more emergency and hospital services (P<0.001), and utilised more services from community care nurses for wound care (P=0.001), enteral feeding tube care (P=0.018), and urinary catheter care (P<0.001). Independent risk factors for 1-year mortality were active pressure sores (P=0.0037), enteral feeding (P=0.008), having a urinary catheter (P=0.0036), and suffering from chronic obstructive pulmonary disease (P=0.011). A history of pneumococcal vaccination was protective with respect to 1-year mortality (P=0.004). Residents of residential care homes for the elderly with advanced cognitive impairment were frail, exhibited multiple co-morbidities and high mortality. They were frequent users of out-patient, emergency, and in-patient services. The development of end-of-life care services in residential care homes for the elderly is an important need for this group of elderly.

  7. The cost-effectiveness of physician staffed Helicopter Emergency Medical Service (HEMS) transport to a major trauma centre in NSW, Australia. (United States)

    Taylor, Colman; Jan, Stephen; Curtis, Kate; Tzannes, Alex; Li, Qiang; Palmer, Cameron; Dickson, Cara; Myburgh, John


    Helicopter Emergency Medical Services (HEMS) are highly resource-intensive facilities that are well established as part of trauma systems in many high-income countries. We evaluated the cost-effectiveness of a physician-staffed HEMS intervention in combination with treatment at a major trauma centre versus ground ambulance or indirect transport (via a referral hospital) in New South Wales (NSW), Australia. Cost and effectiveness estimates were derived from a cohort of trauma patients arriving at St George Hospital in NSW, Australia during an 11-year period. Adjusted estimates of in-hospital mortality were derived using logistic regression and adjusted hospital costs were estimated through a general linear model incorporating a gamma distribution and log link. These estimates along with other assumptions were incorporated into a Markov model with an annual cycle length to estimate a cost per life saved and a cost per life-year saved at one year and over a patient's lifetime respectively in three patient groups (all patients; patients with serious injury [Injury Severity Score>12]; patients with traumatic brain injury [TBI]). Results showed HEMS to be more costly but more effective at reducing in-hospital mortality leading to a cost per life saved of $1,566,379, $533,781 and $519,787 in all patients, patients with serious injury and patients with TBI respectively. When modelled over a patient's lifetime, the improved mortality associated with HEMS led to a cost per life year saved of $96,524, $50,035 and $49,159 in the three patient groups respectively. Sensitivity analyses revealed a higher probability of HEMS being cost-effective in patients with serious injury and TBI. Our investigation confirms a HEMS intervention is associated with improved mortality in trauma patients, especially in patients with serious injury and TBI. The improved benefit of HEMS in patients with serious injury and TBI leads to improved estimated cost-effectiveness. Copyright © 2012 Elsevier

  8. Residential immersive life skills programs for youth with disabilities: service providers' perceptions of change processes. (United States)

    King, Gillian; McPherson, Amy; Kingsnorth, Shauna; Stewart, Debra; Glencross-Eimantas, Tanya; Jones-Galley, Kimberlea; Morrison, Andrea; Isihi, Ana Maria; Gorter, Jan Willem


    Residential immersive life skills (RILS) programs are designed to equip youth with physical disabilities with the foundational life skills required to assume adult roles. The objective was to determine RILS service providers' perceptions of the active ingredients of the intervention change process. Thirty-seven service providers from various disciplines completed measures to assess expertise status and participated in qualitative interviews. Qualitative themes were derived, and similarities and differences in themes were identified for blinded groups of novices, intermediates, and experts. The three main themes, reflecting change processes, were: (a) creating a supportive program atmosphere with multiple opportunities for learning, (b) using strategies to support, encourage, and engage youth, and (c) intentionally fostering youth experiences of skill development, social interaction, and pride in accomplishment. In contrast to the novices, experts displayed a more holistic perspective and paid attention to higher-order issues such as providing opportunities and enabling youth. The findings indicate how RILS service providers work to create a program atmosphere and employ strategies to intentionally foster particular youth experiences. The findings explicate service providers' theories of practice, the intentional design of RILS program environments to bring about client change, and the value of service provider expertise. Implications for Rehabilitation Service providers of youth independence-oriented life skills programs can intentionally create a learning-oriented and supportive program atmosphere by using non-directive, coaching/guiding, and engagement strategies Youth experiences of skill development, shared experience with others, and pride in accomplishment can be cultivated by providing a range of learning opportunities, including choice making, problem-solving, and skill mastery Compared to more novice service providers, experts discussed managing the

  9. 25 CFR 20.508 - What must the social services agency do when a child is placed in foster care, residential care... (United States)


    ... PROGRAMS Child Assistance Foster Care § 20.508 What must the social services agency do when a child is placed in foster care, residential care or guardianship home? The social services agency must make... placed in foster care, residential care or guardianship home? 20.508 Section 20.508 Indians BUREAU OF...

  10. 25 CFR 20.509 - What must the social services worker do when a child is placed in foster care or residential care... (United States)


    ... home or residential care facility to law enforcement and protective services in accordance with tribal... Assistance Foster Care § 20.509 What must the social services worker do when a child is placed in foster care... tribal or state licensed foster home or residential care facility evaluating how the home has fulfilled...

  11. The impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: a tutorial using data from an Australian hospital. (United States)

    McIntosh, Catherine; Dexter, Franklin; Epstein, Richard H


    In this tutorial, we consider the impact of operating room (OR) management on anesthesia group and OR labor productivity and costs. Most of the tutorial focuses on the steps required for each facility to refine its OR allocations using its own data collected during patient care. Data from a hospital in Australia are used throughout to illustrate the methods. OR allocation is a two-stage process. During the initial tactical stage of allocating OR time, OR capacity ("block time") is adjusted. For operational decision-making on a shorter-term basis, the existing workload can be considered fixed. Staffing is matched to that workload based on maximizing the efficiency of use of OR time. Scheduling cases and making decisions on the day of surgery to increase OR efficiency are worthwhile interventions to increase anesthesia group productivity. However, by far, the most important step is the appropriate refinement of OR allocations (i.e., planning service-specific staffing) 2-3 mo before the day of surgery. Reducing surgical and/or turnover times and delays in first-case-of-the-day starts generally provides small reductions in OR labor costs. Results vary widely because they are highly sensitive both to the OR allocations (i.e., staffing) and to the appropriateness of those OR allocations.

  12. Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service. (United States)

    Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren


    Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care

  13. Study protocol: A Montessori approach to dementia-related, non-residential respite services in Australia. (United States)

    Hanna, Andrew; Donnelly, James; Aggar, Christina


    Given the social burden and significant cost of dementia care in Australia, finding evidence-based approaches that improve outcomes, maintain independence, and reduce the impact on patients and families is essential. Finding effective ways to train and assist the healthcare staff who support these individuals is also critical, as they are considered to be at risk of workplace stress, burnout, and other psychological disturbances which negatively affects standards of care. The current paper describes a protocol for evaluating the effects of a Montessori-based approach to dementia care, in non-residential respite centres. An 18 month prospective observational, cohort controlled design is suggested that will compare participants from a community respite service that has undergone a Montessori-based workplace culture change and those from a service that provides a person-centred 'care as usual' approach. To achieve this, the protocol includes the assessment of participants across multiple variables on a monthly basis including the cognitive, behavioural, and emotional functioning of clients with dementia, levels of caregiver burden experienced by informal carers, and burnout, compassion satisfaction and workplace engagement among respite staff. The protocol also employs a qualitative evaluation of program fidelity. This approach will provide further insight into the potential benefits of early intervention with Montessori approaches for persons living with dementia in the community, their caregivers, and the staff and volunteers who assist them. Copyright © 2018 Elsevier B.V. All rights reserved.

  14. Potential energy savings in renovation projects of residential and service buildings; Energiansaeaestoemahdollisuudet rakennuskannan korjaustoiminnassa

    Energy Technology Data Exchange (ETDEWEB)

    Heljo, J.; Vihola, J.


    The study estimates the feasible energy savings potential in the 2010 building stock by 2050. The focus is on energy-saving measures related to renovation of residential and service buildings. The calculations were done by building types and age groups using the EKOREM calculation model. The calculations indicate the building types and structural elements where potential for savings exists. The study did not consider energy-saving measures related to changes in heating systems, electrical equipment, property maintenance or use habits. The study disproved the common belief that considerably more energy savings could be achieved faster by focussing on the existing building stock instead of new construction. That is mainly due the fact that it generally pays to implement structural energy-saving measures only when the targeted elements also require other significant repairs besides energy-efficiency improvements. Thus, energy renovations cannot be speeded up very much. The clearest exception are the extra insulations added to roof assemblies that are easy to implement. Attempts to save more energy in the building stock than can be achieved at a small additional cost in connection with needed renovations may multiply costs, and the saving in energy costs will not necessarily cover the additional investments. The efficiency of energy-saving measures can be affected by recommending or ordering use of more energy efficient windows, thicker extra insulations or more efficient ventilation heat recovery systems than the standard solution selected in connection with renovations. The goal of preserving the characteristics of buildings of cultural-historical or architectural value and the typical solutions and materials used in all buildings of a certain period limit the repair and renovation of structural elements. In the case of these buildings, improvement of energy efficiency can be considered in connection with the planning of renovations and the buildings' use and

  15. Enhancement of Recreation Service to Disabled Children. Part II, Recommended Standards with Evaluative Criteria for Recreation Services in Residential Institutions. Final Report. (United States)

    Berryman, Doris L.

    The suggested standards and evaluative criteria are designed to assist hospitals and other residential institutions in evaluating recreation services provided to residents, primarily children and youth. Described are the development of the standards and the rating instrument, guidelines for using the standards, evaluation and scoring procedures,…

  16. Working with complexity: experiences of caring for mothers seeking residential parenting services in New South Wales, Australia. (United States)

    Fowler, Cathrine; Schmied, Virginia; Dickinson, Marie; Dahlen, Hannah Grace


    To investigate staff perception of the changing complexity of mothers and infants admitted to two residential parenting services in New South Wales in the decade from 2005-2015. For many mothers with a young child, parenting is difficult and stressful. If parenting occurs within the context of anxiety, mental illness or abuse it often becomes a high-risk situation for the primary caregiver. Residential parenting services provide early nursing intervention before parenting problems escalate and require physical or mental health focused care. A qualitative descriptive design using semi-structured interview questions was used as phase three of a larger study. Data were gathered from 35 child and family health nurses and ten physicians during eight focus groups. Three main themes emerged: (1) dealing with complexity; (2) changing practice; and (3) appropriate knowledge and skills to handle greater complexity. There was a mix of participant opinions about the increasing complexity of the mothers presenting at residential parenting services during the past decade. Some of the nurses and physicians confirmed an increase in complexity of the mothers while several participants proposed that it was linked to their increased psychosocial assessment knowledge and skill. All participants recognised their work had grown in complexity regardless of their perception about the increased complexity of the mothers. Australian residential parenting services have a significant role in supporting mothers and their families who are experiencing parenting difficulties. It frequently provides early intervention that helps minimise later emotional and physical problems. Nurses are well placed to work with and support mothers with complex histories. Acknowledgement is required that this work is stressful and nurses need to be adequately supported and educated to manage the complex presentations of many families. © 2016 John Wiley & Sons Ltd.

  17. Effective Staffing Takes a Village: Creating the Staffing Ecosystem. (United States)

    Gavigan, Margaret; Fitzpatrick, Therese A; Miserendino, Carole


    The traditional approaches to staffing and scheduling are often ineffective in assuring sufficient budgeting and deployment of staff to assure the right nurse at the right time for the right cost. As hospital merger activity increases, this exercise is further complicated by the need to rationalize staffing across multiple enterprises and standardize systems and processes. This Midwest hospital system successfully optimized staffing at the unit and enterprise levels by utilizing operations research methodologies. Savings were reinvested to improve staffing models which provided sufficient nonproductive coverage and patient-driven ratios. Over/under-staffing was eliminated in support of the system's recognition that adequate resource planning and deployment are critical to the culture of safety.

  18. Capacity Adjustment through Contingent Staffing Outsourcing


    Neubert , Gilles; Adjadj , Philippe


    International audience; For a long time, contingent staffing was considered as the responsability of the Human Resource department. The high needs of workforce flexibility combined with disseminated agencies have led some companies to a great number of labor suppliers. This situation has produced important cost variation, poor quality of service, and important risk due to the mistunderstanding by local managers of legal considerations. To face this situation, companies have started to move fr...

  19. Barriers to Accessing Detox Facilities, Substance Use Treatment, and Residential Services among Women Impacted by Commercial Sexual Exploitation & Trafficking. (United States)

    Gerassi, Lara B


    More than 50% of women entering substance use treatment in the U.S. reported having traded sex for money or drugs. Women's participation in addiction treatment and related services is essential to their recovery and increased safety, stabilization, and quality of life. This paper's aim is to explore the barriers related to accessing detox facilities and essential services including substance use treatment and residential services for women impacted by commercial sexual exploitation (CSE). Data are drawn from a larger, community-based, grounded theory study. In-depth interview data were collected from 30 adult women who traded sex as adults (through maximum variation and snowball sampling), as well as 20 service providers who come into contact with adult women who trade sex (through nominations and purposive sampling). Finding suggest that women often encountered sobriety requirements, which created barriers to accessing addiction treatment or residential services. Some organizations' policies required evicting women if they were caught using, which created additional challenges for women who relapsed. Women wanted to avoid becoming "dopesick" on the streets or at home, which partially contributed to them needing to maintain their addiction. Consequently, some returned to sex trading, thus increasing their risk of trafficking. Some women engaged in creative strategies, such as claiming they were suicidal, in order to access the detox facilities in hospitals. Some women indicated they were only able to detox when they were forced to do so in jail or prison, often without medical assistance. Implications to improve health care delivery for this population are discussed.

  20. Development of a Quality of Meals and Meal Service Set of Indicators for Residential Facilities for Elderly. (United States)

    Van Damme, N; Buijck, B; Van Hecke, A; Verhaeghe, S; Goossens, E; Beeckman, D


    To develop a content validated set of indicators to evaluate the quality of meals and meal service in residential facilities for elderly. Inadequate food intake is an important risk factor for malnutrition in residential facilities for elderly. Through better meeting the needs and preferences of residents and optimization of meals and meal service, residents' food intake can improve. No indicators were available which could help to guide strategies to improve the quality of meals and meal service. The indicator set was developed according to the Indicator Development Manual of the Dutch Institute for Health Care Improvement (CBO). The working group consisted of three nurse researchers and one expert in gastrology and had expertise in elderly care, malnutrition, indicator development, and food quality. A preliminary list of potential indicators was compiled using the literature and the working group's expertise. Criteria necessary to measure the indicator in practice were developed for each potential indicator. In a double Delphi procedure, the list of potential indicators and respective criteria were analyzed for content validity, using a multidisciplinary expert panel of 11 experts in elderly meal care. A preliminary list of 20 quality indicators, including 45 criteria, was submitted to the expert panel in a double Delphi procedure. After the second Delphi round, 13 indicators and 25 criteria were accepted as having content validity. The content validity index (CVI) ranged from 0.83 to 1. The indicator set consisted of six structural, four result, and three outcome indicators covering the quality domains food, service and choice, as well as nutritional screening. The criteria measure diverse aspects of meal care which are part of the responsibility of kitchen staff and health care professionals. The 'quality of meals and meal service' set of indicators is a resource to map meal quality in residential facilities for elderly. As soon as feasibility tests in practice

  1. Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data. (United States)

    Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Warland, Andrew; Westbrook, Johanna


    To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care. Longitudinal cohort study using routinely collected client management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016. Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used. By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer. Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults' care choices. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  2. Fabulous award for staffing app. (United States)


    A safe staffing app giving up-to-date information on the number of nurses on the wards at Nottingham University Hospitals NHS Trust scooped top prize at the inaugural Academy of Fabulous NHS Stuffawards in London last week.

  3. 77 FR 14832 - Plumchoice, Inc., Including On-Site Leased Workers From Balance Staffing, Insight Global Staffing... (United States)


    ...., Including On-Site Leased Workers From Balance Staffing, Insight Global Staffing, and Technisource..., Insight Global Staffing, and Technisource, Scarborough, Maine. The workers are engaged in activities... leased workers from Balance Staffing, Insight Global Staffing, and Technisource, Scarborough, Maine, who...

  4. Facilities Management Service Delivery in Public and Private High Rise Residential Buildings in Nigeria: A case study of Eko Court Complex and Niger Towers

    Directory of Open Access Journals (Sweden)

    Olanrele O. O.


    Full Text Available This study assessed and compared the delivery of Facilities Management (FM services in public and private high rise residential buildings in Lagos, Nigeria. While some facilities or services may not be available in some public estates, the efficiency of the available ones is inadequate in comparison with the adequacy and efficiency of services provided in private estates. The objectives set for the study include identification of services that are provided in the case studies, service delivery method, and an assessment of the residents’ satisfaction of the services. This study adopted questionnaire survey for collection of data. 127 questionnaires were distributed to the residents of the case studies and 93 were returned. Three of which were discarded for incompleteness, thus 90 were analysed. The study found that most but not all of the facilities services expected in high rise buildings are available in the case studies and the services are outsourced under a standard Service Level Agreement. The service delivery in private high rise residential building is better than the public residential high rise buildings as revealed by the study. The study recommends improved standardization of services, customized services and meeting customer’s expectation for improved service delivery.

  5. Family Life and the Impact of Previous and Present Residential and Day Care Support for Children with Major Cognitive and Behavioural Challenges: A Dilemma for Services and Policy (United States)

    Brown, R. I.; Geider, S.; Primrose, A.; Jokinen, N. S.


    Introduction: Since the development of inclusion and integration, parents have increasingly become the major, and sometimes the only, carers of their children with disabilities. Many families speak of stress and frustration with service and community support, and some have turned to residential and specialised day care services to overcome…

  6. Small distributed generation versus centralised supply: a social cost-benefit analysis in the residential and service sectors

    International Nuclear Information System (INIS)

    Gulli, Francesco


    This paper aims at measuring the social benefits of small CHP distributed generation (DG) in the residential and service sectors. We do this by comparing the social costs of decentralised and centralised supplies, simulating 'ideal' situations in which any source of allocative inefficiencies is eliminated. This comparison focuses on assessing internal and external costs. The internal costs are calculated by simulating the optimal prices of the electricity and gas inputs. The external costs are estimated by using and elaborating the results of the dissemination process of the ExternE project, one of the most recent and accurate methodologies in this field. The analysis takes into account the main sources of uncertainty about the parameter values, including uncertainty about external cost estimations. Despite these sources of uncertainty, the paper concludes that centralised supply is still preferable to small DG. In fact, the overall range of DG social competitiveness is restricted, even considering further remarkable improvements in DG electrical efficiency and investment costs. The results are particularly unfavourable for the residential sector, whereas, in the service sector, the performance of DG technologies is slightly better

  7. Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality. (United States)

    Bowblis, John R; Roberts, Amy Restorick


    Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.

  8. Diagnostic Grouping among Adults with Intellectual Disabilities and Autistic Spectrum Disorders in Staffed Housing (United States)

    Felce, D.; Perry, J.


    Background: There is little evidence to guide the commissioning of residential provision for adults with autistic spectrum disorder (ASD) in the UK. We aim to explore the degree and impact of diagnostic congregation among adults with intellectual disabilities (ID) and ASD living in staffed housing. Methods: One hundred and fifty-seven adults with…

  9. The Role of Residential Early Parenting Services in Increasing Parenting Confidence in Mothers with A History of Infertility

    Directory of Open Access Journals (Sweden)

    Marjan Lynette


    Full Text Available Background Mothers with a history of infertility may experience parenting difficulties and challenges. This study was conducted to investigate the role of residential early parenting services in increasing parenting confidence in mothers with a history of infertility. Materials and Methods This was a retrospective chart review study using the quantitative data from the clients attending the Karitane Residential Units and Parenting Services (known as Karitane RUs during 2013. Parenting confidence (using Karitane Parenting Confidence Scale-KPCS, depression, demographics, reproductive and medical history, as well as child’s information were assessed from a sample of 27 mothers who had a history of infertility and who attended the Karitane RUs for support and assistance. The data were analyzed using SPSS version 19. Results More than half of the women (59.3% reported a relatively low level of parenting confidence on the day of admission. The rate of low parenting confidence, however, dropped to 22.2% after receiving 4-5 days support and training in the Karitane RUs. The mean score of the KPCS increased from 36.9 ± 5.6 before the intervention to 41.1 ± 3.4 after the intervention, indicating an improvement in the parenting confidence of the mothers after attending the Karitane RUs (P<0.0001. No statistically significant association was found between maternal low parenting confidence with parental demographics (including age, country of birth, and employment status, a history of help-seeking, symptoms of depression, as well as child’s information [including gender, age, siblings, diagnosis of gastroesophageal reflux disease (GORD and use of medication]. Conclusion Having a child after a period of infertility can be a stressful experience for some mothers. This can result in low parenting confidence and affect parent-child attachment. Our findings emphasized on the role of the residential early parenting services in promoting the level of

  10. Staffing for Success (United States)

    Perozzi, Brett; Seifert, Tricia; Al-Sharif, Mary Ann Bodine


    This chapter explores institutional capacity building in cross-border student affairs and services. The focus is on human capital and its importance to international higher education within local contexts.

  11. The development of a healing model of care for an Indigenous drug and alcohol residential rehabilitation service: a community-based participatory research approach. (United States)

    Munro, Alice; Shakeshaft, Anthony; Clifford, Anton


    Given the well-established evidence of disproportionately high rates of substance-related morbidity and mortality after release from incarceration for Indigenous Australians, access to comprehensive, effective and culturally safe residential rehabilitation treatment will likely assist in reducing recidivism to both prison and substance dependence for this population. In the absence of methodologically rigorous evidence, the delivery of Indigenous drug and alcohol residential rehabilitation services vary widely, and divergent views exist regarding the appropriateness and efficacy of different potential treatment components. One way to increase the methodological quality of evaluations of Indigenous residential rehabilitation services is to develop partnerships with researchers to better align models of care with the client's, and the community's, needs. An emerging research paradigm to guide the development of high quality evidence through a number of sequential steps that equitably involves services, stakeholders and researchers is community-based participatory research (CBPR). The purpose of this study is to articulate an Indigenous drug and alcohol residential rehabilitation service model of care, developed in collaboration between clients, service providers and researchers using a CBPR approach. This research adopted a mixed methods CBPR approach to triangulate collected data to inform the development of a model of care for a remote Indigenous drug and alcohol residential rehabilitation service. Four iterative CBPR steps of research activity were recorded during the 3-year research partnership. As a direct outcome of the CBPR framework, the service and researchers co-designed a Healing Model of Care that comprises six core treatment components, three core organisational components and is articulated in two program logics. The program logics were designed to specifically align each component and outcome with the mechanism of change for the client or organisation

  12. A staffing decision support methodology using a quality loss function : a cross-disciplinary quantitative study

    NARCIS (Netherlands)

    Mincsovics, G.Z.


    Background Understanding the quality loss implications of short staffing is essential in maintaining service quality on a limited budget. Objectives For elaborate financial control on staffing decisions, it is necessary to quantify the cost of the incidental quality loss that a given workload and

  13. SOLCOST. Solar Hot Water Handbook. A Simplified Design Method for Sizing and Costing Residential and Commercial Solar Service Hot Water Systems. Second Edition. (United States)

    Energy Research and Development Administration, Washington, DC. Div. of Solar Energy.

    This pamphlet offers a preview of information services available from Solcost, a research and development project. The first section explains that Solcost calculates system and costs performance for solar heated and cooled new and retrofit constructions, such as residential buildings and single zone commercial buildings. For a typical analysis,…

  14. Realization of Personalized Services for Intelligent Residential Space based on User Identification Method using Sequential Walking Footprints

    Directory of Open Access Journals (Sweden)

    Jin-Woo Jung


    Full Text Available A new human-friendly assistive home environment, Intelligent Sweet Home (ISH, developed at KAIST, Korea for testing advanced concepts for independent living of the elderly/the physically handicapped. The concept of ISH is to consider the home itself as an intelligent robot. ISH always checks the intention or health status of the resident. Therefore, ISH can do actively the most proper services considering the resident's life-style by the detected intention or emergency information. But, when there are more than two residents, ISH cannot consider the residents' characteristics or tastes if ISH cannot identify who he/she is before. To realize a personalized service system in the intelligent residential space like ISH, we deal with a human-friendly user identification method for ubiquitous computing environment, specially focused on dynamic human footprint recognition. And then, we address some case studies of personalized services that have been experienced by Human-friendly Welfare Robot System research center, KAIST.

  15. Analysis of Social Return on Investment in two systems of support for people with severe disabilities: personal assistance and residential service. A case study

    Directory of Open Access Journals (Sweden)

    Agustín Huete García


    Full Text Available At present, there are several alternatives to support daily life of people with disabilities, which require different resources: human, institutional, technical, material, financial, etc. In addition, these alternatives involve different impacts on both the life of people with disabilites and their immediate environment. This paper presents a case study that compares an user of personal assistance services of the Program for Independent Living (PAVI with an user of a residential service. The study method used is based on the approach of Social Return on Investment (SROI. It also specifies the selection of cases, the partners consulted to gather concepts and values, data collection, variables and formulas for calculating and monetization. Despite its limited scope, it is possible to draw conclusions about the social return on investment in a “standard profile” receiving personal assistance services compared with a “standard profile” in a residential service.

  16. Raising the Bar with Trades Staffing Guidelines. (United States)

    Weidner, Theodore J.


    Examines the APPA's Trades Staffing Guidelines Task Force for college campus building maintenance and presents descriptions of the proposed guideline levels and a matrix of indicators for the Trades Staffing Guidelines. The levels and matrix are intended to mimic features of the custodial staffing guidelines. (GR)

  17. 20 CFR 653.111 - State agency staffing requirements. (United States)


    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false State agency staffing requirements. 653.111 Section 653.111 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR SERVICES... ethnic characteristics in the work force shall be distributed in substantially the same proportion among...

  18. The Pathologist Workforce in the United States: II. An Interactive Modeling Tool for Analyzing Future Qualitative and Quantitative Staffing Demands for Services. (United States)

    Robboy, Stanley J; Gupta, Saurabh; Crawford, James M; Cohen, Michael B; Karcher, Donald S; Leonard, Debra G B; Magnani, Barbarajean; Novis, David A; Prystowsky, Michael B; Powell, Suzanne Z; Gross, David J; Black-Schaffer, W Stephen


    Pathologists are physicians who make diagnoses based on interpretation of tissue and cellular specimens (surgical/cytopathology, molecular/genomic pathology, autopsy), provide medical leadership and consultation for laboratory medicine, and are integral members of their institutions' interdisciplinary patient care teams. To develop a dynamic modeling tool to examine how individual factors and practice variables can forecast demand for pathologist services. Build and test a computer-based software model populated with data from surveys and best estimates about current and new pathologist efforts. Most pathologists' efforts focus on anatomic (52%), laboratory (14%), and other direct services (8%) for individual patients. Population-focused services (12%) (eg, laboratory medical direction) and other professional responsibilities (14%) (eg, teaching, research, and hospital committees) consume the rest of their time. Modeling scenarios were used to assess the need to increase or decrease efforts related globally to the Affordable Care Act, and specifically, to genomic medicine, laboratory consolidation, laboratory medical direction, and new areas where pathologists' expertise can add value. Our modeling tool allows pathologists, educators, and policy experts to assess how various factors may affect demand for pathologists' services. These factors include an aging population, advances in biomedical technology, and changing roles in capitated, value-based, and team-based medical care systems. In the future, pathologists will likely have to assume new roles, develop new expertise, and become more efficient in practicing medicine to accommodate new value-based delivery models.

  19. Practice leadership and active support in residential services for people with intellectual disabilities: an exploratory study. (United States)

    Beadle-Brown, J; Mansell, J; Ashman, B; Ockenden, J; Iles, R; Whelton, B


    We hypothesised that a key factor determining the quality of active support was 'practice leadership' - provided by the first-line manager to focus staff attention and develop staff skills in providing direct support to enable people with intellectual disabilities to have a good quality of life. This exploratory study focused on what levels of practice leadership were found and its role in explaining variation in active support. Relevant aspects of management, including practice leadership, were assessed by questionnaires administered to staff in residential settings alongside observational measures of active support and resident engagement in meaningful activity. Relationships between these variables were explored using regression and post hoc group comparisons. There was wide variation, with average levels of practice leadership being low, though improving over the period studied. Practice leadership had a significant impact on active support, but was fully mediated by the effect of quality of management. When the quality of management was higher better practice leadership did produce a significant difference in active support. However, higher quality of management on its own did not produce better active support. A number of limitations are acknowledged and further research is required. Practice leadership appears to be an important factor in enabling staff to provide active support but as part of generally good management. Given the rather low levels found, attention needs to be given to the training, career development and support of practice leaders and also to how to protect their time from their many other responsibilities. © 2013 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  20. E-service quality: An investigation of its key dimensions and the discriminatory power in the residential property sector

    Directory of Open Access Journals (Sweden)

    Justin Beneke


    Full Text Available Research Statement: With an increase in competition within the South African property sector, real estate agencies need to ensure that their channels are as effective as possible. Using the Internet and mobile technologies represents a new means to reach customers and achieve lower operating costs. This study seeks to ascertain which factors potential buyers consider important when perusing residential property in an online environment. Hence, the dimensions of e-service quality, which constitute their online experience, will be explored. In addition, this research explores buyer typologies and probes whether other forms of technology, such as a mobile interface, may be of commercial value to the realtor. Methodology: The empirical analysis was conducted by means of a quantitative survey. A questionnaire was designed to test the application of the e-service quality construct in the South African real-estate sector. Data was obtained from 300 respondents, across the age spectrum, who filled the criteria of being prospective buyers. Convenience sampling was primarily used to collect responses as the researchers were unable to obtain access to a specific database of listed property buyers. Results & Conclusion: As mirrored in other studies of this nature, it was found that trust is paramount when initiating property sales online. All other variables in the construct (site features, information, accessibility, communication, reliability, responsiveness and personalisation also proved significant. A cluster analysis revealed that older respondents preferred a higher level of support - across all attributes of e-service quality - when interacting with online property services. Lastly, the mobile interface appears to appeal to 'students' as well as 'mature workers'. It is surmised that these individuals have access to smart phones capable of being used for accessing property portals. However, the 'young workers' appear less enthusiastic about the

  1. Residential and service-population exposure to multiple natural hazards in the Mount Hood region of Clackamas County, Oregon (United States)

    Mathie, Amy M.; Wood, Nathan


    The objective of this research is to document residential and service-population exposure to natural hazards in the rural communities of Clackamas County, Oregon, near Mount Hood. The Mount Hood region of Clackamas County has a long history of natural events that have impacted its small, tourism-based communities. To support preparedness and emergency-management planning in the region, a geospatial analysis of population exposure was used to determine the number and type of residents and service populations in flood-, wildfire-, and volcano-related hazard zones. Service populations are a mix of residents and tourists temporarily benefitting from local services, such as retail, education, or recreation. In this study, service population includes day-use visitors at recreational sites, overnight visitors at hotels and resorts, children at schools, and community-center visitors. Although the heavily-forested, rural landscape suggests few people are in the area, there are seasonal peaks of thousands of visitors to the region. “Intelligent” dasymetric mapping efforts using 30-meter resolution land-cover imagery and U.S. Census Bureau data proved ineffective at adequately capturing either the spatial distribution or magnitude of population at risk. Consequently, an address-point-based hybrid dasymetric methodology of assigning population to the physical location of buildings mapped with a global positioning system was employed. The resulting maps of the population (1) provide more precise spatial distributions for hazard-vulnerability assessments, (2) depict appropriate clustering due to higher density structures, such as apartment complexes and multi-unit commercial buildings, and (3) provide new information on the spatial distribution and temporal variation of people utilizing services within the study area. Estimates of population exposure to flooding, wildfire, and volcanic hazards were determined by using overlay analysis in a geographic information system

  2. Analysis of Minimum Efficiency Performance Standards for Residential General Service Lighting in Chile

    Energy Technology Data Exchange (ETDEWEB)

    Letschert, Virginie E.; McNeil, Michael A.; Leiva Ibanez, Francisco Humberto; Ruiz, Ana Maria; Pavon, Mariana; Hall, Stephen


    Minimum Efficiency Performance Standards (MEPS) have been chosen as part of Chile's national energy efficiency action plan. As a first MEPS, the Ministry of Energy has decided to focus on a regulation for lighting that would ban the sale of inefficient bulbs, effectively phasing out the use of incandescent lamps. Following major economies such as the US (EISA, 2007) , the EU (Ecodesign, 2009) and Australia (AS/NZS, 2008) who planned a phase out based on minimum efficacy requirements, the Ministry of Energy has undertaken the impact analysis of a MEPS on the residential lighting sector. Fundacion Chile (FC) and Lawrence Berkeley National Laboratory (LBNL) collaborated with the Ministry of Energy and the National Energy Efficiency Program (Programa Pais de Eficiencia Energetica, or PPEE) in order to produce a techno-economic analysis of this future policy measure. LBNL has developed for CLASP (CLASP, 2007) a spreadsheet tool called the Policy Analysis Modeling System (PAMS) that allows for evaluation of costs and benefits at the consumer level but also a wide range of impacts at the national level, such as energy savings, net present value of savings, greenhouse gas (CO2) emission reductions and avoided capacity generation due to a specific policy. Because historically Chile has followed European schemes in energy efficiency programs (test procedures, labelling program definitions), we take the Ecodesign commission regulation No 244/2009 as a starting point when defining our phase out program, which means a tiered phase out based on minimum efficacy per lumen category. The following data were collected in order to perform the techno-economic analysis: (1) Retail prices, efficiency and wattage category in the current market, (2) Usage data (hours of lamp use per day), and (3) Stock data, penetration of efficient lamps in the market. Using these data, PAMS calculates the costs and benefits of efficiency standards from two distinct but related perspectives: (1) The

  3. Optimal Sizing and Allocation of Residential Photovoltaic Panels in a Distribution Network for Ancillary Services Application

    DEFF Research Database (Denmark)

    Kordheili, Reza Ahmadi; Pourmousavi, Ali; Pillai, Jayakrishnan Radhakrishna


    requirements, such as voltage and current limits. This paper proposes an optimization method for determining the number of photovoltaic (PV) panels together with their arrangement in the grid in order to maximize ancillary service, without violating grid operation limits. The proposed optimization method...

  4. 20 CFR 670.525 - What residential support services must Job Corps center operators provide? (United States)


    ..., vending machines, disciplinary fines, and donations, and is run by an elected student government, with the... the Secretary: (a) A quality living and learning environment that supports the overall training... week, 24 hours a day; (b) An ongoing, structured counseling program for students; (c) Food service...

  5. Prehospital interventions before and after implementation of a physician-staffed helicopter

    DEFF Research Database (Denmark)

    Sonne, Asger; Wulffeld, Sandra; Steinmetz, Jacob


    INTRODUCTION: Implementation of a physician-staffed helicopter emergency medical service (HEMS) in eastern Denmark was associated with increased survival for severely injured patients. This study aimed to assess the potential impact of advanced prehospital interventions by comparing the proportion...

  6. Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities. (United States)

    Bhuyan, Soumitra S; Zhu, He; Chandak, Aastha; Kim, Jungyoon; Stimpson, Jim P


    Healthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs. We used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs. In 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09-1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00-1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption. Our findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients' records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in

  7. A qualitative study examining the preparedness of dental hygiene students for a service-learning placement in residential aged care. (United States)

    Wallace, J P; Blinkhorn, A S; Blinkhorn, F A


    The aim of this qualitative study was to measure the effect of a specifically designed orientation re-enactment DVD used to facilitate dental hygiene students transition from the classroom to a Residential Aged Care Facility (RACF) service-learning placement with less personal anxiety and more confidence in their role during the placement. Final year students (n = 47) were randomly allocated to one of 17 RACFs on the NSW, Central Coast, Australia. All students were then randomly allocated to a two-group study with the active group assigned to view the DVD prior to their placement. Students who viewed the DVD were asked not to discuss the content with students who were assigned to the control group. Post-placement focus groups were organized, recorded and transcribed verbatim. Data were collated, analysed and unitized into emergent themes. Representative quotes are presented in the results. The study was informed by 4 years of previous quantitative and qualitative process evaluation of the RACF programme. Focus group discussions identified that those students who had seen the DVD reported a shorter timeframe to successfully transition from the classroom to the RACF and stated that the DVD provided them with a realistic expectation of the RACF environment and their role in the placement experience. The orientation DVD reduced student anxiety and improved student confidence in their role during the placement by providing a realistic orientation of the RACF environment. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Low Volume, Funding, Staffing and Technical Problems are Key Reasons for Discontinuation of Chat Reference Services. A review of: Radford, Marie L., and M. Kathleen Kern. “A Multiple‐case Study Investigation of the Discontinuation of Nine Chat Reference Services.” Library & Information Science Research 28.4 (Sept. 2006: 521‐47.

    Directory of Open Access Journals (Sweden)

    Stephanie R. Walker


    closed, from 7‐10 p.m. These shifts were covered by librarians working from home. Decisions to either begin or suspend services were generally made by small informal groups or committees. Some cases began with pilot studies and received positive responses. Other than these pilot studies, little pre‐planning appeared to have been done. For example, there were noextensive advance surveys or studies to determine potential demand or markets for the service, or projected costs and benefits. Only one service had a strong, multi‐stage evaluation plan. In future launches of virtual reference services, both extensive pre‐planning and detailed measures for evaluation could be helpful in avoidingsome problems. Major reasons for discontinuation fell into 6 categories: funding problems, staffing problems, technical problems, institutional culture conflicts, low usage overall or low usage by target populations. A table (Table 1 was included that actually listed 7 categories of reasons for discontinuation, but the last one listed, “Software Change,” is discussed as part of “Technical Problems” in the text, though it is separated in the table (527. This is not immediately clear in the article, and thus the table is slightly confusing. Four cases reported funding problems as the major reason for discontinuation. Low volume or low volume for target population were primary reasons for discontinuation by4 cases, and secondary reasons for discontinuation by 4 cases. If one combines primary and secondary categories in this table, low volume is the most frequently cited reason for discontinuation. Lowvolume was determined to be “driven by a complex combination of variables including marketing strategies, insufficient hours of operation, and [failure to provide] an ample amount of time for a service to gain momentum” (527‐528. Funding was cited as the primary reason for cancellation in 4 cases. Technical problems were listed as primary or secondary factors for suspension

  9. Texas Nurse Staffing Trends Before and After Mandated Nurse Staffing Committees. (United States)

    Jones, Terry; Heui Bae, Sung; Murry, Nicole; Hamilton, Patti


    This article describes the evolution of mandated nurse staffing committees in Texas from 2002 to 2009 and presents a study that analyzed nurse staffing trends in Texas using a secondary analysis of hospital staffing data (N = 313 hospitals) from 2000 to 2012 obtained from the American Hospital Association Annual Survey. Nurse staffing patterns based on three staffing variables for registered nurses (RNs), licensed vocational nurses (LVNs), and total licensed nurses were identified: full-time equivalents per 1,000 adjusted patient days, productive hours per adjusted patient day, and RN skill mix. Similar to national trends between 2000 and 2012, most Texas hospitals experienced an increase in RN and total nurse staffing, decrease in LVN staffing, and an increase in RN skill mix. The magnitude of total nurse staffing changes in Texas (5% increase) was smaller than national trends (13.6% increase). Texas's small, rural, government hospitals and those with the highest preregulation staffing levels experienced the least change in staffing between 2000 and 2012: median change of 0 to .13 full-time equivalents per 1,000 adjusted patient days and median change in productive hours per patient day of 0 to .23. The varying effects of staffing committees in different organizational contexts should be considered in future staffing legislative proposals and other policy initiatives. © The Author(s) 2015.

  10. Medical staffing in Ontario neonatal intensive care units. (United States)

    Paes, B; Mitchell, A; Hunsberger, M; Blatz, S; Watts, J; Dent, P; Sinclair, J; Southwell, D


    Advances in technology have improved the survival rates of infants of low birth weight. Increasing service commitments together with cutbacks in Canadian training positions have caused concerns about medical staffing in neonatal intensive care units (NICUs) in Ontario. To determine whether an imbalance exists between the supply of medical personnel and the demand for health care services, in July 1985 we surveyed the medical directors, head nurses and staff physicians of nine tertiary level NICUs and the directors of five postgraduate pediatric residency programs. On the basis of current guidelines recommending an ideal neonatologist:patient ratio of 1:6 (assuming an adequate number of support personnel) most of the NICUs were understaffed. Concern about the heavy work pattern and resulting lifestyle implications has made Canadian graduates reluctant to enter this subspecialty. We propose strategies to correct staffing shortages in the context of rapidly increasing workloads resulting from a continuing cutback of pediatric residency positions and restrictions on immigration of foreign trainees.

  11. STAF: A Powerful and Sophisticated CAI System. (United States)

    Loach, Ken


    Describes the STAF (Science Teacher's Authoring Facility) computer-assisted instruction system developed at Leeds University (England), focusing on STAF language and major program features. Although programs for the system emphasize physical chemistry and organic spectroscopy, the system and language are general purpose and can be used in any…

  12. The impact of managed care penetration and hospital quality on efficiency in hospital staffing. (United States)

    Mobley, Lee R; Magnussen, Jon


    The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals.

  13. First 2 Years of Experience of "Residential Care" at "Sakalawara Rehabilitation Services," National Institute of Mental Health and Neurosciences, Bengaluru, India. (United States)

    Manjunatha, Narayana; Agarwal, Preeti Pansari; Shashidhara, Harihara N; Palakode, Mohan; Raj, E Aravind; Mary Kapanee, Aruna Rose; Nattala, Prashanthi; Kumar, C Naveen; Sudhir, Paulomi; Thirthalli, Jagadisha; Bharath, Srikala; Sekar, Kasi; Varghese, Mathew


    There is an unmet need for continuity-of-care is well known for those with severe mental disorders (SMDs) after acute care at hospitals in India. The "Sakalawara Rehabilitation Services (SRS)" functioned from March 2014 at "Sakalawara Community Mental Health Centre" (SCMHC) of "National Institute of Mental Health and Neurosciences," Bengaluru, India in the concepts of residential care (half-way-home) with the aim to develop a replicable model. To review the inpatient records after the initial 2 years of experience in residential care at SCMHC. Retrospective file review of inpatients at SCMHC from March 2014 to March 2016 in a semi-structured proforma designed for the study. Ethical committee of NIMHANS Bengaluru has approved the study. The total number of inpatients during this period was 85. It was found that Schizophrenia spectrum disorders were the most common diagnosis among these patients. The activity of daily living and psycho-education were the most common individual interventions. The majority of families underwent structured family psycho-educational interventions. This review also demonstrated the feasibility of tele-aftercare in continuity of care after discharge of patients. SRS kind of residential set-up is feasible and demonstrated effectiveness in maintaining continuity of care of SMDs. There is a need for better structured and customized interventions. There is further a scope for tele (video) aftercare for those with SMDs.

  14. Modular health services : A single case study approach to the applicability of modularity to residential mental healthcare

    NARCIS (Netherlands)

    Soffers, R.; Meijboom, B.R.; van Zaanen, J.; van der Feltz, C.M.


    Background The Dutch mental healthcare sector has to decrease costs by reducing intramural capacity with one third by 2020 and treating more patients in outpatient care. This transition necessitates enabling patients to become as self-supporting as possible, by customising the residential care they

  15. Residential Care (United States)

    ... Kids For Teens For Parents & Teachers Resolving Family Conflicts The Holidays and Alzheimer's Glossary Virtual Library Online ... longer an option Costs Choosing a care setting Types of residential care A good long-term care ...

  16. Nursing teamwork, staff characteristics, work schedules, and staffing. (United States)

    Kalisch, Beatrice J; Lee, Hyunhwa


    This study aimed to explore whether and how staff characteristics, staffing, and scheduling variables are associated with the level of teamwork in nursing staff on acute care hospital patient units. This was a cross-sectional study with a sample of 1,758 nursing staff members from two different hospitals on 38 patient care units who completed the Nursing Teamwork Survey in 2008. This study focused on nursing teams who are stationed on a particular patient care unit (as opposed to visitors to the units). The return rate was 56.9%. The sample was made up of 77.4% nurses (registered nurses and licensed practical nurses), 11.9% assistive personnel, and 7.9% unit secretaries. Teamwork varied by unit and service type, with the highest scores occurring in pediatrics and maternity and the lowest scores on the medical-surgical and emergency units. Staff with less than 6 months of experience, those working 8- or 10-hour shifts (as opposed to 12 hours or a combination of 8 and 12 hours), part-time staff (as opposed to full time), and those working on night shift had higher teamwork scores. The higher teamwork scores were also associated with no or little overtime. The higher perception of the adequacy of staffing and the fewer patients cared for on a previous shift, the higher the teamwork scores. There is a relationship between selected staff characteristics, aspects of work schedules, staffing, and teamwork. Nursing staff want to work where teamwork is high, and perceptions of good staffing lead to higher teamwork. Higher teamwork scores correlated with those who worked less overtime.

  17. Human Resources Staffing Plan for the Tank Farm Contractor

    International Nuclear Information System (INIS)

    BOSLEY, J.W.


    The Human Resources Staffing Plan quantified the equivalent staffing needs required for the Tank Farm Contractor (TFC) and its subcontractors to execute the readiness to proceed baseline between FY 2000-2008. The TFC staffing needs were assessed along with the staffings needs of Fluor Hanford and the privatization contractor. The plan then addressed the staffing needs and recruitment strategies required to execute the baseline

  18. Residential Waste

    DEFF Research Database (Denmark)

    Christensen, Thomas Højlund; Fruergaard, Thilde; Matsufuji, Y.


    are discussed in this chapter. Characterizing residential waste is faced with the problem that many residences already divert some waste away from the official collection systems, for example performing home composting of vegetable waste and garden waste, having their bundled newspaper picked up by the scouts...... twice a year or bringing their used furniture to the flea markets organized by charity clubs. Thus, much of the data available on residential waste represents collected waste and not necessarily all generated waste. The latter can only be characterized by careful studies directly at the source......, but such studies are very expensive if fair representation of both spatial and temporal variations should be obtained. In addition, onsite studies may affect the waste generation in the residence because of the increased focus on the issue. Residential waste is defined in different ways in different countries...

  19. Examination of the utility of the promoting action on research implementation in health services framework for implementation of evidence based practice in residential aged care settings. (United States)

    Perry, Lin; Bellchambers, Helen; Howie, Andrew; Moxey, Annette; Parkinson, Lynne; Capra, Sandra; Byles, Julie


    This study examined the relevance and fit of the PARiHS framework (Promoting Action on Research Implementation in Health Services) as an explanatory model for practice change in residential aged care. Translation of research knowledge into routine practice is a complex matter in health and social care environments. Examination of the environment may identify factors likely to support and hinder practice change, inform strategy development, predict and explain successful uptake of new ways of working. Frameworks to enable this have been described but none has been tested in residential aged care. This paper reports preliminary qualitative analyses from the Encouraging Best Practice in Residential Aged Care Nutrition and Hydration project conducted in New South Wales in 2007-2009. We examined congruence with the PARiHS framework of factors staff described as influential for practice change during 29 digitally recorded and transcribed staff interviews and meetings at three facilities. Unique features of the setting were flagged, with facilities simultaneously filling the roles of residents' home, staff's workplace and businesses. Participants discussed many of the same characteristics identified by the PARiHS framework, but in addition temporal dimensions of practice change were flagged. Overall factors described by staff as important for practice change in aged care settings showed good fit with those of the PARiHS framework. This framework can be recommended for use in this setting. Widespread adoption will enable cross-project and international synthesis of findings, a major step towards building a cumulative science of knowledge translation and practice change. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  20. Demonstration of the usefulness of a theoretical framework for humanising care with reference to a residential aged care service in Australia. (United States)

    Borbasi, Sally; Galvin, Kathleen T; Adams, Trevor; Todres, Les; Farrelly, Brona


    To demonstrate the usefulness of a theoretical framework for humanising care of dementia patients. The term humanisation of care has been increasingly used to describe an approach to health care that is informed by core dimensions of what it means to be human. Recent developments in dementia care highlight the importance of maintaining personhood in people with dementia. A conceptual framework is proposed by which the humanisation of care can be understood and applied. Eight dimensions that articulate core features of what needs to be attended to in order for a person to feel more deeply 'met' as a human being are discussed. Evidence from an evaluative study of a dementia outreach service is used to illustrate the usefulness of the humanising framework. Case study examples demonstrate the value of this framework by describing how a dementia outreach service enables care staff in residential aged care facilities to change their focus in the provision of care to residents with dementia. Each of the eight dimensions of humanisation/dehumanisation is used to illustrate how the dementia outreach service team have led to the improvements in resident care. Positive outcomes can be achieved by providing humanised care to residents with dementia. The paper highlights the potential for the humanising framework to be used in dementia care and shows how the framework can be helpfully translated into practice so that carers are supported to adopt an inclusive view of care delivery. A comprehensive framework, grounded in a strong philosophical foundation, can name a breadth of criteria for humanly sensitive care and can be translated into practice in such a way as to potentially transform the provision of care to residents in residential aged care facilities. © 2012 Blackwell Publishing Ltd.

  1. Impact of a physician-staffed helicopter on a regional trauma system

    DEFF Research Database (Denmark)

    Hesselfeldt, R; Steinmetz, J; Jans, H


    This study aims to compare the trauma system before and after implementing a physician-staffed helicopter emergency medical service (PS-HEMS). Our hypothesis was that PS-HEMS would reduce time from injury to definitive care for severely injured patients.......This study aims to compare the trauma system before and after implementing a physician-staffed helicopter emergency medical service (PS-HEMS). Our hypothesis was that PS-HEMS would reduce time from injury to definitive care for severely injured patients....

  2. [Evaluating the activity of the Italian Mental Health Services inpatient and residential facilities: the PRISM (Process Indicator System for Mental health) indicators]. (United States)

    Picardi, Angelo; Tarolla, Emanuele; de Girolamo, Giovanni; Gigantesco, Antonella; Neri, Giovanni; Rossi, Elisabetta; Biondi, Massimo


    This article describes the activities of a project aimed at developing a system of process and process/outcome indicators suitable to monitor over time the quality of psychiatric care of Italian inpatient and residential psychiatric facilities. This system, named PRISM (Process Indicator System for Mental health), was developed by means of a standardized evaluation made by a panel of experts and a consecutive pilot study in 17 inpatient and 13 residential psychiatric facilities. A total of 28 indicators were selected from a set of 251 candidate indicators developed by the most relevant and qualified Italian and international authorities. These indicators are derived by data from medical records and information about characteristics of facilities, and they cover processes of care, operational equipment of facilities, staff training and working, relationships with external agencies, and sentinel events. The procedure followed for the development of the indicator system was reliable and innovative. The data collected from the pilot study suggested a favourable benefit-cost ratio between the workload associated with regular use of the indicators into the context of daily clinical activities and the advantages related to the information gathered through regular use of the indicators. CONCLUSIONS.:The PRISM system provides additional information about the healthcare processes with respect to the information gathered via routine information systems, and it might prove useful for both continuous quality improvement programs and health services research.

  3. Decision-making experiences of family members of older adults with moderate dementia towards community and residential care home services: a grounded theory study protocol. (United States)

    Le Low, Lisa Pau; Lam, Lai Wah; Fan, Kim Pong


    Caring and supporting older people with dementia have become a major public health priority. Recent reports have also revealed a diminishing number of family carers to provide dementia care in the future. Carers who are engaged in the caring role are known to bear significant psychological, practical and economic challenges as the disease advances over time. Seemingly, evidence indicates that the burden of care can be relieved by formal services. This study aims to explore decision-making experiences of family members of older adults with moderate dementia towards the use of community support (CS) and residential care home (RCH) services. A large multi-site constructivist grounded theory in a range of non-government organizations and a private aged home will frame this Hong Kong study. Purposive sampling will begin the recruitment of family members, followed by theoretical sampling. It is estimated that more than 100 family members using CS and RCH services will participate in an interview. The process of successive constant comparative analysis will be undertaken. The final product, a theory, will generate an integrated and comprehensive conceptual understanding which will explain the processes associated with decision-making of family members for dementia sufferers. Deeper understanding of issues including, but not exclusive to, service needs, expectations and hopes among family carers for improving service support to serve dementia sufferers in CS and RCH services will also be revealed. Importantly, this study seeks to illustrate the practical and strategic aspects of the theory and how it may be useful to transfer its applicability to various service settings to better support those who deliver formal and informal care to the dementia population.

  4. Characteristics and service needs of women and babies admitted to residential parenting units in New South Wales: a mixed methods study. (United States)

    Priddis, Holly; Thornton, Charlene; Fowler, Cathrine; Schmied, Virginia; Tooher, Jane; Dickinson, Marie; Dahlen, Hannah Grace


    This study aims to examine the characteristics and service needs of women and babies admitted to Residential Parenting Services (RPS) in the first year following birth in New South Wales (NSW), Australia. In Australia there is a tiered system to support maternal, child and family health, which includes residential parenting services (RPS). Sequential explanatory mixed methods design. Individual patient data were obtained from a random review of 10% of all medical records (n = 300 of 3011 admissions) of women with an infant of less than 12 months of age who were admitted to RPS in 2013. Following review of the medical records, qualitative data were collected via interviews with eight women who accessed RPS. Chi square analysis and student t-testing were used to analyse quantitative data. Qualitative data were analysed using a descriptive interpretive approach. An integrative approach was taken in reporting the findings RESULTS: Women admitted to the RPS were on average 32 years of age, were Australian born (72%), had a university qualification (40%) and most were employed. The majority of women were primiparous (60%), and had a vaginal birth (61%). Women with male infants were much more likely to be admitted to the RPS (58%) compared to the NSW male to female ratio (51.3% versus 48.7%). Over 50% of women reported mental health issues with 27% having an Edinburgh Postnatal Depression Scale score ≥13 on admission. The primary reason women sought parenting support were for sleep and settling (83%). During their stay, services used by women included social workers (44%), psychologists (52%) and psychiatrists (4.5%). Women who access RPS report psychosocial and mental health issues. Services provided by RPS support women during this challenging early parenting period by providing multidisciplinary, holistic and peer support. A high prevalence of mental health issues identified in this study indicated a need for ongoing training and support for RPS staff. Ensuring

  5. Support sought for petition on safer staffing levels in Wales. (United States)


    RCN WALES is urging the public to sign an e-petition supporting draft legislation on safe staffing. The petition calls for support for the Safe Nursing Staffing Levels (Wales) Bill, drawn up by Welsh Liberal Democrat leader Kirsty Williams.

  6. Residential hospice environments: evidence-based architectural and landscape design considerations. (United States)

    Verderber, Stephen


    The residential hospice care movement is increasingly accepted and supported globally, and yet, unfortunately, the amount of literature on best practices in the planning and design of residential hospice facilities and adjacent outdoor spaces remains relatively small. This paper reports on a compendium of architectural and landscape design considerations that reflect the fundamental dimensions of the residential hospice experience: site and context, arrival spaces, communal and private spaces of the residential milieu, transitional spaces, and nature connectivity. Additionally, key staffing and administrative ramifications of this built-environment compendium are addressed, as are prognostications and challenges for the future.

  7. Staffing Policy for Solving the Information Security

    Directory of Open Access Journals (Sweden)

    A. I. Tolstoy


    Full Text Available Determining staffing policy implementation of information security tasks is given. The basic requirements that must be taken into account when developing policies are defined. The policy framework is determined and recommendations for the design of such policies are formulated. Requirements for the implementation of the policy are defined.

  8. Staffing the Global Organization: "Cultural Nomads" (United States)

    McPhail, Ruth; Fisher, Ron; Harvey, Michael; Moeller, Miriam


    This article explores the evolution of international staffing in an increasingly globalized and hypercompetitive marketplace. As the issue of staff retention becomes critical in global organizations, it is important to understand the types of managers that may be on or assigned to overseas assignments. The purpose of this article is to present a…

  9. Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing. (United States)

    McHugh, Matthew D; Berez, Julie; Small, Dylan S


    The Affordable Care Act's Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals' financial incentives with payers' and patients' quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses' efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.

  10. 38 CFR 17.81 - Contracts for residential treatment services for veterans with alcohol or drug dependence or... (United States)


    ... treatment services for veterans with alcohol or drug dependence or abuse disabilities. 17.81 Section 17.81... dependence or abuse disabilities. (a) Contracts for treatment services authorized under § 17.80(a) may be... Department of Veterans Affairs sponsored residents to adjust to and maintain freedom from dependence on or...

  11. Maintenance Staffing Standards for Zero-Based Budgeting. (United States)

    Adams, Matthew C.; And Others


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

  12. Quality of life following trauma before and after implementation of a physician-staffed helicopter

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Rasmussen, L.S.; Hesselfeldt, R


    BACKGROUND: Implementation of a physician-staffed helicopter emergency medical service (PS-HEMS) in Denmark was associated with lower 30-day mortality in severely injured trauma patients and less time on social subsidy. However, the reduced 30-day mortality in severely injured patients might...... be at the expense of a worse functional outcome and quality of life (QoL) in those who survive. The aim of this study was to investigate the effect of a physician-staffed helicopter on long-term QoL in trauma patients. METHODS: Prospective, observational study including trauma patients who survived at least 3 years...

  13. Using a complex audit tool to measure workload, staffing and quality in district nursing. (United States)

    Kirby, Esther; Hurst, Keith


    This major community, workload, staffing and quality study is thought to be the most comprehensive community staffing project in England. It involved over 400 staff from 46 teams in 6 localities and is unique because it ties community staffing activity to workload and quality. Scotland was used to benchmark since the same evidence-based Safer Nursing Care Tool methodology developed by the second-named author was used (apart from quality) and took into account population and geographical similarities. The data collection method tested quality standards, acuity, dependency and nursing interventions by looking at caseloads, staff activity and service quality and funded, actual, temporary and recommended staffing. Key findings showed that 4 out of 6 localities had a heavy workload index that stretched staffing numbers and time spent with patients. The acuity and dependency of patients leaned heavily towards the most dependent and acute categories requiring more face-to-face care. Some areas across the localities had high levels of temporary staff, which affected quality and increased cost. Skill and competency shortages meant that a small number of staff had to travel significantly across the county to deliver complex care to some patients.

  14. Hospital staffing and hospital costs. (United States)

    Andrew, R R


    A comparative study of costs per bed per day in teaching hospitals affiliated with Monash University compared with large non-teaching metropolitan hospitals (1964 to 1974) shows they are much higher in teaching hospitals. There is no evidence that this is due to the additional costs arising from the clinical schools. Research in the teaching hospitals and the accompanying high professional standards and demands on services are major factors accounting for the difference. Over the decade studied, the resident staff have increased by 77% and other salaried staff by 24%. The index of expenditure for the three teaching hospitals in the decade has increased by 386%.

  15. 77 FR 29362 - Kohler Company, Malvern Division, Including On-Site Leased Workers From Manpower Staffing and Dow... (United States)


    ... Division, Including On-Site Leased Workers From Manpower Staffing and Dow Cleaning Services, Malvern, AR..., and components. The company reports that workers from Dow Cleaning Services were employed on-site at... leased from Dow Cleaning Services working on-site at the Malvern, Arkansas location of Kohler Company...

  16. Nurse Staffing and Quality of Care of Nursing Home Residents in Korea. (United States)

    Shin, Juh Hyun; Hyun, Ta Kyung


    To investigate the relationship between nurse staffing and quality of care in nursing homes in Korea. This study used a cross-sectional design to describe the relationship between nurse staffing and 15 quality-of-care outcomes. Independent variables were hours per resident day (HPRD), skill mix, and turnover of each nursing staff, developed with the definitions of the Centers for Medicare & Medicaid Services and the American Health Care Association. Dependent variables were prevalence of residents who experienced more than one fall in the recent 3 months, aggressive behaviors, depression, cognitive decline, pressure sores, incontinence, prescribed antibiotics because of urinary tract infection, weight loss, dehydration, tube feeding, bed rest, increased activities of daily living, decreased range of motion, use of antidepressants, and use of restraints. Outcome variables were quality indicators from the U.S. Centers for Medicare & Medicaid and 2013 nursing home evaluation manual by the Korean National Health Insurance Service. The effects of registered nurse (RN) HPRD was supported in fall prevention, decreased tube feeding, decreased numbers of residents with deteriorated range of motion, and decreased aggressive behavior. Higher turnover of RNs related to more residents with dehydration, bed rest, and use of antipsychotic medication. Study results supported RNs' unique contribution to resident outcomes in comparison to alternative nurse staffing in fall prevention, decreased use of tube feeding, better range of motion for residents, and decreased aggressive behaviors in nursing homes in Korea. More research is required to confirm the effects of nurse staffing on residents' outcomes in Korea. We found consistency in the effects of RN staffing on resident outcomes acceptable. By assessing nurse staffing levels and compositions of nursing staffs, this study contributes to more effective long-term care insurance by reflecting on appropriate policies, and ultimately

  17. Staffing Up and Dropping Out

    Directory of Open Access Journals (Sweden)

    Mark Fetler


    Full Text Available Growing public school enrollment and the need to maintain or improve service to students has increased the demand for teachers, perhaps more rapidly than existing sources can accommodate. While some schools recruit well qualified teachers by offering higher salaries or better working conditions, others may satisfy their need for staff by relaxing hiring standards or assigning novice teachers to difficult classrooms. Schools' hiring policies have consequences for student success. Dropout rates tend to be higher where faculties include a greater percentage of minimally educated teachers or teachers with little experience. The relationship between dropout rate and teacher qualifications is independent of student poverty, school size, and location. A proposed strategy to reduce dropout rates is to encourage higher preparation and employment standards, and to provide appropriate classroom assignments, mentoring, and support for new teachers.

  18. Avoiding mandatory hospital nurse staffing ratios: an economic commentary. (United States)

    Buerhaus, Peter I


    The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.

  19. Residential greenhouse

    Energy Technology Data Exchange (ETDEWEB)


    The following report examines the technical and economic viability of residential greenhouse additions in Whitehorse, Yukon. The greenhouse was constructed using the south facing wall of an existing residence as a common wall. Total construction costs were $18,000, including labour. Annual fuel demand for the residence has been reduced by about 10 per cent for an annual saving of $425. In addition, produce to the value of $1,000 is grown annually in the greenhouse for domestic consumption and commercial resale. Typically the greenhouse operates for nine months each year. There is a net thermal loss during the months of November, December and January as a result of the large area of glazing. As well as supplementing the heating supply solar greenhouses can provide additional cash crops which can be used to offset the cost of construction. Humidity problems are minimal and can be dealt with by exhausting high humidity air. One system which has been considered for the greenhouse is to use a standard residential heat pump to remove excess moisture and to pump heat into the house. This would have a secondary benefit of excluding the need to circulate greenhouse air through the house. Thus any allergenic reactions to the greenhouse air would be prevented. 8 refs., 3 figs, 2 tabs.

  20. Requirements for SSC central computing staffing (conceptual)

    International Nuclear Information System (INIS)

    Pfister, J.


    Given a computation center with --10,000 MIPS supporting --1,000 users, what are the staffing requirements? The attempt in this paper is to list the functions and staff size required in a central computing or centrally supported computing complex. The organization assumes that although considerable computing power would exist (mostly for online) in the four interaction regions (IR) that there are functions/capabilities better performed outside the IR and in this model at a ''central computing facility.'' What follows is one staffing approach, not necessarily optimal, with certain assumptions about numbers of computer systems, media, networks and system controls, that is, one would get the best technology available. Thus, it is speculation about what the technology may bring and what it takes to operate it. From an end user support standpoint it is less clear, given the geography of an SSC, where and what the consulting support should look like and its location

  1. Radiotherapy staffing in the European countries

    DEFF Research Database (Denmark)

    Lievens, Yolande; Defourny, Noémie; Coffey, Mary


    includes a detailed analysis of radiotherapy staffing (questionnaire items 47-60), analysed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis was conducted between February and July 2014, and is based on validated responses from 24 of the 40...... of countries can be distinguished on the basis of available personnel resources and socio-economic status. CONCLUSIONS: The average personnel figures in Europe are now consistent with, or even more favourable than the QUARTS recommendations, probably reflecting a combination of better availability as such......, in parallel with the current use of more complex treatments than a decade ago. A considerable variation in available personnel and delivered courses per year however persists among the highest and lowest staffing levels. This not only reflects the variation in cancer incidence and socio-economic determinants...

  2. Staffing for Cyberspace Operations: Summary of Analysis (United States)


    military-unique knowledge or skills required; (2) military incumbency is required by law, Executive Order, treaty or international agreement (e.g., DPH...civilian employment . 1 Thomas H. Barth et al., “(U) Staffing for Cyberspace Operations,” IDA Paper P...DoD cyberspace strategies, doctrine, and current concepts of operation and employment for CMF. Additionally, the team conducted interviews with

  3. The Effects of an Experiential Service-Learning Project on Residential Interior Design Students' Attitudes toward Design and Community (United States)

    Gomez-Lanier, Lilia


    This mixed research methods study explores whether project-based service-learning projects promote greater learning than standard project-based projects and whether introduced earlier into the curriculum promotes a greater student understanding of the world issues affecting their community. The present study focused on comparing sophomore and…

  4. Science Teacher Education for Sustainable Development: A Case Study of a Residential Field Course in a Norwegian Pre-Service Teacher Education Programme (United States)

    Jegstad, Kirsti Marie; Gjøtterud, Sigrid Marie; Sinnes, Astrid Tonette


    In this paper, we explore how a Norwegian teacher education institution promotes education for sustainable development (ESD) through a residential field course. The residential field course was located in a mountain area and data were collected through participant observation. The data included--together with instructional artefacts--evaluation…

  5. Impact of staffing parameters on operational reliability

    International Nuclear Information System (INIS)

    Hahn, H.A.; Houghton, F.K.


    This paper reports on a project related to human resource management of the Department of Energy's (DOE's) High-Level Waste (HLW) Tank program. Safety and reliability of waste tank operations is impacted by several issues, including not only the design of the tanks themselves, but also how operations and operational personnel are managed. As demonstrated by management assessments performed by the Tiger Teams, DOE believes that the effective use of human resources impacts environment safety, and health concerns. For the of the current paper, human resource management activities are identified as ''Staffing'' and include the of developing the functional responsibilities and qualifications of technical and administrative personnel. This paper discusses the importance of staff plans and management in the overall view of safety and reliability. The work activities and procedures associated with the project, a review of the results of these activities, including a summary of the literature and a preliminary analysis of the data. We conclude that although identification of staffing issues and the development of staffing plans contributes to the overall reliability and safety of the HLW tanks, the relationship is not well understood and is in need of further development

  6. Staffing, overtime, and shift scheduling project

    International Nuclear Information System (INIS)

    Lewis, P.M.


    Recent events at the Peach Bottom nuclear power plant have demonstrated the need to establish a quantifiable basis for assessing the safety significance of long work hours on nuclear power plant operators. The incidents at TMI-2, Chernobyl, and Bhopal, which all occurred during the late evening/night shift, further highlight the importance of the relationship between shift scheduling and performance. The objective of this project is to estimate, using statistical analysis on data from the nuclear industry, the effects on safety of staffing levels, overtime, and shift scheduling for operators and maintenance personnel. Regarding staffing levels, the Nuclear Regulatory Commission (NRC) currently has no explicit regulation concerning the minimum acceptable levels of staffing in a plant that has an operating license. The NRC has no systematic method for collecting data on the number of licensed operators on the operating crews. In 1982 the NRC recommended that plants write into their technical specifications a model policy on overtime. Currently, 77 nuclear power plant units have the model policy or a modification of it written into their technical specifications; 33 units have no policy on overtime. The model policy sets limits on overtime for safety related personnel, although these limits can be exceeded with plant manger approval. The US nuclear power industry has three types of shift schedules: (1) forward-rotating 8-hour/day shift schedules, (2) backward-rotating 8-hour/day schedules, and (3) 12-hour/day schedules

  7. Spent Nuclear Fuel Project operational staffing plan

    International Nuclear Information System (INIS)

    Debban, B.L.


    Using the Spent Nuclear Fuel (SNF) Project's current process flow concepts and knowledge from cognizant engineering and operational personnel, an initial assessment of the SNF Project radiological exposure and resource requirements was completed. A small project team completed a step by step analysis of fuel movement in the K Basins to the new interim storage location, the Canister Storage Building (CSB). This analysis looked at fuel retrieval, conditioning of the fuel, and transportation of the fuel. This plan describes the staffing structure for fuel processing, fuel movement, and the maintenance and operation (M ampersand O) staffing requirements of the facilities. This initial draft does not identify the support function resources required for M ampersand O, i.e., administrative and engineering (technical support). These will be included in future revisions to the plan. This plan looks at the resource requirements for the SNF subprojects, specifically, the operations of the facilities, balances resources where applicable, rotates crews where applicable, and attempts to use individuals in multi-task assignments. This plan does not apply to the construction phase of planned projects that affect staffing levels of K Basins

  8. Impact of staffing parameters on operational reliability

    International Nuclear Information System (INIS)

    Hahn, H.A.; Houghton, F.K.


    This paper reports on a project related to human resource management of the Department of Energy (DOEs) High-Level Waste (HLW) Tank program. Safety and reliability of waste tank operations is impacted by several issues, including not only the design of the tanks themselves, but also how operations and operational personnel are managed. As demonstrated by management assessments performed by the Tiger Teams, DOE believes that the effective use of human resources impacts environment, safety, and health concerns. For the purposes of the current paper, human resource management activities are identified as 'Staffing' and include the process of developing the functional responsibilities and qualifications of technical and administrative personnel. This paper discusses the importance of staff plans and management in the overall view of safety and reliability, the work activities and procedures associated with the project, a review of the results of these activities, including a summary of the literature and a preliminary analysis of the data. We conclude that, although identification of staffing issues and the development of staffing plans contributes to the overall reliability and safety of the HLW tanks, the relationship is not well understood and is in need of further development

  9. New law on staffing levels will save lives. (United States)


    Good news about nurse staffing levels can be hard to find, so how fantastic that a protracted campaign in Wales finally paid off last week with the passage of legislation to ensure hospital wards are staffed safely. Next month, the Queen will give royal assent to the Safe Nurse Staffing Levels (Wales) Bill, which will save lives, produce better outcomes and enhance the patient experience of care.

  10. Mining routinely collected acute data to reveal non-linear relationships between nurse staffing levels and outcomes. (United States)

    Leary, Alison; Cook, Rob; Jones, Sarahjane; Smith, Judith; Gough, Malcolm; Maxwell, Elaine; Punshon, Geoffrey; Radford, Mark


    Nursing is a safety critical activity but not easily quantified. This makes the building of predictive staffing models a challenge. The aim of this study was to determine if relationships between registered and non-registered nurse staffing levels and clinical outcomes could be discovered through the mining of routinely collected clinical data. The secondary aim was to examine the feasibility and develop the use of 'big data' techniques commonly used in industry for this area of healthcare and examine future uses. The data were obtained from 1 large acute National Health Service hospital trust in England. Routinely collected physiological, signs and symptom data from a clinical database were extracted, imported and mined alongside a bespoke staffing and outcomes database using Mathmatica V.10. The physiological data consisted of 120 million patient entries over 6 years, the bespoke database consisted of 9 years of daily data on staffing levels and safety factors such as falls. To discover patterns in these data or non-linear relationships that would contribute to modelling. To examine feasibility of this technique in this field. After mining, 40 correlations (pdata (such as the presence or absence of nausea) and staffing factors. Several inter-related factors demonstrated step changes where registered nurse availability appeared to relate to physiological parameters or outcomes such as falls and the management of symptoms. Data extraction proved challenging as some commercial databases were not built for extraction of the massive data sets they contain. The relationship between staffing and outcomes appears to exist. It appears to be non-linear but calculable and a data-driven model appears possible. These findings could be used to build an initial mathematical model for acute staffing which could be further tested. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  11. The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study. (United States)

    Stergiopoulos, Vicky; Schuler, Andrée; Nisenbaum, Rosane; deRuiter, Wayne; Guimond, Tim; Wasylenki, Donald; Hoch, Jeffrey S; Hwang, Stephen W; Rouleau, Katherine; Dewa, Carolyn


    Although a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model. In total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains. We observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures. Our findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.

  12. Staffing and training experience at the Bilibino nuclear power plant

    International Nuclear Information System (INIS)

    Tukhvetov, F.


    Bilibino NPP has four 12 MW(e) water cooled graphite moderated channel reactors. The plant has been in operation since 1973 in conditions of isolated local energy system in a remote area with extreme climatic conditions. The plant accounts for almost 70 per cent of energy produced in the region, it also provides heating to the regional centre. The plant's organisational structure is on the whole consistent with the standard structure of other NPPs of ex-USSR. At the same time there are some specific features due to high cost of personnel in the prime cost of the generated energy. As a result a need arises to broaden the task of catering for each worker and, therefore, to extend and increase the level of training. The number of high-quality personnel is on the increase. A method of step-by-step training is widely used at all work areas for training operations personnel. At the end of each step a worker is engaged in independent activities at this work area. When a plant is located in a remote area efficient and effective maintenance becomes highly instrumental. The engineering and design support on the part of the utility and equipment manufacturer begins to play a greater role. Activities to optimise the plant organisational structure were mostly characterised by merging of subdivisions and by some change in the proportion of different categories of personnel. It would be an optimum decision to put all supporting services, namely, logistics, book-keeping and staffing departments, within the utility's authority. Operations experience of the Bilibino plant will certainly be valuable for projection, location choice and staffing of plants with small and medium reactors. (author)

  13. Therapeutic Residential Care for Children and Youth:

    DEFF Research Database (Denmark)

    Whittaker, James K.; Holmes, Lisa; del Valle, Jorge F.


    so in closer collaboration with their families and in closer proximity to their home communities; and, (3) with the hope of reducing the high costs often associated with group residential provision. In some jurisdictions, efforts to reduce residential care resources in the absence of sufficient...... alternatives to serve high-resource needing youth has had unintended and negative consequences. It is within this context that a working group international experts representing research, policy, service delivery and families (International Work Group for Therapeutic Residential Care) convened at the Centre...... for Child and Family Research, Loughborough University in the U.K. for a Summit meeting on therapeutic residential care for children and youth funded by the Sir Halley Stewart Trust (UK). The focus centered on what is known about therapeutic residential care and what key questions should inform a priority...

  14. Rostering from staffing levels: a branch-and-price approach

    NARCIS (Netherlands)

    van der Veen, Egbert; Veltman, Bart

    Many rostering methods first create shifts from some given staffing levels, and after that create rosters from the set of created shifts. Although such a method has some nice properties, it also has some bad ones. In this paper we outline a method that creates rosters directly from staffing levels.

  15. Brown & Smith Communication Solutions: A Staffing System Simulation (United States)

    Small, Erika E.; Doll, Jessica L.; Bergman, Shawn M.; Heggestad, Eric D.


    Developing students' practical skills in strategic staffing and selection within the classroom can be challenging. This article describes a staffing system simulation designed to engage students and develop applied skills in strategic recruiting, assessment, and evaluation of job applicants. Instructors looking for a multifaceted team project…

  16. The energy-related services are the major sales promotion. Customized electricity and district heat supply technology and services for the newly developed residential area Boerkhauser Feld at Solingen-Aufderhoehe; Die Dienstleistung bringt den (Verkaufs-)Erfolg. Strom- und Waermeversorgung fuer Wohngebiet Boerkhauser Feld in Solingen-Aufderhoehe

    Energy Technology Data Exchange (ETDEWEB)



    The firm COMUNA-metall, Herford, is the contractor and service provider for installation and operation of the electricity and district heat supply systems based on a modular cogeneration plant (CHP system). The residential area will eventually encompass about 450 residential units, all buildings are low-energy houses. The article explains the systems and gives an initial performance report covering 100 existing residential units. (orig./CB) [German] Die Firma COMUNA-metall, Herford, hat als Dienstleister die Erstellung und den Betrieb einer Strom- und Nahwaermeversorgung mit Kraft-Waerme-Kopplung fuer das Wohngebiet uebernommen, das nach Fertigstellung ca. 450 Wohneinheiten in Niedrigenergiebauweise umfassen wird. Der Beitrag schildert die technischen Einrichtungen und eine erste Leistungsbilanz im Bauabschnitt mit 100 Wohneinheiten. (orig./CB)

  17. Nurse staffing, medical staffing and mortality in Intensive Care: An observational study. (United States)

    West, Elizabeth; Barron, David N; Harrison, David; Rafferty, Anne Marie; Rowan, Kathy; Sanderson, Colin


    To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal. Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs. A cross-sectional, retrospective, risk adjusted observational study. Multivariable, multilevel logistic regression. ICU and in-hospital mortality. After controlling for patient characteristics and workload we found that higher numbers of nurses per bed (odds ratio: 0.90, 95% confidence interval: [0.83, 0.97]) and higher numbers of consultants (0.85, [0.76, 0.95]) were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death (0.98, [0.96, 0.99]) whereas the effect of medical staffing was unchanged across the range of patient acuity (1.00, [0.97, 1.03]). No relationship between patient outcomes and the number of support staff (administrative, clerical, technical and scientific staff) was found. Distinguishing between direct care and supernumerary nurses and restricting the analysis to patients who had been in the unit for more than 8h made little difference to the results. Separate analysis of in-unit and in-hospital survival showed that the clinical workforce in intensive care had a greater impact on ICU mortality than on

  18. [Impact of nurse, nurses' aid staffing and turnover rate on inpatient health outcomes in long term care hospitals]. (United States)

    Kim, Yunmi; Lee, Ji Yun; Kang, Hyuncheol


    This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

  19. Information Service. (United States)

    Scofield, James

    Newspaper librarians discussed the public use of their newspapers' libraries. Policies run the gamut from well-staffed public information services, within or outside the newspaper library, to no service at all to those outside the staff of the paper. Problems of dealing with tax and law enforcement agencies were covered, as well as cooperative…

  20. Staffing and job satisfaction: nurses and nursing assistants. (United States)

    Kalisch, Beatrice; Lee, Kyung Hee


    The aim of this study was to examine the relationship between staffing and job satisfaction of registered nurses (RNs) and nursing assistants (NAs). Although a number of previous studies have demonstrated the link between the numbers of patients cared for on the last shift and/or perceptions of staffing adequacy, we could find only one study that utilized a measure of actual staffing (opposed to perceptions of staffing adequacy) and correlated it with job satisfaction of registered nurses. This cross-sectional study included 3523 RNs and 1012 NAs in 131 patient care units. Staff were surveyed to determine job satisfaction and demographic variables. In addition, actual staffing data were collected from each of the study units. Hours per patient day was a significant positive predictor for registered nurse job satisfaction after controlling for covariates. For NAs, a lower skill mix was marginally significant with higher job satisfaction. In addition, the more work experience the NAs reported, the lower their job satisfaction. Adequate staffing levels are essential for RN job satisfaction whereas NA job satisfaction depends on the number of assistive personnel in the mix of nursing staff. Two implications are (1) providing adequate staffing is critical to maintain RN job satisfaction and (2) the NA job needs to be re-engineered to make it a more attractive and satisfying career. © 2012 John Wiley & Sons Ltd.

  1. Technical basis for staffing levels at nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Shurberg, D.A.; Haber, S.B. [Brookhaven National Lab., Upton, NY (United States); Morisseau, D. [Nuclear Regulatory Commission, Washington, DC (United States)] [and others


    The objective of this project is to provide a technical basis for the establishment of criteria for minimum staffing levels of licensed and non-licensed NPP shift personnel. Minimum staffing levels for the purpose of this study, are defined as those necessary for successful accomplishment of all safety and additional functions that must be performed in order for the licensee to meet applicable regulatory requirements. This project involves a multi-faceted approach to the investigation of the issue. Relevant NRC documentation was identified and reviewed. Using the information obtained from this documentation review, a test plan was developed to aid in the collection of further information regarding the adequacy of current shift staffing levels. The test plan addresses three different activities to be conducted to provide information to the NRC for use in the assessment of current minimum staffing levels. The first activity is collection of data related to industry shift staffing practices through site visits to seven nuclear power plants. The second activity is a simulator study, which will use licensed operator crews responding to a simulated event, under two different staffing levels. Finally, workload models will be constructed for both licensed and non-licensed personnel, using a priori knowledge of the simulator scenarios with data resulting from one of the staffing levels studied in the simulator, and the data collected from the site visits. The model will then be validated against the data obtained from the second staffing level studied in the simulator. The validated model can then be used to study the impact of changing staffing-related variables on the plant shift crew`s ability to effectively mitigate an event.

  2. Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions. (United States)

    Ms, Suzie Aparicio; Welch Bacon, Cailee E; Parsons, John T; Bay, R Curtis; Cohen, Randy P; DeZeeuw, Terry; McLeod, Tamara C Valovich


    The "Appropriate Medical Coverage for Intercollegiate Athletics" (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Cross-sectional study. Web-based survey. Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1-3 FTE athletic trainers for football would change their compliance status. A uniform definition of the term FTE within collegiate athletics is needed to allow for structured

  3. Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions (United States)

    MS, Suzie Aparicio; Welch Bacon, Cailee E.; Parsons, John T.; Bay, R. Curtis; Cohen, Randy P.; DeZeeuw, Terry; McLeod, Tamara C. Valovich


    Context The “Appropriate Medical Coverage for Intercollegiate Athletics” (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. Objective To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. Main Outcome Measure(s) The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. Results The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). Conclusions The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1–3 FTE athletic trainers for football would change their

  4. Wage, Work Environment, and Staffing: Effects on Nurse Outcomes (United States)

    McHugh, Matthew D.; Ma, Chenjuan


    Research has shown that hospitals with better nurse staffing and work environments have better nurse outcomes—less burnout, job dissatisfaction, and intention to leave the job. Many studies, however, have not accounted for wage effects, which may confound findings. By using a secondary analysis with cross-sectional administrative data and a four-state survey of nurses, we investigated how wage, work environment, and staffing were associated with nurse outcomes. Logistic regression models, with and without wage, were used to estimate the effects of work environment and staffing on burnout, job dissatisfaction, and intent to leave. We discovered that wage was associated with job dissatisfaction and intent to leave but had little influence on burnout, while work environment and average patient-to-nurse ratio still have considerable effects on nurse outcomes. Wage is important for good nurse outcomes, but it does not diminish the significant influence of work environment and staffing on nurse outcomes. PMID:25121923

  5. The Implications of Flexible Staffing Arrangements for Job Stability


    Houseman, Susan N.; Polivka, Anne E.


    In this paper, we examine the job stability of workers in a wide range of flexible staffing arrangements: agency temporary, direct-hire temporary, on-call, contract company, independent contractor, and regular part-time work. We draw upon two data sources in our analysis. The first is a nationwide survey of employers on their use of flexible staffing arrangements conducted by the Upjohn Institute for Employment Research. This survey provides evidence on why employers use various types of flex...

  6. Special Education Staffing and Service Models in Christian Schools (United States)

    Lane, Julie M.


    Christian schools are not obligated to accept children with disabilities. However, the growing trend in Christian schools is to serve children with disabilities. Recent literature has begun to identify enrollment trends, areas of disability served, and professional development in Christian schools as it relates to disability. Literature exists…

  7. Cost analysis of nursing home registered nurse staffing times. (United States)

    Dorr, David A; Horn, Susan D; Smout, Randall J


    To examine potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing. A retrospective cost study using differences in adverse outcome rates of pressure ulcers (PUs), urinary tract infections (UTIs), and hospitalizations per resident per day from low staffing and adequate staffing nursing homes. Cost savings from reductions in these events are calculated in dollars and compared with costs of increasing nurse staffing. Eighty-two nursing homes throughout the United States. One thousand three hundred seventy-six frail elderly long-term care residents at risk of PU development. Event rates are from the National Pressure Ulcer Long-Term Care Study. Hospital costs are estimated from Medicare statistics and from charges in the Healthcare Cost and Utilization Project. UTI costs and PU costs are from cost-identification studies. Time horizon is 1 year; perspectives are societal and institutional. Analyses showed an annual net societal benefit of 3,191 dollars per resident per year in a high-risk, long-stay nursing home unit that employs sufficient nurses to achieve 30 to 40 minutes of registered nurse direct care time per resident per day versus nursing homes that have nursing time of less than 10 minutes. Sensitivity analyses revealed a robust set of estimates, with no single or paired elements reaching the cost/benefit equality threshold. Increasing nurse staffing in nursing homes may create significant societal cost savings from reduction in adverse outcomes. Challenges in increasing nurse staffing are discussed.

  8. Staffing and structure of infection prevention and control programs. (United States)

    Stone, Patricia W; Dick, Andrew; Pogorzelska, Monika; Horan, Teresa C; Furuya, E Yoko; Larson, Elaine


    The nature of infection prevention and control is changing; however, little is known about current staffing and structure of infection prevention and control programs. Our objectives were to provide a snapshot of the staffing and structure of hospital-based infection prevention and control programs in the United States. A Web-based survey was sent to 441 hospitals that participate in the National Healthcare Safety Network. The response rate was 66% (n = 289); data were examined on 821 professionals. Infection preventionist (IP) staffing was significantly negatively related to bed size, with higher staffing in smaller hospitals (P hospital epidemiologists were reported to have authority to close beds for outbreaks always or most of the time (n = 225, 78%). Only 32% (n = 92) reported using an electronic surveillance system to track infections. This study is the first to provide a comprehensive description of current infection prevention and control staffing, organization, and support in a select group of hospitals across the nation. Further research is needed to identify effective staffing levels for various hospital types as well as examine how the IP role is changing over time.

  9. The Need for Higher Minimum Staffing Standards in U.S. Nursing Homes (United States)

    Harrington, Charlene; Schnelle, John F.; McGregor, Margaret; Simmons, Sandra F.


    Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality. PMID:27103819

  10. Economic evaluation of nurse staffing and nurse substitution in health care: a scoping review. (United States)

    Goryakin, Yevgeniy; Griffiths, Peter; Maben, Jill


    Several systematic reviews have suggested that greater nurse staffing as well as a greater proportion of registered nurses in the health workforce is associated with better patient outcomes. Others have found that nurses can substitute for doctors safely and effectively in a variety of settings. However, these reviews do not generally consider the effect of nurse staff on both patient outcomes and costs of care, and therefore say little about the cost-effectiveness of nurse-provided care. Therefore, we conducted a scoping literature review of economic evaluation studies which consider the link between nurse staffing, skill mix within the nursing team and between nurses and other medical staff to determine the nature of the available economic evidence. Scoping literature review. English-language manuscripts, published between 1989 and 2009, focussing on the relationship between costs and effects of care and the level of registered nurse staffing or nurse-physician substitution/nursing skill mix in the clinical team, using cost-effectiveness, cost-utility, or cost-benefit analysis. Articles selected for the review were identified through Medline, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Google Scholar database searches. After selecting 17 articles representing 16 unique studies for review, we summarized their main findings, and assessed their methodological quality using criteria derived from recommendations from the guidelines proposed by the Panel on Cost-Effectiveness in Health Care. In general, it was found that nurses can provide cost effective care, compared to other health professionals. On the other hand, more intensive nurse staffing was associated with both better outcomes and more expensive care, and therefore cost effectiveness was not easy to assess. Although considerable progress in economic evaluation studies has been reached in recent years, a number of methodological issues remain. In the future

  11. Toward a geoinformatics framework for understanding the social and biophysical influences on urban nutrient pollution due to residential impervious service connectivity (United States)

    Miles, B.; Band, L. E.


    Water sustainability has been recognized as a fundamental problem of science whose solution relies in part on high-performance computing. Stormwater management is a major concern of urban sustainability. Understanding interactions between urban landcover and stormwater nutrient pollution requires consideration of fine-scale residential stormwater management, which in turn requires high-resolution LIDAR and landcover data not provided through national spatial data infrastructure, as well as field observation at the household scale. The objectives of my research are twofold: (1) advance understanding of the relationship between residential stormwater management practices and the export of nutrient pollution from stormwater in urbanized ecosystems; and (2) improve the informatics workflows used in community ecohydrology modeling as applied to heterogeneous urbanized ecosystems. In support of these objectives, I present preliminary results from initial work to: (1) develop an ecohydrology workflow platform that automates data preparation while maintaining data provenance and model metadata to yield reproducible workflows and support model benchmarking; (2) perform field observation of existing patterns of residential rooftop impervious surface connectivity to stormwater networks; and (3) develop Regional Hydro-Ecological Simulation System (RHESSys) models for watersheds in Baltimore, MD (as part of the Baltimore Ecosystem Study (BES) NSF Long-Term Ecological Research (LTER) site) and Durham, NC (as part of the NSF Urban Long-Term Research Area (ULTRA) program); these models will be used to simulate nitrogen loading resulting from both baseline residential rooftop impervious connectivity and for disconnection scenarios (e.g. roof drainage to lawn v. engineered rain garden, upslope v. riparian). This research builds on work done as part of the NSF EarthCube Layered Architecture Concept Award where a RHESSys workflow is being implemented in an iRODS (integrated Rule

  12. Improving Staffing and Nurse Engagement in a Neuroscience Intermediate Unit. (United States)

    Nadolski, Charles; Britt, Pheraby; Ramos, Leah C


    The neuroscience intermediate unit is a 23-bed unit that was initially staffed with a nurse-to-patient ratio of 1:4 to 1:5. In time, the unit's capacity to care for the exceeding number of progressively acute patients fell short of the desired goals in the staff affecting the nurse satisfaction. The clinical nurses desired a lower nurse-patient ratio. The purpose of this project was to justify a staffing increase through a return on investment and increased quality metrics. This initiative used mixed methodology to determine the ideal staffing for a neuroscience intermediate unit. The quantitative section focused on a review of the acuity of the patients. The qualitative section was based on descriptive interviews with University Healthcare Consortium nurse managers from similar units. The study reviewed the acuity of 9,832 patient days to determine the accurate acuity of neuroscience intermediate unit patients. Nurse managers at 12 University Healthcare Consortium hospitals and 8 units at the Medical University of South Carolina were contacted to compare staffing levels. The increase in nurse staffing contributed to an increase in many quality metrics. There were an 80% decrease in controllable nurse turnover and a 75% reduction in falls with injury after the lowered nurse-patient ratio. These 2 metrics established a return on investment for the staffing increase. In addition, the staffing satisfaction question on the Press Ganey employee engagement survey increased from 2.44 in 2013 to 3.72 in 2015 in response to the advocacy of the bedside nurses.

  13. A strategy for optimizing staffing to improve the timeliness of inpatient phlebotomy collections. (United States)

    Morrison, Aileen P; Tanasijevic, Milenko J; Torrence-Hill, Joi N; Goonan, Ellen M; Gustafson, Michael L; Melanson, Stacy E F


    The timely availability of inpatient test results is a key to physician satisfaction with the clinical laboratory, and in an institution with a phlebotomy service may depend on the timeliness of blood collections. In response to safety reports filed for delayed phlebotomy collections, we applied Lean principles to the inpatient phlebotomy service at our institution. Our goal was to improve service without using additional resources by optimizing our staffing model. To evaluate the effect of a new phlebotomy staffing model on the timeliness of inpatient phlebotomy collections. We compared the median time of morning blood collections and average number of safety reports filed for delayed phlebotomy collections during a 6-month preimplementation period and 5-month postimplementation period. The median time of morning collections was 17 minutes earlier after implementation (7:42 am preimplementation; interquartile range, 6:27-8:48 am; versus 7:25 am postimplementation; interquartile range, 6:20-8:26 am). The frequency of safety reports filed for delayed collections decreased 80% from 10.6 per 30 days to 2.2 per 30 days. Reallocating staff to match the pattern of demand for phlebotomy collections throughout the day represents a strategy for improving the performance of an inpatient phlebotomy service.

  14. The drivers to adopt renewable energy among residential users. (United States)

    Rahman, Zahari Abdul; Elinda, Esa


    This study aims to examine the drivers to adopt renewable energy (RE) among residential users in Malaysia. Based on the theoretical framework of a consumer’s decision making process, an empirical study of the adoption of RE was conducted. A total of 501 residential users were used in this study. This study proved that perceived utility of new technology, perceived utility of new service, and perceived benefit of new technology are the drivers to adopt RE among residential users. These factors are knowing crucial to RE suppliers and producers because it will generates more demand from the residential users and the percentage of energy mix from RE sources can be increase.

  15. 77 FR 28519 - Test Procedure Guidance for Room Air Conditioners, Residential Dishwashers, and Residential... (United States)


    ... Guidance for Room Air Conditioners, Residential Dishwashers, and Residential Clothes Washers: Public... procedures for room air conditioners, residential dishwashers, and residential clothes washers. DATES: DOE...'s existing test procedures for residential room air conditioners, residential dishwashers, and...

  16. Staffing requirements for future small and medium reactors

    International Nuclear Information System (INIS)

    McQuade, D.


    As power generators around the world grapple with the challenges of the environment, deregulation, competitions and changing prices of fuels, the economics of running a future power plant are influenced significantly by the component of labour costs. These costs, from plant staff, corporate support and purchased services, will affect the overall plant economics. To achieve improved efficiency and effectiveness of organization structures and staff, vendors and utilities are working jointly to apply lessons learned for future designs. This paper will examine the experience gained to date with Canadian CANDU 6 type reactors both in Canada and abroad. The strategies which have been very successful will be reviewed, together with the results of collaboration between Atomic Energy of Canada and the utilities. An assessment of the staffing numbers is provided as a comparison between current number at a Canadian utility and the projected number from a future plant with the improvements in the design. The influence to the overall plant economics are discussed with some broad generalities that look at the effects of increasing and reducing staff levels showing the probable impact on capacity factor. The lessons from other plants can contribute significantly to the performance improvement process. The paper points to the need for a balanced approach in the future for the distribution of operating maintenance and administration (OM and A) cost between nuclear safety studies; maintenance programs and staff training. In the future, utilities, together with the designers, will have to greatly improve plant maintenance and training. The improved design features detailed in the paper will support this strategy by utilizing operational experience. (author)

  17. Excellence and evidence in staffing: a data-driven model for excellence in staffing (2nd edition). (United States)

    Baggett, Margarita; Batcheller, Joyce; Blouin, Ann Scott; Behrens, Elizabeth; Bradley, Carol; Brown, Mary J; Brown, Diane Storer; Bolton, Linda Burnes; Borromeo, Annabelle R; Burtson, Paige; Caramanica, Laura; Caspers, Barbara A; Chow, Marilyn; Christopher, Mary Ann; Clarke, Sean P; Delucas, Christine; Dent, Robert L; Disser, Tony; Eliopoulos, Charlotte; Everett, Linda Q; Garcia, Amy; Glassman, Kimberly; Goodwin, Susan; Haagenson, Deb; Harper, Ellen; Harris, Kathy; Hoying, Cheryl L; Hughes-Rease, Marsha; Kelly, Lesly; Kiger, Anna J; Kobs-Abbott, Ann; Krueger, Janelle; Larson, Jackie; March, Connie; Martin, Deborah Maust; Mazyck, Donna; Meenan, Penny; McGaffigan, Patricia; Myers, Karen K; Nell, Kate; Newcomer, Britta; Cathy, Rick; O'Rourke, Maria; Rosa, Billy; Rose, Robert; Rudisill, Pamela; Sanford, Kathy; Simpson, Roy L; Snowden, Tami; Strickland, Bob; Strohecker, Sharon; Weems, Roger B; Welton, John; Weston, Marla; Valentine, Nancy M; Vento, Laura; Yendro, Susan


    The Patient Protection and Affordable Care Act (PPACA, 2010) and the Institute of Medicine's (IOM, 2011) Future of Nursing report have prompted changes in the U.S. health care system. This has also stimulated a new direction of thinking for the profession of nursing. New payment and priority structures, where value is placed ahead of volume in care, will start to define our health system in new and unknown ways for years. One thing we all know for sure: we cannot afford the same inefficient models and systems of care of yesterday any longer. The Data-Driven Model for Excellence in Staffing was created as the organizing framework to lead the development of best practices for nurse staffing across the continuum through research and innovation. Regardless of the setting, nurses must integrate multiple concepts with the value of professional nursing to create new care and staffing models. Traditional models demonstrate that nurses are a commodity. If the profession is to make any significant changes in nurse staffing, it is through the articulation of the value of our professional practice within the overall health care environment. This position paper is organized around the concepts from the Data-Driven Model for Excellence in Staffing. The main concepts are: Core Concept 1: Users and Patients of Health Care, Core Concept 2: Providers of Health Care, Core Concept 3: Environment of Care, Core Concept 4: Delivery of Care, Core Concept 5: Quality, Safety, and Outcomes of Care. This position paper provides a comprehensive view of those concepts and components, why those concepts and components are important in this new era of nurse staffing, and a 3-year challenge that will push the nursing profession forward in all settings across the care continuum. There are decades of research supporting various changes to nurse staffing. Yet little has been done to move that research into practice and operations. While the primary goal of this position paper is to generate research

  18. VA residential substance use disorder treatment program providers' perceptions of facilitators and barriers to performance on pre-admission processes. (United States)

    Ellerbe, Laura S; Manfredi, Luisa; Gupta, Shalini; Phelps, Tyler E; Bowe, Thomas R; Rubinsky, Anna D; Burden, Jennifer L; Harris, Alex H S


    these domains. Efficient screening processes, effective patient flow, and available beds were perceived to facilitate shorter wait times, while lack of beds, poor staffing levels, and lengths of stay of existing patients were thought to lengthen wait times. Accessible outpatient services, strong patient outreach, and strong encouragement of pre-admission outpatient treatment emerged as facilitators of engagement while waiting; poor staffing levels, socioeconomic barriers, and low patient motivation were viewed as barriers. Metrics for pre-admission processes can be helpful for monitoring residential SUD treatment programs. Interviewing program management and staff about drivers of performance metrics can play a complementary role by identifying innovative and other strong practices, as well as high-value targets for quality improvement. Key facilitators of high-performing facilities may offer programs with lower performance useful strategies to improve specific pre-admission processes.

  19. Nurse dose: linking staffing variables to adverse patient outcomes. (United States)

    Manojlovich, Milisa; Sidani, Souraya; Covell, Christine L; Antonakos, Cathy L


    Inconsistent findings in more than 100 studies have made it difficult to explain how variation in nurse staffing affects patient outcomes. Nurse dose, defined as the level of nurses required to provide patient care in hospital settings, draws on variables used in staffing studies to describe the influence of many staffing variables on outcomes. The aim of this study was to examine the construct validity of nurse dose by determining its association with methicillin-resistant Staphylococcus aureus (MRSA) infections and reported patient falls on a sample of inpatient adult acute care units. Staffing data came from 26 units in Ontario, Canada, and Michigan. Financial and human resource data were data sources for staffing variables. Sources of data for MRSA came from infection control departments. Incident reports were the data source for patient falls. Data analysis consisted of bivariate correlations and Poisson regression. Bivariate correlations revealed that nurse dose attributes (active ingredient and intensity) were associated significantly with both outcomes. Active ingredient (education, experience, skill mix) and intensity (full-time employees, registered nurse [RN]:patient ratio, RN hours per patient day) were significant predictors of MRSA. Coefficients for both attributes were negative and almost identical. Both attributes were significant predictors of reported patient falls, and coefficients were again negative, but coefficient sizes differed. By conceptualizing nurse and staffing variables (education, experience, skill mix, full-time employees, RN:patient ratio, RN hours per patient day) as attributes of nurse dose and by including these in the same analysis, it is possible to determine their relative influence on MRSA infections and reported patient falls.

  20. Medicaid payment rates, case-mix reimbursement, and nursing home staffing--1996-2004. (United States)

    Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent


    We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day. Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing. Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.

  1. In-reach specialist nursing teams for residential care homes: uptake of services, impact on care provision and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Nelson Sara


    Full Text Available Abstract Background A joint NHS-Local Authority initiative in England designed to provide a dedicated nursing and physiotherapy in-reach team (IRT to four residential care homes has been evaluated. The IRT supported 131 residents and maintained 15 'virtual' beds for specialist nursing in these care homes. Methods Data captured prospectively (July 2005 to June 2007 included: numbers of referrals; reason for referral; outcome (e.g. admission to IRT bed, short-term IRT support; length of stay in IRT; prevented hospital admissions; early hospital discharges; avoided nursing home transfers; and detection of unrecognised illnesses. An economic analysis was undertaken. Results 733 referrals were made during the 2 years (range 0.5 to 13.0 per resident per annum resulting in a total of 6,528 visits. Two thirds of referrals aimed at maintaining the resident's independence in the care home. According to expert panel assessment, 197 hospital admissions were averted over the period; 20 early discharges facilitated; and 28 resident transfers to a nursing home prevented. Detection of previously unrecognised illnesses accounted for a high number of visits. Investment in IRT equalled £44.38 per resident per week. Savings through reduced hospital admissions, early discharges, delayed transfers to nursing homes, and identification of previously unrecognised illnesses are conservatively estimated to produce a final reduction in care cost of £6.33 per resident per week. A sensitivity analysis indicates this figure might range from a weekly overall saving of £36.90 per resident to a 'worst case' estimate of £2.70 extra expenditure per resident per week. Evaluation early in implementation may underestimate some cost-saving activities and greater savings may emerge over a longer time period. Similarly, IRT costs may reduce over time due to the potential for refinement of team without major loss in effectiveness. Conclusion Introduction of a specialist nursing in

  2. Identifying nurse staffing research in Medline: development and testing of empirically derived search strategies with the PubMed interface. (United States)

    Simon, Michael; Hausner, Elke; Klaus, Susan F; Dunton, Nancy E


    The identification of health services research in databases such as PubMed/Medline is a cumbersome task. This task becomes even more difficult if the field of interest involves the use of diverse methods and data sources, as is the case with nurse staffing research. This type of research investigates the association between nurse staffing parameters and nursing and patient outcomes. A comprehensively developed search strategy may help identify nurse staffing research in PubMed/Medline. A set of relevant references in PubMed/Medline was identified by means of three systematic reviews. This development set was used to detect candidate free-text and MeSH terms. The frequency of these terms was compared to a random sample from PubMed/Medline in order to identify terms specific to nurse staffing research, which were then used to develop a sensitive, precise and balanced search strategy. To determine their precision, the newly developed search strategies were tested against a) the pool of relevant references extracted from the systematic reviews, b) a reference set identified from an electronic journal screening, and c) a sample from PubMed/Medline. Finally, all newly developed strategies were compared to PubMed's Health Services Research Queries (PubMed's HSR Queries). The sensitivities of the newly developed search strategies were almost 100% in all of the three test sets applied; precision ranged from 6.1% to 32.0%. PubMed's HSR queries were less sensitive (83.3% to 88.2%) than the new search strategies. Only minor differences in precision were found (5.0% to 32.0%). As with other literature on health services research, nurse staffing studies are difficult to identify in PubMed/Medline. Depending on the purpose of the search, researchers can choose between high sensitivity and retrieval of a large number of references or high precision, i.e. and an increased risk of missing relevant references, respectively. More standardized terminology (e.g. by consistent use of the

  3. Development of the staffing evaluation technique for mental tasks of the advanced main control room

    International Nuclear Information System (INIS)

    Hsieh Tsungling; Yang Chihwei; Lin Chiuhsiangjoe


    The key goals of staffing and qualifications review element are to ensure that the right numbers of people with the appropriate skills and abilities are available to support plant operations and events. If the staffing level is too few, excessive stress that caused human errors possibly will be placed on the operators. Accordingly, this study developed a staffing evaluation technique based on CPM-GOMS for the mental tasks such as operations in the advanced main control room. A within-subject experiment was designed to examine the validity of the staffing evaluation technique. The results indicated the performance of evaluated staffing level via the staffing evaluation technique was significantly higher than that of non-evaluated staffing level; thus, validity of the staffing evaluation technique can be accepted. Finally, the implications for managerial practice on the findings of this study were discussed. (author)

  4. Influence of design improvements in optimising staffing of NPPs - an Indian experience

    International Nuclear Information System (INIS)

    Bhattacharya, A.S.


    Three decades of operating experience in India has led to sustained high performance of NPP's. The staffing modules and policies are standardised. The basic functions of operation, maintenance, technical support and quality assurance are carried out by a team of 727 in-plant persons (for a 2 x 220 MW PHWR station) organised at five levels, for fifty positions in ten job families. The organisational factors that led to optimising of staff are described in the companion paper. This optimisation of manpower is a result of continuous learning - for (i) optimising quantum of workload and (ii) improving productivity. For the first category, design improvements over older Indian NPP's have increased reliability, operability, maintainability and human factors. Few examples: (i) improved man-machine interface in plant controls and on-power refuelling system with operator guidance, logging as well as diagnostic/health monitoring features; (ii) spread out layout for better access and ease of maintenance, separation of plant services for unit-1 from unit-2 and, removal of reactor auxiliaries out to separate buildings; (iii) reduction of maintenance tasks through redesigned equipment and improved condition monitoring means. However, design and procedural improvements also include additional equipment for upgradation of safety measures, e.g. larger number of safety related pumps separate switchyard control room and increased service system equipment. This paper outlines experience of design improvements in optimising staffing and uses a specific case illustration to establish the findings for better use of staff. (author)

  5. [Model to predict staffing for anesthesiology and post-anesthesia intensive care units and pain clinics]. (United States)

    Canet, J; Moral, V; Villalonga, A; Pelegrí, D; Gomar, C; Montero, A


    Human resources account for a large part of the budgets of anesthesia and post-anesthesia intensive care units and pain clinics (A-PICU-PC). Adequate staffing is a key factor in providing for both effective care and professional staff development. Changes in professional responsibilities have rendered obsolete the concept of one anesthesiologist per operating room. Duties must be analyzed objectively to facilitate understanding between hospital administrators and A-PICU-PC chiefs of service when assigning human resources. The Catalan Society of Anesthesiology, Post-anesthesia Intensive Care and Pain Therapy has developed a model for estimating requirements for A-PICU-PC staffing based on three factors: 1) Definition of staff positions that must be filled and criteria for assigning human resources; 2) Estimation of non-care-related time required by the department for training, teaching, research and internal management, and 3) Estimation of staff required to cover absences from work for vacations, personal leave or illness. The model revealed that the ratio of number of staff positions to number of persons employed by an A-PICU-PC is approximately 1.3. Differences in the nature of services managed by an A-PICU-PC or the type of hospital might change the ratio slightly. The model can be applied universally, independently of differences that might exist among departments. Widespread application would allow adoption of a common language to be used by health care managers and A-PICU-PC departments when discussing a basis for consensus about our specialty.

  6. Staffing the Principalship: Finding, Coaching, and Mentoring School Leaders (United States)

    Lovely, Suzette


    "Help Wanted" signs are springing up outside schools. The shortage of school administrators is not coming, it is here. To thwart the shortage and keep schools on the cutting edge, diligence in cultivating, training, and inspiring a new generation of school leaders--especially for the principalship, must be exercised. Staffing the Principalship…

  7. Staffing UK University Campuses Overseas: Lessons from MNE Practice (United States)

    Salt, John; Wood, Peter


    This article suggests that as their internal labor markets become more multinational in scope, UK universities may acquire similar staffing characteristics to commercial multinational enterprises (MNEs). Comparing evidence from four UK universities with several surveys of MNEs it concludes that, although there are broad similarities in the…

  8. Flexible Training Strategy (National Task Force on Medical Staffing)


    Department of Health (Ireland)


    Flexible Training Strategy (National Task Force on Medical Staffing) The Flexible Training Strategy, while endorsing flexible/part-time options recognises that the preferred option for the majority of doctors-in-training and consultants is most likely to continue to be full-time training and work. Click here to download PDF

  9. Healthcare security staffing for smaller facilities: where science meets art. (United States)

    Warren, Bryan


    Obtaining effective security resourcing and staffing for smaller healthcare facilities presents many difficulties, according to the author In this article, he provides guidance to security practitioners on taking existing data and translating it into a language that administration will understand and appreciate.

  10. Flexible nurse staffing based on hourly bed census predictions

    NARCIS (Netherlands)

    Kortbeek, Nikky; Braaksma, Aleida; Burger, C.A.J.; Bakker, P.J.M; Boucherie, Richardus J.


    Workload on nursing wards depends highly on patient arrivals and patient lengths of stay, which are both inherently variable. Predicting this workload and staffing nurses accordingly is essential for guaranteeing quality of care in a cost effective manner. This paper introduces a stochastic method

  11. Flexible nurse staffing based on hourly bed census predictions

    NARCIS (Netherlands)

    Kortbeek, Nikky; Braaksma, Aleida; Burger, C.A.J.; Bakker, P.J.M; Boucherie, Richardus J.

    Workloads in nursing wards depend highly on patient arrivals and lengths of stay, both of which are inherently variable. Predicting these workloads and staffing nurses accordingly are essential for guaranteeing quality of care in a cost-effective manner. This paper introduces a stochastic method

  12. Expressions of Prayer in Residential Care Homes. (United States)

    Reimer-Kirkham, Sheryl; Sharma, Sonya; Smith, Brenda; Schutt, Kelly; Janzen, Kyla


    Although the value of spiritual care in the care of older adults is supported by research, few studies have focused specifically on prayer in residential care settings. This ethnographic study with fifteen chaplains and administrators in eleven residential care homes involved analyses of walking interviews and research diaries. Findings revealed the spaces in which prayer happens and the forms it takes. The identities of chaplains-their own spiritual practices, religious beliefs, and positioning within the facility-shaped their dis/comfort with prayer and how they located prayer within public and private spaces. Where organizational leadership endorsed the legitimacy of chaplaincy services, prayer was more likely to be offered. Even in these circumstances, however, religious diversity and questions about secularism left chaplains ambivalent about the appropriateness of prayer. The results demonstrate the relevance of religion and spirituality to residential care, and illustrate how prayer functions as an opportunity for connection and understanding.

  13. Integrated Management of Residential Energy Resources

    Directory of Open Access Journals (Sweden)

    Antunes C. H.


    Full Text Available The increasing deployment of distributed generation systems based on renewables in the residential sector, the development of information and communication technologies and the expected evolution of traditional power systems towards smart grids are inducing changes in the passive role of end-users, namely with stimuli to change residential demand patterns. The residential user should be able to make decisions and efficiently manage his energy resources by taking advantages from his flexibility in load usage with the aim to minimize the electricity bill without depreciating the quality of energy services provided. The aim of this paper is characterizing electricity consumption in the residential sector and categorizing the different loads according to their typical usage, working cycles, technical constraints and possible degree of control. This categorization of end-use loads contributes to ascertain the availability of controllable loads to be managed as well as the different direct management actions that can be implemented. The ability to implement different management actions over diverse end-use load will increase the responsiveness of demand and potentially raises the willingness of end-users to accept such activities. The impacts on the aggregated national demand of large-scale dissemination of management systems that would help the end-user to make decisions regarding electricity consumption are predicted using a simulator that generates the aggregated residential sector electricity consumption under variable prices.

  14. Leadership, staffing and quality of care in nursing homes (United States)


    Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is

  15. Leadership, staffing and quality of care in nursing homes

    Directory of Open Access Journals (Sweden)

    Havig Anders


    Full Text Available Abstract Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78. Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses

  16. Experiences and lessons learnt on staffing from the first Indian nuclear power plant (PHWR)

    International Nuclear Information System (INIS)

    Bhattacharya, A.S.


    Three decades of operating experience in India has led to sustained high performance of NPPs. The staffing modules and policies are standardised. The basic functions of operation, maintenance, technical support and quality assurance are carried out by a team of 727 in-plant persons (for a 2 x 220 MW PHWR station) organised at five levels, for fifty positions in ten job families. Specific qualification levels apply to each position - six at management positions, five licensed positions with the rest qualified through an equivalent training scheme. Practically all O and M activities are carried out on-site by the utility manpower with minimum involvement of contractors. The entire process of human resource development is in-house - with each NPP organisation comprised of 30% experienced staff transferred from older NPPs and 70% totally developed out of fresh recruits. Four to eight years lead time goes to qualify fresh recruits depending on the position. This optimisation of manpower is a result of continuous learning - through operating experience and regulatory feed back and self assessment for (i) optimising quantum of work load and (ii) improving productivity. For the first category, design improvements over older NPP's increased reliability, operability, maintainability and human factors are described separately in the companion paper. In this paper the organisation factors are discussed, starting with the initial lessons that demanded improved management and enhanced quality programmes and caused temporarily, high demand of staffing for bringing out new systems, e.g., (i) attaining maturity of units; (ii) standardising training, retraining and cross training and qualifications; (in) job rotations, (iv) in service inspection of reactor components; (v) quality audits. The experiences on subsequent optimisation of staffing levels are outlined. (author)

  17. Staff Assist: A Resource to Improve Nursing Home Quality and Staffing (United States)

    Castle, Nicholas G.


    Purpose: This study describes the creation and use of a web-based resource, designed to help nursing homes implement quality improvements through changes in staffing characteristics. Design and Methods: Information on staffing characteristics (i.e., staffing levels, turnover, stability, and use of agency staff), facility characteristics (e.g.,…

  18. Staffing Patterns in Public School Systems: Current Status and Trends, Update 2001. Research Snapshot. (United States)

    Williams, Alicia D.; Protheroe, Nancy; Parks, Michael C.

    Staffing patterns in American public-school systems are presented in this report of the 2000-01 school year. The report addresses the following: why information about staffing ratios is important; how many people currently work in public schools; what proportion of these are teachers, administrators, and support staff; current staffing patterns in…

  19. Nurse staffing issues are just the tip of the iceberg: a qualitative study about nurses' perceptions of nurse staffing

    NARCIS (Netherlands)

    van Oostveen, Catharina J.; Mathijssen, Elke; Vermeulen, Hester


    To obtain in-depth insight into the perceptions of nurses in the Netherlands regarding current nurse staffing levels and use of nurse-to-patient-ratios (NPR) and patient classification systems (PCS). In response to rising health care demands due to ageing of the patient population and increasing

  20. Investigating the factors that affect the communication of death-related bad news to people with intellectual disabilities by staff in residential and supported living services: An interview study. (United States)

    Tuffrey-Wijne, I; Rose, T


    Most staff working in intellectual disability services will be confronted with people with intellectual disabilities who need support around death, dying and bereavement. Previous studies suggest that intellectual disability staff tend to protect clients from knowing about death and avoid communication about death. The aims of this study were to gain further insight into the individual, organisational and contextual factors that affect the communication of death-related bad news to people with intellectual disabilities by intellectual disability staff and to develop guidelines for services to enable appropriate communication with clients about death and dying. Semi-structured interviews were held with 20 social care staff working in intellectual disability residential or supported living services in London, who had supported a client affected by death-related bad news in the past 6 months. Staff found supporting people with intellectual disabilities around death and dying extremely difficult and tended to avoid communication about death. The following factors had a particularly strong influence on staff practice around communicating death-related bad news: fear and distress around death; life and work experience; and organisational culture. Staff attitudes to death communication had a stronger influence than their client's level of cognitive or communicative abilities. Managers were important role models. Service managers should ensure not only that all their staff receive training in death, loss and communication but also that staff are enabled to reflect on their practice, through emotional support, supervision and team discussions. Future work should focus on the development and testing of strategies to enable intellectual disability staff to support their clients in the areas of dying, death and bereavement. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  1. Planning estimates for the provision of core mental health services in Queensland 2007 to 2017. (United States)

    Harris, Meredith G; Buckingham, William J; Pirkis, Jane; Groves, Aaron; Whiteford, Harvey


    To derive planning estimates for the provision of public mental health services in Queensland 2007-2017. We used a five-step approach that involved: (i) estimating the prevalence and severity of mental disorders in Queensland, and the number of people at each level of severity treated by health services; (ii) benchmarking the level and mix of specialised mental health services in Queensland against national data; (iii) examining 5-year trends in Queensland public sector mental health service utilisation; (iv) reviewing Australian and international planning benchmarks; and (v) setting resource targets based on the results of the preceding four steps. Best available evidence was used where possible, supplemented by value judgements as required. Recommended resource targets for inpatient service were: 20 acute beds per 100,000 population, consistent with national average service provision but 13% above Queensland provision in 2005; and 10 non-acute beds per 100,000, 65% below Queensland levels in 2005. Growth in service provision was recommended for all other components. Adult residential rehabilitation service targets were 10 clinical 24-hour staffed beds per 100,000, and 18 non-clinical beds per 100,000. Supported accommodation targets were 35 beds per 100,000 in supervised hostels and 35 places per 100,000 in supported public housing. A direct care clinical workforce of 70 FTE per 100,000 for ambulatory care services was recommended. Fifteen per cent of total mental health funding was recommended for community support services provided by non-government organisations. The recommended targets pointed to specific areas for priority in Queensland, notably the need for additional acute inpatient services for older persons and expansion of clinical ambulatory care, residential rehabilitation and supported accommodation services. The development of nationally agreed planning targets for public mental health services and the mental health community support sector were

  2. Family ties and residential locations

    NARCIS (Netherlands)

    Mulder, C.H.; Cooke, T.J.


    In this paper, and in the Special Issue it introduces, the focus is on the role of family ties in residential location choice and, conversely, the role of residential locations in maintaining family ties. Not only do events in the nuclear family trigger residential relocations, but nearby family

  3. Comparing the staffing models of outsourcing in selected companies


    Chaloupková, Věra


    This thesis deals with problems of takeover of employees in outsourcing. The capital purpose is to compare the staffing model of outsourcing in selected companies. To compare in selected companies I chose multi-criteria analysis. This thesis is dividend into six chapters. The first charter is devoted to the theoretical part. In this charter describes the basic concepts as outsourcing, personal aspects, phase of the outsourcing projects, communications and culture. The rest of thesis is devote...


    When compared with the rest of the world, the United States consumes a disproportionately large amount of energy and is a major source of greenhouse gases from fossil fuel combustion. As much as two thirds of U.S. electricity production is consumed by residential and commerci...

  5. Residential Mechanical Precooling

    Energy Technology Data Exchange (ETDEWEB)

    German, a. [Alliance for Residential Building Innovation (ARBI), Davis, CA (United States); Hoeschele, M. [Alliance for Residential Building Innovation (ARBI), Davis, CA (United States)


    This research conducted by the Alliance for Residential Building Innovation team evaluated mechanical air conditioner pre-cooling strategies in homes throughout the United States. EnergyPlus modeling evaluated two homes with different performance characteristics in seven climates. Results are applicable to new construction homes and most existing homes built in the last 10 years, as well as fairly efficient retrofitted homes.


    Directory of Open Access Journals (Sweden)

    Tuti Andriani


    Full Text Available Staffing in an organization can be defined as a series of processes and efforts to acquire, develop, motivate, and evaluate the overall human resources. It is required within the organization in achieving its goals. In staffing, putting a person in a work should be in accordance with his capabilities and expertise so that all are expected to be achieved. Job placement principle is the principle of humanity, democracy, the right man on the right place, equal pay for equal work, unity of direction, the principle of unity of purpose, unity of command, Efficiency and Productivity Work. The concept is the placement, promotion, transfer and demotion. Staffing in the Qur'an and Hadith seen from education management is an employee must complete properly, responsibility, trust, has the capability and expertise, serve, work ethic, strong and trustworthy, honest, sincere, true and trustful, physical and mental strength, and high manners. Professionalism in view of sharia is characterized by three things, namely ahliyah (expertise, himmatul 'charity (high work ethic, trustworthy (reliable.


    Erlingmark, Julia; Hedström, Mariann; Lindberg, Magnus


    Current trends in renal anaemia management place greater emphasis, and thus increased workload, on the role of the nurse in haemodialysis settings. However, there is little evidence that demonstrates the relationship between nurse staffing and patient outcomes. To describe nurse staffing in haemodialysis settings, its relationship with target levels of renal anaemia management and to describe target level achievement for different ways of organising anaemia management. Cross-sectional audit. Forty (out of 78) haemodialysis centres in Sweden reported quality assurance data. The numbers of bedside registered nurses, licensed nurse assistants and patients undergoing haemodialysis during a predefined morning shift; type of anaemia management and achieved target levels of anaemia management. The mean patient:registered nurse ratio was 2.4 and the mean patient:nurse assistant ratio was 12.8. There were no significant relationships between registered nurse staffing and target level achievement. On average, 45.6% of the patients had haemoglobin within the target levels at centres applying nurse-driven anaemia management, compared with 47.3% at physician-driven centres. These cross-sectional data suggest that renal anaemia outcomes are unrelated to the patient:registered nurse ratio. There is, however, room for improvement in renal anaemia management in the units included in this study, particularly the achievement of target levels of haemoglobin and transferrin saturation. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  8. Structure and staffing of radiotherapy physics in the UK

    International Nuclear Information System (INIS)

    Thwaites, D I


    In 1989 IPSM brought out a policy document on the role of the physical scientist in radiotherapy. At roughly the same time IPSM also produced recommended minimum staffing levels for the medical physics support of radiotherapy, which drew heavily on comprehensive reviews of both physicist and physics technician staffing carried out by the Scottish Radiotherapy Physicists Group in 1980 (updated in 1989). The IPSM figures remain professional recommendations and have not been taken up by any official body. However some of the Scottish figures were included in a SHHD Planning Council Scientific Advisory report and so have some measure of official endorsement. All these figures were derived specifically for the UK situation of essentially regional oncology centres, where generally medium to large radiotherapy departments are the norm, to concentrate equipment, expertise and experience. Thus there are approximately 60 centres for a population of 55 million. In addition the recommendations reflect the typical structure of UK departments, in terms of professional roles and relationships. The current situation regarding physicist and physics technician numbers is reviewed, using evidence from recent surveys. The UK and other recommendations are applied to a number of representative centres and the figures obtained are compared to each other and to the actual staffing levels

  9. Residential tourism and migration of foreign retirees in Mexico: A case study on the environmental impacts and public services in Baja California Sur

    Directory of Open Access Journals (Sweden)

    Diego Armando Casas-Beltrán


    Full Text Available Migration of foreign retirees in Mexico has increased, especially in Los Cabos, where settlements trailer type are increasing and are moving into rural coastal areas of high ecological value, without the knowledge of impacts that may result. Thus the aim of this paper is to contribute to the understanding of this type of settlement, by documenting a case study, the characteristics of their community, their environmental impacts and implications for the provision of public services. We conclude that the town will become a short-term retreat site, because while it does not have high densities, its environmental implications are significant and broad coverage. Its current demand for services is minimal, but may cause conflicts in the future, especially with the water

  10. 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


    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

  11. Guidelines for equipment and staffing of radiotherapy facilities in the European countries: Final results of the ESTRO-HERO survey

    International Nuclear Information System (INIS)

    Dunscombe, Peter; Grau, Cai; Defourny, Noémie; Malicki, Julian; Borras, Josep M.; Coffey, Mary; Bogusz, Marta; Gasparotto, Chiara; Slotman, Ben; Lievens, Yolande; Kokobobo, Arianit; Sedlmayer, Felix; Slobina, Elena; De Hertogh, Olivier; Hadjieva, Tatiana; Petera, Jiri; Eriksen, Jesper Grau; Jaal, Jana; Bly, Ritva; Azria, David


    Background and purpose: In planning to meet evidence based needs for radiotherapy, guidelines for the provision of capital and human resources are central if access, quality and safety are not to be compromised. A component of the ESTRO-HERO (Health Economics in Radiation Oncology) project is to document the current availability and content of guidelines for radiotherapy in Europe. Materials and methods: An 84 part questionnaire was distributed to the European countries through their national scientific and professional radiotherapy societies with 30 items relating to the availability of guidelines for equipment and staffing and selected operational issues. Twenty-nine countries provided full or partial evaluable responses. Results: The availability of guidelines across Europe is far from uniform. The metrics used for capital and human resources are variable. There seem to have been no major changes in the availability or specifics of guidelines over the ten-year period since the QUARTS study with the exception of the recent expansion of RTT staffing models. Where comparison is possible it appears that staffing for radiation oncologists, medical physicists and particularly RTTs tend to exceed guidelines suggesting developments in clinical radiotherapy are moving faster than guideline updating. Conclusion: The efficient provision of safe, high quality radiotherapy services would benefit from the availability of well-structured guidelines for capital and human resources, based on agreed upon metrics, which could be linked to detailed estimates of need

  12. [The new methods to define the staffing requirements for doctors,nurses and nurses aides: an example of their implementation in an Italian hospital]. (United States)

    Laquintana, Dario; Pazzaglia, Silvia; Demarchi, Antonia


    . The new methods to define the staffing requirements for doctors, nurses and nurses aides: an example of their implementation in an Italian hospital. The Italian government, after the transposition of European Union legislation on working hours, made a declaration of commitment to increase the number of staff of the National Health Service (NHS). The method for assessing the staffing needs innovates the old one that dated back a few decades. To implement the method proposed by the Ministry of Health to an Italian hospital and assess its impact on staffing and costs. The model was implemented on all the wards, multiplying the minutes of care expected in 2016, dividing the result by 60 to obtain the hours of care, and further dividing by the number of yearly hours of work of a nurse (1418). Same was done for nurses aides. The minutes of care were related to mean weight of the Diagnosis Related Groups of the ward and the results obtained compared to the actual staffing of nurses and nurses aides. The costs of the differences were calculated. The implementation of the model produced an excess of 23 nurses and a scarcity of 95 nurses aides compared to the actual staffing, with an increase of the costs of € 1.828.562,00. The results obtained and the criticisms received so far show the need of major changes. The data from international studies that associate staffing and patients outcomes and the nurse/patient ratio are macro-indicators already available that may orient choices and investments on the health care professions.

  13. Consequences of Inadequate Staffing Include Missed Care, Potential Failure to Rescue, and Job Stress and Dissatisfaction. (United States)

    Simpson, Kathleen Rice; Lyndon, Audrey; Ruhl, Catherine


    To evaluate responses of registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) to a survey that sought their recommendations for staffing guidelines and their perceptions of the consequences of inadequate nurse staffing. The goal was to use these member data to inform the work of the AWHONN nurse staffing research team. Secondary analysis of responses to the 2010 AWHONN nurse staffing survey. Online. AWHONN members (N = 884). Review of data from an online survey of AWHONN members through the use of thematic analysis for descriptions of the consequences of inadequate nurse staffing during the childbirth process. Three main themes emerged as consequences of inadequate staffing or being short-staffed: Missed Care, Potential for Failure to Rescue, and Job-Related Stress and Dissatisfaction. These themes are consistent with those previously identified in the literature related to inadequate nurse staffing. Based on the responses from participants in the 2010 AWHONN nurse staffing survey, consequences of inadequate staffing can be quite serious and may put patients at risk for preventable harm. Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  14. Guidelines for residential commissioning

    Energy Technology Data Exchange (ETDEWEB)

    Wray, Craig P.; Walker, Iain S.; Sherman, Max H.


    Currently, houses do not perform optimally or even as many codes and forecasts predict, largely because they are field assembled and there is no consistent process to identify problems or to correct them. Residential commissioning is a solution to this problem. This guide is the culmination of a 30-month project that began in September 1999. The ultimate objective of the project is to increase the number of houses that undergo commissioning, which will improve the quality, comfort, and safety of homes for California citizens. The project goal is to lay the groundwork for a residential commissioning industry in California focused on end-use energy and non-energy issues. As such, we intend this guide to be a beginning and not an end. Our intent is that the guide will lead to the programmatic integration of commissioning with other building industry processes, which in turn will provide more value to a single site visit for people such as home energy auditors and raters, home inspectors, and building performance contractors. Project work to support the development of this guide includes: a literature review and annotated bibliography, which facilitates access to 469 documents related to residential commissioning published over the past 20 years (Wray et al. 2000), an analysis of the potential benefits one can realistically expect from commissioning new and existing California houses (Matson et al. 2002), and an assessment of 107 diagnostic tools for evaluating residential commissioning metrics (Wray et al. 2002). In this guide, we describe the issues that non-experts should consider in developing a commissioning program to achieve the benefits we have identified. We do this by providing specific recommendations about: how to structure the commissioning process, which diagnostics to use, and how to use them to commission new and existing houses. Using examples, we also demonstrate the potential benefits of applying the recommended whole-house commissioning approach to

  15. Improving traffic signal management and operations : a basic service model. (United States)


    This report provides a guide for achieving a basic service model for traffic signal management and : operations. The basic service model is based on simply stated and defensible operational objectives : that consider the staffing level, expertise and...

  16. District nursing renascent as Wales adopts safe staffing levels. (United States)

    Labourne, Paul


    This article reflects on the history of the NHS in Wales and how this has led to its current structure. How this structure supports integrated working across primary, community and secondary care and how further integration with social care is moving forward and its direct effects on district nursing are explored. This article describes how district nursing is meeting these challenges. Support for district nurses as part of integrated multiprofessional teams is being developed to promote appropriately staffed teams centred on meeting the requirements of people within a designated area and ensuring that home is the best and first place of care.

  17. California's minimum-nurse-staffing legislation and nurses' wages. (United States)

    Mark, Barbara; Harless, David W; Spetz, Joanne


    In 2004, California became the first state to implement minimum-nurse-staffing ratios in acute care hospitals. We examined the wages of registered nurses (RNs) before and after the legislation was enacted. Using four data sets-the National Sample Survey of Registered Nurses, the Current Population Survey, the National Compensation Survey, and the Occupational Employment Statistics Survey-we found that from 2000 through 2006, RNs in California metropolitan areas experienced real wage growth as much as twelve percentage points higher than the growth in the wages of nurses employed in metropolitan areas outside of California.

  18. Aiming for Service Excellence: Implementing a Plan for Customer Service Quality at a Blended Service Desk (United States)

    Oud, Joanne; Genzinger, Peter


    This article discusses a public service review and redesign that resulted in a blended service desk combining reference and circulation functions, staffed by nonlibrarians. The redesign implements a number of organizational structures that encourage service excellence, as found in the business literature and in examples of nonlibrary organizations…

  19. Residential outage cost estimation: Hong Kong

    International Nuclear Information System (INIS)

    Woo, C.K.; Ho, T.; Shiu, A.; Cheng, Y.S.; Horowitz, I.; Wang, J.


    Hong Kong has almost perfect electricity reliability, the result of substantial investments ultimately financed by electricity consumers who may be willing to accept lower reliability in exchange for lower bills. But consumers with high outage costs are likely to reject the reliability reduction. Our ordered-logit regression analysis of the responses by 1876 households to a telephone survey conducted in June 2013 indicates that Hong Kong residents exhibit a statistically-significant preference for their existing service reliability and rate. Moreover, the average residential cost estimate for a 1-h outage is US$45 (HK$350), topping the estimates reported in 10 of the 11 studies published in the last 10 years. The policy implication is that absent additional compelling evidence, Hong Kong should not reduce its service reliability. - Highlights: • Use a contingent valuation survey to obtain residential preferences for reliability. • Use an ordered logit analysis to estimate Hong Kong's residential outage costs. • Find high outage cost estimates that imply high reliability requirements. • Conclude that sans new evidence, Hong Kong should not reduce its reliability

  20. Guidelines for equipment and staffing of radiotherapy facilities in the European countries: Final results of the ESTRO-HERO survey

    DEFF Research Database (Denmark)

    Dunscombe, Peter; Grau, Cai; Defourny, Noémie


    of guidelines for equipment and staffing and selected operational issues. Twenty-nine countries provided full or partial evaluable responses. RESULTS: The availability of guidelines across Europe is far from uniform. The metrics used for capital and human resources are variable. There seem to have been no major...... guidelines suggesting developments in clinical radiotherapy are moving faster than guideline updating. CONCLUSION: The efficient provision of safe, high quality radiotherapy services would benefit from the availability of well-structured guidelines for capital and human resources, based on agreed upon...

  1. Psychotherapy services outside the National Health Service * (United States)

    Kroll, Una


    With the help of an Upjohn Travelling Fellowship, I visited 15 units providing services for people under stress. There were nine residential units and six non-residential units, all were Christian charitable organisations and in all there was close co-operation with the medical profession. All these organisations accept referrals from general practitioners and deserve to be more widely known. PMID:1255548

  2. Psychotherapy services outside the National Health Service. (United States)

    Kroll, U


    With the help of an Upjohn Travelling Fellowship, I visited 15 units providing services for people under stress. There were nine residential units and six non-residential units, all were Christian charitable organisations and in all there was close co-operation with the medical profession.All these organisations accept referrals from general practitioners and deserve to be more widely known.

  3. Re-thinking residential mobility (United States)

    van Ham, Maarten; Findlay, Allan M.


    While researchers are increasingly re-conceptualizing international migration, far less attention has been devoted to re-thinking short-distance residential mobility and immobility. In this paper we harness the life course approach to propose a new conceptual framework for residential mobility research. We contend that residential mobility and immobility should be re-conceptualized as relational practices that link lives through time and space while connecting people to structural conditions. Re-thinking and re-assessing residential mobility by exploiting new developments in longitudinal analysis will allow geographers to understand, critique and address pressing societal challenges. PMID:27330243

  4. Large-Scale Residential Demolition (United States)

    The EPA provides resources for handling residential demolitions or renovations. This includes planning, handling harmful materials, recycling, funding, compliance assistance, good practices and regulations.

  5. Nurse staffing patterns and hospital efficiency in the United States. (United States)

    Bloom, J R; Alexander, J A; Nuchols, B A


    The objective of this exploratory study was to assess the effects of four nurse staffing patterns on the efficiency of patient care delivery in the hospital: registered nurses (RNs) from temporary agencies; part-time career RNs; RN rich skill mix; and organizationally experienced RNs. Using Transaction Cost Analysis, four regression models were specified to consider the effect of these staffing plans on personnel and benefit costs and on non-personnel operating costs. A number of additional variables were also included in the models to control for the effect of other organization and environmental determinants of hospital costs. Use of career part-time RNs and experienced staff reduced both personnel and benefit costs, as well as total non-personnel operating costs, while the use of temporary agencies for RNs increased non-personnel operating costs. An RN rich skill mix was not related to either measure of hospital costs. These findings provide partial support of the theory. Implications of our findings for future research on hospital management are discussed.

  6. Westinghouse, DOE see apples, oranges in IG staffing report

    International Nuclear Information System (INIS)

    Lobsenz, G.


    The operator of the Energy Department's Savannah River weapons plant has at least 1,800 more employees than it needs, and could save $400 million over a five-year period by cutting its staff accordingly, a DOE inspector general study says. Most of the boat - 1,206 employees - was attributed to excessive numbers of managers, with the inspector general concluding that Westinghouse Savannah River Co. had roughly twice as many layers of management than two other DOE weapons contractors. The study also concluded that Westinghouse in fiscal year 1992 significantly understated its actual staffing levels in reports to DOE, failing to disclose 1,765 full-time employees or the equivalent hours worked. Through such underreporting Westinghouse was able to open-quotes circumvent staffing ceilings established by the department,close quotes the study added. Overall, DOE Inspector General John Layton said Westinghouse's staff levels substantially exceeded those needed for efficient operation of the South Carolina nuclear weapons facility. Layton based his analysis on efficiency standards attained by other DOE weapons plant contractors, such as Martin Marietta Energy Systems at DOE's Oak Ridge, Tenn., plant and EG ampersand G Rocky Flats, as well as widely utilized worker performance requirements used by the Navy and private sector companies that perform work similar to that done at Savannah River

  7. Obesity and intensive staffing needs of nursing home residents. (United States)

    Harris, John Alexander; Engberg, John; Castle, Nicholas George


    The objective of this study is to examine how increasing body mass index (BMI) among nursing home residents affects the amount of staffing assistance needed for activities of daily living (ADL). We analyzed 1,627,141 US nursing home residents reported in the 2013 Minimum Data Set in seven BMI categories, from underweight (BMI < 18.5 kg/m 2 ) to obesity Class IIIB (≥50 kg/m 2 ). Logistic regression models estimated the odds of nursing home-reported need for extensive (≥2 staff member) assistance needed for ADLs. The adjusted odds increased from 1.07 (95% Confidence Interval (95%CI) 1.06-1.08) for Class I, 1.16 (95%CI 1.14-1.17) for Class II, 1.33 (95%CI 1.31-1.35) for Class IIIA, and 1.90 (95%CI 1.86-1.95) for Class IIIB obesity residents compared to residents of normal weight. As a nursing home resident's BMI increases, especially for BMI ≥40 kg/m 2 , the need for extensive staffing assistance with ADLs also increases substantially. Copyright © 2018 Elsevier Inc. All rights reserved.

  8. ASHRAE and residential ventilation

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max H.


    In the last quarter of a century, the western world has become increasingly aware of environmental threats to health and safety. During this period, people psychologically retreated away from outdoors hazards such as pesticides, smog, lead, oil spills, and dioxin to the seeming security of their homes. However, the indoor environment may not be healthier than the outdoor environment, as has become more apparent over the past few years with issues such as mold, formaldehyde, and sick-building syndrome. While the built human environment has changed substantially over the past 10,000 years, human biology has not; poor indoor air quality creates health risks and can be uncomfortable. The human race has found, over time, that it is essential to manage the indoor environments of their homes. ASHRAE has long been in the business of ventilation, but most of the focus of that effort has been in the area of commercial and institutional buildings. Residential ventilation was traditionally not a major concern because it was felt that, between operable windows and envelope leakage, people were getting enough outside air in their homes. In the quarter of a century since the first oil shock, houses have gotten much more energy efficient. At the same time, the kinds of materials and functions in houses changed in character in response to people's needs. People became more environmentally conscious and aware not only about the resources they were consuming but about the environment in which they lived. All of these factors contributed to an increasing level of public concern about residential indoor air quality and ventilation. Where once there was an easy feeling about the residential indoor environment, there is now a desire to define levels of acceptability and performance. Many institutions--both public and private--have interests in Indoor Air Quality (IAQ), but ASHRAE, as the professional society that has had ventilation as part of its mission for over 100 years, is the

  9. The Value of Green Infrastructure on Vacant and Residential Land in Roanoke, Virginia

    Directory of Open Access Journals (Sweden)

    Gunwoo Kim


    Full Text Available Using the City of Roanoke, Virginia as a study site, this paper quantifies the forest structure, ecosystem services and values of vacant and residential land. Single family residential land had more trees (1,683,000 than vacant land (210,000 due largely to the differences in land area (32.44 km2 of vacant land vs. 57.94 km2 residential. While the percentage of tree coverage was almost identical across land uses (30.6% in vacant to 32.3% in residential, the number of trees per ha is greater on residential land (290.3 than on vacant land (63.4. The average healthy leaf surface area on individual trees growing on vacant land was greater than that of individual trees on residential land. The fact that trees in vacant land were found to provide more ecosystem services per tree than residential trees was attributed to this leaf area difference. Trees on vacant land are growing in more natural conditions and there are more large trees per ha. Assessing the forest structure and ecosystem services of Roanoke’s vacant and residential land provides a picture of the current extent and condition of the vacant and residential land. Understanding these characteristics provides the information needed for improved management and utilization of urban vacant land and estimating green infrastructure value.

  10. Residential Mechanical Precooling

    Energy Technology Data Exchange (ETDEWEB)

    German, Alea [Davis Energy Group, Davis, CA (United States). Alliance for Residential Building Innovation (ARBI); Hoeschele, Marc [Davis Energy Group, Davis, CA (United States). Alliance for Residential Building Innovation (ARBI)


    Residential air conditioning (AC) represents a challenging load for many electric utilities with poor load factors. Mechanical precooling improves the load factor by shifting cooling operation from on-peak to off-peak hours. This provides benefits to utilities and the electricity grid, as well as to occupants who can take advantage of time-of-use (TOU) electricity rates. Performance benefits stem from reduced compressor cycling, and shifting condensing unit operation to earlier periods of the day when outdoor temperatures are more favorable to operational efficiency. Finding solutions that save energy and reduce demand on the electricity grid is an important national objective and supports key Building America goals. The Alliance for Residential Building Innovation team evaluated mechanical AC precooling strategies in homes throughout the United States. EnergyPlus modeling was used to evaluate two homes with different performance characteristics in seven climates. Results are applicable to new construction homes and most existing homes built in the last 10 years, as well as fairly efficient retrofitted homes. A successful off-peak AC strategy offers the potential for increased efficiency and improved occupant comfort, and promotes a more reliable and robust electricity grid. Demand response capabilities and further integration with photovoltaic TOU generation patterns provide additional opportunities to flatten loads and optimize grid impacts.

  11. Customer Perception of a Supermarket Nutrition Centre Staffed by a Registered Dietitian. (United States)

    Evans, KATE; Taper, JANETTE; Quintal, DEBORAH


    The purpose of this study was to examine consumers' attitudes toward a supermarket nutrition centre staffed full time by a registered dietitian. A questionnaire was administered over three consecutive days in that store and in a control store that was similar to the experimental site in every way, except for the absence of a nutrition centre. Participants were chosen randomly at timed intervals in specific areas of the store. Of 428 customers approached, 232 agreed to participate in the survey. At the experimental site, 75% of the participants were extremely satisfied with the registered dietitian's services and 69% ranked having a registered dietitian on staff in any store as extremely important, compared to 31% at the control site (p importance of 13 required and optional services offered by the supermarkets, 15% of participants at the experimental site ranked having a registered dietitian on staff in the top five, compared with 4% at the control site (p service. There may therefore be an expanded role for registered dietitians in the supermarket setting.

  12. Residential energy demand in Brazil

    International Nuclear Information System (INIS)

    Arouca, M.; Gomes, F.M.; Rosa, L.P.


    The energy demand in Brazilian residential sector is studied, discussing the methodology for analyzing this demand from some ideas suggested, for developing an adequate method to brazilian characteristics. The residential energy consumption of several fuels in Brazil is also presented, including a comparative evaluation with the United States and France. (author)

  13. A comparison of current Naval Facilities Engineering Command field office staffing methods, state staffing methods and the construction industry institutes owner contractor work structure


    Monreal, Michael


    CIVINS (Civilian Institutions) Thesis document This report was generated by accepting a report topic contained in a list of topics on the Civil Engineer Corps Graduate School Information web page. The topic request and description is noted as follows: Topic. How to Measure Staffing Requirements in ROICC offices and Other Acquisition Functions with a description. Description: We base current staffing requirements on history and only adjust from what we have used in the past years. It is sus...

  14. Organisational culture in residential aged care facilities: a cross-sectional observational study. (United States)

    Etherton-Beer, Christopher; Venturato, Lorraine; Horner, Barbara


    Organisational culture is increasingly recognised as important for provision of high-quality long-term care. We undertook this study to measure organisational culture in residential aged care facilities in two Australian states. Cross-sectional observational study in 21 residential aged care facilities in Western Australia (n = 14) and Queensland (n = 7), Australia. Staff and next-of-kin of residents participated. Measurement comprised surveys of facility staff and residents' next-of-kin, and structured observation of indicators of care quality. Staff tended to rate organisational culture positively. Some qualitative feedback from staff emphasised negative perceptions of communication, leadership and teamwork. Staffing levels were perceived as a dominant challenge, threatening care quality. Direct observation revealed variability within and between facilities but suggested that most facilities (n = 12) were in the typical range, or were quality facilities (n = 8). There was scope to strengthen organisational culture in participating aged care facilities.

  15. High School Administrative Staffing in Washington State: Principal Perspectives on Resource Needs and Utilization (United States)

    Steach, John C.


    This mixed methods study explored how high school principals prioritize their work and utilize available human resources to adjust to inadequate administrative staffing. Analysis of staffing levels across the state of Washington and specifically inside two eastern Washington districts framed interview questions for central office administration…

  16. Why Employers Use Flexible Staffing Arrangements: Evidence from an Establishment Survey. Upjohn Institute Staff Working Paper. (United States)

    Houseman, Susan N.

    Use of flexible staffing arrangements--including temporary help agency, short-term, on-call, regular part-time, and contract workers--is widespread and two-thirds of employers believe this trend will increase in the near future. A study examined which employers use flexible staffing arrangements, why they use these arrangements, and their…

  17. Worthy Work, Unlivable Wages: The National Child Care Staffing Study, 1988-1997. (United States)

    Whitebook, Marcy; Howes, Carollee; Phillips, Deborah

    In 1988, the National Child Care Staffing Study first gathered information on staffing and quality from a sample of child care centers in five metropolitan areas--Atlanta, Boston, Detroit, Phoenix, and Seattle--and returned for updated information in 1992. In 1997, directors of the original sample of centers still in operation were contacted again…

  18. Development of Staffing Patterns in Six New Medical Schools Established 1952-1960. (United States)

    National Institutes of Health (DHEW), Bethesda, MD. Resources Analysis Branch.

    This summary report of staffing patterns in 6 medical schools established between 1952 and 1960 is the first phase of a proposed study of biomedical staffing requirements in institutions of higher education, 1965-1975. The 6 schools are: the University of Miami, Albert Einstein College of medicine at Yeshiva University, the University of Florida,…

  19. 75 FR 28295 - Cummins Filtration, Including On-Site Leased Workers From Manpower and Spherion Staffing... (United States)


    .... The Department has determined that workers from Spherion Staffing were sufficiently under the control..., Including On-Site Leased Workers From Manpower and Spherion Staffing, Including On-Site Workers From Hagemeyer North America, Lake Mills, IA; Amended Certification Regarding Eligibility To Apply for Worker...

  20. Improvements in nuclear plant staffing resulting from the AP600 design programme

    International Nuclear Information System (INIS)

    Mycoff, C.


    The staffing for a single-unit AP600 is estimated to require a staff for operation and maintenance about 32% smaller than current generation power plants of similar size. These staffing reductions are driven primarily by various features incorporated into the AP600 plant design. (author)

  1. Assessing Residential Customer Satisfaction for Large Electric Utilities


    Lea Kosnik; L. Douglas Smith; Satish Nayak; Maureen Karig; Mark Konya; Kristy Lovett; Zhennan Liu; Harrison Luvai


    Electric utilities, like other service organizations, rely on customer surveys to assess the quality of their services and customer relations. With responses to an in-depth survey of 2,216 residential customers, complementary data from geo-coded public sources, aggregate assessments of performance by J.D. Power & Associates from their independent surveys, historical records of individual customer usage and bill payments, streams of published media content and records of actual service deliver...

  2. Lack of sensitivity of staffing for 8-hour sessions to standard deviation in daily actual hours of operating room time used for surgeons with long queues. (United States)

    Pandit, Jaideep J; Dexter, Franklin


    At multiple facilities including some in the United Kingdom's National Health Service, the following are features of many surgical-anesthetic teams: i) there is sufficient workload for each operating room (OR) list to almost always be fully scheduled; ii) the workdays are organized such that a single surgeon is assigned to each block of time (usually 8 h); iii) one team is assigned per block; and iv) hardly ever would a team "split" to do cases in more than one OR simultaneously. We used Monte-Carlo simulation using normal and Weibull distributions to estimate the times to complete lists of cases scheduled into such 8 h sessions. For each combination of mean and standard deviation, inefficiencies of use of OR time were determined for 10 h versus 8 h of staffing. When the mean actual hours of OR time used averages standard deviation and relative cost of over-run to under-run. When mean > or = 8 h 50 min, 10 h staffing has higher OR efficiency. For 8 h 25 min standard deviation of 60 min and relative cost of over-run to under-run of 2.0 versus (b) 8 h 48 min for normal, standard deviation of 0 min and relative cost ratio of 1.50. Although the simplest decision rule would be to staff for 8 h if the mean workload is standard deviation 60 min, and relative cost ratio of 2.00, the inefficiency of use of OR time would be 34% larger if staffing were planned for 8 h instead of 10 h. For surgical teams with 8 h sessions, use the following decision rule for anesthesiology and OR nurse staffing. If actual hours of OR time used averages or = 8 h 50 min, plan 10 h staffing. For averages in between, perform the full analysis of McIntosh et al. (Anesth Analg 2006;103:1499-516).

  3. 75 FR 15495 - Agency Information Collection (Application for Furnishing Long-Term Care Services to... (United States)


    ... (Application for Furnishing Long- Term Care Services to Beneficiaries of Veterans Affairs, and Residential Care... Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, VA Form 10-1170. b. Residential Care... application used by a residential care facility or home that wishes to provide residential home care to...

  4. Factors affecting long-term mortality of residential shade trees: evidence from Sacramento, California (United States)

    Yekang Ko; Jun-Hak Lee; E. Gregory McPherson; Lara A. Roman


    Urban tree survival is essential to sustain the ecosystem services of urban forests and monitoring is needed to accurately assess benefits. While some urban forestry studies have reported street tree survival, little is known about the factors influencing residential yard tree survival, especially over the long-term. We assessed residential shade tree survival in...

  5. A Model of Clean Water Supply and Improvement of Enviromental Sanitary Conditions in Residential Clusters in The Mekong Delta, Vietnam

    Directory of Open Access Journals (Sweden)

    Chi Nguyen Thuy Lan


    Full Text Available In accordance with Decision 99/TTg dated 9/2/1996 and Decision 173/TTg dated 6/11/2001 of the Prime Minister regarding the construction program of residential clusters (residential flood free areas, these residential areas as constructed would be fully equipped with critical infrastructures and services such as water supply and drainage works, toilets with sanitary appropriateness, etc. to ensure environmental sanitary conditions in the residential clusters. However, the actual surveys done in residential clusters in the Mekong Delta show that many arising problems must be addressed to enable the local communities to have better living conditions and ensure the sanitary conditions and environmental safety.

  6. Staffing and Workflow of a Maturing Institutional Repository

    Directory of Open Access Journals (Sweden)

    Debora L. Madsen


    Full Text Available Institutional repositories (IRs have become established components of many academic libraries. As an IR matures it will face the challenge of how to scale up its operations to increase the amount and types of content archived. These challenges involve staffing, systems, workflows, and promotion. In the past eight years, Kansas State University's IR (K-REx has grown from a platform for student theses, dissertations, and reports to also include faculty works. The initial workforce of a single faculty member was expanded as a part of a library-wide reorganization, resulting in a cross-departmental team that is better able to accommodate the expansion of the IR. The resultant need to define staff responsibilities and develop resources to manage the workflows has led to the innovations described here, which may prove useful to the greater library community as other IRs mature.

  7. Managerial Ownership in Nursing Homes: Staffing, Quality, and Financial Performance. (United States)

    Huang, Sean Shenghsiu; Bowblis, John R


    Ownership of nursing homes (NHs) has primarily focused broadly on differences between for-profit (FP), nonprofit (NFP), and government-operated facilities. Yet, among FPs, the understanding of detailed ownership structures at individual NHs is rather limited. Particularly, NH administrators may hold significant equity interests in their facilities, leading to heterogeneous financial incentives and NH outcomes. Through the principal-agent theory, this article studies how managerial ownership of individual facilities affects NH outcomes. We use a unique panel dataset of Ohio NHs (2005-2010) to empirically examine the relationship between managerial equity ownership and NH staffing, quality, and financial performance. We identify facility administrators as owner-managers if they have more than 5% of the equity stakes or are relatives of the owners. The statistical analysis is based on the pooled ordinary least squares and NH-fixed effect models. We find that owner-managed NHs are associated with higher nursing staff levels compared to other FP NHs. Surprisingly, despite higher staffing levels, owner-managed NHs are not associated with better quality and we find no statistically significant difference in financial performance between owner-managed and nonowner-managed FP NHs. Our results do not support the principal-agent model and we offer alternative explanations for future research. Our findings provide empirical evidence that NH ownership structures are more nuanced than simply broadly categorizing facilities as FP or NFP, and our results do not fully align with the standard principal-agent model. The role of managerial ownership should be considered in future NH research and policy discussions. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail:

  8. Residential Energy Performance Metrics

    Directory of Open Access Journals (Sweden)

    Christopher Wright


    Full Text Available Techniques for residential energy monitoring are an emerging field that is currently drawing significant attention. This paper is a description of the current efforts to monitor and compare the performance of three solar powered homes built at Missouri University of Science and Technology. The homes are outfitted with an array of sensors and a data logger system to measure and record electricity production, system energy use, internal home temperature and humidity, hot water production, and exterior ambient conditions the houses are experiencing. Data is being collected to measure the performance of the houses, compare to energy modeling programs, design and develop cost effective sensor systems for energy monitoring, and produce a cost effective home control system.

  9. The "Residential" Effect Fallacy in Neighborhood and Health Studies: Formal Definition, Empirical Identification, and Correction. (United States)

    Chaix, Basile; Duncan, Dustin; Vallée, Julie; Vernez-Moudon, Anne; Benmarhnia, Tarik; Kestens, Yan


    Because of confounding from the urban/rural and socioeconomic organizations of territories and resulting correlation between residential and nonresidential exposures, classically estimated residential neighborhood-outcome associations capture nonresidential environment effects, overestimating residential intervention effects. Our study diagnosed and corrected this "residential" effect fallacy bias applicable to a large fraction of neighborhood and health studies. Our empirical application investigated the effect that hypothetical interventions raising the residential number of services would have on the probability that a trip is walked. Using global positioning systems tracking and mobility surveys over 7 days (227 participants and 7440 trips), we employed a multilevel linear probability model to estimate the trip-level association between residential number of services and walking to derive a naïve intervention effect estimate and a corrected model accounting for numbers of services at the residence, trip origin, and trip destination to determine a corrected intervention effect estimate (true effect conditional on assumptions). There was a strong correlation in service densities between the residential neighborhood and nonresidential places. From the naïve model, hypothetical interventions raising the residential number of services to 200, 500, and 1000 were associated with an increase by 0.020, 0.055, and 0.109 of the probability of walking in the intervention groups. Corrected estimates were of 0.007, 0.019, and 0.039. Thus, naïve estimates were overestimated by multiplicative factors of 3.0, 2.9, and 2.8. Commonly estimated residential intervention-outcome associations substantially overestimate true effects. Our somewhat paradoxical conclusion is that to estimate residential effects, investigators critically need information on nonresidential places visited.

  10. 77 FR 63872 - Alternative Management Resources, Inc., Doepker Group, Inc., D.B.A. Time Staffing, Inc... (United States)


    ... Resources, Inc., Doepker Group, Inc., D.B.A. Time Staffing, Inc., Personnel Management Group, Inc...., Doepker Group, Inc., D.B.A. Time Staffing, Inc., Personnel Management Group, Inc., Select Staffing, and... follows: ''All workers of Alternative Management Resources, Inc., Doepker Group, Inc., D.B.A. Time...

  11. 77 FR 40638 - Syniverse Technologies, Inc., Including On-Site Leased Workers From Insight Global Stone Staffing... (United States)


    ..., Inc., Including On-Site Leased Workers From Insight Global Stone Staffing, and Randstad Formerly Known..., Massachusetts, including on-site leased workers from Insight Global, Stone Staffing, Randstad formerly known as... Insight Global, Stone Staffing, Randstad, formerly known as Sapphire Technologies, were employed on-site...

  12. A review of residential computer oriented energy control systems

    Energy Technology Data Exchange (ETDEWEB)

    North, Greg


    The purpose of this report is to bring together as much information on Residential Computer Oriented Energy Control Systems as possible within a single document. This report identifies the main elements of the system and is intended to provide many technical options for the design and implementation of various energy related services.

  13. Residential Wiring. Teacher Edition [and] Student Edition. Third Edition. (United States)

    Taylor, Mark; Batson, Larry; Carroll, Charles; Ipock, Dan; Leak, Lester; Onstott, Todd

    This revised curriculum guide for teachers and students is designed to help prepare students for entry-level employment in the residential wiring trade. The curriculum guide contains six units that cover the following topics: (1) blueprint reading and load calculations; (2) service; (3) rough-in; (4) trim out and troubleshooting; (5) low voltage…

  14. Comparison of nurse staffing based on changes in unit-level workload associated with patient churn. (United States)

    Hughes, Ronda G; Bobay, Kathleen L; Jolly, Nicholas A; Suby, Chrysmarie


    This analysis compares the staffing implications of three measures of nurse staffing requirements: midnight census, turnover adjustment based on length of stay, and volume of admissions, discharges and transfers. Midnight census is commonly used to determine registered nurse staffing. Unit-level workload increases with patient churn, the movement of patients in and out of the nursing unit. Failure to account for patient churn in staffing allocation impacts nurse workload and may result in adverse patient outcomes. Secondary data analysis of unit-level data from 32 hospitals, where nursing units are grouped into three unit-type categories: intensive care, intermediate care, and medical surgical. Midnight census alone did not account adequately for registered nurse workload intensity associated with patient churn. On average, units were staffed with a mixture of registered nurses and other nursing staff not always to budgeted levels. Adjusting for patient churn increases nurse staffing across all units and shifts. Use of the discharges and transfers adjustment to midnight census may be useful in adjusting RN staffing on a shift basis to account for patient churn. Nurse managers should understand the implications to nurse workload of various methods of calculating registered nurse staff requirements. © 2013 John Wiley & Sons Ltd.

  15. [Impact of Increased Supply of Newly Licensed Nurses on Hospital Nurse Staffing and Policy Implications]. (United States)

    Kim, Yunmi; You, Sunju; Kim, Jinhyun


    This study aimed to analyze the impact of increasing the supply of newly licensed nurses on improving the hospital nurse staffing grades for the period of 2009~2014. Using public administrative data, we analyzed the effect of newly licensed nurses on staffing in 1,594 hospitals using Generalized Estimating Equation (GEE) ordered logistic regression, and of supply variation on improving staffing grades in 1,042 hospitals using GEE logistic regression. An increase of one newly licensed nurse per 100 beds in general units had significantly lower odds of improving staffing grades (grades 6~0 vs. 7) (odds ratio=0.95, p=.005). The supply of newly licensed nurses increased by 32% from 2009 to 2014, and proportion of hospitals whose staffing grade had improved, not changed, and worsened was 19.1%, 70.1%, and 10.8% respectively. Compared to 2009, the supply variation of newly licensed nurses in 2014 was not significantly related to the increased odds of improving staffing grades in the region (OR=1.02, p=.870). To achieve a balance in the regional supply and demand for hospital nurses, compliance with nurse staffing legislation and revisions in the nursing fee differentiation policy are needed. Rather than relying on increasing nurse supply, retention policies for new graduate nurses are required to build and sustain competent nurse workforce in the future. © 2017 Korean Society of Nursing Science

  16. Staffing decision processes and issues: Case studies of seven US Nuclear Power Plants

    International Nuclear Information System (INIS)

    Melber, B.; Roussel, A.; Baker, K.; Durbin, N.; Hunt, P.; Hauth, J.; Forslund, C.; Terrill, E.; Gore, B.


    The objective of this report is to identify how decisions are made regarding staffing levels and positions for a sample of U.S. nuclear power plants. In this report, a framework is provided for understanding the major forces driving staffing and the implications of staffing decisions for plant safety. The focus of this report is on driving forces that have led to changes in staffing levels and to the establishment of new positions between the mid-1980s and the early 1990s. Processes used at utilities and nuclear power plants to make and implement these staffing decisions are also discussed in the report. While general trends affecting the plant as a whole are presented, the major emphasis of this report is on staffing changes and practices in the operations department, including the operations shift crew. The findings in this report are based on interviews conducted at seven nuclear power plants and their parent utilities. A discussion of the key findings is followed by a summary of the implications of staffing issues for plant safety

  17. The relationship of California's Medicaid reimbursement system to nurse staffing levels. (United States)

    Mukamel, Dana B; Kang, Taewoon; Collier, Eric; Harrington, Charlene


    Policy initiatives at the Federal and state level are aimed at increasing staffing in nursing homes. These include direct staffing standards, public reporting, and financial incentives. To examine the impact of California's Medicaid reimbursement for nursing homes which includes incentives directed at staffing. Two-stage limited-information maximum-likelihood regressions were used to model the relationship between staffing [registered nurses (RNs), licensed practical nurses, and certified nursing assistants hours per resident day] and the Medicaid payment rate, accounting for the specific structure of the payment system, endogeneity of payment and case-mix, and controlling for facility and market characteristics. A total of 927 California free-standing nursing homes in 2006. The model included facility characteristics (case-mix, size, ownership, and chain affiliation), market competition and excess demand, labor supply and wages, unemployment, and female employment. The instrumental variable for Medicaid reimbursement was the peer group payment rate for 7 geographical market areas, and the instrumental variables for resident case-mix were the average county revenues for professional therapy establishments and the percent of county population aged 65 and over. Consistent with the rate incentives and rational expectation behavior, expected nursing home reimbursement rates in 2008 were associated with increased RN staffing levels in 2006 but had no relationship with licensed practical nurse and certified nursing assistant staffing. The effect was estimated at 2 minutes per $10 increase in rate. The incentives in the Medicaid system impacted only RN staffing suggesting the need to improve the state's rate setting methodology.

  18. Medical physics staffing for radiation oncology: a decade of experience in Ontario, Canada (United States)

    Battista, Jerry J.; Patterson, Michael S.; Beaulieu, Luc; Sharpe, Michael B.; Schreiner, L. John; MacPherson, Miller S.; Van Dyk, Jacob


    The January 2010 articles in The New York Times generated intense focus on patient safety in radiation treatment, with physics staffing identified frequently as a critical factor for consistent quality assurance. The purpose of this work is to review our experience with medical physics staffing, and to propose a transparent and flexible staffing algorithm for general use. Guided by documented times required per routine procedure, we have developed a robust algorithm to estimate physics staffing needs according to center‐specific workload for medical physicists and associated support staff, in a manner we believe is adaptable to an evolving radiotherapy practice. We calculate requirements for each staffing type based on caseload, equipment inventory, quality assurance, educational programs, and administration. Average per‐case staffing ratios were also determined for larger‐scale human resource planning and used to model staffing needs for Ontario, Canada over the next 10 years. The workload specific algorithm was tested through a survey of Canadian cancer centers. For center‐specific human resource planning, we propose a grid of coefficients addressing specific workload factors for each staff group. For larger scale forecasting of human resource requirements, values of 260, 700, 300, 600, 1200, and 2000 treated cases per full‐time equivalent (FTE) were determined for medical physicists, physics assistants, dosimetrists, electronics technologists, mechanical technologists, and information technology specialists, respectively. PACS numbers: 87.55.N‐, 87.55.Qr PMID:22231223

  19. Optimizing staffing, quality, and cost in home healthcare nursing: theory synthesis. (United States)

    Park, Claire Su-Yeon


    To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. Theory synthesis. Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed. © 2017 The Author. Journal of Advanced Nursing © John Wiley & Sons Ltd.

  20. ENERGY STAR Certified Residential Dishwashers (United States)

    U.S. Environmental Protection Agency — Certified models meet all ENERGY STAR requirements as listed in the Version 6.0 ENERGY STAR Program Requirements for Residential Dishwashers that are effective as of...

  1. ENERGY STAR Certified Residential Freezers (United States)

    U.S. Environmental Protection Agency — Certified models meet all ENERGY STAR requirements as listed in the Version 5.0 ENERGY STAR Program Requirements for Residential Refrigerators and Freezers that are...

  2. ENERGY STAR Certified Residential Refrigerators (United States)

    U.S. Environmental Protection Agency — Certified models meet all ENERGY STAR requirements as listed in the Version 5.0 ENERGY STAR Program Requirements for Residential Refrigerators and Freezers that are...

  3. A survey of nurse staffing levels in interventional radiology units throughout the UK

    International Nuclear Information System (INIS)

    Christie, A.; Robertson, I.


    Aim: To supplement previous surveys analysing provision of interventional radiology (IR), in-hours (IH) and out-of-hours (OOH), by specifically surveying the level of nursing support provided. Materials and methods: A web-based questionnaire was distributed to all British Society of Interventional Radiology (BSIR) members. This addressed several aspects of radiology nursing support for IR procedures, both IH and OOH. Results: Sixty percent of respondents indicated that they have a formal OOH service. Of these, all have a dedicated nursing rota, with the vast majority operating with one nurse. IH, 77% of respondents always have a scrubbed nurse assistant, but this reduces to 40% OOH. IH, 4% never have a scrubbed radiology nurse assistant, which rises to 25% OOH. IH, 75% of respondents always have a radiology nurse dedicated to patient monitoring, but this reduces to 20% OOH. IH, 3% never have a radiology nurse dedicated to patient monitoring, which rises to 42% OOH. Conclusion: A significant disparity exists in the level of IR nursing support between IH and OOH. The majority of sites provide a single nurse with ad hoc additional support. This is potentially putting patients at increased risk. Radiology nurses are integral to the safe and sustainable provision of IR OOH services and a greater focus is required to ensure adequate and safe staffing levels for 24/7 IR services. - Highlights: • A significant disparity exists between the level of nursing support provided in-hours and OOH. • This applies to both the availability of a nurse to scrub and to monitor the patient. • Having a dedicated 24/7 nursing rota is mandatory to providing a deliverable OOH service.

  4. Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia

    Directory of Open Access Journals (Sweden)

    Schroder Kate


    Full Text Available Abstract Background The Ministry of Health (MOH in Zambia is currently operating with fewer than half of the health workers required to deliver basic health services. The MOH has developed a human resources for health (HRH strategic plan to address the crisis through improved training, hiring, and retention. However, the projected success of each strategy or combination of strategies is unclear. Methods We developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. We model, using Excel (Office, Microsoft; 2007, the effects of changes in these variables on the projected number of doctors, clinical officers, nurses and midwives in the public sector workforce in 2018. Results With no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels. Conclusions Meeting the minimum need for health workers in Zambia this decade will require an increase in health

  5. The impact of HMO penetration on the relationship between nurse staffing and quality. (United States)

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


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

  6. Preparing emergency personnel in dialysis: a just-in-time training program for additional staffing during disasters. (United States)

    Stoler, Genevieve B; Johnston, James R; Stevenson, Judy A; Suyama, Joe


    There are 341 000 patients in the United States who are dependent on routine dialysis for survival. Recent large-scale disasters have emphasized the importance of disaster preparedness, including supporting dialysis units, for people with chronic disease. Contingency plans for staffing are important for providing continuity of care for a technically challenging procedure such as dialysis. PReparing Emergency Personnel in Dialysis (PREP-D) is a just-in-time training program designed to train individuals having minimum familiarity with the basic steps of dialysis to support routine dialysis staff during a disaster. A 5-module educational program was developed through a collaborative, multidisciplinary effort. A pilot study testing the program was performed using 20 nontechnician dialysis facility employees and 20 clinical-year medical students as subjects. When comparing pretest and posttest scores, the entire study population showed a mean improvement of 28.9%, with dialysis facility employees and medical students showing improvements of 21.8% and 36.4%, respectively (P just-in-time training format. The knowledge gained by using the PREP-D program during a staffing shortage may allow for continuity of care for critical services such as dialysis during a disaster.

  7. Mining usage patterns in residential intranet of things


    Poghosyan , Gevorg; Pefkianakis , Ioannis; Le Guyadec , Pascal; Christophides , Vassilis


    International audience; Ubiquitous smart technologies gradually transform modern homes into Intranet of Things, where a multitude of connected devices allow for novel home automation services (e.g., energy or bandwidth savings, comfort enhancement, etc.). Optimizing and enriching the Quality of Experience (QoE) of residential users emerges as a critical differentiator for Internet and Communication Service providers (ISPs and CSPs, respectively) and heavily relies on the analysis of various k...

  8. Incorporating nurse absenteeism into staffing with demand uncertainty. (United States)

    Maass, Kayse Lee; Liu, Boying; Daskin, Mark S; Duck, Mary; Wang, Zhehui; Mwenesi, Rama; Schapiro, Hannah


    Increased nurse-to-patient ratios are associated negatively with increased costs and positively with improved patient care and reduced nurse burnout rates. Thus, it is critical from a cost, patient safety, and nurse satisfaction perspective that nurses be utilized efficiently and effectively. To address this, we propose a stochastic programming formulation for nurse staffing that accounts for variability in the patient census and nurse absenteeism, day-to-day correlations among the patient census levels, and costs associated with three different classes of nursing personnel: unit, pool, and temporary nurses. The decisions to be made include: how many unit nurses to employ, how large a pool of cross-trained nurses to maintain, how to allocate the pool nurses on a daily basis, and how many temporary nurses to utilize daily. A genetic algorithm is developed to solve the resulting model. Preliminary results using data from a large university hospital suggest that the proposed model can save a four-unit pool hundreds of thousands of dollars annually as opposed to the crude heuristics the hospital currently employs.

  9. Turnover, staffing, skill mix, and resident outcomes in a national sample of US nursing homes. (United States)

    Trinkoff, Alison M; Han, Kihye; Storr, Carla L; Lerner, Nancy; Johantgen, Meg; Gartrell, Kyungsook


    The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.

  10. Synthesis of the project leadership staffing needs for successful development of alternative delivery programs. (United States)


    This research provides a synthesis of practices in organizational structuring and professional staffing of the innovative delivery units in several state DOTs across the nation that are actively utilizing alternative project delivery. Several major c...

  11. Extension Staffing Models to Serve 4-H Clientele in Changing Times

    Directory of Open Access Journals (Sweden)

    Donna R. Gillespie


    Full Text Available In response to budget cuts in 2002, 4-H staffing models were restructured. The response by University of Idaho Extension was intended to continue meeting the needs of Idaho’s citizens with fewer UI Extension faculty. This staffing reorganization led to the formation of the District III 4-H Team who united to bring stronger 4-H programs to south central Idaho and expand programs to underserved audiences. Information from surveys and interviews over the past seven years reflects the effectiveness, challenges and successes of the District III 4-H Team. In Making the Best Better: 4-H Staffing Patterns and Trends in the Largest Professional Network in the Nation (2007, author Kirk A. Astroth notes a nationwide change in 4-H leadership at the county level from 4-H faculty to program assistants or coordinators. The information gathered in our research may help other states determine staffing models to meet the needs of clientele in these changing times.

  12. Staffing Levels and Inpatient Outcomes at Military Health Care Facilities: A Resource-Based View

    National Research Council Canada - National Science Library

    Yap, Glenn


    Using a Resource-Based Theory/View of the firm, this study examined if increased inpatient staffing levels at military hospitals can generate a competitive advantage based on better patient quality outcomes...

  13. Staffing to Maximize Profit for Call Centers with Impatient and Repeat-Calling Customers

    Directory of Open Access Journals (Sweden)

    Jun Gong


    Full Text Available Motivated by call center practice, we study the optimal staffing of many-server queues with impatient and repeat-calling customers. A call center is modeled as an M/M/s+M queue, which is developed to a behavioral queuing model in which customers come and go based on their satisfaction with waiting time. We explicitly take into account customer repeat behavior, which implies that satisfied customers might return and have an impact on the arrival rate. Optimality is defined as the number of agents that maximize revenues net of staffing costs, and we account for the characteristic that revenues are a direct function of staffing. Finally, we use numerical experiments to make certain comparisons with traditional models that do not consider customer repeat behavior. Furthermore, we indicate how managers might allocate staffing optimally with various customer behavior mechanisms.

  14. Implementation of a mechanical CPR device in a physician staffed HEMS - a prospective observational study. (United States)

    Rauch, Simon; Strapazzon, Giacomo; Brodmann, Monika; Fop, Ernst; Masoner, Christian; Rauch, Lydia; Forti, Alessandro; Pietsch, Urs; Mair, Peter; Brugger, Hermann


    In this prospective, observational study we describe the incidence and characteristics of out of hospital cardiac arrest (OHCA) cases who received mechanical CPR, after the implementation of a mechanical CPR device (LUCAS 2; Physio Control, Redmond, WA, USA) in a physician staffed helicopter emergency medical service (HEMS) in South Tyrol, Italy. During the study period (06/2013-04/2016), 525 OHCA cases were registered by the dispatch centre, 271 (51.6%) were assisted by HEMS. LUCAS 2 was applied in 18 (6.6%) of all HEMS-assisted OHCA patients; ten were treated with LUCAS 2 at the scene only, and eight were transported to hospital with ongoing CPR. Two (11.1%) of the 18 patients survived long term with full neurologic recovery. In seven of eight patients transferred to hospital with ongoing CPR, CPR was ceased in the emergency room without further intervention. Retrospectively, all HEMS-assisted OHCA cases were screened for proposed indication criteria for prolonged CPR. Thirteen patients fulfilled these criteria, but only two of them were transported to hospital. Based on these results, we propose a standard operating procedure for HEMS-assisted patients with refractory OHCA in a region without hospitals with ECLS capacity.

  15. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. (United States)

    Aiken, Linda H; Sloane, Douglas M; Bruyneel, Luk; Van den Heede, Koen; Griffiths, Peter; Busse, Reinhard; Diomidous, Marianna; Kinnunen, Juha; Kózka, Maria; Lesaffre, Emmanuel; McHugh, Matthew D; Moreno-Casbas, M T; Rafferty, Anne Marie; Schwendimann, Rene; Scott, P Anne; Tishelman, Carol; van Achterberg, Theo; Sermeus, Walter


    for an average of eight patients. Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Qualitative exploration of relationships between peers in residential addiction treatment. (United States)

    Neale, Joanne; Tompkins, Charlotte N E; Strang, John


    Relationships between peers are often considered central to the therapeutic process, yet there is relatively little empirical research either on the nature of peer-to-peer relationships within residential treatment or on how those relationships generate positive behaviour change or facilitate recovery. In this paper, we explore relationships between peers in residential addiction treatment, drawing upon the concept of social capital to frame our analyses. Our study was undertaken during 2015 and 2016 in two English residential treatment services using the same therapeutic community-informed model of treatment. We conducted 22 in-depth interviews with 13 current and 9 former service residents. All interviews were audio-recorded, transcribed verbatim, coded in MAXQDA, and analysed using Iterative Categorisation. Residents reported difficult relationship histories and limited social networks on entry into treatment. Once in treatment, few residents described bonding with their peers on the basis of shared experiences and lifestyles. Instead, interpersonal differences polarised residents in ways that undermined their social capital further. Some senior peers who had been in residential treatment longer acted as positive role models, but many modelled negative behaviours that undermined others' commitment to treatment. Relationships between peers could generate feelings of comfort and connectedness, and friendships developed when residents found things in common with each other. However, residents more often reported isolation, loneliness, wariness, bullying, manipulation, intimidation, social distancing, tensions and conflict. Overall, relationships between peers within residential treatment seemed to generate some positive but more negative social capital; undermining the notion of the community as a method of positive behaviour change. With the caveat that our data have limitations and further research is needed, we suggest that residential treatment providers should

  17. The effects of nurse staffing on hospital financial performance: competitive versus less competitive markets. (United States)

    Everhart, Damian; Neff, Donna; Al-Amin, Mona; Nogle, June; Weech-Maldonado, Robert


    Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing-related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result of better financial performance, particularly in more competitive markets. In this study, we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida. By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals. Nurse staffing levels had a positive association with financial performance (β = 3.3, p = .02) in competitive hospital markets, but no significant association was found in less competitive hospital markets. Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost-cutting measures may be inefficient and negatively affect financial performance.

  18. Nurse burnout in China: a questionnaire survey on staffing, job satisfaction, and quality of care. (United States)

    Lu, Minmin; Ruan, Hui; Xing, Weijie; Hu, Yan


    The investigators examined how nurse staffing affects nurse job satisfaction and quality of care. Inadequate nurse staffing is a worldwide issue with profound effects on nurse job satisfaction and quality of care. Few studies have examined the relationship between nurse staffing and job satisfaction and quality of care in China. A cross-sectional design was adopted, wherein 873 nurses were surveyed on demographics, nurse staffing, job-related burnout, job dissatisfaction, intent to leave, and quality of care. The median patient-nurse ratio was five; 45.1% nurses reported high levels of job-related burnout, and 55.6%, job dissatisfaction. In adjusted regression models, patient-nurse ratios of four or less were related to a decrease in the odds of job dissatisfaction (odds ratio 0.55, 95% confidence interval 0.36-0.85) and increase in the odds of quality of care (odds ratio 1.78, 95% confidence interval 1.02-2.82). Nurse staffing is associated with job dissatisfaction and quality of care. Nurse managers should maintain an adequate level of nurse staffing, referring to the patient-nurse ratio. They should create new initiatives to increase job satisfaction among nurses and to evaluate their effects. © 2013 John Wiley & Sons Ltd.

  19. The Effects of Nurse Staffing on Hospital Financial Performance: Competitive Versus Less Competitive Markets (United States)

    Everhart, Damian; Neff, Donna; Al-Amin, Mona; Nogle, June; Weech-Maldonado, Robert


    Background Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result better financial performance, particularly in more competitive markets Purpose In this study we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida. Methodology/Approach By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals. Findings Nurse staffing levels had a positive association with financial performance (β=3.3; p=0.02) in competitive hospital markets, but no significant association was found in less competitive hospital markets. Practice Implications Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost cutting measures may be inefficient and negatively affect financial performance. PMID:22543824

  20. Assessment of Residential History Generation Using a Public-Record Database

    Directory of Open Access Journals (Sweden)

    David C. Wheeler


    Full Text Available In studies of disease with potential environmental risk factors, residential location is often used as a surrogate for unknown environmental exposures or as a basis for assigning environmental exposures. These studies most typically use the residential location at the time of diagnosis due to ease of collection. However, previous residential locations may be more useful for risk analysis because of population mobility and disease latency. When residential histories have not been collected in a study, it may be possible to generate them through public-record databases. In this study, we evaluated the ability of a public-records database from LexisNexis to provide residential histories for subjects in a geographically diverse cohort study. We calculated 11 performance metrics comparing study-collected addresses and two address retrieval services from LexisNexis. We found 77% and 90% match rates for city and state and 72% and 87% detailed address match rates with the basic and enhanced services, respectively. The enhanced LexisNexis service covered 86% of the time at residential addresses recorded in the study. The mean match rate for detailed address matches varied spatially over states. The results suggest that public record databases can be useful for reconstructing residential histories for subjects in epidemiologic studies.

  1. Development of staffing evaluation principle for advanced main control room and the effect on situation awareness and mental workload

    International Nuclear Information System (INIS)

    Lin, Chiuhsiang Joe; Hsieh, Tsung-Ling; Lin, Shiau-Feng


    Highlights: • A staffing evaluation principle was developed for the advanced main control room. • The principle proposed to improve situation awareness and mental workload. • The principle has good validity that was examined by experimental design. - Abstract: Situation awareness and mental workload, both of which influence operator performance in the advanced main control room of a nuclear power plant, can be affected by staffing level. The key goal of staffing is to ensure the proper number of personnel to support plant operations and events. If the staffing level is not adaptive, the operators may have low situation awareness and an excessive mental workload, which lead to human error. Accordingly, this study developed a staffing evaluation principle based on CPM-GOMS modeling for operations in the advanced main control room. A within-subject experiment was designed to examine the validity of the staffing evaluation principle. The results indicated that the situation awareness, mental workload, and operating performance of the staffing level determined by the staffing evaluation principle was significantly better than that of the non-evaluated staffing level; thus, the validity of the staffing evaluation technique is acceptable. The implications of the findings of this study on managerial practice are discussed

  2. Nurses' perceptions of critical issues requiring consideration in the development of guidelines for professional registered nurse staffing for perinatal units. (United States)

    Simpson, Kathleen Rice; Lyndon, Audrey; Wilson, Jane; Ruhl, Catherine


    To solicit input from registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) on critical considerations for review and revision of existing nurse staffing guidelines. Thematic analysis of responses to a cross-sectional on-line survey question: "Please give the staffing task force your input on what they should consider in the development of recommendations for staffing of perinatal units." Members of AWHONN (N = 884). Descriptions of staffing concerns that should be considered when evaluating and revising existing perinatal nurse staffing guidelines. Consistent themes identified included the need for revision of nurse staffing guidelines due to requirements for safe care, increases in patient acuity and complexity, invisibility of the fetus and newborn as separate and distinct patients, difficulties in providing comprehensive care during labor and for mother-baby couplets under current conditions, challenges in staffing small volume units, and the negative effect of inadequate staffing on nurse satisfaction and retention. Participants overwhelmingly indicated current nurse staffing guidelines were inadequate to meet the needs of contemporary perinatal clinical practice and required revision based on significant changes that had occurred since 1983 when the original staffing guidelines were published. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  3. Development of staffing evaluation principle for advanced main control room and the effect on situation awareness and mental workload

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Chiuhsiang Joe, E-mail: [Department of Industrial Management, National Taiwan University of Science and Technology, 43, Section 4, Keelung Road, Taipei 10607, Taiwan (China); Hsieh, Tsung-Ling, E-mail: [Institute of Nuclear Energy Research, 1000, Wenhua Road, Chiaan Village, Lungtan 32546, Taiwan (China); Lin, Shiau-Feng, E-mail: [Department of Industrial Engineering, Chung-Yuan Christian University, 200, Chung Pei Road, Chung-Li 32023, Taiwan (China)


    Highlights: • A staffing evaluation principle was developed for the advanced main control room. • The principle proposed to improve situation awareness and mental workload. • The principle has good validity that was examined by experimental design. - Abstract: Situation awareness and mental workload, both of which influence operator performance in the advanced main control room of a nuclear power plant, can be affected by staffing level. The key goal of staffing is to ensure the proper number of personnel to support plant operations and events. If the staffing level is not adaptive, the operators may have low situation awareness and an excessive mental workload, which lead to human error. Accordingly, this study developed a staffing evaluation principle based on CPM-GOMS modeling for operations in the advanced main control room. A within-subject experiment was designed to examine the validity of the staffing evaluation principle. The results indicated that the situation awareness, mental workload, and operating performance of the staffing level determined by the staffing evaluation principle was significantly better than that of the non-evaluated staffing level; thus, the validity of the staffing evaluation technique is acceptable. The implications of the findings of this study on managerial practice are discussed.

  4. Does daily nurse staffing match ward workload variability? Three hospitals' experiences. (United States)

    Gabbay, Uri; Bukchin, Michael


    Nurse shortage and rising healthcare resource burdens mean that appropriate workforce use is imperative. This paper aims to evaluate whether daily nursing staffing meets ward workload needs. Nurse attendance and daily nurses' workload capacity in three hospitals were evaluated. Statistical process control was used to evaluate intra-ward nurse workload capacity and day-to-day variations. Statistical process control is a statistics-based method for process monitoring that uses charts with predefined target measure and control limits. Standardization was performed for inter-ward analysis by converting ward-specific crude measures to ward-specific relative measures by dividing observed/expected. Two charts: acceptable and tolerable daily nurse workload intensity, were defined. Appropriate staffing indicators were defined as those exceeding predefined rates within acceptable and tolerable limits (50 percent and 80 percent respectively). A total of 42 percent of the overall days fell within acceptable control limits and 71 percent within tolerable control limits. Appropriate staffing indicators were met in only 33 percent of wards regarding acceptable nurse workload intensity and in only 45 percent of wards regarding tolerable workloads. The study work did not differentiate crude nurse attendance and it did not take into account patient severity since crude bed occupancy was used. Double statistical process control charts and certain staffing indicators were used, which is open to debate. Wards that met appropriate staffing indicators prove the method's feasibility. Wards that did not meet appropriate staffing indicators prove the importance and the need for process evaluations and monitoring. Methods presented for monitoring daily staffing appropriateness are simple to implement either for intra-ward day-to-day variation by using nurse workload capacity statistical process control charts or for inter-ward evaluation using standardized measure of nurse workload intensity

  5. Solar Energy Systems for Ohioan Residential Homeowners (United States)

    Luckett, Rickey D.

    Dwindling nonrenewable energy resources and rising energy costs have forced the United States to develop alternative renewable energy sources. The United States' solar energy industry has seen an upsurge in recent years, and photovoltaic holds considerable promise as a renewable energy technology. The purpose of this case study was to explore homeowner's awareness of the benefits of solar energy. Disruptive-innovation theory was used to explore marketing strategies for conveying information to homeowners about access to new solar energy products and services. Twenty residential homeowners were interviewed face-to-face to explore (a) perceived benefits of solar energy in their county in Ohio, and (b) perceptions on the rationale behind the marketing strategy of solar energy systems sold for residential use. The study findings used inductive analyses and coding interpretation to explore the participants' responses that revealed 3 themes: the existence of environmental benefits for using solar energy systems, the expensive cost of equipment associated with government incentives, and the lack of marketing information that is available for consumer use. The implications for positive social change include the potential to enable corporate leaders, small business owners, and entrepreneurs to develop marketing strategies for renewable energy systems. These strategies may promote use of solar energy systems as a clean, renewable, and affordable alternative electricity energy source for the 21st century.

  6. Services

    International Nuclear Information System (INIS)

    Hardeman, F.


    The objectives of the services section is (1) to offer complete services in health-physics measurements according to international quality standards, (2) to improve continuously these measurement techniques and to follow up international recommendations and legislation concerning the surveillance of workers, (3) to support and advise nuclear and non-nuclear industry on problems of radioactive contamination. Achievements related to gamma spectrometry, whole-body counting, beta and alpha spectrometry, dosimetry, radon measurements, calibration, instrumentation, and neutron activation analysis are described

  7. Children With Intellectual Disability and Hospice Utilization: The Moderating Effect of Residential Care. (United States)

    Lindley, Lisa C


    Children with intellectual disability commonly lack access to pediatric hospice care services. Residential care may be a critical component in providing access to hospice care for children with intellectual disability. This research tested whether residential care intensifies the relationship between intellectual disability and hospice utilization (ie, hospice enrollment, hospice length of stay), while controlling for demographic characteristics. Multivariate regression analyses were conducted using 2008 to 2010 California Medicaid claims data. The odds of children with intellectual disability in residential care enrolling in hospice care were 3 times higher than their counterparts in their last year of life, when controlling for demographics. Residential care promoted hospice enrollment among children with intellectual disability. The interaction between intellectual disability and residential care was not related to hospice length of stay. Residential care did not attenuate or intensify the relationship between intellectual disability and hospice length of stay. The findings highlight the important role of residential care in facilitating hospice enrollment for children with intellectual disability. More research is needed to understand the capability of residential care staff to identify children with intellectual disability earlier in their end-of-life trajectory and initiate longer hospice length of stays.

  8. The association between nurse staffing and omissions in nursing care: A systematic review. (United States)

    Griffiths, Peter; Recio-Saucedo, Alejandra; Dall'Ora, Chiara; Briggs, Jim; Maruotti, Antonello; Meredith, Paul; Smith, Gary B; Ball, Jane


    To identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing. Research has established associations between nurse staffing levels and adverse patient outcomes including in-hospital mortality. However, the causal nature of this relationship is uncertain and omissions of nursing care (referred as missed care, care left undone or rationed care) have been proposed as a factor which may provide a more direct indicator of nurse staffing adequacy. Systematic review. We searched the Cochrane Library, CINAHL, Embase and Medline for quantitative studies of associations between staffing and missed care. We searched key journals, personal libraries and reference lists of articles. Two reviewers independently selected studies. Quality appraisal was based on the National Institute for Health and Care Excellence quality appraisal checklist for studies reporting correlations and associations. Data were abstracted on study design, missed care prevalence and measures of association. Synthesis was narrative. Eighteen studies gave subjective reports of missed care. Seventy-five per cent or more nurses reported omitting some care. Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care. Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy. The extent to which the relationships observed represent actual failures, is yet to be investigated. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

  9. 38 CFR 17.80 - Alcohol and drug dependence or abuse treatment and rehabilitation in residential and... (United States)


    ... dependence or abuse treatment and rehabilitation in residential and nonresidential facilities by contract. 17... of Services of Other Federal Agencies § 17.80 Alcohol and drug dependence or abuse treatment and rehabilitation in residential and nonresidential facilities by contract. (a) Alcohol and drug dependence or abuse...

  10. Understanding Residential Polarization in a Globalizing City

    Directory of Open Access Journals (Sweden)

    Ibrahim Rotimi Aliu


    Full Text Available This study examines the spatial polarization that characterizes the dwellings in the African leading megacity of Lagos. Data were collected through an extensive housing survey carried out on 1,485 household residences in 56 wards within 12 administrative units in Lagos megacity. The spatial dimension of residential density in the city generates three unique residential patterns which are low residential density (LRD, medium residential density (MRD, and high residential density (HRD areas. Descriptive and multivariate inferential statistics were used to render explanations for the spatial variations in the residential quality variables in the study area. Findings indicated that a clear difference exists in the residential quality within the three residential density areas of Lagos. High correlations exist among the residential quality indicators and housing type. The principal component analysis shows that residential polarizations that occur in the LRD, MRD, and HRD are based on the location, dwelling facility, interior and exterior quality, neighborhood integrity, social bond, barrier to entry, and security. The practical implications of residential polarizations along the residential density areas are explicitly expressed.

  11. Learning Space Service Design

    Directory of Open Access Journals (Sweden)

    Elliot Felix


    Full Text Available Much progress has been made in creating informal learning spaces that incorporate technology and flexibly support a variety of activities. This progress has been principally in designing the right combination of furniture, technology, and space. However, colleges and universities do not design services within learning spaces with nearly the same level of sophistication or integration. Nor do they adequately assess their services. This paper calls for a focus on designing services to facilitate better learning experiences. It describes the fundamentals of service design practice, a selection of exemplary spaces, and the implications for design, budgeting, and staffing.

  12. Technical Problems of Residential Construction (United States)

    Nowogońska, Beata; Cibis, Jerzy


    Beauty, utility, durability - these are the features of good architecture and should also be the distinguishing qualities of every residential building. But do beauty and utility remain along with the passing of time? Performance characteristics are an indicator of both, the technical as well as aesthetic state of buildings. Aesthetic needs are in disagreement with the merciless aging process. The beauty of a city is formed not only by the original forms of new residential buildings, but also by existing tenement housing; thus preserving their aesthetics becomes a necessity. Time is continuously passing and along with it, aging intensifies. The aging process is a natural phenomenon for every material. The life expectancy of building materials is also limited. Along with the passing of time, the technical state of residential buildings continuously deteriorates. With the passing of time, the aesthetic values and preferences of users of flats change and the usability of the building decreases. The permanence of buildings, including residential buildings, is shaped not only by the forces of nature but also by activities of humans. A long lifespan is ensured by carrying out ongoing, systematic renovation-repair works. It is thanks to them that buildings derived from past centuries are still being used, and their market attractiveness is not decreasing.

  13. Main challenges of residential areas

    Directory of Open Access Journals (Sweden)

    Oana Luca


    Full Text Available The present article is a position paper aiming to initiate a professional debate related to the aspects related to the urban dysfunctions leading to the wear of the residential areas. The paper proposes a definition of the wear process, identify the main causes leading to its occurrence and propose a number of solutions to neutralise the dysfunctions. The three wearing phases of residential areas components are emphasized, exploring their lifecycle. In order to perform the study of urban wear, the status of the residential areas components can be established and monitored, and also the variables of the function that can mathematically model the specific wear process may be considered. The paper is considered a first step for the model adjustment, to be tested and validated in the following steps. Based on the mathematical method and model, there can be created, in a potential future research, the possibility of determining the precarity degree for residential areas/neighbourhoods and cities, by minimising the subjective component of the analyses preceding the decision for renovation or regeneration.

  14. Residential solar-heating system (United States)


    Complete residential solar-heating and hot-water system, when installed in highly-insulated energy-saver home, can supply large percentage of total energy demand for space heating and domestic hot water. System which uses water-heating energy storage can be scaled to meet requirements of building in which it is installed.

  15. Convergence of Residential Gateway Technology

    NARCIS (Netherlands)

    Hartog, F.T.H. den; Balm, M.; Jong, C.M. de; Kwaaitaal, J.J.B.


    A new OSI-based model is described that can be used for the classification of residential gateways. It is applied to analyze current gateway solutions and draw evolutionary paths for the medium to long term. From this it is concluded that particularly set-top boxes and broadband modems, as opposed

  16. Convergence of residential gateway technology

    NARCIS (Netherlands)

    Hartog, den F.T.H.; Balm, M.; Jong, de C.M.; Kwaaitaal, J.J.B.


    A new OSI-based model is described that can be used for the classification of residential gateways. It is applied to analyze current gateway solutions and draw evolutionary paths for the medium to long term. From this it is concluded that particularly set-top boxes and broadband modems, as opposed

  17. Trends of Sustainable Residential Architecture


    Narvydas, A


    The article is based on Master’s research conducted during Scottish Housing Expo 2010. The aim of the research was to determine the prevailing trends in sustainable residential architecture. Each trend can be described by features detected during visual and technical observation of project data. Based on that architects may predict possible problems related to a specific trend.

  18. Reduce tax on residential mobility

    NARCIS (Netherlands)

    van Ewijk, C.; van Leuvensteijn, M.


    How can Europe increase structural growth? This column argues that labour market flexibility is key. As a major barrier to labour movement is rigidity in the housing market, abolishing transfer taxes on residential property could result in gains of up to 0.4% of GDP.

  19. Zones 30 : urban residential areas.

    NARCIS (Netherlands)


    Sustainable Safety uses a road categorization in which through traffic is concentrated on motorways and other main roads. In residential areas, which have a living, shopping, or work function, through traffic is discouraged by setting a speed limit of 30 km/h, and by speed reducing measures such as

  20. The effect of physician staffing model on patient outcomes in a medical progressive care unit. (United States)

    Yoo, E J; Damaghi, N; Shakespeare, W G; Sherman, M S


    Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Twenty years of staffing, practice environment, and outcomes research in military nursing. (United States)

    Patrician, Patricia A; Loan, Lori A; McCarthy, Mary S; Swiger, Pauline; Breckenridge-Sproat, Sara; Brosch, Laura Ruse; Jennings, Bonnie Mowinski

    Two decades ago, findings from an Institute of Medicine (IOM) report sparked the urgent need for evidence supporting relationships between nurse staffing and patient outcomes. This article provides an overview of nurse staffing, practice environment, and patient outcomes research, with an emphasis on findings from military studies. Lessons learned also are enumerated. This study is a review of the entire Military Nursing Outcomes Database (MilNOD) program of research. The MilNOD, in combination with evidence from other health care studies, provides nurses and leaders with information about the associations between staffing, patient outcomes, and the professional practice environment of nursing in the military. Leaders, therefore, have useful empirical evidence to make data-driven decisions. The MilNOD studies are the basis for the current Army nursing dashboard, and care delivery framework, called the Patent CaringTouch System. Future research is needed to identify ideal staffing based on workload demands, and provide leaders with factors to consider when operationalizing staffing recommendations. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. 45 CFR 1306.20 - Program staffing patterns. (United States)


    ... family child care provider, the maximum group size is six children and no more than two of the six may be... and ensure the provision of quality Head Start services at each family child care home. These..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES, HEAD START...

  3. Survey on Services to Multicultural Populations. (United States)

    Olivier, Lee; And Others


    Reports results of a recent national survey that examined the availability and variety of services provided to multicultural populations by medium and large public libraries. Highlights include measuring multicultural activity; planning for new services; staffing; languages; literacy and English-as-a-Second-Language programs; and barriers to…

  4. Integrated Payment and Delivery Models Offer Opportunities and Challenges for Residential Care Facilities


    Grabowski, David C.; Caudry, Daryl J.; Dean, Katie M.; Stevenson, David G.


    Under health care reform, a series of new financing and delivery models are being piloted to integrate health and long-term care services for older adults. To date, these programs have not encompassed residential care facilities, with most programs focusing on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with simila...

  5. The effect of investor-owned chain acquisitions on hospital expenses and staffing. (United States)

    Manheim, L M; Shortell, S M; McFall, S


    Much concern has been raised about the effect of "corporatization" of health through the expansion of investor-owned hospital chains. One method of expansion is through hospital acquisition. At issue is the question of the effect of acquisitions on expenses and on such patient care inputs as staffing levels. In this article, we examine the effect of acquisition by one investor-owned chain on hospital costs and staffing. Subsequent to acquisition, hospital costs increase and staffing decreases, relative to competitor hospitals. However, since investor-owned hospitals not recently acquired do not have higher cost levels than their competitors, the increase in costs appears to be due to factors associated with the acquisition itself rather than factors associated with being an investor-owned hospital. Under the retrospective payment system in effect at the time, revenues also were higher for acquired hospitals. Under prospective payment, increasing revenues has been more difficult, decreasing acquisition incentives. PMID:2807933

  6. Interim results of the study of control room crew staffing for advanced passive reactor plants

    International Nuclear Information System (INIS)

    Hallbert, B.P.; Sebok, A.; Haugset, K.


    Differences in the ways in which vendors expect the operations staff to interact with advanced passive plants by vendors have led to a need for reconsideration of the minimum shift staffing requirements of licensed Reactor Operators and Senior Reactor Operators contained in current federal regulations (i.e., 10 CFR 50.54(m)). A research project is being carried out to evaluate the impact(s) of advanced passive plant design and staffing of control room crews on operator and team performance. The purpose of the project is to contribute to the understanding of potential safety issues and provide data to support the development of design review guidance. Two factors are being evaluated across a range of plant operating conditions: control room crew staffing; and characteristics of the operating facility itself, whether it employs conventional or advanced, passive features. This paper presents the results of the first phase of the study conducted at the Loviisa nuclear power station earlier this year. Loviisa served as the conventional plant in this study. Data collection from four crews were collected from a series of design basis scenarios, each crew serving in either a normal or minimum staffing configuration. Results of data analyses show that crews participating in the minimum shift staffing configuration experienced significantly higher workload, had lower situation awareness, demonstrated significantly less effective team performance, and performed more poorly as a crew than the crews participating in the normal shift staffing configuration. The baseline data on crew configurations from the conventional plant setting will be compared with similar data to be collected from the advanced plant setting, and a report prepared providing the results of the entire study

  7. An international comparison of commercial nuclear power plant staffing regulations and practice, 1980--1990

    International Nuclear Information System (INIS)

    Melber, B.; Hauth, J.; Terrill, E.; Berk, B.; Gore, B.


    In this report an international review of regulatory and industry practices is provided in the area of nuclear power plant staffing during the 1980s in Canada, France, Germany, Japan, Sweden, and the United Kingdom. The objective of this review is to highlight trends in staffing regulatory approaches, industry practices, and issues of concern in other countries that have potential relevance to nuclear power plant staffing issues in the United States. The decade of the 1980s was marked by a great deal of growth in nuclear power operations internationally; however, growth of nuclear power is not expected to continue in the 1990s except in France and Japan. A continuum of regulatory approaches to staffing was identified, ranging from prescribed regulations that are applied to all licensees (Germany is most similar to the United States in this regard), to indirect staffing regulations where the regulatory authority oversees plant operating practices that are agreed to in the plant operating license (most notably, France and the United Kingdom). Most of the changes observed in staffing regulations and practices in the early 1980s were made in response to the accident at the Three Mile Island Unit 2 nuclear power plant (TMI) in 1979. These changes included the widespread issuance of new operator and licensing requirements and the establishment of national training centers. After the post-TMI changes were implemented, a period of relative stability followed. Changes in the latter half of the 1980s have focused on continuing improvements and additions to training curricula and methods, most notably increased reliance on simulator training

  8. Effects of Medicare payment changes on nursing home staffing and deficiencies. (United States)

    Konetzka, R Tamara; Yi, Deokhee; Norton, Edward C; Kilpatrick, Kerry E


    To investigate the effects of Medicare's Prospective Payment System (PPS) for skilled nursing facilities (SNFs) and associated rate changes on quality of care as represented by staffing ratios and regulatory deficiencies. Online Survey, Certification and Reporting (OSCAR) data from 1996-2000 were linked with Area Resource File (ARF) and Medicare Cost Report data to form a panel dataset. A difference-in-differences model was used to assess effects of the PPS and the BBRA (Balanced Budget Refinement Act) on staffing and deficiencies, a design that allows the separation of the effects of the policies from general trends. Ordinary least squares and negative binomial models were used. The OSCAR and Medicare Cost Report data are self-reported by nursing facilities; ARF data are publicly available. Data were linked by provider ID and county. We find that professional staffing decreased and regulatory deficiencies increased with PPS, and that both effects were mitigated with the BBRA rate increases. The effects appear to increase with the percent of Medicare residents in the facility except, in some cases, at the highest percentage of Medicare. The findings on staffing are statistically significant. The effects on deficiencies, though exhibiting consistent signs and magnitudes with the staffing results, are largely insignificant. Medicare's PPS system and associated rate cuts for SNFs have had a negative effect on staffing and regulatory compliance. Further research is necessary to determine whether these changes are associated with worse outcomes. Findings from this investigation could help guide policy modifications that support the provision of quality nursing home care.

  9. Factors that affect implementation of a nurse staffing directive: results from a qualitative multi-case evaluation. (United States)

    Robinson, Claire H; Annis, Ann M; Forman, Jane; Krein, Sarah L; Yankey, Nicholas; Duffy, Sonia A; Taylor, Beth; Sales, Anne E


    To assess implementation of the Veterans Health Administration staffing methodology directive. In 2010 the Veterans Health Administration promulgated a staffing methodology directive for inpatient nursing units to address staffing and budget forecasting. A qualitative multi-case evaluation approach assessed staffing methodology implementation. Semi-structured telephone interviews were conducted from March - June 2014 with Nurse Executives and their teams at 21 facilities. Interviews focused on the budgeting process, implementation experiences, use of data, leadership support, and training. An implementation score was created for each facility using a 4-point rating scale. The scores were used to select three facilities (low, medium and high implementation) for more detailed case studies. After analysing interview summaries, the evaluation team developed a four domain scoring structure: (1) integration of staffing methodology into budget development; (2) implementation of the Directive elements; (3) engagement of leadership and staff; and (4) use of data to support the staffing methodology process. The high implementation facility had leadership understanding and endorsement of staffing methodology, confidence in and ability to work with data, and integration of staffing methodology results into the budgeting process. The low implementation facility reported poor leadership engagement and little understanding of data sources and interpretation. Implementation varies widely across facilities. Implementing staffing methodology in facilities with complex and changing staffing needs requires substantial commitment at all organizational levels especially for facilities that have traditionally relied on historical levels to budget for staffing. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  10. Residents' perceptions and experiences of social interaction and participation in leisure activities in residential aged care. (United States)

    Thomas, Jessica E; O'Connell, Beverly; Gaskin, Cadeyrn J


    Social interaction and participation in leisure activities are positively related to the health and well-being of elderly people. The main focus of this exploratory study was to investigate elderly peoples' perceptions and experiences of social interaction and leisure activities living in a residential aged care (RAC) facility. Six residents were interviewed. Themes emerging from discussions about their social interactions included: importance of family, fostering friendships with fellow residents, placement at dining room tables, multiple communication methods, and minimal social isolation and boredom. Excursions away from the RAC facility were favourite activities. Participants commonly were involved in leisure activities to be socially connected. Poor health, family, the RAC facility, staffing, transportation, and geography influenced their social interaction and participation in leisure activities. The use of new technologies and creative problem solving with staff are ways in which residents could enhance their social lives and remain engaged in leisure activities.

  11. Organization and staffing of the regulatory body for nuclear facilities. Safety guide

    International Nuclear Information System (INIS)


    The purpose of this safety guide is to provide recommendations for national authorities on the appropriate management system, organization and staffing for the regulatory body responsible for the regulation of nuclear facilities in order to achieve compliance with the applicable safety requirements. This safety guide covers the organization and staffing in relation to nuclear facilities such as: enrichment and fuel manufacturing plants. Nuclear power plants. Other reactors such as research reactors and critical assemblies. Spent fuel reprocessing plants. And radioactive waste management facilities such as treatment, storage and disposal facilities. This safety guide also covers issues related to the decommissioning of nuclear facilities, the closure of waste disposal facilities and site rehabilitation

  12. Residential mobility and childhood leukemia. (United States)

    Amoon, A T; Oksuzyan, S; Crespi, C M; Arah, O A; Cockburn, M; Vergara, X; Kheifets, L


    Studies of environmental exposures and childhood leukemia studies do not usually account for residential mobility. Yet, in addition to being a potential risk factor, mobility can induce selection bias, confounding, or measurement error in such studies. Using data collected for California Powerline Study (CAPS), we attempt to disentangle the effect of mobility. We analyzed data from a population-based case-control study of childhood leukemia using cases who were born in California and diagnosed between 1988 and 2008 and birth certificate controls. We used stratified logistic regression, case-only analysis, and propensity-score adjustments to assess predictors of residential mobility between birth and diagnosis, and account for potential confounding due to residential mobility. Children who moved tended to be older, lived in housing other than single-family homes, had younger mothers and fewer siblings, and were of lower socioeconomic status. Odds ratios for leukemia among non-movers living mobility, including dwelling type, increased odds ratios for leukemia to 2.61 (95% CI: 1.76-3.86) for living mobility of childhood leukemia cases varied by several sociodemographic characteristics, but not by the distance to the nearest power line or calculated magnetic fields. Mobility appears to be an unlikely explanation for the associations observed between power lines exposure and childhood leukemia. Copyright © 2018 Elsevier Inc. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Dementiev N. P.


    Full Text Available The article presents a comparative analysis of residential mortgages in Russia and the United States. The primary ways of mortgage refinancing are outlined. Predominance of the elements of two-level refinancing system of residential mortgage in Russia and the United States is shown. The activity of the Agency for Housing Mortgage Lending (AHML, the basic tool of the Russian government’s mortgage policy, is described in detail. In its objectives and functions the AHML is similar to the American mortgage agencies Ginnie Mae, Fannie Mae and Freddie Mac. Similarities were identified in the Russian and US residential mortgages in the pre-crisis period (high rates of mortgage growth, favourable economic conjuncture, low interest rates, large increase in house prices, speculative housing demand. During the mortgage crisis, the policies of the Russian and US governments and monetary authorities had also much in common (monetary policy easing, cheap central banks loans, extended facilities of mortgage refinancing on the part of state agencies, mortgage rescue scheme, social mortgage programs. But the scope of mortgage in Russia is enormously narrow as compared to the US mortgage. The most important reason for that - low incomes of the Russian population.

  14. Residential Carers' Knowledge and Attitudes towards Physiotherapy Interventions for Adults with Learning Disabilities (United States)

    Stewart, Stephen; Macha, Ruth; Hebblethwaite, Amy; Hames, Annette


    Through the use of face-to-face interviews, this article explores residential carers' perceptions and understanding of a physiotherapy service provided to patients with a learning disability, with the aim of highlighting potential areas for improvement in the service. Carers involved in the study reported a good relationship with the…

  15. 45 CFR 1336.65 - Staffing and organization of the Revolving Loan Fund: Responsibilities of the Loan Administrator. (United States)


    ... organization table, including: (a) The structure and composition of the Board of Directors of the RLF; (b) The... 45 Public Welfare 4 2010-10-01 2010-10-01 false Staffing and organization of the Revolving Loan... Hawaiian Revolving Loan Fund Demonstration Project § 1336.65 Staffing and organization of the Revolving...

  16. New Directions for Academic Libraries in Research Staffing: A Case Study at National University of Ireland Galway (United States)

    Cox, John


    New research needs, global developments and local shifts in emphasis are demanding a broader range of interactions by librarians with researchers and are challenging previous staffing structures. Research has a higher institutional profile and academic libraries have responded by creating new roles and staffing models, with stronger linkage across…

  17. 75 FR 45166 - Jeld-Wen, Inc., Hawkins Window Division, Including On-Site Leased Workers of Nicolet Staffing... (United States)


    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-71,014] Jeld-Wen, Inc., Hawkins Window Division, Including On-Site Leased Workers of Nicolet Staffing, Hawkins, WI; Notice of Negative...., Hawkins Window Division, including on-site leased workers of Nicolet Staffing, Hawkins, Wisconsin. Signed...

  18. Registered Nurse Staffing in Pennsylvania Nursing Homes: Comparison before and after Implementation of Medicare's Prospective Payment System. (United States)

    Kanda, Katsuya; Mezey, Mathy


    Examined changes in resident acuity and registered nurse staffing in all nursing homes in Pennsylvania before and after introduction of Medicare Prospective Payment System (PPS) in 1983. Found that acuity of nursing home residents increased significantly since introduction of PPS, full-time registered nurse staffing remained unchanged, and…

  19. Key Residential Building Equipment Technologies for Control and Grid Support PART I (Residential)

    Energy Technology Data Exchange (ETDEWEB)

    Starke, Michael R [ORNL; Onar, Omer C [ORNL; DeVault, Robert C [ORNL


    Electrical energy consumption of the residential sector is a crucial area of research that has in the past primarily focused on increasing the efficiency of household devices such as water heaters, dishwashers, air conditioners, and clothes washer and dryer units. However, the focus of this research is shifting as objectives such as developing the smart grid and ensuring that the power system remains reliable come to the fore, along with the increasing need to reduce energy use and costs. Load research has started to focus on mechanisms to support the power system through demand reduction and/or reliability services. The power system relies on matching generation and load, and day-ahead and real-time energy markets capture most of this need. However, a separate set of grid services exist to address the discrepancies in load and generation arising from contingencies and operational mismatches, and to ensure that the transmission system is available for delivery of power from generation to load. Currently, these grid services are mostly provided by generation resources. The addition of renewable resources with their inherent variability can complicate the issue of power system reliability and lead to the increased need for grid services. Using load as a resource, through demand response programs, can fill the additional need for flexible resources and even reduce costly energy peaks. Loads have been shown to have response that is equal to or better than generation in some cases. Furthermore, price-incentivized demand response programs have been shown to reduce the peak energy requirements, thereby affecting the wholesale market efficiency and overall energy prices. The residential sector is not only the largest consumer of electrical energy in the United States, but also has the highest potential to provide demand reduction and power system support, as technological advancements in load control, sensor technologies, and communication are made. The prevailing loads

  20. 42 CFR 403.734 - Condition of participation: Food services. (United States)


    ... 42 Public Health 2 2010-10-01 2010-10-01 false Condition of participation: Food services. 403.734...-Benefits, Conditions of Participation, and Payment § 403.734 Condition of participation: Food services. The RNHCI must have an organized food service that is directed and adequately staffed by qualified personnel...

  1. Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model. (United States)

    Schnelle, John F; Schroyer, L Dale; Saraf, Avantika A; Simmons, Sandra F


    Nursing aides provide most of the labor-intensive activities of daily living (ADL) care to nursing home (NH) residents. Currently, most NHs do not determine nurse aide staffing requirements based on the time to provide ADL care for their unique resident population. The lack of an objective method to determine nurse aide staffing requirements suggests that many NHs could be understaffed in their capacity to provide consistent ADL care to all residents in need. Discrete event simulation (DES) mathematically models key work parameters (eg, time to provide an episode of care and available staff) to predict the ability of the work setting to provide care over time and offers an objective method to determine nurse aide staffing needs in NHs. This study had 2 primary objectives: (1) to describe the relationship between ADL workload and the level of nurse aide staffing reported by NHs; and, (2) to use a DES model to determine the relationship between ADL workload and nurse aide staffing necessary for consistent, timely ADL care. Minimum Data Set data related to the level of dependency on staff for ADL care for residents in over 13,500 NHs nationwide were converted into 7 workload categories that captured 98% of all residents. In addition, data related to the time to provide care for the ADLs within each workload category was used to calculate a workload score for each facility. The correlation between workload and reported nurse aide staffing levels was calculated to determine the association between staffing reported by NHs and workload. Simulations to project staffing requirements necessary to provide ADL care were then conducted for 65 different workload scenarios, which included 13 different nurse aide staffing levels (ranging from 1.6 to 4.0 total hours per resident day) and 5 different workload percentiles (ranging from the 5th to the 95th percentile). The purpose of the simulation model was to determine the staffing necessary to provide care within each workload

  2. X Marks the Spot: Creating and Managing a Single Service Point to Improve Customer Service and Maximize Resources (United States)

    Venner, Mary Ann; Keshmiripour, Seti


    This article will describe how merging service points in an academic library is an opportunity to improve customer service and utilize staffing resources more efficiently. Combining service points provides libraries with the ability to create a more positive library experience for patrons by minimizing the ping-pong effect for assistance. The…


    African Journals Online (AJOL)


    May 5, 2008 ... to accomplish the activities, available working hours, category and individual allowances, ... analysis when we were given a full week out of our working .... -4 routine lab. 38. 34. 4 histology. 07. 06. 1. Blood services. 19. 16. 3.

  4. 25 CFR 275.3 - Methods for staffing. (United States)


    ... provided by the Area Personnel Office in complying with Civil Service instructions (Federal Personnel... coverage for any of the following Federal benefits: (i) Compensation for work injuries. (ii) Retirement... designated by the tribal governing body, is responsible for the planning, coordination, and completion of the...

  5. A social pedagogy approach to residential care: balancing education and placement in the development of an innovative child welfare residential program in Ontario, Canada. (United States)

    Gharabaghi, Kiaras; Groskleg, Ron


    This paper chronicles the exploration and development of a residential program of the child welfare authority of Renfrew County in Ontario, Canada. Recognizing that virtually its entire population of youth in care was failing to achieve positive outcomes in education, Renfrew County Family and Children Services embarked on a program development process that included many unique elements within the Ontario child welfare context. This process introduced the theoretical framework of social pedagogy to the provision of residential care, and it replaced the idea of psychotherapy as the primary agent of change for youth with the concept of living and learning. The result is a template for the Ottawa River Academy, a living and learning program for youth in care that exemplifies the possibilities embedded in creative thought, attention to research and evidence, and a preparedness to transcend traditional assumptions with respect to service designs and business models for residential care in child welfare.

  6. The Benefit Implications of Recent Trends in Flexible Staffing Arrangements. Staff Working Paper. (United States)

    Houseman, Susan N.

    Workers in flexible staffing arrangementsincluding temporary agency, direct-hire temporary, on-call, and contract workersare much less likely than regular, direct-hire employees to be covered by laws mandating or regulating workplace benefits. They are also much less likely to receive pension, health insurance, and other benefits on the job.…

  7. Staffing a call center with uncertain non-stationary arrival rate and flexibility

    NARCIS (Netherlands)

    Liao, S.; van Delft, C.; Jouini, O.; Koole, G.M.


    We consider a multi-period staffing problem in a single-shift call center. The call center handles inbound calls, as well as some alternative back-office jobs. The call arrival process is assumed to follow a doubly non-stationary stochastic process with a random mean arrival rate. The inbound calls

  8. Daddy's Gone to Colorado: Male-Staffed Child Care for Father-Absent Boys. (United States)

    Brody, Steve


    The article presents the goals, methods, and case examples of The Nutury, a predominantly male-staffed child care center serving single-parent children. The primary goal is to provide consistent relationships with men for children without a male model in their home. Clinical observations reveal positive life-styles and attitudes. (LPG)

  9. Survey of foreign reactor operator qualifications, training, and staffing requirements. Final report

    International Nuclear Information System (INIS)

    Au, M.L.; DiSalvo, R.; Merschoff, E.


    The report is a compilation of the data obtained from a survey of foreign nuclear power plant operator requirements. Included among the considerations are: (1) shift staffing; (2) operator eligibility; (3) operator training programs; (4) operator licensing or certification; and (5) operator retraining. The data obtained from this survey are presented in matrix form and contrasted with U.S. requirements

  10. 76 FR 73683 - Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing... (United States)


    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,593] Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing, Andrews International, IBM Corporation... refrigerators and trash compactors. The notice was published in the Federal Register on October 25, 2010 (75 FR...

  11. 76 FR 72978 - Whirlpool Corporation Including On-Site Leased Workers From Career Solutions TEC Staffing... (United States)


    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,593] Whirlpool Corporation Including On-Site Leased Workers From Career Solutions TEC Staffing, Andrews International, IBM Corporation... workers are engaged in the production of refrigerators and trash compactors. The notice was published in...

  12. Nuclear power plant organization and staffing for improved performance: Lessons learned

    International Nuclear Information System (INIS)


    Experience from well operated nuclear power plants (NPPs) around the world indicates that an organizational structure which efficiently supports plant operation is essential in economically achieving both high level of safety and operational performance. At the same time energy markets are being opened to competition in many Member States. It is in consideration of this new competitive energy market that the overall objective of this document is to provide NPP managers information on lessons learned on improving the organization and staffing of NPP activities. Within this overall objective, specific objectives are to: Identify organisational design and staffing principles, Provide examples of how NPPs implement these principles, Identify typical NPP staffing levels, Factors affecting these levels, and staffing trends among various NPP types. Although it is not expected that any particular utility or NPP manager would consider all of the suggestions provided here to be appropriate, it is anticipated that nearly every NPP manager in IAEA Member States would find some ideas useful in improving the efficiency and effectiveness of NPP activities

  13. Staffing, recruitment, training, qualification and certification of operating personnel of nuclear power plants

    International Nuclear Information System (INIS)


    Safety of public, occupational workers and the protection of environment should be assured while activities for economic and social progress are pursued. These activities include the establishment and utilisation of nuclear facilities and the use of radioactive sources. This safety guide provides guidance on the aspects of staffing, recruitment, training, qualification and certification of operating personnel of nuclear power plants

  14. Nurse turnover in New Zealand: costs and relationships with staffing practises and patient outcomes. (United States)

    North, Nicola; Leung, William; Ashton, Toni; Rasmussen, Erling; Hughes, Frances; Finlayson, Mary


    To determine the rates and costs of nurse turnover, the relationships with staffing practises, and the impacts on outcomes for nurses and patients. In the context of nursing shortages, information on the rates and costs of nursing turnover can improve nursing staff management and quality of care. Quantitative and qualitative data were collected prospectively for 12 months. A re-analysis of these data used descriptive statistics and correlational analysis techniques. The cost per registered nurse turnover represents half an average salary. The highest costs were related to temporary cover, followed by productivity loss. Both are associated with adverse patient events. Flexible management of nursing resources (staffing below budgeted levels and reliance on temporary cover), and a reliance on new graduates and international recruitment to replace nurses who left, contributed to turnover and costs. Nurse turnover is embedded in staffing levels and practises, with costs attributable to both. A culture of turnover was found that is inconsistent with nursing as a knowledge workforce. Nurse managers did not challenge flexible staffing practices and high turnover rates. Information on turnover and costs is needed to develop strategies that retain nurses as knowledge-based workers. © 2012 Blackwell Publishing Ltd.

  15. A Functional Model of Quality Assurance for Psychiatric Hospitals and Corresponding Staffing Requirements. (United States)

    Kamis-Gould, Edna; And Others


    A model for quality assurance (QA) in psychiatric hospitals is described. Its functions (general QA, utilization review, clinical records, evaluation, management information systems, risk management, and infection control), subfunctions, and corresponding staffing requirements are reviewed. This model was designed to foster standardization in QA…

  16. Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing

    Directory of Open Access Journals (Sweden)

    Christopher E. Pelt, MD


    Conclusions: A relatively simple change to staffing hours, using resources currently available to us, and little additional financial or institutional investment resulted in a significant improvement in the number of patients ambulating on POD 0, with a modest reduction in both LOS and inpatient costs.

  17. Outcomes and Costs of Community Living: Semi-Independent Living and Fully Staffed Group Homes (United States)

    Felce, David; Perry, Jonathan; Romeo, Renee; Robertson, Janet; Meek, Andrea; Emerson, Eric; Knapp, Martin


    In a matched-groups design, costs and quality of life outcomes for adults with intellectual disabilities with relatively low support needs were compared between those in fully staffed group homes (n = 35) and in semi-independent living (n = 35). Data were collected on participant characteristics, setting organization, various lifestyle outcomes,…

  18. 75 FR 16512 - Willstaff Staffing Agency, Willstaff Crystal, Inc., and MDS Industrial Resources, Inc., Working... (United States)


    ... Agency, Willstaff Crystal, Inc., and MDS Industrial Resources, Inc., Working On-Site at Tyler Pipe... MDS Industrial Resources, Inc., working on-site at Tyler Pipe Company, Waterworks Division, South... Staffing Agency, Willstaff Crystal, Inc., and MDS Industrial Resources, Inc., working on-site at Tyler Pipe...

  19. Library/Media Centers in U.S. Public Schools: Growth, Staffing, and Resources. Full Report (United States)

    Tuck, Kathy D.; Holmes, Dwight R.


    At the request of New Business Item: 89 (NBI: 89) adopted at the 2015 NEA Representative Assembly, this study examines the extent to which students have access to public school library/media centers with qualified staff and up-to-date resources. The study explores trends in library/media center openings and closings as well as staffing patterns…

  20. Reversing Course: The Troubled State of Academic Staffing and a Path Forward (United States)

    American Federation of Teachers (NJ), 2008


    Over the last generation, the instructional staffing system in American higher education has experienced a significant reduction in the proportion of jobs for full-time tenured and tenure-track faculty members and a dramatic growth in fixed-term full- and part-time instructional jobs without tenure. About 70 percent of the people teaching in…

  1. Residential care : Dutch and Italian residents of residential care facilities compared

    NARCIS (Netherlands)

    de Heer-Wunderink, Charlotte; Caro-Nienhuis, Annemarie D.; Sytema, Sjoerd; Wiersma, Durk


    Aims - Characteristics of patients living in residential care facilities and the availability of mental hospital- and residential beds in Italy and The Netherlands were compared to assess whether differences in the process of deinstitutionalisation have influenced the composition of their

  2. The relation between residential property and its surroundings and day- and night-time residential burglary

    NARCIS (Netherlands)

    Montoya, Lorena; Junger, Marianne; Ongena, Yfke

    This article examines how residential property and its surroundings influence day- and night-time residential burglary. Crime Prevention Through Environmental Design (CPTED) principles of territoriality, surveillance, access control, target hardening, image maintenance, and activity support underpin

  3. The Relation Between Residential Property and its Surroundings and Day- and Night-Time Residential Burglary

    NARCIS (Netherlands)

    Montoya, L.; Junger, Marianne; Ongena, Yfke

    This article examines how residential property and its surroundings influence day- and night-time residential burglary. Crime Prevention Through Environmental Design (CPTED) principles of territoriality, surveillance, access control, target hardening, image maintenance, and activity support underpin

  4. A Paramedic-staffed Helicopter Emergency Medical Service's Response to Winch Missions in Victoria, Australia. (United States)

    Meadley, Ben; Heschl, Stefan; Andrew, Emily; de Wit, Anthony; Bernard, Stephen A; Smith, Karen


    Winching emergency medical care providers from a helicopter to the scene enables treatment of patients in otherwise inaccessible locations, but is not without risks. The objective of this study was to define characteristics of winch missions undertaken by Intensive Care Flight Paramedics (ICFP) in Victoria, Australia with a focus on extraction methods and clinical care delivered at the scene. A retrospective data analysis was performed to identify all winch missions between November 2010 and March 2014. Demographic data, winch characteristics, physiological parameters, and interventions undertaken on scene by the ICFP were extracted. Out of 5,003 missions in the study period, 125 were identified as winch operations. Winter missions were significantly less frequent than those of any other season. Patients were predominantly male (78.4%) and had a mean age of 38 years (±17.6). A total of 109 (87.2%) patients were identified as experiencing trauma with a mean Revised Trauma Score of 7.5288, and isolated limb fractures were the most frequently encountered injury. Falls and vehicle-related trauma were the most common mechanisms of injury. The total median scene duration was 49 minutes (IQR 23-91). Sixty-three patients (50.4%) were extracted using a stretcher, 45 (36.0%) using a hypothermic strop, and 6 (4.8%) via normal rescue strop. Eleven patients (8.8%) were not winched to the helicopter. Vascular access (38.4%), analgesia (44.0%), and anti-emetic administration (28.8%) were the most frequent clinical interventions. Forty-nine patients (39.2%) did not receive any clinical intervention prior to winch extraction. Winch operations in Victoria, Australia consisted predominantly of patients with minor to moderate traumatic injuries. A significant proportion of patients did not require any clinical treatment prior to winching, and among those who did, analgesia was the most frequent intervention. Advanced medical procedures were rarely required prior to winch extraction.

  5. Does the STAF score help detect paroxysmal atrial fibrillation in acute stroke patients? (United States)

    Horstmann, S; Rizos, T; Güntner, J; Hug, A; Jenetzky, E; Krumsdorf, U; Veltkamp, R


    Detecting paroxysmal atrial fibrillation (pAF) soon after acute cerebral ischaemia has a major impact on secondary stroke prevention. Recently, the STAF score, a composite of clinical and instrumental findings, was introduced to identify stroke patients at risk of pAF. We aimed to validate this score in an independent study population. Consecutive patients admitted to our stroke unit with acute ischaemic stroke were prospectively enrolled. The diagnostic work-up included neuroimaging, neuroultrasound, baseline 12-channel electrocardiogram (ECG), 24-h Holter ECG, continuous ECG monitoring, and echocardiography. Presence of AF was documented according to the medical history of each patient and after review of 12-lead ECG, 24-h Holter ECG, or continuous ECG monitoring performed during the stay on the ward. Additionally, a telephone follow-up visit was conducted for each patient after 3 months to inquire about newly diagnosed AF. Items for each patient-age, baseline NIHSS, left atrial dilatation, and stroke etiology according to the TOAST criteria - were assessed to calculate the STAF score. Overall, 584 patients were enrolled in our analysis. AF was documented in 183 (31.3%) patients. In multivariable analysis, age, NIHSS, left atrial dilatation, and absence of vascular etiology were independent predictors for AF. The logistic AF-prediction model of the STAF score revealed fair classification accuracy in receiver operating characteristic curve analysis with an area under the curve of 0.84. STAF scores of ≥5 had a sensitivity of 79% and a specificity of 74% for predicting AF. The value of the STAF score for predicting the risk of pAF in stroke patients is limited. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  6. Creating pharmacy staffing-to-demand models: predictive tools used at two institutions. (United States)

    Krogh, Paul; Ernster, Jason; Knoer, Scott


    The creation and implementation of data-driven staffing-to-demand models at two institutions are described. Predictive workload tools provide a guideline for pharmacy managers to adjust staffing needs based on hospital volume metrics. At Abbott Northwestern Hospital, management worked with the department's staff and labor management committee to clearly outline the productivity monitoring system and the process for reducing hours. Reference charts describing the process for reducing hours and a form to track the hours of involuntary reductions for each employee were created to further enhance communication, explain the rationale behind the new process, and promote transparency. The University of Minnesota Medical Center-Fairview, found a strong correlation between measured pharmacy workload and an adjusted census formula. If the daily census and admission report indicate that the adjusted census will provide enough workload for the fully staffed department, no further action is needed. If the census report indicates the adjusted census is less than the breakeven point, staff members are asked to leave work, either voluntarily or involuntarily. The opposite holds true for days when the adjusted census is higher than the breakeven point, at which time additional staff are required to synchronize worked hours with predicted workload. Successful staffing-to- demand models were implemented in two hospital pharmacies. Financial savings, as indicated by decreased labor costs secondary to reduction of staffed shifts, were approximately $42,000 and $45,500 over a three-month period for Abbott Northwestern Hospital and the University of Minnesota Medical Center-Fairview, respectively. Maintenance of 100% productively allowed the departments to continue to replace vacant positions and avoid permanent staff reductions.

  7. Schedule and staffing of a nuclear power project

    International Nuclear Information System (INIS)

    Polliart, A.J.; Csik, B.


    Establishment of construction schedule: a) preliminary construction schedule; b) PERT (Program Evaluation Review Techniques) analytical method; c) identify key milestone target dates; d) inter-action by participants and contribution to support revised construction schedule. - Construction schedule control: a) ability to update and modify construction schedule; b) alternate plans to circumvent restraints (problems); c) critical path activity-controls; d) continuous review and report system. - Updating construction site reports to include: 1) progress, 2) accomplishments, 3) potential problems and alternate plans; b) progress reports on related support services; c) total assessment of participating groups on schedule; d) information required by management for decisions. - Typical causes for delays in project schedule. (orig.) [de

  8. The bottom line: an ethnography of for-profit elderly residential care


    Greener, Joe


    In the last 20 years the UK’s elderly residential care system has become progressively more privatised with an increase in the number of for-profit organisations delivering these services. This study is a participant observation of care work in one privatised elderly residential care home (‘Meadowvale’), owned and operated by a large provider of such services (‘Moonlight Care’). It provides a rich ethnographic depiction of life at Meadowvale both from the point of view of the workers and the ...

  9. The effects of staffing and training on firm productivity and profit growth before, during, and after the Great Recession. (United States)

    Kim, Youngsang; Ployhart, Robert E


    This study integrates research from strategy, economics, and applied psychology to examine how organizations may leverage their human resources to enhance firm performance and competitive advantage. Staffing and training are key human resource management practices used to achieve firm performance through acquiring and developing human capital resources. However, little research has examined whether and why staffing and training influence firm-level financial performance (profit) growth under different environmental (economic) conditions. Using 359 firms with over 12 years of longitudinal firm-level profit data, we suggest that selective staffing and internal training directly and interactively influence firm profit growth through their effects on firm labor productivity, implying that staffing and training contribute to the generation of slack resources that help buffer and then recover from the effects of the Great Recession. Further, internal training that creates specific human capital resources is more beneficial for prerecession profitability, but staffing is more beneficial for postrecession recovery, apparently because staffing creates generic human capital resources that enable firm flexibility and adaptation. Thus, the theory and findings presented in this article have implications for the way staffing and training may be used strategically to weather economic uncertainty (recession effects). They also have important practical implications by demonstrating that firms that more effectively staff and train will outperform competitors throughout all pre- and postrecessionary periods, even after controlling for prior profitability. (c) 2014 APA, all rights reserved.

  10. Residential Electricity Consumption in Poland

    Directory of Open Access Journals (Sweden)

    Edyta Ropuszyńska-Surma


    Full Text Available Key factors influencing electricity consumption in the residential sector in Poland have been identified. A fixed-effects model was used, which includes time effects, and a set of covariates, based on the model developed by Houthakker et al. This model estimates electricity demand by using lagged values of the dependent variable along with current and lagged values of electricity prices, and other variables that affect electricity demand such as: population, economic growth, income per capita, price of related goods, etc. The model has been identified according to the research results of the authors and those obtained by Bentzen and Engsted. The set of covariates was extended to the lagged electricity price given by a tariff (taken from two years previous to the time of interest and heating degree days index, a very important factor in European Union countries, where the climate is temperate. The authors propose four models of residential electricity demand, for which a confidence interval of 95% has been assumed. Estimation was based on Polish quarterly data for the years 2003-2013. (original abstract

  11. Residential ventilation standards scoping study

    Energy Technology Data Exchange (ETDEWEB)

    McKone, Thomas E.; Sherman, Max H.


    The goals of this scoping study are to identify research needed to develop improved ventilation standards for California's Title 24 Building Energy Efficiency Standards. The 2008 Title 24 Standards are the primary target for the outcome of this research, but this scoping study is not limited to that timeframe. We prepared this scoping study to provide the California Energy Commission with broad and flexible options for developing a research plan to advance the standards. This document presents the findings of a scoping study commissioned by the Public Interest Energy Research (PIER) program of the California Energy Commission to determine what research is necessary to develop new residential ventilation requirements for California. This study is one of three companion efforts needed to complete the job of determining the ventilation needs of California residences, determining the bases for setting residential ventilation requirements, and determining appropriate ventilation technologies to meet these needs and requirements in an energy efficient manner. Rather than providing research results, this scoping study identifies important research questions along with the level of effort necessary to address these questions and the costs, risks, and benefits of pursuing alternative research questions. In approaching these questions and corresponding levels of effort, feasibility and timing were important considerations. The Commission has specified Summer 2005 as the latest date for completing this research in time to update the 2008 version of California's Energy Code (Title 24).

  12. Integration of motor traffic in residential areas.

    NARCIS (Netherlands)

    Schreuder, D.A.


    In stead of banning the cars from residential areas, the plan is to integrate them in such a way that they can still be used, but that they will loose their predominant position. The areas where this integration is to take place are called residential yards. This paper concentrates on the lighting

  13. The Size and Scope of Collegiate Athletic Training Facilities and Staffing. (United States)

    Gallucci, Andrew R; Petersen, Jeffrey C


      Athletic training facilities have been described in terms of general design concepts and from operational perspectives. However, the size and scope of athletic training facilities, along with staffing at different levels of intercollegiate competition, have not been quantified.   To define the size and scope of athletic training facilities and staffing levels at various levels of intercollegiate competition. To determine if differences existed in facilities (eg, number of facilities, size of facilities) and staffing (eg, full time, part time) based on the level of intercollegiate competition.   Cross-sectional study.   Web-based survey.   Athletic trainers (ATs) who were knowledgeable about the size and scope of athletic training programs.   Athletic training facility size in square footage; the AT's overall facility satisfaction; athletic training facility component spaces, including satellite facilities, game-day facilities, offices, and storage areas; and staffing levels, including full-time ATs, part-time ATs, and undergraduate students.   The survey was completed by 478 ATs (response rate = 38.7%) from all levels of competition. Sample means for facilities were 3124.7 ± 4425 ft 2 (290.3 ± 411 m 2 ) for the central athletic training facility, 1013 ± 1521 ft 2 (94 ± 141 m 2 ) for satellite athletic training facilities, 1272 ± 1334 ft 2 (118 ± 124 m 2 ) for game-day athletic training facilities, 388 ± 575 ft 2 (36 ± 53 m 2 ) for athletic training offices, and 424 ± 884 ft 2 (39 ± 82 m 2 ) for storage space. Sample staffing means were 3.8 ± 2.5 full-time ATs, 1.6 ± 2.5 part-time ATs, 25 ± 17.6 athletic training students, and 6.8 ± 7.2 work-study students. Division I schools had greater resources in multiple categories (P facilities in recent years was common, and almost half of ATs reported that upgrades have been approved for the near future.   This study provides benchmark descriptive data on athletic training staffing and

  14. Does a hostel's managing agency determine the access to psychiatric services of its residents? (United States)

    Lucas, B; Audini, B; Chisholm, D; Knapp, M; Lelliott, P


    This study examines the effect of managing agency (local authority, private or voluntary) on the use of other health and social care services by residents in mental health hostels and group homes with different levels of staffing in England and Wales. The sample comprised 1323 residents in 275 facilities in eight districts. The measures of service use were number of days in hospital and number of other service contacts. There were highly significant differences between facilities with similar levels of staffing managed by different agencies. Residents in the voluntary sector used fewer community services overall; residents in low-staffed local authority facilities used more services than those in similar facilities managed by other agencies. These differences were not easily explained by differences in the social or clinical characteristics of residents. This suggests that there may be organisational factors, e.g. hostel staff, knowledge of services, which influence access to and use of community services.

  15. Estimating the Determinants of Residential Water Demand in Italy

    Directory of Open Access Journals (Sweden)

    Giulia Romano


    Full Text Available The aim of this study was to estimate the determinants of residential water demand for chief towns of every Italian province, in the period 2007–2009, using the linear mixed-effects model estimated with the restricted-maximum-likelihood method. Results confirmed that the applied tariff had a negative effect on residential water consumption and that it was a relevant driver of domestic water consumption. Moreover, income per capita had a positive effect on water consumption. Among measured climatic and geographical features, precipitation and altitude exerted a strongly significant negative effect on water consumption, while temperature did not influence water demand. Further, data show that small towns in terms of population served were characterized by lower levels of consumption. Water utilities ownership itself did not have a significant effect on water consumption but tariffs were significantly lower and residential water consumption was higher in towns where the water service was managed by publicly owned water utilities. However, further research is needed to gain a better understanding of the connection between ownership of water utilities and water prices and water consumption.

  16. ICT for whole life optimisation of residential buildings

    Energy Technology Data Exchange (ETDEWEB)

    Haekkinen, T.; Vares, S.; Huovila, P.; Vesikari, E.; Porkka, J. (VTT Technical Research Centre of Finland, Espoo (FI)); Nilsson, L.-O.; Togeroe, AA. (Lund University (SE)); Jonsson, C.; Suber, K. (Skanska Sverige AB (SE)); Andersson, R.; Larsson, R. (Cementa, Malmoe (SE)); Nuorkivi, I. (Skanska Oyj, Helsinki (FI))


    The research project 'ICT for whole life optimisation of residential buildings' (ICTWLORB) developed and tested the whole life design and optimisation methods for residential buildings. The objective of the ICTWLORB project was to develop and implement an ICT based tool box for integrated life cycle design of residential building. ICTWLORB was performed in cooperation with Swedish and Finnish partners. The ICTWLORB project defined as a premise that an industrialised building process is characterised by two main elements: a building concept based approach and efficient information management. Building concept based approach enables (1) the product development of the end product, (2) repetition of the basic elements of the building from one project to others and (3) customisation of the end-product considering the specific needs of the case and the client. Information management enables (1) the consideration of wide spectrum of aspects including building performance, environmental aspects, life cycle costs and service life, and (2) rapid adapting of the design to the specific requirements of the case. (orig.)

  17. An innovative educational program for residential energy efficiency. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Laquatra, J.; Chi, P.S.K.


    Recognizing the importance of energy conservation, under sponsorship of the US Department of Energy, Cornell University conducted a research and demonstration project entitled An Innovative Educational Program for Residential Energy Efficiency. The research project examined the amount of residential energy that can be saved through changes in behavior and practices of household members. To encourage these changes, a workshop was offered to randomly-selected households in New York State. Two surveys were administered to household participants (Survey 1 and Survey 2, Appendix A) and a control group; and a manual was developed to convey many easy but effective ways to make a house more energy efficient (see Residential Manual, Appendix B). Implementing methods of energy efficiency will help reduce this country`s dependence on foreign energy sources and will also reduce the amount of money that is lost on inefficient energy use. Because Cornell Cooperative Extension operates as a component of the land-grant university system throughout the US, the results of this research project have been used to develop a program that can be implemented by the Cooperative Extension Service nationwide. The specific goals and objectives for this project will be outlined, the population and sample for the research will be described, and the instruments utilized for the survey will be explained. A description of the workshop and manual will also be discussed. This report will end with a summary of the results from this project and any observed changes and/or recommendations for future surveys pertaining to energy efficiency.

  18. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings. (United States)

    Haas, Sheila A; Vlasses, Frances; Havey, Julia


    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

  19. Medical physics personnel for medical imaging: requirements, conditions of involvement and staffing levels-French recommendations

    International Nuclear Information System (INIS)

    Isambert, Aurelie; Valero, Marc; Rousse, Carole; Blanchard, Vincent; Le Du, Dominique; Guilhem, Marie-Therese; Dieudonne, Arnaud; Pierrat, Noelle; Salvat, Cecile


    The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. (authors)

  20. Medical physics personnel for medical imaging: requirements, conditions of involvement and staffing levels-French recommendations. (United States)

    Isambert, Aurélie; Le Du, Dominique; Valéro, Marc; Guilhem, Marie-Thérèse; Rousse, Carole; Dieudonné, Arnaud; Blanchard, Vincent; Pierrat, Noëlle; Salvat, Cécile


    The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email:

  1. Dynamic Staffing and Rescheduling in Software Project Management: A Hybrid Approach.

    Directory of Open Access Journals (Sweden)

    Yujia Ge

    Full Text Available Resource allocation could be influenced by various dynamic elements, such as the skills of engineers and the growth of skills, which requires managers to find an effective and efficient tool to support their staffing decision-making processes. Rescheduling happens commonly and frequently during the project execution. Control options have to be made when new resources are added or tasks are changed. In this paper we propose a software project staffing model considering dynamic elements of staff productivity with a Genetic Algorithm (GA and Hill Climbing (HC based optimizer. Since a newly generated reschedule dramatically different from the initial schedule could cause an obvious shifting cost increase, our rescheduling strategies consider both efficiency and stability. The results of real world case studies and extensive simulation experiments show that our proposed method is effective and could achieve comparable performance to other heuristic algorithms in most cases.

  2. Restructuring and the retail residential market for power in Pennsylvania

    International Nuclear Information System (INIS)

    Kleit, Andrew N.; Shcherbakova, Anastasia V.; Chen Xu


    In January 2010 electricity retail residential rate caps expired in a large part of Pennsylvania, allowing consumers to shop for electricity in the retail market. In this paper we employ customer-level data from the relevant territory to analyze what residential customer and community characteristics impacted the decision of whether or not to switch to an alternative electricity provider, and when to make the switch. Results show that customers with higher usage levels (especially around the time of the program's introduction), electric heating, and those living in more urban and more educated communities with lower unemployment rates and higher median household incomes were both more likely to switch, and more likely to do so faster. Lower switching rates and a slower switching response was observed from customers with more variable month to month usage (perhaps this made them unsure of future benefits from switching), those on alternative residential electricity rates (time-of-day and thermal storage programs), and those new to the relevant area (perhaps due to lack of information about the residential choice program). Critics of retail electricity competition have suggested that it disadvantages poor and elderly ratepayers. Our results do not support this contention. Customers living in communities with higher poverty rates were actually more likely to switch (and do so faster) than middle-income consumers. Communities with higher shares of senior population were not found to have lower switching rates from younger communities. - Highlights: ► We analyze introduction of retail competition in Pennsylvania's electricity sector. ► We evaluate what characteristics influence consumers to switch electric providers. ► Higher usage and electric heat influence customers to switch and to do so faster. ► More variable usage and being new to service area deter switching. ► High poverty rates induce switching; older communities no less likely to switch.

  3. Residential electricity demand in Singapore

    International Nuclear Information System (INIS)

    Ang, B.W.; Goh, T.N.; Liu, X.Q.


    Residential electricity consumption in Singapore increased at a rate of 8.8% per year between 1972 and 1990. Estimates of the long-run income and price elasticities are 1.0 and -0.35, respectively. The energy-conservation campaigns that have been launched are found to have marginal effects on consumption. A statistical analysis shows that the consumption is sensitive to small changes in climatic variables, particularly the temperature, which is closely linked to the growing diffusion of electric appliances for environmental controls. There has been a temporal increase in the ownership levels of appliances associated with increasing household incomes. However, other factors were involved since the ownership levels would also increase over time after the elimination of the income effect. A large part of the future growth in electricity demand will arise from the growing need for air-conditioning, which will lead to increasingly large seasonal variations in electricity use. (author)

  4. Residential radon survey in Finland

    International Nuclear Information System (INIS)

    Arvela, H.; Maekelaeinen, I.; Castren, O.


    The study measured the indoor radon concentration in the dwellings of 3074 persons, selected randomly from the central population register of Finland. Alpha track detectors and two consecutive half year measuring periods were used. The national mean of indoor radon concentration for persons living in low-rise residential buildings as well as blocks of flats was 145 and 82 Bq/m 3 , respectively. The mean for the total population was 123 Bq/m 3 . Based on the decision of the Ministry of Social Affairs and Health in 1992, the indoor radon concentration should not exceed 400 Bq/m 3 in already existing houses, the target for new construction being less than 200 Bq/m 3 . According to the study, the percentage of the Finnish population living in houses with an indoor radon concentration exceeding 200, 400 and 800 Bq/m 3 was 12.3 %, 3.6 % and 1.0 %

  5. Economic evaluation of nurse staffing and nurse substitution in health care: a scoping review


    Griffiths, P; Goryakin, Y.; Maben, J.


    OBJECTIVE: Several systematic reviews have suggested that greater nurse staffing as well as a greater proportion of registered nurses in the health workforce is associated with better patient outcomes. Others have found that nurses can substitute for doctors safely and effectively in a variety of settings. However, these reviews do not generally consider the effect of nurse staff on both patient outcomes and costs of care, and therefore say little about the cost-effectiveness of nurse-provide...

  6. The Staffing Policies of Swedish Companies at their Chinese Production Units


    Dolinska, Nina; Hrlovic, Dzenita; Swane, Katarina


    Increasing production costs and high pressure from the consumers are leading Swedish companies towards an expansion to China. Since more and more companies are moving their production, we found it interesting to study the problems they might encounter while employing personnel. The purpose of this dissertation is to analyse what staffing policies companies choose and variables that influence the decision at Swedish production plants in China. Ethnocentric, polycentric and geocentric polic...

  7. Effects of nurse staffing, work environments, and education on patient mortality: an observational study. (United States)

    Cho, Eunhee; Sloane, Douglas M; Kim, Eun-Young; Kim, Sera; Choi, Miyoung; Yoo, Il Young; Lee, Hye Sun; Aiken, Linda H


    While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. To examine the effects of nurse staffing, work environment, and education on patient mortality. This study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Generalizable items and modular structure for computerised physician staffing calculation on intensive care units. (United States)

    Weiss, Manfred; Marx, Gernot; Iber, Thomas


    Intensive care medicine remains one of the most cost-driving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks (performed in every patient) and additional tasks (necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society of Anesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.

  9. A scientific model to determine the optimal radiographer staffing component in a nuclear medicine department

    International Nuclear Information System (INIS)

    Shipanga, A.N.; Ellmann, A.


    Full text: Introduction: Nuclear medicine in South Africa is developing fast. Much has changed since the constitution of a scientific model for determining an optimum number of radiographer posts in a Nuclear Medicine department in the late 1980's. Aim: The aim of this study was to ascertain whether the number of radiographers required by a Nuclear Medicine department can still be determined according to the norms established in 1988. Methods: A quantitative study using non-experimental evaluation design was conducted to determine the ratios between current radiographer workload and staffing norms. The workload ratios were analysed using the procedures statistics of the Nuclear Medicine department at Tygerberg Hospital. Radiographers provided data about their activities related to patient procedures, including information about the condition of the patients, activities in the radiopharmaceutical laboratory, and patient related administrative tasks. These were factored into an equation relating this data to working hours, including vacation and sick leave. The calculation of Activity Standards and an annual Standard Workload was used to finally calculate the staffing requirements for a Nuclear Medicine department. Results: Preliminary data confirmed that old staffing norms cannot be used in a modern Nuclear Medicine department. Protocols for several types of study have changed, including the additional acquisition of tomographic studies. Interest in the use of time-consuming non-imaging studies has been revived and should be factored Into the equation. Conclusions: All Nuclear Medicine departments In South Africa, where the types of studies performed have changed over the past years, should look carefully at their radiographer staffing ratio to ascertain whether the number of radiographers needed is adequate for the current workload. (author)

  10. Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand. (United States)

    Nantsupawat, Apiradee; Srisuphan, Wichit; Kunaviktikul, Wipada; Wichaikhum, Orn-Anong; Aungsuroch, Yupin; Aiken, Linda H


    To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. Secondary data analysis of the 2007 Thai Nurse Survey. The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world. © 2011 Sigma Theta Tau International.

  11. Setting-related influences on physical inactivity of older adults in residential care settings: a review. (United States)

    Douma, Johanna G; Volkers, Karin M; Engels, Gwenda; Sonneveld, Marieke H; Goossens, Richard H M; Scherder, Erik J A


    Despite the detrimental effects of physical inactivity for older adults, especially aged residents of residential care settings may spend much time in inactive behavior. This may be partly due to their poorer physical condition; however, there may also be other, setting-related factors that influence the amount of inactivity. The aim of this review was to review setting-related factors (including the social and physical environment) that may contribute to the amount of older adults' physical inactivity in a wide range of residential care settings (e.g., nursing homes, assisted care facilities). Five databases were systematically searched for eligible studies, using the key words 'inactivity', 'care facilities', and 'older adults', including their synonyms and MeSH terms. Additional studies were selected from references used in articles included from the search. Based on specific eligibility criteria, a total of 12 studies were included. Quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Based on studies using different methodologies (e.g., interviews and observations), and of different quality (assessed quality range: 25-100%), we report several aspects related to the physical environment and caregivers. Factors of the physical environment that may be related to physical inactivity included, among others, the environment's compatibility with the abilities of a resident, the presence of equipment, the accessibility, security, comfort, and aesthetics of the environment/corridors, and possibly the presence of some specific areas. Caregiver-related factors included staffing levels, the available time, and the amount and type of care being provided. Inactivity levels in residential care settings may be reduced by improving several features of the physical environment and with the help of caregivers. Intervention studies could be performed in order to gain more insight into causal effects of improving setting-related factors on

  12. Assessing STD Partner Services in State and Local Health Departments. (United States)

    Cuffe, Kendra M; Leichliter, Jami S; Gift, Thomas L


    State and local health department STD programs provide several partner services to reduce disease transmission. Budget cuts and temporary staff reassignments for public health emergencies may affect the provision of partner services. Determining the impact of staffing reductions on STD rates and public health response should be further assessed.

  13. Strategies for using international domain standards within a national context: The case of the Dutch temporary staffing industry

    NARCIS (Netherlands)

    Folmer, Erwin Johan Albert; van Bekkum, Michael; Verhoosel, Jack


    This paper will discuss strategies for using international domain standards within a national context. The various strategies are illustrated by means of a case study of the temporary staffing industry.

  14. Hospital nurse staffing and patient mortality, emotional exhaustion, and job dissatisfaction. (United States)

    Halm, Margo; Peterson, Michelle; Kandels, Mary; Sabo, Julie; Blalock, Miriam; Braden, Rebecca; Gryczman, Anna; Krisko-Hagel, Kathryn; Larson, Dave; Lemay, Diane; Sisler, Bette; Strom, Linda; Topham, Debra


    To conduct an investigation similar to a landmark study that investigated the association between nurse-to-patient ratio and patient mortality, failure-to-rescue, emotional exhaustion and job satisfaction of nurses. Cross-sectional analysis of 2709 general, orthopedic, and vascular surgery patients, and 140 staff nurses (42% response rate) caring for these patients in a large Midwestern institution. The main outcome measures were mortality, failure-to-rescue, emotional exhaustion, and job dissatisfaction. Staffing was not a significant predictor of mortality or failure-to-rescue, nor did clinical specialty predict emotional exhaustion or job dissatisfaction. Although these findings reinforce adequate staffing ratios at this institution, programs that support nurses in their daily practice and positively impact job satisfaction need to be explored. The Nursing Research Council not only has heightened awareness of how staffing ratios affect patient and nurse outcomes, but also a broader understanding of how the research process can be used to effectively shape nurse's practice and work environments.

  15. Staffing requirements for future small and medium reactors (SMRs) based on operating experience and projections

    International Nuclear Information System (INIS)


    At the time of this study there were about 160 small and medium sized nuclear power reactors (referred to as SMRs) in operation worldwide, and about 25 more under construction. Operation and maintenance costs for operating SMRs represent a substantial portion of the cost of electricity produced. Of these costs, the direct and indirect cost of staff represents the major cost component. In recent years, particularly since 1990, there has been increased interest in SMRs by many developing countries wishing to take advantage of nuclear power and several small and medium reactor designs are in various stages of development. To enhance the economic competitive position of SMRs relative to alternative methods of electricity generation, it is essential to ensure that new SMRs can be operated reliably and efficiently using the optimum number of staff. This publication reviews the lessons learned from the reactor operation, and the insights gained through the design of new SMRs, with a view to optimizing staffing in order to improve overall plant economics without compromising safety.This publication is intended to evaluate the estimated staffing size of various SMRs, the staff qualification and training required for the operation of future SMRs. and the key issues which impact the staffing requirements that should be considered in the development and deployment of future SMRs

  16. Benefits of High-Intensity Intensive Care Unit Physician Staffing under the Affordable Care Act

    Directory of Open Access Journals (Sweden)

    Sachin Logani


    Full Text Available The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform.

  17. [Staffing levels in medical radiation physics in radiation therapy in Germany. Summary of a questionnaire]. (United States)

    Leetz, Hans-Karl; Eipper, Hermann Hans; Gfirtner, Hans; Schneider, Peter; Welker, Klaus


    To get a general idea of the actual staffing level situation in medical radiation physics in 1999 a survey was carried out by the task-group "Personalbedarf" of Deutsche Gesellschaft für Medizinische Physik (DGMP) among all DGMP-members who are active in this field. Main components for equipment and activities are defined in Report 8 and 10 of DGMP for staffing requirements in medical radiation physics. 322 forms were sent out, 173 of them have been evaluated. From the answers regarding equipment and activities numbers for staff are calculated by the methods given in Report 8 and 10 for this spot check target and compared with effective staffing levels. The data of the spot check are then extrapolated on total Germany. The result is a calculated deficit of 865 medical physicists for the whole physics staff, 166 of them in radiation therapy. From the age distribution of DGMP-members and the calculated deficit resulted a training capacity of about 100 medical physicists at all per year (19 in radiation therapy) if the deficit shall be cut back in 10 years.

  18. The Leapfrog initiative for intensive care unit physician staffing and its impact on intensive care unit performance: a narrative review. (United States)

    Gasperino, James


    The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist. On a systems level, critical care services managed by an intensivist-led multidisciplinary team are now recognized by their ability to efficiently utilize hospital resources and improve patient outcomes. Due to the numerous cost and quality issues related to the delivery of critical care medicine, intensive care unit physician staffing (IPS) has become a charged subject in recent years. Although the federal government has played a large role in regulating best practices by physicians, other third parties have entered the arena. Perhaps the most influential of these has been The Leapfrog Group, a consortium representing 130 employers and 65 Fortune 500 companies that purchase health care for their employees. This group has proposed specific regulatory guidelines for IPS that are purported to result in substantial cost containment and improved quality of care. This narrative review examines the impact of The Leapfrog Group's recommendations on critical care delivery in the United States. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  19. E-Box. A residential gateway for cost saving and sustainability. Integration of Internet and ICT-networks for energy conservation services. Architecture and interface description of energy- and cost saving potential; E-Box. Een 'residential gateway' voor kostenbesparing en duurzaamheid. Integratie Internet en ICT-netwerken voor energiebesparingsdiensten. Architectuur en interface beschrijving Energie- en kostenbesparingspotentieel

    Energy Technology Data Exchange (ETDEWEB)

    Kamphuis, I.G. [ECN Duurzame Energie in de Gebouwde Omgeving DEGO, Petten (Netherlands)


    The results of a study on using new information and communication technology in small-scale energy management systems on the level of individual households are presented. Detailed requirements are formulated for such an energy management system. A hardware and software architecture is proposed based on existing standards for delivering service applications. A large part of the energy management functionality for such a E-box for energy efficiency and cost control has been implemented in a software prototype. The results of prototype simulation studies indicate that there is a cost saving potential and a potential for improved embedding of small scale, sustainable energy generators, if operations of appliances are co-ordinated in view of real-time market price signals. The potential (spread in cost plus or minus 15%) is highest for combined operation of small micro-CHP (Stirling motor powered or fuel cell installations) satisfying a house's heat demand with laundry washing and drying processes in a real time electricity pricing situation. A similar increase in cost effectiveness can be achieved, if buffering of energy-carriers (electricity or heat) is used. Possible market and business models for implementing the functionality of an E-box are dealt with and some possible implementation opportunities in a real-time price liberalised end user energy consumption market are discussed. [Dutch] De resultaten van een haalbaarheidsstudie naar de mogelijkheden van het gebruik van Internet-technologie en kleinschalige ICT-netwerken voor het opzetten van energie- en kosten-besparingsdiensten in woningen worden besproken. Vanuit de context van bestaande energie monitoring en management toepassingen in utiliteitsgebouwen wordt een vertaalslag gemaakt naar woningen. Aan de hand van een inventarisatie en definitie van een aantal voorbeeldtoepassingen is een globale vereistenspecificatie voor een energiemanagement systeem in woningen opgesteld. In deze vereistenspecificatie

  20. Designing a podiatry service to meet the needs of the population: a service simulation. (United States)

    Campbell, Jackie A


    A model of a podiatry service has been developed which takes into consideration the effect of changing access criteria, skill mix and staffing levels (among others) given fixed local staffing budgets and the foot-health characteristics of the local community. A spreadsheet-based deterministic model was chosen to allow maximum transparency of programming. This work models a podiatry service in England, but could be adapted for other settings and, with some modification, for other community-based services. This model enables individual services to see the effect on outcome parameters such as number of patients treated, number discharged and size of waiting lists of various service configurations, given their individual local data profile. The process of designing the model has also had spin-off benefits for the participants in making explicit many of the implicit rules used in managing their services.

  1. Is Theory Applied in Practice?A Stady of Linkage between Swedish MNC's Strategies and Húman Resource Staffing Policies


    Ivinger, Linnea; Lindvetter, Lisa


    Theory suggests that there is a linkage between strategies and human resource staffing policies. Our aim with the dissertation was to test if such a linkage could be proven in Swedish MNCs. Also, indications spoke for ethnocentric tendencies in MNCs. We wanted to test if this was the reality for Swedish companies. In order to test the linkage we had to categorise the companies’ strategies and human resource staffing policies. By a survey we concluded that there was not full consistency in the...

  2. 12 CFR 541.23 - Residential real estate. (United States)


    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Residential real estate. 541.23 Section 541.23... AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.23 Residential real estate. The terms residential real estate... home used in part for business); (c) Other real estate used for primarily residential purposes other...

  3. 12 CFR 541.16 - Improved residential real estate. (United States)


    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Improved residential real estate. 541.16... REGULATIONS AFFECTING FEDERAL SAVINGS ASSOCIATIONS § 541.16 Improved residential real estate. The term improved residential real estate means residential real estate containing offsite or other improvements...

  4. 78 FR 38810 - Proposed Information Collection (Application for Furnishing Long-Term Care Service to... (United States)


    ... (Application for Furnishing Long- Term Care Service to Beneficiaries of Veterans Affairs, and Residential Care.... 2900-0616.'' SUPPLEMENTARY INFORMATION: Title: Residential Care Home Program--Sponsor Application, VA... collection. Abstract: VA Form 10-2407 is an application used by a residential care facility or home that...

  5. The Design of an Effective Family Reintegration and Aftercare Program for Youth Successfully Leaving Residential Care. (United States)

    Roley, Jeffrey H.

    The lack of support services following the release of adolescent youths from a residential treatment center back to their families is examined in this practicum. Consequently, the development of a family reintegration program for the treatment center is focused on the concept that effective aftercare begins at intake. Understandably, families…

  6. 24 CFR 570.511 - Use of escrow accounts for rehabilitation of privately owned residential property. (United States)


    ... Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY... neighborhood-scale non-residential space within the same structure, if any, e.g., a store front below a... rehabilitation services costs under § 570.202(b)(9), are not permissible uses of escrowed funds. Such other...

  7. 24 CFR 1003.511 - Use of escrow accounts for rehabilitation of privately owned residential property. (United States)


    ... Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR PUBLIC AND... neighborhood-scale non-residential space within the same structure, if any, e.g., a store front below a... loan or grant, e.g., the grantee's administrative costs under § 1003.206 or rehabilitation services...

  8. Piloting a Therapeutic Residential for Children, Young People and Families Bereaved through Suicide in Northern Ireland (United States)

    Braiden, Hannah Jane; McCann, Monica; Barry, Helen; Lindsay, Carrie


    Families bereaved by suicide can experience an extremely intense and complicated grieving process. This can be associated with a range of difficulties and can put bereaved family members at risk of a range of problems. In recognition of this, Barnardo's Child Bereavement Service piloted a two-day residential programme (integrating separate…

  9. Budgeting for International Projects: In-Country Business Operations and Long-Term Residential Assignments. (United States)

    Richey, John B.


    A discussion of international sponsored research program administration looks at budgeting, costs, and procedures for both projects with in-country business operations in developing nations and projects with long-term residential assignments. It is intended for university administrators providing new services to faculty working on international…

  10. Perceptions of Personal Well-Being among Youth Accessing Residential or Intensive Home-Based Treatment (United States)

    Preyde, Michele; Watkins, Hanna; Ashbourne, Graham; Lazure, Kelly; Carter, Jeff; Penney, Randy; White, Sara; Frensch, Karen; Cameron, Gary


    The outcomes of youth accessing residential treatment or intensive home-based treatment are varied. Understanding youth's perceptions of their well-being may inform service. The purpose of this report was to explore perceptions of youth's mental health, life satisfaction, and outlook for the future. Youth reported ongoing struggles with mental…

  11. Determinants of establishment survival for residential trees in Sacramento County, CA (United States)

    Lara A. Roman; John J. Battles; Joe R. McBride


    Urban forests can provide ecosystem services that motivate tree planting campaigns, and tree survival is a key element of program success and projected benefits. We studied survival in a shade tree give-away program in Sacramento, CA, monitoring a cohort of young trees for five years on single-family residential properties. We used conditional inference trees to...

  12. Development of Residential SOFC Cogeneration System (United States)

    Ono, Takashi; Miyachi, Itaru; Suzuki, Minoru; Higaki, Katsuki


    Since 2001 Kyocera has been developing 1kW class Solid Oxide Fuel Cell (SOFC) for power generation system. We have developed a cell, stack, module and system. Since 2004, Kyocera and Osaka Gas Co., Ltd. have been developed SOFC residential co-generation system. From 2007, we took part in the "Demonstrative Research on Solid Oxide Fuel Cells" Project conducted by New Energy Foundation (NEF). Total 57 units of 0.7kW class SOFC cogeneration systems had been installed at residential houses. In spite of residential small power demand, the actual electric efficiency was about 40%(netAC,LHV), and high CO2 reduction performance was achieved by these systems. Hereafter, new joint development, Osaka Gas, Toyota Motors, Kyocera and Aisin Seiki, aims early commercialization of residential SOFC CHP system.

  13. Development of Residential SOFC Cogeneration System

    International Nuclear Information System (INIS)

    Ono, Takashi; Miyachi, Itaru; Suzuki, Minoru; Higaki, Katsuki


    Since 2001 Kyocera has been developing 1kW class Solid Oxide Fuel Cell (SOFC) for power generation system. We have developed a cell, stack, module and system. Since 2004, Kyocera and Osaka Gas Co., Ltd. have been developed SOFC residential co-generation system. From 2007, we took part in the 'Demonstrative Research on Solid Oxide Fuel Cells' Project conducted by New Energy Foundation (NEF). Total 57 units of 0.7kW class SOFC cogeneration systems had been installed at residential houses. In spite of residential small power demand, the actual electric efficiency was about 40%(netAC,LHV), and high CO2 reduction performance was achieved by these systems. Hereafter, new joint development, Osaka Gas, Toyota Motors, Kyocera and Aisin Seiki, aims early commercialization of residential SOFC CHP system.

  14. Forecasting residential electricity demand in provincial China. (United States)

    Liao, Hua; Liu, Yanan; Gao, Yixuan; Hao, Yu; Ma, Xiao-Wei; Wang, Kan


    In China, more than 80% electricity comes from coal which dominates the CO2 emissions. Residential electricity demand forecasting plays a significant role in electricity infrastructure planning and energy policy designing, but it is challenging to make an accurate forecast for developing countries. This paper forecasts the provincial residential electricity consumption of China in the 13th Five-Year-Plan (2016-2020) period using panel data. To overcome the limitations of widely used predication models with unreliably prior knowledge on function forms, a robust piecewise linear model in reduced form is utilized to capture the non-deterministic relationship between income and residential electricity consumption. The forecast results suggest that the growth rates of developed provinces will slow down, while the less developed will be still in fast growing. The national residential electricity demand will increase at 6.6% annually during 2016-2020, and populous provinces such as Guangdong will be the main contributors to the increments.

  15. Influence of Macroeconomic Factors on Residential Property ...

    African Journals Online (AJOL)


    exerted by macroeconomic factors on residential property returns in Abuja. The backward .... explanatory power and positive influence of employment and ...... Project. Management In Property Development: the Nigeria experience. Ibadan:.

  16. Plasma Processing of Model Residential Solid Waste (United States)

    Messerle, V. E.; Mossé, A. L.; Nikonchuk, A. N.; Ustimenko, A. B.; Baimuldin, R. V.


    The authors have tested the technology of processing of model residential solid waste. They have developed and created a pilot plasma unit based on a plasma chamber incinerator. The waste processing technology has been tested and prepared for commercialization.

  17. Architectural design of passive solar residential building

    Directory of Open Access Journals (Sweden)

    Ma Jing


    Full Text Available This paper studies thermal environment of closed balconies that commonly exist in residential buildings, and designs a passive solar residential building. The design optimizes the architectural details of the house and passive utilization of solar energy to provide auxiliary heating for house in winter and cooling in summer. This design might provide a more sufficient and reasonable modification for microclimate in the house.

  18. Business Case Analysis of the Walter Reed Army Medical Center Medical/Surgical Prime Vendor Generation III Service Level Electron Program

    National Research Council Canada - National Science Library

    Markot, Peter B


    ...) staffing and medical/surgical services offered under the Prime Vendor (PV) Generation III contract would provide the best supply chain management solution for Walter Reed Army Medical Center (WRAMC...

  19. Medical Physics Staffing Needs in Diagnostic Imaging and Radionuclide Therapy: An Activity Based Approach [Endorsed by International Organization for Medical Physics

    International Nuclear Information System (INIS)


    Over the last decades, the rapid technological development of diagnostic and interventional radiology and nuclear medicine has made them major tools of modern medicine. However, at the same time the involved risks, the growing number of procedures and the increasing complexity of the procedures require competent professional staff to ensure safe and effective patient diagnosis, treatment and management. Medical physicists (or clinically qualified medical physicists) have been recognized as vital health professionals with important and clear responsibilities related to quality and safety of applications of ionizing radiation in medicine. This publication describes an algorithm developed to determine the recommended staffing levels for clinical medical physics services in medical imaging and radionuclide therapy, based on current best practice, as described in international guidelines.

  20. Dental Care Utilization and Satisfaction of Residential University Students

    Directory of Open Access Journals (Sweden)

    Bamise CT


    Full Text Available Aim: The objective of this study was to provide information on the level of utilization and satisfaction of residential university students with the dental services provided by the dental clinic of a teaching hospital. Volunteers and Material: A stratified sampling technique was used to recruit volunteers from the outpatient clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Information was collected by a self-administered questionnaire composed of questions that measure the level of utilization and satisfaction with the dental services provided. Questionnaires were provided to 650 randomly chosen students residing in the University hostels. There were 39 refusals, and 6 incomplete questionnaires were discarded. This left a sample size of 605 volunteers. Results: Forty seven students (7.8% indicated that they visited the dental hospital within the last 12 months. Males and females utilized the dental services equally, and utilization increased with age and the number of years spent on campus. Anticipation of painful dental treatment, high dental charges, long waiting times and being too busy for a dental visit were cited as the most important impediments to seeking dental treatment. Females expressed greater satisfaction with the services. Conclusion: Dental service utilization among the students was found to be low. Oral health awareness campaigns, improving the quality of the services, and shortening the waiting time are expected to increase service utilization and satisfaction.

  1. The 1986 residential occupant survey

    Energy Technology Data Exchange (ETDEWEB)

    Ivey, D.L.; Alley, P.K.


    In 1986, Pacific Northwest Laboratory developed the Residential Occupant Survey-Spring '86, which was implemented. The overall purpose of the study was to collect demographic, attitudinal, and behavioral data related to the use and conservation of electricity in dwellings participating in the Bonneville Power Administration's End-Use Load and Conservation Assessment Program (ELCAP). Information was collected on the respondents' perceptions of the energy efficiency of their dwelling, temperature the dwelling was kept when people were at home and awake during the last heating season, which rooms, if any, were not heated during the last heating season, number of times the dwelling was unoccupied for at least one week, number of times pets were let out of the dwelling per day, attitudes toward energy use and conservation and several socio-demographic variables such as age, sex, and total household income. The results of the data analyses showed age to be an important factor for reported indoor temperature and perceived energy efficiency of the dwelling. The results also showed that almost 60% of the ELCAP occupants do not heat one or more rooms during the heating season, and almost 45% of the ELCAP dwellings were unoccupied for at least one week during the reporting period. In terms of the reported allocation of household income for household energy expenses, the results showed that the reported dollar amount spent for the expenses remained relatively constant over income levels.

  2. 25 CFR 20.502 - Can Child Assistance funds be used to place Indian children in residential care facilities? (United States)


    ... 25 Indians 1 2010-04-01 2010-04-01 false Can Child Assistance funds be used to place Indian children in residential care facilities? 20.502 Section 20.502 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance How...

  3. Library 2.0: Service for the Next-Generation Library (United States)

    Casey, Michael E.; Savastinuk, Laura C.


    Libraries are changing. Funding limits and customer demands are transforming staffing levels, service models, access to resources, and services to the public. Administrators and taxpayers are seeking more efficient ways of delivering services to achieve greater returns on financial investments. In this article, the author discusses the benefits of…

  4. Assessment of activities performed by clinical nurse practitioners and implications for staffing and patient care at primary health care level in South Africa

    Directory of Open Access Journals (Sweden)

    Jude Igumbor


    Full Text Available Background: The shortage of nurses in public healthcare facilities in South Africa is well documented; finding creative solutions to this problem remains a priority. Objective: This study sought to establish the amount of time that clinical nurse practitioners (CNPs in one district of the Western Cape spend on clinical services and the implications for staffing and skills mix in order to deliver quality patient care. Methods: A descriptive cross-sectional study was conducted across 15 purposively selected clinics providing primary health services in 5 sub-districts. The frequency of activities and time CNPs spent on each activity in fixed and mobile clinics were recorded. Time spent on activities and health facility staff profiles were correlated and predictors of the total time spent by CNPs with patients were identified. Results: The time spent on clinical activities was associated with the number of CNPs in the facilities. CNPs in fixed clinics spent a median time of about 13 minutes with each patient whereas CNPs in mobile clinics spent 3 minutes. Fixed-clinic CNPs also spent more time on their non-core functions than their core functions, more time with patients, and saw fewer patients compared to mobile-clinic CNPs. Conclusions: The findings give insight into the time CNPs in rural fixed and mobile clinics spend with their patients, and how patient caseload may affect consultation times. Two promising strategies were identified – task shifting and adjustments in health workerd eployment – as ways to address staffing and skills mix, which skills mix creates the potential for using healthcare workers fully whilst enhancing the long-term health of these rural communities.

  5. Medical services at a music festival. (United States)

    Streat, S; McCallum, J A; Boswell, R; Hunton, R


    A three-day open air musical festival attended by approximately 20 000 people was held at Ngaruawahia in January 1973. A medical service was provided and staffed mainly by medical students, nurses and young medical graduates. There were 1998 patient visits to the medical area, the five most common complaints being sunburn, headaches, minor foot trauma, gastroenteritis and lacerations which collectively accounted for 75 percent of the diagnoses. The medical services provided are discussed and recommendations for future festivals made.

  6. The Association of Team-Specific Workload and Staffing with Odds of Burnout Among VA Primary Care Team Members. (United States)

    Helfrich, Christian D; Simonetti, Joseph A; Clinton, Walter L; Wood, Gordon B; Taylor, Leslie; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Fihn, Stephan D; Nelson, Karin M


    Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians. To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams. We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014. Primary care personnel at VA clinics responding to a national survey. Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity). There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition. Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.

  7. Productivity Commission Submission to the Review of Pricing Arrangements in Residential Aged Care


    Productivity Commission


    The Commission’s submission to the Review of Pricing Arrangements for Residential Aged Care draws on earlier work, including its inquiry into Nursing Home Subsidies and a major conference on Policy Implications of the Ageing of Australia’s Population. The submission provides an assessment of the current funding and service delivery arrangements for aged care services; an analysis of the implications of ageing, trends in disability rates and other key influences on the future demand for and co...

  8. Cable networks, services, and management

    CERN Document Server


    Cable Networks, Services, and Management is the first book to cover cable networks, services, and their management, in-depth, for network operators, engineers, researchers, and students. Thirteen experts in various fields have contributed their knowledge of network architectures and services, Operations, Administration, Maintenance, Provisioning, Troubleshooting (OAMPT) for residential and business services, cloud, Software Defined Networks (SDN), as well as virtualization concepts and their applications as part of the future directions of cable networks. The book begins by introducing architecture and services for Data Over Cable Service Interface Specification (DOCSIS) 3.0/ 3.1, Converged Cable Access Platform (CCAP), Content Distribution Networks (CDN, IP TV, and Packet Cable and Wi-Fi for Residential Services. Topics that are discussed in proceeding chapters include: operational systems and management architectures, service orders, provisioning, fault manageme t, performance management, billing systems a...

  9. Strategic Staffing (United States)

    Clark, Ann B.


    Business and industry leaders do not flinch at the idea of placing top talent in struggling departments and divisions. This is not always the case in public education. The Charlotte-Mecklenburg Schools made a bold statement to its community in its strategic plan by identifying two key reform levers--(1) an effective principal leading each school;…

  10. Integrated Payment And Delivery Models Offer Opportunities And Challenges For Residential Care Facilities. (United States)

    Grabowski, David C; Caudry, Daryl J; Dean, Katie M; Stevenson, David G


    Under health care reform, new financing and delivery models are being piloted to integrate health and long-term care services for older adults. Programs using these models generally have not included residential care facilities. Instead, most of them have focused on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with matched individuals in the community and nursing home, and rates of functional dependency that fall between those of their counterparts in the other two settings. These results suggest that the residential care facility population could benefit greatly from models that coordinated health and long-term care services. However, few providers have invested in the infrastructure needed to support integrated delivery models. Challenges to greater care integration include the private-pay basis for residential care facility services, which precludes shared savings from reduced Medicare costs, and residents' preference for living in a home-like, noninstitutional environment. Project HOPE—The People-to-People Health Foundation, Inc.

  11. Ontario: linking nursing outcomes, workload and staffing decisions in the workplace: the Dashboard Project. (United States)

    Fram, Nancy; Morgan, Beverley


    Research shows that nurses want to provide more input into assessing patient acuity, changes in patient needs and staffing requirements. The Dashboard Project involved the further development and application of an electronic monitoring tool that offers a single source of nursing, patient and organizational information. It is designed to help inform nurse staffing decisions within a hospital setting. The Dashboard access link was installed in computers in eight nursing units within the Hamilton Health Sciences (HHS) network. The Dashboard indicators are populated from existing information/patient databases within the Decision Support Department at HHS. Committees composed of the unit manager, staff nurses, project coordinator, financial controller and an information controller met regularly to review the Dashboard indicators. Participants discussed the ability of the indicators to reflect their patients' needs and the feasibility of using the indicators to inform their clinical staffing plans. Project findings suggest that the Dashboard is a work in progress. Many of the indicators that had originally been incorporated were refined and will continue to be revised based on suggestions from project participants and further testing across HHS. Participants suggested the need for additional data, such as the time that nurses are off the unit (for code blue response, patient transfers and accompanying patients for tests); internal transfers/bed moves to accommodate patient-specific issues and particularly to address infection control issues; deaths and specific unit-centred data in addition to the generic indicators. The collaborative nature of the project enabled staff nurses and management to work together on a matter of high importance to both, providing valuable recommendations for shared nursing and interprofessional planning, further Dashboard development and project management.

  12. Unbundling the retail gas market: Current activities and guidance for serving residential and small customers

    Energy Technology Data Exchange (ETDEWEB)

    Costello, K.W.; Lemon, J.R.


    The restructuring of retail gas services has followed a typical pattern for previously heavily regulated industries: large customers are initially given rights to purchase unbundled services from different entities, with the same rights dispersed over time to smaller customers. For about ten years now industrial customers in most states have been able to {open_quotes}play the market{close_quotes}. Since the passage of the Federal Energy Regulatory Commission (FERC) Order 636 in 1992, interest has centered on expanding service unbundling to small retail customers, including residential customers. Importantly, the Order prohibited pipelines from providing bundled sales service. This is not surprising - in the telecommunications industry, for example, the unbundling of wholesale services was a strong stimulant for developing competition in the local exchange market. The push for small-customer service unbundling has derived from the basic but politically attractive idea that all retail customers should directly benefit from competitive forces in the natural gas industry. When one looks at the movement of prices since 1985, it is easy to see that large retail customers have enjoyed more favorable prices than other retail customers. For example, over the period 1985 to 1994 gas prices to industrial customers and electric utilities fell around 23 percent and 36 percent, respectively. In comparison, gas prices to residential customers increased by around 5 percent while gas prices to commercial customers decreased slightly by about 1 percent. This report examines various aspects of unbundling to small retail gas customers, with special emphasis on residential customers.

  13. Unbundling the retail gas market: Current activities and guidance for serving residential and small customers

    International Nuclear Information System (INIS)

    Costello, K.W.; Lemon, J.R.


    The restructuring of retail gas services has followed a typical pattern for previously heavily regulated industries: large customers are initially given rights to purchase unbundled services from different entities, with the same rights dispersed over time to smaller customers. For about ten years now industrial customers in most states have been able to open-quotes play the marketclose quotes. Since the passage of the Federal Energy Regulatory Commission (FERC) Order 636 in 1992, interest has centered on expanding service unbundling to small retail customers, including residential customers. Importantly, the Order prohibited pipelines from providing bundled sales service. This is not surprising - in the telecommunications industry, for example, the unbundling of wholesale services was a strong stimulant for developing competition in the local exchange market. The push for small-customer service unbundling has derived from the basic but politically attractive idea that all retail customers should directly benefit from competitive forces in the natural gas industry. When one looks at the movement of prices since 1985, it is easy to see that large retail customers have enjoyed more favorable prices than other retail customers. For example, over the period 1985 to 1994 gas prices to industrial customers and electric utilities fell around 23 percent and 36 percent, respectively. In comparison, gas prices to residential customers increased by around 5 percent while gas prices to commercial customers decreased slightly by about 1 percent. This report examines various aspects of unbundling to small retail gas customers, with special emphasis on residential customers

  14. Differences between Residential and Non-Residential Fathers on Sexual Socialisation of African American Youth (United States)

    Sneed, Carl D.; Willis, Leigh A.


    This study investigated differences between residential and non-residential fathers on topics discussed during father-child sex communication and factors associated with child sexual socialisation. Young people (N = 159, 53% female) provided self-reports using computer surveys on the role of their fathers on father-child sex communication, general…

  15. Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics. (United States)

    Everhart, Damian; Schumacher, Jessica R; Duncan, R Paul; Hall, Allyson G; Neff, Donna F; Shorr, Ronald I


    Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time. The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups. We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression. A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group. Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able

  16. Implementing an Assessment Clinic in a Residential PTSD Program

    Directory of Open Access Journals (Sweden)

    Joan McDowell


    Full Text Available Creating useful treatment plans can help improve services to consumers of mental health services. As more evidence-based practices are implemented, deciding what treatment, at what time, for whom becomes an important factor in facilitating positive outcomes. Readiness for trauma-focused treatments for Posttraumatic Stress Disorder (PTSD such as Cognitive Processing Therapy or Prolonged Exposure Therapy may influence whether an individual can successfully complete either protocol. In addition, components of adjunctive therapies such as Acceptance and Commitment Therapy or Dialectical Behavior Therapy may be useful in moving a particular patient toward readiness and successful completion of treatment. Psychological assessment adds valuable data to inform these types of treatment decisions. This paper describes the implementation of a psychological assessment clinic in a residential PTSD treatment setting. Barriers to implementation, use of the data, and Veterans’ reactions to the feedback provided to them are included.

  17. Post-Retrofit Residential Assessments

    Energy Technology Data Exchange (ETDEWEB)

    Lancaster, Ross; lutzenhiser, Loren; Moezzi, Mithra; Widder, Sarah H.; Chandra, Subrato; Baechler, Michael C.


    This study examined a range of factors influencing energy consumption in households that had participated in residential energy-efficiency upgrades. The study was funded by a grant from the U.S. Department of Energy’s Pacific Northwest National Laboratory and was conducted by faculty and staff of Portland State University Center for Urban Studies and Department of Economics. This work was made possible through the assistance and support of the Energy Trust of Oregon (ETO), whose residential energy-efficiency programs provided the population from which the sample cases were drawn. All households in the study had participated in the ETO Home Performance with Energy Star (HPwES) program. A number of these had concurrently pursued measures through other ETO programs. Post-retrofit energy outcomes are rarely investigated on a house-by-house basis. Rather, aggregate changes are ordinarily the focus of program impact evaluations, with deviation from aggregate expectations chalked up to measurement error, the vagaries of weather and idiosyncrasies of occupants. However, understanding how homes perform post-retrofit on an individual basis can give important insights to increase energy savings at the participant and the programmatic level. Taking a more disaggregated approach, this study analyzed energy consumption data from before and after the retrofit activity and made comparisons with engineering estimates for the upgrades, to identify households that performed differently from what may have been expected based on the estimates. A statistical analysis using hierarchal linear models, which accounted for weather variations, was performed looking separately at gas and electrical use during the periods before and after upgrades took place. A more straightforward comparison of billing data for 12-month periods before and after the intervention was also performed, yielding the majority of the cases examined. The later approach allowed total energy use and costs to be

  18. Effects of Heterogeneity in Residential Preferences on an Agent-Based Model of Urban Sprawl

    Directory of Open Access Journals (Sweden)

    Daniel G. Brown


    Full Text Available The ability of agent-based models (ABMs to represent heterogeneity in the characteristics and behaviors of actors enables analyses about the implications of this heterogeneity for system behavior. The importance of heterogeneity in the specification of ABMs, however, creates new demands for empirical support. An earlier analysis of a survey of residential preferences within southeastern Michigan revealed seven groups of residents with similar preferences on similar characteristics of location. In this paper, we present an ABM that represents the process of residential development within an urban system and run it for a hypothetical pattern of environmental variation. Residential locations are selected by residential agents, who evaluate locations on the basis of preference for nearness to urban services, including jobs, aesthetic quality of the landscape, and their similarity to their neighbors. We populate our ABM with a population of residential preferences drawn from the survey results in five different ways: (1 preferences drawn at random; (2 equal preferences based on the mean from the entire survey sample; (3 preferences drawn from a single distribution, whose mean and standard deviation are derived from the survey sample; (4 equal preferences within each of seven groups, based on the group means; and (5 preferences drawn from distributions for each of seven groups, defined by group means and standard deviations. Model sensitivity analysis, based on multiple runs of our model under each case, revealed that adding heterogeneity to agents has a significant effect on model outcomes, measured by aggregate patterns of development sprawl and clustering.

  19. Modeling and analysis of long term energy demands in residential sector of pakistan

    International Nuclear Information System (INIS)

    Rashid, T.; Sahir, M.H.


    Residential sector is the core among the energy demand sectors in Pakistan. Currently, various techniques are being used worldwide to assess future energy demands including integrated system modeling (ISM). Therefore, the current study is focused on implementation of ISM approach for future energy demand analysis of Pakistan's residential sector in terms of increase in population, rapid urbanization, household size and type, and increase/decrease in GDP. A detailed business-as-usual (BAU) model is formulated in TIMES energy modeling framework using different factors like growth in future energy services, end-use technology characterization, and restricted fuel supplies. Additionally, the developed model is capable to compare the projected energy demand under different scenarios e.g. strong economy, weak economy and energy efficiency. The implementation of ISM proved a viable approach to predict the future energy demands of Pakistan's residential sector. Furthermore, the analysis shows that the energy consumption in the residential sector would be 46.5 Mtoe (Million Ton of Oil Equivalent) in 2040 compared to 23 Mtoe of the base year (2007) along with 600% increase in electricity demands. The study further maps the potential residential energy policies to congregate the future demands. (author)

  20. System reliability worth assessment at a midwest utility-survey results for residential customers

    Energy Technology Data Exchange (ETDEWEB)

    Chowdhury, A.A.; Mielnik, T.C. [Electric System Planning, MidAmerican Energy Company, Davenport, Iowa (United States); Lawton, L.E.; Sullivan, M.J.; Katz, A. [Population Research Systems, San Francisco, CA (United States)


    This paper presents the overall results of a residential customer survey conducted in service areas of MidAmerican Energy Company, a Midwest utility. A similar survey was conducted concurrently in the industrial, commercial and institutional sectors and the survey results are presented in a companion paper. The results of this study are compared with the results of other studies performed in the high cost areas of the US east and west coasts. This is the first ever study of this nature performed for the residential customers in the US Midwest region. Methodological differences in the study design compared to coastal surveys are discussed. Customer survey costing techniques can be categorized into three main groups: contingent valuation techniques, direct costing techniques and indirect costing techniques. Most customer surveys conducted by different organizations in the last two decades used a combination of all three techniques. The selection of a technique is mainly dependent on the type of customer being surveyed. In this MidAmerican study, contingent valuation techniques and an indirect costing technique have been used, as most consequences of power outages to residential users are related to inconvenience or disruption of housekeeping and leisure activities that are intangible in nature. The major contribution of this paper is that particulars of Midwest residential customers compared to residential customers of coastal utilities are noted and customer responses on power quality issues that are important to customers are summarized. (author)

  1. Impact of Rate Design Alternatives on Residential Solar Customer Bills. Increased Fixed Charges, Minimum Bills and Demand-based Rates

    Energy Technology Data Exchange (ETDEWEB)

    Bird, Lori [National Renewable Energy Lab. (NREL), Golden, CO (United States); Davidson, Carolyn [National Renewable Energy Lab. (NREL), Golden, CO (United States); McLaren, Joyce [National Renewable Energy Lab. (NREL), Golden, CO (United States); Miller, John [National Renewable Energy Lab. (NREL), Golden, CO (United States)


    With rapid growth in energy efficiency and distributed generation, electric utilities are anticipating stagnant or decreasing electricity sales, particularly in the residential sector. Utilities are increasingly considering alternative rates structures that are designed to recover fixed costs from residential solar photovoltaic (PV) customers with low net electricity consumption. Proposed structures have included fixed charge increases, minimum bills, and increasingly, demand rates - for net metered customers and all customers. This study examines the electricity bill implications of various residential rate alternatives for multiple locations within the United States. For the locations analyzed, the results suggest that residential PV customers offset, on average, between 60% and 99% of their annual load. However, roughly 65% of a typical customer's electricity demand is non-coincidental with PV generation, so the typical PV customer is generally highly reliant on the grid for pooling services.

  2. Prevention and management of "do not return" notices: a quality improvement process for supplemental staffing nursing agencies. (United States)

    Ade-Oshifogun, Jochebed Bosede; Dufelmeier, Thaddeus


    This article describes a quality improvement process for "do not return" (DNR) notices for healthcare supplemental staffing agencies and healthcare facilities that use them. It is imperative that supplemental staffing agencies partner with healthcare facilities in assuring the quality of supplemental staff. Although supplemental staffing agencies attempt to ensure quality staffing, supplemental staff are sometimes subjectively evaluated by healthcare facilities as "DNR." The objective of this article is to describe a quality improvement process to prevent and manage "DNR" within healthcare organizations. We developed a curriculum and accompanying evaluation tool by adapting Rampersad's problem-solving discipline approach: (a) definition of area(s) for improvement; (b) identification of all possible causes; (c) development of an action plan; (d) implementation of the action plan; (e) evaluation for program improvement; and (f) standardization of the process. Face and content validity of the evaluation tool was ascertained by input from a panel of experienced supplemental staff and nursing faculty. This curriculum and its evaluation tool will have practical implications for supplemental staffing agencies and healthcare facilities in reducing "DNR" rates and in meeting certification/accreditation requirements. Further work is needed to translate this process into future research. © 2012 Wiley Periodicals, Inc.

  3. Nurses experiences regarding staffing patterns in the surgical wards of a private hospital in Gauteng South Africa

    Directory of Open Access Journals (Sweden)

    Moloko Malatji


    Purpose: The purpose of this study was to explore and describe nurses' experiences regarding staffing patterns in the surgical wards of a private hospital in Gauteng in order to develop recommendations for staffing patterns in these wards. Methodology: A qualitative, exploratory, descriptive and contextual research design was used. Data was collected by means of in-depth semi structured individual interviews from a purposive sample of professional nurses working in the surgical wards of this hospital. Data was analysed using Tesch's method of qualitative thematic analysis. Principles of trustworthiness and ethical principles to ensure the protection of human rights were applied throughout the study. Results: The findings of the study revealed one central theme which reflected that participants experienced the staffing patterns of the surgical wards negatively. Two main themes emerged as, nurses had negative experiences in the surgical wards as well as negative emotional experiences related to the staffing patterns. Conclusion: It is evident from the findings of the study that nurses are experiencing staffing patterns negatively.

  4. Electric and gas utility marketing of residential energy conservation case studies

    Energy Technology Data Exchange (ETDEWEB)



    The objective of this research was to obtain information about utility conservation marketing techniques from companies actively engaged in performing residential conservation services. Many utilities currently are offering comprehensive services (audits, listing of contractors and lenders, post-installation inspection, advertising, and performing consumer research). Activities are reported for the following utilities: Niagara Mohawk Power Corporation; Tampa Electric Company; Memphis Light, Gas, and Water Division; Northern States Power-Wisconsin; Public Service Company of Colorado; Arizona Public Service Company; Pacific Gas and Electric Company; Sacramento Municipal Utility District; and Pacific Power and Light Company.


    Directory of Open Access Journals (Sweden)

    O. Petrenko


    Full Text Available In all countries across the world macroeconomic shift from the production of physical things (agriculture and manufactured goods to execution of the service of public service. In headmost countries more than 70% of GDP forms by service industry, in which over half of mankind is working today (according to the information of International Labor Organization. The science of services that occurred recently upon an initiative of IBM firm, designed to explore the main principles of functioning complex services systems, ways of creation, scaling and improving such systems. In this paper considered the questions of penetration the services in engineering systems (particularly, in software structures capabilities of the engineering and staffing processes of creating and maintaining of system services.

  6. Nursing Services Delivery Theory: an open system approach. (United States)

    Meyer, Raquel M; O'Brien-Pallas, Linda L


    This paper is a discussion of the derivation of the Nursing Services Delivery Theory from the application of open system theory to large-scale organizations. The underlying mechanisms by which staffing indicators influence outcomes remain under-theorized and unmeasured, resulting in a 'black box' that masks the nature and organization of nursing work. Theory linking nursing work, staffing, work environments, and outcomes in different settings is urgently needed to inform management decisions about the allocation of nurse staffing resources in organizations. A search of CINAHL and Business Source Premier for the years 1980-2008 was conducted using the following terms: theory, models, organization, organizational structure, management, administration, nursing units, and nursing. Seminal works were included. The healthcare organization is conceptualized as an open system characterized by energy transformation, a dynamic steady state, negative entropy, event cycles, negative feedback, differentiation, integration and coordination, and equifinality. The Nursing Services Delivery Theory proposes that input, throughput, and output factors interact dynamically to influence the global work demands placed on nursing work groups at the point of care in production subsystems. THE Nursing Services Delivery Theory can be applied to varied settings, cultures, and countries and supports the study of multi-level phenomena and cross-level effects. The Nursing Services Delivery Theory gives a relational structure for reconciling disparate streams of research related to nursing work, staffing, and work environments. The theory can guide future research and the management of nursing services in large-scale healthcare organizations. © 2010 Blackwell Publishing Ltd.

  7. Integration of fuel cells into residential buildings

    International Nuclear Information System (INIS)

    Bell, J.M.; Entchev, E.; Gusdorf, J.; Szadkowski, F.; Swinton, M.; Kalbfleisch, W.; Marchand, R.


    Integration of small combined heat and power systems (CHP) into residential buildings is challenging as the loads are small, the load diversity is limited and there are a number of unresolved issues concerning sizing, control, peak loads, emergency operation, grid connection and export, etc. Natural Resources Canada has undertaken an initiative to investigate and develop techniques for the integration of small CHP systems into residential buildings using a highly instrumented house modified to allow quick installation and thorough monitoring of CHP integration techniques as well determining the performance of the CHP systems themselves when operating in a house. The first CHP system installed was a Stirling engine residential CHP system. It was used to examine the completeness of the CHP modifications to the house, to evaluate various building integration techniques and to measure the performance of the CHP system itself. The testing demonstrated the modified house to be an excellent facility for the development of CHP building integration techniques and the testing of residential CHP systems. The Stirling engine CHP system was found to operate well and produce meaningful input to the house. A second system (residential fuel cell) is presently being installed and building integration techniques and the performance of the fuel cell will be tested over the coming year. (author)

  8. Residentialization of Public Spaces: Bratislava Example (United States)

    Bacová, Andrea; Puškár, Branislav; Vráblová, Edita


    The housing estates in Bratislava saturated the housing needs of a large number of inhabitants who come after World War II to the city. Design of public spaces often did not have priority in the process of designing. The solutions for mentioned exterior spaces had been planned after blocks of flat realization, but many of them are not realized to this day. The article analyzes the example of the unrealized public spaces in existing housing estates Devinska Nova Ves and Petržalka (city districts of Bratislava) and offer practical solutions in relation to residencialization method. Residencialization of missing public places is an effective method of adding identities to settlements. It improves the quality of residential environment and public spaces. The main aim is to create better conditions for social activities in public areas, which are missing on the present. The research will be focused on the examination of the urban, cultural and construction potential of the existing residential enviroment in Bratislava. The main aim of residentialization is not only to enhance the quality of spatial and building structures in the selected residential area and maintain long-term sustainability in the pertinent programme area, but mainly to improve the quality of living for the residents. The outputs of the project are proposals and practical procedures developed with regard to planning documents for local municipal authorities and regional organizations. The solutions will have a positive impact on the enhancement of the quality of public spaces, attractive social activities and of a conceptual link - residentialization.

  9. Managed land settlement process: "Thought piece" on basic services

    CSIR Research Space (South Africa)

    Wall, K


    Full Text Available – the higher the residential densities, the more likely it is that a public transport operation will find it financially viable to provide a service that will reach physically closer to each individual household. And of course reduction in unit costs... levels, and before investments are made. Returning for a moment to site-specific characteristics. These are of fundamental importance, rendering some sites unsuitable for residential development, or relatively expensive for residential development...

  10. Home health care agency staffing patterns before and after the Balanced Budget Act of 1997, by rural and urban location. (United States)

    McAuley, William J; Spector, William; Van Nostrand, Joan


    The Balanced Budget Act (BBA) of 1997 and other recent policies have led to reduced Medicare funding for home health agencies (HHAs) and visits per beneficiary. We examine the staffing characteristics of stable Medicare-certified HHAs across rural and urban counties from 1996 to 2002, a period encompassing the changes associated with the BBA and related policies. Data were drawn from Medicare Provider of Service files and the Area Resource File. The unit of analysis was the 3,126 counties in the United States, grouped into 5 categories: metropolitan, nonmetropolitan adjacent, and 3 nonmetropolitan nonadjacent groups identified by largest town size. Only relatively stable HHAs were included. We generated summary HHA staff statistics for each county group and year. All staff categories, other than therapists, declined from 1997 to 2002 across the metropolitan and nonmetropolitan county groupings. There were substantial population-adjusted decreases in stable HHA-based home health aides in all counties, including remote counties. The limited presence of stable HHA staff in certain nonmetropolitan county types has been exacerbated since implementation of the BBA, especially in the most rural counties. The loss of aides in more rural counties may limit the availability of home-based long-term care in these locations, where the need for long-term care is considerable. Future research should examine the degree to which the presence of HHA staff influences actual access and whether other paid and unpaid sources of care substitute for Medicare home health care in counties with limited supplies of HHA staff.

  11. Lessons learned from Gen II NPP staffing approaches applicable to new reactors - 15003

    International Nuclear Information System (INIS)

    Goodnight, C.


    This paper discusses lessons learned from the operation of the Gen II fleet of existing nuclear power plants (NPPs), in terms of staffing, that can be applied to the final design, deployment, and operation of new reactor designs. The most significant of these lessons is the need to appropriately staff the facility, having the right number of people with the required skills and experience. This begs the question of how to identify those personnel requirements. For NPPs, there are five key factors that ultimately will determine the effectiveness and costs of operating nuclear power plants (NPPs): 1) The Nuclear Steam Supply System (NSSS) and the layout of the plant site; 2) The processes which the operating organization applies; 3) The organizational structure of the operating organization; 4) The organizational culture of the operating organization, and 5) The regulatory framework under which the licensee must operate. In summary, this paper identifies opportunities to minimize staffing and costs learned from Gen II NPPs that may be applicable for new nuclear plants. (author)


    Directory of Open Access Journals (Sweden)

    Agus Arianto Toly


    Full Text Available The high level of turnover intentions by accountant staffs had raised the potential cost for public accountant firms. The prior research done by Suwandi and Indriantoro (1999 had succesfully identified the process of turnover intentions, which related to the antecedents and consequences of job insecurity. The responses of 30 accountant staffs from some public accountant firms to a questionnaire designed to measure variables were analyzed using a Pearson's correlation coefficient. The result of this study was not generally consistent with Suwandi and Indriantoro (1999 because some hypotheses were rejected. This study identified that public accountant firm must be noticed organizational factors, such as organizational commitment, role conflict, role ambiguity, and organizational change. Abstract in Bahasa Indonesia : Tingkat keinginan berpindah yang tinggi para staf akuntan telah menimbulkan biaya potensial untuk Kantor Akuntan Publik (KAP. Penelitian sebelumnya yang dilakukan oleh Suwandi dan Indriantoro (1999 telah berhasil mengidentifikasi proses keinginan berpindah, yang berhubungan dengan anteseden dan konsekuensi dari ketidakamanan kerja. Respon 30 staf akuntan dari beberapa KAP terhadap kuesioner yang dibuat untuk mengukur berbagai variabel, dianalisis menggunakan kofisien korelasi Pearson. Hasil dari studi ini secara umum tidak konsisten dengan Suwandi dan Indriantoro (1999 karena ditolaknya beberapa hipotesis. Studi ini mengidentifikasi bahwa KAP harus memberi perhatian terhadap beberapa faktor organisasional, seperti komitmen organisasional, konflik peran, ketidakjelasan peran, dan perubahan organisasional. Kata kunci: konflik peran; ketidakjelasan peran; perubahan organisasional; ketidakamanan kerja; komitmen organisasional; keinginan berpindah.

  13. Workload and time management in central cancer registries: baseline data and implication for registry staffing. (United States)

    Chapman, Susan A; Mulvihill, Linda; Herrera, Carolina


    The Workload and Time Management Survey of Central Cancer Registries was conducted in 2011 to assess the amount of time spent on work activities usually performed by cancer registrars. A survey including 39 multi-item questions,together with a work activities data collection log, was sent by email to the central cancer registry (CCR) manager in each of the 50 states and the District of Columbia. Twenty-four central cancer registries (47%) responded to the survey.Results indicate that registries faced reductions in budgeted staffing from 2008-2009. The number of source records and total cases were important indicators of workload. Four core activities, including abstracting at the registry, visual editing,case consolidation, and resolving edit reports, accounted for about half of registry workload. We estimate an average of 12.4 full-time equivalents (FTEs) are required to perform all cancer registration activities tracked by the survey; however,estimates vary widely by registry size. These findings may be useful for registries as a benchmark for their own registry workload and time-management data and to develop staffing guidelines.

  14. Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing. (United States)

    Pelt, Christopher E; Anderson, Mike B; Pendleton, Robert; Foulks, Matthew; Peters, Christopher L; Gililland, Jeremy M


    An early physical therapy (PT) care pathway was implemented to provide same-day ambulation after total joint arthroplasty by changing PT staffing hours. After receiving an exemption from our institutional review board, we performed a secondary data analysis on a cohort of patients that underwent primary TJA of the hip or knee 6 months before and 12 months after implementation of the change. Data on same-day ambulation rates, length of stay (LOS), and in-hospital costs were reviewed. Early evaluation and mobilization of patients by PT improved on postoperative day (POD) 0 from 64% to 85% after the change ( P ≤ .001). The median LOS before the change was 3.27 days compared to 3.23 days after the change ( P  = .014). Patients with higher American Society of Anesthesiologists scores were less likely to ambulate on POD 0 ( P  = .038) and had longer hospital stays ( P < .001). Early mobilization in the entire cohort was associated with a greater cost savings ( P < .001). A relatively simple change to staffing hours, using resources currently available to us, and little additional financial or institutional investment resulted in a significant improvement in the number of patients ambulating on POD 0, with a modest reduction in both LOS and inpatient costs.

  15. Enhancing Nursing Staffing Forecasting With Safety Stock Over Lead Time Modeling. (United States)

    McNair, Douglas S


    In balancing competing priorities, it is essential that nursing staffing provide enough nurses to safely and effectively care for the patients. Mathematical models to predict optimal "safety stocks" have been routine in supply chain management for many years but have up to now not been applied in nursing workforce management. There are various aspects that exhibit similarities between the 2 disciplines, such as an evolving demand forecast according to acuity and the fact that provisioning "stock" to meet demand in a future period has nonzero variable lead time. Under assumptions about the forecasts (eg, the demand process is well fit as an autoregressive process) and about the labor supply process (≥1 shifts' lead time), we show that safety stock over lead time for such systems is effectively equivalent to the corresponding well-studied problem for systems with stationary demand bounds and base stock policies. Hence, we can apply existing models from supply chain analytics to find the optimal safety levels of nurse staffing. We use a case study with real data to demonstrate that there are significant benefits from the inclusion of the forecast process when determining the optimal safety stocks.

  16. Night and day in the VA: associations between night shift staffing, nurse workforce characteristics, and length of stay. (United States)

    de Cordova, Pamela B; Phibbs, Ciaran S; Schmitt, Susan K; Stone, Patricia W


    In hospitals, nurses provide patient care around the clock, but the impact of night staff characteristics on patient outcomes is not well understood. The aim of this study was to examine the association between night nurse staffing and workforce characteristics and the length of stay (LOS) in 138 veterans affairs (VA) hospitals using panel data from 2002 through 2006. Staffing in hours per patient day was higher during the day than at night. The day nurse workforce had more educational preparation than the night workforce. Nurses' years of experience at the unit, facility, and VA level were greater at night. In multivariable analyses controlling for confounding variables, higher night staffing and a higher skill mix were associated with reduced LOS. © 2014 Wiley Periodicals, Inc.

  17. Analyzing Residential End-Use Energy Consumption Data to Inform Residential Consumer Decisions and Enable Energy Efficiency Improvements (United States)

    Carlson, Derrick R.

    consumption, which suggests significant diminishing returns for parties interested in monitoring appliance level electricity consumption. Another way to improve understanding of residential energy consumption is through the development of residential use phase energy vectors for use in the Economic Input-Output Life Cycle Assessment (EIO-LCA) model. The EIO-LCA model is a valuable scoping tool to predict the environmental impacts of economic activity. This tool has a gap in its capabilities as residential use phase energy is outside the scope of the model. Adding use phase energy vectors to the EIO-LCA model will improve the modeling, provide a more complete estimation of energy impacts and allow for embedded energy to be compared to use phase energy for the purchase of goods and services in the residential sector. This work adds 21 quads of energy to the residential energy sector for the model and 15 quads of energy for personal transportation. These additions represent one third of the total energy consumption of the United States and a third of the total energy in the EIO-LCA model. This work also demonstrates that for many products such as electronics and household appliances use phase energy demands are much greater than manufacturing energy demands and dominate the life cycles for these products. A final way in which this thesis improves upon the understanding of how use phase energy is consumed in a home is through the exploration of potential energy reductions in a home. This analysis selects products that are used or consumed in a home, and explores the potential for reductions in the embedded manufacturing and use phase energy of that product using EIO-LCA and the energy vectors created in Chapter 3. The results give consumers an understanding of where energy is consumed in the lifecycle of products that they purchase and provide policy makers with valuable information on how to focus or refocus policies that are aimed and reducing energy in the residential sector

  18. Estimation of energy efficiency of residential buildings

    Directory of Open Access Journals (Sweden)

    Glushkov Sergey


    Full Text Available Increasing energy performance of the residential buildings by means of reducing heat consumption on the heating and ventilation is the last segment in the system of energy resources saving. The first segments in the energy saving process are heat producing and transportation over the main lines and outside distribution networks. In the period from 2006 to 2013. by means of the heat-supply schemes optimization and modernization of the heating systems. using expensive (200–300 $US per 1 m though hugely effective preliminary coated pipes. the economy reached 2.7 mln tons of fuel equivalent. Considering the multi-stage and multifactorial nature (electricity. heat and water supply of the residential sector energy saving. the reasonable estimate of the efficiency of the saving of residential buildings energy should be performed in tons of fuel equivalent per unit of time.

  19. Residential neighbourhoods in Kathmandu: Key design guidelines

    Directory of Open Access Journals (Sweden)

    Bijaya K. Shrestha


    Full Text Available Residential neighbourhoods developed using various techniques in Kathmandu by both the public and private sectors have not only provided a poor urban setting and failed to address socio-cultural needs, but are also poor at building a community and creating links to the built environment, with the result that the planned areas lack a sense of place and the inhabitants lack a feeling of home. Although traditional neighbourhoods in the historic core area had many features of a good residential neighbourhood in the past, they are currently undergoing rapid destruction. The residents of these neighbourhoods have little awareness of these issues. The existing legal and institutional frameworks are inadequate and ineffective and cannot address these problems, and so the formulation of design guidelines, their strict implementation, and enhancement of socio-cultural events including social networking are recommended for future residential neighbourhood development.

  20. Gentrification and Residential Mobility in Philadelphia. (United States)

    Ding, Lei; Hwang, Jackelyn; Divringi, Eileen


    Gentrification has provoked considerable controversy surrounding its effects on residential displacement. Using a unique individual-level, longitudinal data set, this study examines mobility rates and residential destinations of residents in gentrifying neighborhoods during the recent housing boom and bust in Philadelphia for various strata of residents and different types of gentrification. We find that vulnerable residents, those with low credit scores and without mortgages, are generally no more likely to move from gentrifying neighborhoods compared with their counterparts in nongentrifying neighborhoods. When they do move, however, they are more likely to move to lower-income neighborhoods. Residents in gentrifying neighborhoods at the aggregate level have slightly higher mobility rates, but these rates are largely driven by more advantaged residents. These findings shed new light on the heterogeneity in mobility patterns across residents in gentrifying neighborhoods and suggest that researchers should focus more attention on the quality of residential moves and nonmoves for less advantaged residents, rather than mobility rates alone.

  1. Solar Photovoltaic Financing: Residential Sector Deployment

    Energy Technology Data Exchange (ETDEWEB)

    Coughlin, J.; Cory, K.


    This report presents the information that homeowners and policy makers need to facilitate PV financing at the residential level. The full range of cash payments, bill savings, and tax incentives is covered, as well as potentially available solar attribute payments. Traditional financing is also compared to innovative solutions, many of which are borrowed from the commercial sector. Together, these mechanisms are critical for making the economic case for a residential PV installation, given its high upfront costs. Unfortunately, these programs are presently limited to select locations around the country. By calling attention to these innovative initiatives, this report aims to help policy makers consider greater adoption of these models to benefit homeowners interested installing a residential PV system.

  2. Energy savings in Danish residential building stock

    DEFF Research Database (Denmark)

    Tommerup, Henrik M.; Svendsen, Svend


    a short account of the technical energy-saving possibilities that are present in existing dwellings and presents a financial methodology used for assessing energy-saving measures. In order to estimate the total savings potential detailed calculations have been performed in a case with two typical...... buildings representing the residential building stock and based on these calculations an assessment of the energy-saving potential is performed. A profitable savings potential of energy used for space heating of about 80% is identified over 45 years (until 2050) within the residential building stock......A large potential for energy savings exists in the Danish residential building stock due to the fact that 75% of the buildings were constructed before 1979 when the first important demands for energy performance of building were introduced. It is also a fact that many buildings in Denmark face...

  3. Residential family treatment for parents with substance use disorders who are involved with child welfare: two perspectives on program design, collaboration, and sustainability. (United States)

    Hammond, Gretchen Clark; McGlone, Amanda


    This article discusses the service design, implementation, and evaluation findings of two residential family treatment programs: Wayside House (MN) and OnTrack (OR). Both programs specialize in family-centered services for adults with substance use disorders (SUD) who are involved with child welfare. Information on program design, services offered, and key collaborations are detailed. Implications for program sustainability are provided.

  4. Modelling and forecasting Turkish residential electricity demand

    International Nuclear Information System (INIS)

    Dilaver, Zafer; Hunt, Lester C


    This research investigates the relationship between Turkish residential electricity consumption, household total final consumption expenditure and residential electricity prices by applying the structural time series model to annual data over the period from 1960 to 2008. Household total final consumption expenditure, real energy prices and an underlying energy demand trend are found to be important drivers of Turkish residential electricity demand with the estimated short run and the long run total final consumption expenditure elasticities being 0.38 and 1.57, respectively, and the estimated short run and long run price elasticities being -0.09 and -0.38, respectively. Moreover, the estimated underlying energy demand trend, (which, as far as is known, has not been investigated before for the Turkish residential sector) should be of some benefit to Turkish decision makers in terms of energy planning. It provides information about the impact of past policies, the influence of technical progress, the impacts of changes in consumer behaviour and the effects of changes in economic structure. Furthermore, based on the estimated equation, and different forecast assumptions, it is predicted that Turkish residential electricity demand will be somewhere between 48 and 80 TWh by 2020 compared to 40 TWh in 2008. - Research highlights: → Estimated short run and long run expenditure elasticities of 0.38 and 1.57, respectively. → Estimated short run and long run price elasticities of -0.09 and -0.38, respectively. → Estimated UEDT has increasing (i.e. energy using) and decreasing (i.e. energy saving) periods. → Predicted Turkish residential electricity demand between 48 and 80 TWh in 2020.

  5. Strategy Guideline: High Performance Residential Lighting

    Energy Technology Data Exchange (ETDEWEB)

    Holton, J.


    The Strategy Guideline: High Performance Residential Lighting has been developed to provide a tool for the understanding and application of high performance lighting in the home. The high performance lighting strategies featured in this guide are drawn from recent advances in commercial lighting for application to typical spaces found in residential buildings. This guide offers strategies to greatly reduce lighting energy use through the application of high quality fluorescent and light emitting diode (LED) technologies. It is important to note that these strategies not only save energy in the home but also serve to satisfy the homeowner's expectations for high quality lighting.

  6. The state of the residential fire fatality problem in Sweden: Epidemiology, risk factors, and event typologies. (United States)

    Jonsson, Anders; Bonander, Carl; Nilson, Finn; Huss, Fredrik


    Residential fires represent the largest category of fatal fires in Sweden. The purpose of this study was to describe the epidemiology of fatal residential fires in Sweden and to identify clusters of events. Data was collected from a database that combines information on fatal fires with data from forensic examinations and the Swedish Cause of Death-register. Mortality rates were calculated for different strata using population statistics and rescue service turnout reports. Cluster analysis was performed using multiple correspondence analysis with agglomerative hierarchical clustering. Male sex, old age, smoking, and alcohol were identified as risk factors, and the most common primary injury diagnosis was exposure to toxic gases. Compared to non-fatal fires, fatal residential fires more often originated in the bedroom, were more often caused by smoking, and were more likely to occur at night. Six clusters were identified. The first two clusters were both smoking-related, but were separated into (1) fatalities that often involved elderly people, usually female, whose clothes were ignited (17% of the sample), (2) middle-aged (45-64years old), (often) intoxicated men, where the fire usually originated in furniture (30%). Other clusters that were identified in the analysis were related to (3) fires caused by technical fault, started in electrical installations in single houses (13%), (4) cooking appliances left on (8%), (5) events with unknown cause, room and object of origin (25%), and (6) deliberately set fires (7%). Fatal residential fires were unevenly distributed in the Swedish population. To further reduce the incidence of fire mortality, specialized prevention efforts that focus on the different needs of each cluster are required. Cooperation between various societal functions, e.g. rescue services, elderly care, psychiatric clinics and other social services, with an application of both human and technological interventions, should reduce residential fire

  7. Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators. (United States)

    Vlaeyen, Ellen; Stas, Joke; Leysens, Greet; Van der Elst, Elisa; Janssens, Elise; Dejaeger, Eddy; Dobbels, Fabienne; Milisen, Koen


    To identify the barriers and facilitators for fall prevention implementation in residential care facilities. Systematic review. Review registration number on PROSPERO: CRD42013004655. Two independent reviewers systematically searched five databases (i.e. MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science) and the reference lists of relevant articles. This systematic review was conducted in line with the Center for Reviews and Dissemination Handbook and reported according to the PRISMA guideline. Only original research focusing on determinants of fall prevention implementation in residential care facilities was included. We used the Mixed Method Appraisal Tool for quality appraisal. Thematic analysis was performed for qualitative data; quantitative data were analyzed descriptively. To synthesize the results, we used the framework of Grol and colleagues that describes six healthcare levels wherein implementation barriers and facilitators can be identified. We found eight relevant studies, identifying 44 determinants that influence implementation. Of these, 17 were facilitators and 27 were barriers. Results indicated that the social and organizational levels have the greatest number of influencing factors (9 and 14, respectively), whereas resident and economical/political levels have the least (3 and 4, respectively). The most cited facilitators were good communication and facility equipment availability, while staff feeling overwhelmed, helpless, frustrated and concerned about their ability to control fall management, staffing issues, limited knowledge and skills (i.e., general clinical skill deficiencies, poor fall management skills or lack of computer skills); and poor communication were the most cited barriers. Successful implementation of fall prevention depends on many factors across different healthcare levels. The focus of implementation interventions, however, should be on modifiable barriers and facilitators such as communication, knowledge, and skills

  8. Forecasting HotWater Consumption in Residential Houses

    Directory of Open Access Journals (Sweden)

    Linas Gelažanskas


    Full Text Available An increased number of intermittent renewables poses a threat to the system balance. As a result, new tools and concepts, like advanced demand-side management and smart grid technologies, are required for the demand to meet supply. There is a need for higher consumer awareness and automatic response to a shortage or surplus of electricity. The distributed water heater can be considered as one of the most energy-intensive devices, where its energy demand is shiftable in time without influencing the comfort level. Tailored hot water usage predictions and advanced control techniques could enable these devices to supply ancillary energy balancing services. The paper analyses a set of hot water consumption data from residential dwellings. This work is an important foundation for the development of a demand-side management strategy based on hot water consumption forecasting at the level of individual residential houses. Various forecasting models, such as exponential smoothing, seasonal autoregressive integrated moving average, seasonal decomposition and a combination of them, are fitted to test different prediction techniques. These models outperform the chosen benchmark models (mean, naive and seasonal naive and show better performance measure values. The results suggest that seasonal decomposition of the time series plays the most significant part in the accuracy of forecasting.

  9. Optimal tree design for daylighting in residential buildings

    Energy Technology Data Exchange (ETDEWEB)

    Hongbing, Wang [College of Landscape Architecture, Beijing Forestry University, 35, East Qinghua Rd., Beijing (China); Shanghai Botanical Garden, 1111, Longwu Rd., Shanghai (China); Jun, Qin; Yonghong, Hu [Shanghai Botanical Garden, 1111, Longwu Rd., Shanghai (China); Li, Dong [College of Landscape Architecture, Beijing Forestry University, 35, East Qinghua Rd., Beijing (China)


    Urban reforestation is advocated as an efficient countermeasure to the intensification of urban heat islands. The greening and beautification of residential quarters is one of the main concerns of residents, while lighting and ventilation are two main energy-consuming building services. Hence, the tree layout in green space between buildings is important, and it is necessary to determine the relationships between trees and buildings. This study takes Shanghai as a case study to optimize tree design between residential buildings and meet good daylighting requirements. Models were made using software such as AutoCAD and SketchUp. The relationships between maximum tree height and building separation were determined. For the same building layout, there were different tree height limits according to crown shape; the order of decreasing height limits was cylindrical, conical, spherical, and inverted conical crowns. Three cases having different green space between building layouts were studied. Their maximum tree heights differed. Overall, our model helps us realize good daylighting of a building environment. The formula allows us to determine which trees to plant between buildings in that we can predict the effects of future tree growth on building daylighting. (author)

  10. Profitability of Residential Battery Energy Storage Combined with Solar Photovoltaics

    Directory of Open Access Journals (Sweden)

    Christoph Goebel


    Full Text Available Lithium-ion (Li-Ion batteries are increasingly being considered as bulk energy storage in grid applications. One such application is residential energy storage combined with solar photovoltaic (PV panels to enable higher self-consumption rates, which has become financially more attractive recently due to decreasing feed-in subsidies. Although residential energy storage solutions are commercially mature, it remains unclear which system configurations and circumstances, including aggregator-based applications such as the provision of ancillary services, lead to profitable consumer investments. Therefore, we conduct an extensive simulation study that is able to jointly capture these aspects. Our results show that, at current battery module prices, even optimal system configurations still do not lead to profitable investments into Li-Ion batteries if they are merely used as a buffer for solar energy. The first settings in which they will become profitable, as prices are further declining, will be larger households at locations with higher average levels of solar irradiance. If the batteries can be remote-controlled by an aggregator to provide overnight negative reserve, their profitability increases significantly.

  11. Impacts of Water Quality on Residential Water Heating Equipment

    Energy Technology Data Exchange (ETDEWEB)

    Widder, Sarah H.; Baechler, Michael C.


    Water heating is a ubiquitous energy use in all residential housing, accounting for 17.7% of residential energy use (EIA 2012). Today, there are many efficient water heating options available for every fuel type, from electric and gas to more unconventional fuel types like propane, solar, and fuel oil. Which water heating option is the best choice for a given household will depend on a number of factors, including average daily hot water use (total gallons per day), hot water draw patterns (close together or spread out), the hot water distribution system (compact or distributed), installation constraints (such as space, electrical service, or venting accommodations) and fuel-type availability and cost. While in general more efficient water heaters are more expensive than conventional water heating technologies, the savings in energy use and, thus, utility bills can recoup the additional upfront investment and make an efficient water heater a good investment over time in most situations, although the specific payback period for a given installation will vary widely. However, the expected lifetime of a water heater in a given installation can dramatically influence the cost effectiveness and savings potential of a water heater and should be considered, along with water use characteristics, fuel availability and cost, and specific home characteristics when selecting the optimum water heating equipment for a particular installation. This report provides recommendations for selecting and maintaining water heating equipment based on local water quality characteristics.

  12. Sustainable residential districts : the residents' role in project success

    NARCIS (Netherlands)

    Abdalla, G.


    Sustainable residential districts have been realized worldwide. These districts are promoted to be efficient in the use of natural materials and sustainable energy resources. Realization of sustainable residential districts can strongly contribute to achieve environmental objectives as imposed by

  13. PRN 2011-1: Residential Exposure Joint Venture (United States)

    This PR Notice is to advise registrants of an industry-wide joint venture, titled the Residential Exposure Joint Venture (REJV), which has developed a national survey regarding residential consumer use/usage data for pesticides.

  14. Steering Angle Function Algorithm of Morphing of Residential Area

    Directory of Open Access Journals (Sweden)

    XIE Tian


    Full Text Available A residential area feature morphing method based on steering angle function is presented. To residential area with the same representation under two different scales,transforming the representation of the residential area polygon from vector coordinates to steering angle function,then using the steering angle function to match,and finding out the similarity and the differences between the residential areas under different scale to get the steering angle function of the the residential areas under any middle scale,the final,transforming the middle scale steering angle function to vector coordinates form,and get the middle shape interpolation of the the residential area polygon.Experimental results show:the residential area morphing method by using steering angle function presented can realize the continuous multi-scale representation under the premise of keeping in shape for the residential area with the rectangular boundary features.

  15. An audit of povincial Gastroenterology services in the Western Cape ...

    African Journals Online (AJOL)

    All hospitals in the Western Cape providing endoscopy were evaluated by means of a hands-on audit, to identify available organisational infrastructure. Data including staffing, details and utilisation of existing equipment, maintenance and disinfection techniques and delays in service provision were collected. Results.

  16. Theatre and emergency services rendered by generalist medical ...

    African Journals Online (AJOL)

    The 27 district hospitals were staffed by 147 full time, part-time and community service practitioners at the time of the study. The part-time practitioners had statistically significant more experience. Fifty percent of the respondents had done an ATLS or equivalent course, whilst only 5% were qualified family physicians.

  17. Modeling Residential Electricity Consumption Function in Malaysia: Time Series Approach


    L. L. Ivy-Yap; H. A. Bekhet


    As the Malaysian residential electricity consumption continued to increase rapidly, effective energy policies, which address factors affecting residential electricity consumption, is urgently needed. This study attempts to investigate the relationship between residential electricity consumption (EC), real disposable income (Y), price of electricity (Pe) and population (Po) in Malaysia for 1978-2011 period. Unlike previous studies on Malaysia, the current study focuses on the residential secto...

  18. Suggestions on Strengthening Greening Construction of Ecological Residential Areas


    Li, Peng


    Greening construction is an important part of the construction of ecological residential areas, but there exist some misunderstandings in greening construction of ecological residential districts at present. Based on the description of functions of green space in ecological residential areas, the summarization of principles of greening design, and the discussion of questions in greening construction of ecological residential districts, some suggestions as well as specific measures for strengt...

  19. 78 FR 12358 - Cardinal Health, Financial Shared Services West, Including On-Site Leased Workers From Aerotek... (United States)


    ... office financial services from India and the Philippines. Based on these findings, the Department is..., Financial Shared Services West, Including On- Site Leased Workers From Aerotek, eXcel Staffing, Experis..., applicable to workers of Cardinal Health, Financial Shared Services West, including on-site leased workers...

  20. Health care aides use of time in a residential long-term care unit: a time and motion study. (United States)

    Mallidou, Anastasia A; Cummings, Greta G; Schalm, Corinne; Estabrooks, Carole A


    Organizational resources such as caregiver time use with older adults in residential long-term care facilities (nursing homes) have not been extensively studied, while levels of nurse staffing and staffing-mix are the focus of many publications on all types of healthcare organizations. Evidence shows that front-line caregivers' sufficient working time with residents is associated with performance, excellence, comprehensive care, quality of outcomes (e.g., reductions in pressure ulcers, urinary tract infections, and falls), quality of life, cost savings, and may be affiliated with transformation of organizational culture. To explore organizational resources in a long-term care unit within a multilevel residential facility, to measure healthcare aides' use of time with residents, and to describe working environment and unit culture. An observational pilot study was conducted in a Canadian urban 52-bed long-term care unit within a faith-based residential multilevel care facility. A convenience sample of seven healthcare aides consented to participate. To collect the data, we used an observational sheet (to monitor caregiver time use on certain activities such as personal care, assisting with eating, socializing, helping residents to be involved in therapeutic activities, paperwork, networking, personal time, and others), semi-structured interview (to assess caregiver perceptions of their working environment), and field notes (to illustrate the unit culture). Three hundred and eighty seven hours of observation were completed. The findings indicate that healthcare aides spent most of their working time (on an eight-hour day-shift) in "personal care" (52%) and in "other" activities (23%). One-to-three minute activities consumed about 35% of the time spent in personal care and 20% of time spent in assisting with eating. Overall, caregivers' time spent socializing was less than 1%, about 6% in networking, and less than 4% in paperwork. Re-organizing healthcare aides

  1. Computer Aided Reference Services in the Academic Library: Experiences in Organizing and Operating an Online Reference Service. (United States)

    Hoover, Ryan E.


    Summarizes the development of the Computer-Aided Reference Services (CARS) division of the University of Utah Libraries' reference department. Development, organizational structure, site selection, equipment, management, staffing and training considerations, promotion and marketing, budget and pricing, record keeping, statistics, and evaluation…

  2. Greenhouse gas emissions accounting of urban residential consumption: a household survey based approach.

    Directory of Open Access Journals (Sweden)

    Tao Lin

    Full Text Available Devising policies for a low carbon city requires a careful understanding of the characteristics of urban residential lifestyle and consumption. The production-based accounting approach based on top-down statistical data has a limited ability to reflect the total greenhouse gas (GHG emissions from residential consumption. In this paper, we present a survey-based GHG emissions accounting methodology for urban residential consumption, and apply it in Xiamen City, a rapidly urbanizing coastal city in southeast China. Based on this, the main influencing factors determining residential GHG emissions at the household and community scale are identified, and the typical profiles of low, medium and high GHG emission households and communities are identified. Up to 70% of household GHG emissions are from regional and national activities that support household consumption including the supply of energy and building materials, while 17% are from urban level basic services and supplies such as sewage treatment and solid waste management, and only 13% are direct emissions from household consumption. Housing area and household size are the two main factors determining GHG emissions from residential consumption at the household scale, while average housing area and building height were the main factors at the community scale. Our results show a large disparity in GHG emissions profiles among different households, with high GHG emissions households emitting about five times more than low GHG emissions households. Emissions from high GHG emissions communities are about twice as high as from low GHG emissions communities. Our findings can contribute to better tailored and targeted policies aimed at reducing household GHG emissions, and developing low GHG emissions residential communities in China.

  3. Greenhouse Gas Emissions Accounting of Urban Residential Consumption: A Household Survey Based Approach (United States)

    Lin, Tao; Yu, Yunjun; Bai, Xuemei; Feng, Ling; Wang, Jin


    Devising policies for a low carbon city requires a careful understanding of the characteristics of urban residential lifestyle and consumption. The production-based accounting approach based on top-down statistical data has a limited ability to reflect the total greenhouse gas (GHG) emissions from residential consumption. In this paper, we present a survey-based GHG emissions accounting methodology for urban residential consumption, and apply it in Xiamen City, a rapidly urbanizing coastal city in southeast China. Based on this, the main influencing factors determining residential GHG emissions at the household and community scale are identified, and the typical profiles of low, medium and high GHG emission households and communities are identified. Up to 70% of household GHG emissions are from regional and national activities that support household consumption including the supply of energy and building materials, while 17% are from urban level basic services and supplies such as sewage treatment and solid waste management, and only 13% are direct emissions from household consumption. Housing area and household size are the two main factors determining GHG emissions from residential consumption at the household scale, while average housing area and building height were the main factors at the community scale. Our results show a large disparity in GHG emissions profiles among different households, with high GHG emissions households emitting about five times more than low GHG emissions households. Emissions from high GHG emissions communities are about twice as high as from low GHG emissions communities. Our findings can contribute to better tailored and targeted policies aimed at reducing household GHG emissions, and developing low GHG emissions residential communities in China. PMID:23405187

  4. Best practices guide for residential HVAC Retrofits

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Iain S.


    This best practices guide for residential HVAC system retrofits is aimed at contractors who want guidance on delivering energy efficient, cost effective and innovative products. It has been developed around the idea of having packages of changes to the building HVAC system and building envelope that are climate and house construction dependent. These packages include materials, procedures and equipment and are designed to remove some of the guesswork from a builder, contractor, installer or homeowner decisions about how best to carry out HVAC changes. The packages are not meant to be taken as rigid requirements--instead they are systems engineered guidelines that form the basis for energy efficient retrofits. Similar approaches have been taken previously for new construction to develop extremely energy efficient homes that are comfortable safe and durable, and often cost less than standard construction. This is best epitomized by the Building America program whose partners have built thousands of residences throughout the U.S. using these principles. The differences between retrofitting and new construction tend to limit the changes one can make to a building, so these packages rely on relatively simple and non-intrusive technologies and techniques. The retrofits also focus on changes to a building that will give many years of service to the occupants. Another key aspect of these best practices is that we need to know how a house is working so that we know what parts have the potential for improvement. To do this we have put together a set of diagnostic tools that combine physical measurements and checklists/questionnaires. The measured test results, observations and homeowner answers to questions are used to direct us towards the best retrofits applicable to each individual house. The retrofits will depend on the current condition of the building envelope and HVAC system, the local climate, the construction methods used for the house, and the presence of various

  5. 24 CFR 40.2 - Definition of “residential structure”. (United States)


    ... OWNED RESIDENTIAL STRUCTURES § 40.2 Definition of “residential structure”. (a) As used in this part, the term residential structure means a residential structure (other than a privately owned residential structure and a residential structure on a military reservation): (1) Constructed or altered by or on behalf...

  6. Residential Preferences and Moving Behavior: A Family Life Cycle Analysis. (United States)

    McAuley, William J.; Nutty, Cheri L.

    The relationship of family life cycle changes to housing preferences and residential mobility is examined. Two residential decision-making issues are explored in detail--how family life cycle stages influence what people view as important to their choice of residential setting and what individuals at different family life cycle stages view as the…

  7. 38 CFR 36.4357 - Combination residential and business property. (United States)


    ... Reporting § 36.4357 Combination residential and business property. If otherwise eligible, a loan for the purchase or construction of a combination of residential property and business property which the veteran... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Combination residential...

  8. Family events and the residential mobility of couples

    NARCIS (Netherlands)

    Michielin, F.; Mulder, C.H.


    Using data from retrospective surveys carried out in the Netherlands during the early 1990s, we describe how the residential mobility of couples—that is, short-distance moves—is affected by family events and how fertility is affected by residential mobility. The results show that residential moves

  9. Running Head: Evaluation of Contract Versus VA-Staffed CBOCs. Evaluating Contract versus VA-Staffed Community Based Outpatient Clinics (CBOCs) Using Patient Satisfaction and Access Measures in the Veterans Health Administration (United States)


    staffed CBOC, with dependent variables adjusting for SHEP scores and case mix factors. The equation for the null hypothesis is Hho = In (estimated...that the model can be further improved through combining several of the satisfaction scores. The equation for the null hypothesis is that Hho = In

  10. Hydrological processes at the urban residential scale (United States)

    Q. Xiao; E.G. McPherson; J.R. Simpson; S.L. Ustin


    In the face of increasing urbanization, there is growing interest in application of microscale hydrologic solutions to minimize storm runoff and conserve water at the source. In this study, a physically based numerical model was developed to understand hydrologic processes better at the urban residential scale and the interaction of these processes among different...

  11. Does Fall History Influence Residential Adjustments? (United States)

    Leland, Natalie; Porell, Frank; Murphy, Susan L.


    Purpose of the study: To determine whether reported falls at baseline are associated with an older adult's decision to make a residential adjustment (RA) and the type of adjustment made in the subsequent 2 years. Design and Methods: Observations (n = 25,036) were from the Health and Retirement Study, a nationally representative sample of…

  12. Condition assessment and strengthening of residential units

    Directory of Open Access Journals (Sweden)

    Tatheer Zahra


    Full Text Available About 40, ground plus one (G+1 residential units were designed using a hybrid structural framing system (RC frame and load bearing walls. A few months after the completion of the ground floor of the residential units, cracks appeared at several locations in the structure. Field and Laboratory testing was conducted to ascertain the in situ strength of concrete and steel reinforcement. The results of the experimental work were used in the analytical ETABS model for the structural stability calculations. The results indicated that residential units were marginally safe in the existing condition (completed ground floor, but the anticipated construction of the floor above the ground floor (G+1 could not be carried out as the strength of the structural system was inadequate. To increase the safety of existing ground floor and to provide the option of the construction of one floor above, rehabilitation and strengthening design was performed. The proposed strengthening design made use of welded wire fabric (WWF and carbon fibre reinforced polymer (CFRP laminates/sheets for the strengthening of walls, columns and slabs. The residential units will be strengthened in the near future.

  13. Development of a Residential Integrated Ventilation Controller

    Energy Technology Data Exchange (ETDEWEB)

    Staff Scientist; Walker, Iain; Sherman, Max; Dickerhoff, Darryl


    The goal of this study was to develop a Residential Integrated Ventilation Controller (RIVEC) to reduce the energy impact of required mechanical ventilation by 20percent, maintain or improve indoor air quality and provide demand response benefits. This represents potential energy savings of about 140 GWh of electricity and 83 million therms of natural gas as well as proportional peak savings in California. The RIVEC controller is intended to meet the 2008 Title 24 requirements for residential ventilation as well as taking into account the issues of outdoor conditions, other ventilation devices (including economizers), peak demand concerns and occupant preferences. The controller is designed to manage all the residential ventilation systems that are currently available. A key innovation in this controller is the ability to implement the concept of efficacy and intermittent ventilation which allows time shifting of ventilation. Using this approach ventilation can be shifted away from times of high cost or high outdoor pollution towards times when it is cheaper and more effective. Simulations, based on the ones used to develop the new residential ventilation requirements for the California Buildings Energy code, were used to further define the specific criteria and strategies needed for the controller. These simulations provide estimates of the energy, peak power and contaminant improvement possible for different California climates for the various ventilation systems. Results from a field test of the prototype controller corroborate the predicted performance.

  14. Employee influenza vaccination in residential care facilities. (United States)

    Apenteng, Bettye A; Opoku, Samuel T


    The organizational literature on infection control in residential care facilities is limited. Using a nationally representative dataset, we examined the organizational factors associated with implementing at least 1 influenza-related employee vaccination policy/program, as well as the effect of vaccination policies on health care worker (HCW) influenza vaccine uptake in residential care facilities. The study was a cross-sectional study using data from the 2010 National Survey of Residential Care Facilities. Multivariate logistic regression analysis was used to address the study's objectives. Facility size, director's educational attainment, and having a written influenza pandemic preparedness plan were significantly associated with the implementation of at least 1 influenza-related employee vaccination policy/program, after controlling for other facility-level factors. Recommending vaccination to employees, providing vaccination on site, providing vaccinations to employees at no cost, and requiring vaccination as a condition of employment were associated with higher employee influenza vaccination rates. Residential care facilities can improve vaccination rates among employees by adopting effective employee vaccination policies. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  15. Chapter 6: Residential Lighting Evaluation Protocol

    Energy Technology Data Exchange (ETDEWEB)

    Dimetrosky, Scott [Apex Analytics LLC, Boulder, CO (United States); Parkinson, Katie [Apex Analytics LLC, Boulder, CO (United States); Lieb, Noah [Apex Analytics LLC, Boulder, CO (United States)


    In recent years, residential lighting has represented a significant share of ratepayer-funded energy-efficiency electricity savings. Utilities have achieved the majority of these savings by promoting the purchase and installation of compact fluorescent lamps (CFLs), both standard 'twister' bulbs and specialty CFLs such as reflectors, A-Lamps, globes, and dimmable lights.

  16. Residential and Light Commercial HVAC. Teacher Edition. (United States)

    Stephenson, David; Fulkerson, Dan, Ed.

    This curriculum guide contains 18 units of instruction for a competency-based course in residential and light commercial heating, ventilating, and air conditioning (HVAC). Introductory materials include a competency profile and an instructional/task analysis that correlates job training with related information for this course. Each instructional…


    African Journals Online (AJOL)

    This report presents the findings of the study on the determinants of residential per capita water demand of Makurdi metropolis in Benue State, Nigeria. Data for the study was obtained by the use of questionnaires, oral interviews and observations. The data was analyzed using SPSS. Twenty variables were considered in ...

  18. Consumer Decision Rules and Residential Finance. (United States)

    Brandt, Jeanette A.; Jaffe, Austin J.


    As guidelines for residential financing, the authors compare different approaches to understanding and figuring the costs of home ownership: the relation of income to house price and housing costs, interest rate, and mortgage term. Instead of the traditional method, they recommend the time value of money approach. (MF)

  19. Staffing an Academic Reference Desk with Librarians is not Cost-effective. A Review of: Ryan, Susan M. “Reference Transactions Analysis: The Cost-effectiveness of Staffing a Traditional Academic Reference Desk.” Journal of Academic Librarianship 34.5 (2008: 389-99.

    Directory of Open Access Journals (Sweden)

    Cari Merkley


    technology questions followed at 15.4% (US$7,620 and 12.4% (US$6,110.18 respectively (396. According to Ryan, questions in all three categories could be addressed by students and staff. The cost of addressing research questions, the only category requiring librarians, was US$5557.29. Research transactions were greatly outnumbered by directional and technology related questions. An average of 3.6 research questions were asked at the reference desk during the 12 hours it was open each day, compared to 20.8 directional/technical questions.Conclusion – The nature of questions logged at the Stetson University library reference desk suggests that it is inefficient to staff the desk with librarians, given the salary costs of such a staffing model and the fact that librarian’s skills may not be required to answer most of the questions posed. Since the number of questions that need a librarian is so low, Ryan suggests that alternative staffing and service models be considered, so the energies of librarians could be more effectively employed elsewhere in the organization in areas such as information literacy instruction and the development of enhanced web services. It is noted that any reorganization of reference services should be done in concert with user surveys, consultation with staff, and extensive training to prepare staff for new roles. Suggested areas for further research identified by the researcher include the quality of reference transactions in an increasingly online environment.

  20. Program evaluation: Weatherization Residential Assistance Partnership (WRAP) Program

    Energy Technology Data Exchange (ETDEWEB)


    The Connecticut low income weatherization program was developed in response to a 1987 rate docket order from the Connecticut Department of Public Utility Control (DPUC) to Connecticut Light Power Co., an operating subsidiary of Northeast Utilities (NU). (Throughout this report, NU is referred to as the operator of the program.) This program, known as the Weatherization Residential Assistance Partnership, or WRAP, was configured utilizing input from a collaborative group of interested parties to the docket. It was agreed that this program would be put forth by the electric utility, but would not ignore oil and gas savings (thus, it was to be fuel- blind''). The allocated cost of conservation services for each fuel source, however, should be cost effective. It was to be offered to those utility customers at or below 200 percent of the federal poverty levels, and provide a wide array of energy saving measures directed toward heating, water heating and lighting. It was felt by the collaborative group that this program would raise the level of expenditures per participant for weatherization services provided by the state, and by linking to and revising the auditing process for weatherization, would lower the audit unit cost. The program plans ranged from the offering of low-cost heating, water heating and infiltration measures, increased insulation levels, carpentry and plumbing services, to furnace or burner replacement. The program was configured to allow for very comprehensive weatherization and heating system servicing.

  1. Strategic foresight, leadership, and the future of rural healthcare staffing in the United States. (United States)

    Reimers-Hild, Connie


    This article uses a strategic foresight tool, megatrends, to examine forces influencing long-term healthcare staffing in the rural United States. Two megatrends-exponential advances in science and technology and the continued evolution of the decentralized global marketplace-will influence and ultimately help shape the future of rural healthcare. Successful health ecosystems of the future will need to be customer-driven, more affordable, and tech-savvy. Successful evolution in an era of continuous change will require a blend of intentional engagement with stakeholders, strategic foresight, and future-focused leadership. More research is needed to fully understand not only the challenges of rural healthcare but also the emerging opportunities.

  2. Staffing Foreign Subsidiaries with Parent Country Nationals or Host Country Nationals?

    DEFF Research Database (Denmark)

    Dörrenbächer, Christoph; Gammelgaard, Jens; McDonald, Frank

    captures the effects of PCN verses HCN managers on key characteristics of subsidiaries. The results of the study indicate that the PCN/HCN dichotomy widely used in the international staffing literature needs to take account of the following issues: First: The study confirms theoretical assumptions based...... on social capital theory that subsidiaries led by HCNs are more embedded in the host country's external environment (by having more frequent relationships with host country customers, suppliers and competitors). However, the study reveals that the assumed advantages PCN led subsidiaries have...... to the local institutional environment (HRM). Our study finds that this is also the case with regard to strategic decisions on financial control as well as on R&D and new product development. Third: On average, HCN led subsidiaries perform significantly better than PCN led subsidiaries with regard to sales...

  3. The relationship between UK hospital nurse staffing and emotional exhaustion and job dissatisfaction. (United States)

    Sheward, Louisa; Hunt, Jennifer; Hagen, Suzanne; Macleod, Margaret; Ball, Jane


    To explore the relationship between nurse outcomes (dissatisfaction and emotional exhaustion) and nurse workload, nurse characteristics and hospital variables. Concern about the impact of restructuring of nurse staffing, and reports of nurse shortages, on nurse and patient outcomes led to the research being reported on in this article. A questionnaire survey of registered nurses in Scotland and England. A questionnaire survey of the hospitals in which these nurses worked. Respondents in the two countries were similar in terms of demographic, work and employment characteristics. Significant relationships were found using the combined English and Scottish data between nurse patient ratios and (1) emotional exhaustion and (2) dissatisfaction with current job reported by nurses. Increasing numbers of patients to nurses was associated with increasing risk of emotional exhaustion and dissatisfaction with current job.

  4. Appendix VI: KHNP staffing plan of construction site office: ULCHIN 5 and 6 construction project (ROK)

    International Nuclear Information System (INIS)


    KHNP, as an owner/operator organization, is responsible for all project activities including design, procurement, construction, and commissioning, for Korea's nuclear power plant (NPP) construction projects. Four separate functional offices of KHNP are set up to complete the construction management work. These offices are (1) home office, (2) field construction office, (3) field quality assurance office, and (4) field startup/commissioning office. This paper presents a staffing plan for the field construction office starting initial project implementation to final turnover to operations stages. It is recognized that the plan may not be applicable to other utility situations in terms of project management of site activity depending upon how the overall project contract is structured

  5. Working together: critical care nurses experiences of temporary staffing within Swedish health care: A qualitative study. (United States)

    Berg Jansson, Anna; Engström, Åsa


    The aim of this study is to describe critical care nurses (CCN's) experiences of working with or as temporary agency staff. This explorative qualitative study is based on interviews with five agency CCNs and five regular CCNs, a total of ten interviews, focusing on the interviewees' experiences of daily work and temporary agency staffing. The interviews were analysed manually and thematically following an inductive approach. Four themes that illustrate both similarities and differences between regular and temporary agency CCNs emerged: "working close to patients versus being responsible for everything", "teamwork versus independence", "both groups needed" and "opportunities and challenges". The study findings illustrate the complexity of the working situation for agency and regular staff in terms of the organisation and management of the temporary agency nurses and the opportunities and challenges faced by both groups. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Achieving effective staffing through a shared decision-making approach to open-shift management. (United States)

    Valentine, Nancy M; Nash, Jan; Hughes, Douglas; Douglas, Kathy


    Managing costs while retaining qualified nurses and finding workforce solutions that ensure the delivery of high-quality patient care is of primary importance to nurse leaders and executive management. Leading healthcare organizations are using open-shift management technology as a strategy to improve staffing effectiveness and the work environment. In many hospitals, open-shift management technology has become an essential workforce management tool, nursing benefit, and recruitment and retention incentive. In this article, the authors discuss how a successful nursing initiative to apply automation to open-shift scheduling and fulfillment across a 3-hospital system had a broad enterprise-wide impact resulting in dramatic improvements in nurse satisfaction, retention, recruitment, and the bottom line.

  7. Locating helicopter emergency medical service bases to optimise population coverage versus average response time

    NARCIS (Netherlands)

    Garner, A.A. (Alan A.); P.L. van den Berg (Pieter)


    textabstractBackground: New South Wales (NSW), Australia has a network of multirole retrieval physician staffed helicopter emergency medical services (HEMS) with seven bases servicing a jurisdiction with population concentrated along the eastern seaboard. The aim of this study was to estimate

  8. "Librarian's Anxiety"? How Community College Librarians Feel about Their Reference Desk Service (United States)

    Powers, Anne


    A survey of community college librarians in California reveals that the nature of reference service required of them, limitations on budget, staffing, technical support, resources, decision-making ability, and professional development opportunities, affect their professional attitudes. Librarians see reference service as primarily a teaching role.…

  9. Information Processing and Creative Thinking Abilities of Residential and Non-Residential School Children

    Directory of Open Access Journals (Sweden)

    Atasi Mohanty


    Full Text Available This study attempts to assess and compare the residential and non-residential schoolchildren in information-processing skills and creative thinking abilities. A sample of 80 children from Classes 5 and 7 were selected from two types of schools, residential/ashram (02 and non-residential/formal schools (02 in Bolpur subdivision of West Bengal in India where the medium of instruction is Bengali language/mother-tongue. All the children were individually administered the PASS (Planning, Attention, Simultaneous, Successive, Stroop, Matching Familiar Figure Test (MFFT-20, and creative thinking tasks. The residential school children were found to perform better both in information processing and creative thinking tasks. The developmental trend could not be clearly observed due to small sample size, but with increasing age, children were using better processing strategies. Due to ashram environment, creative pedagogy, and various co-curricular activities, the residential school children were found to be more creative than their formal school counterparts. Moreover, some significant positive correlations were found among information processing skills and creative thinking dimensions.

  10. Charging Schedule for Electric Vehicles in Danish Residential Distribution Grids

    DEFF Research Database (Denmark)

    Pillai, Jayakrishnan Radhakrishna; Huang, Shaojun; Bak-Jensen, Birgitte


    energy sources like wind in power systems. The EV batteries could be used to charge during periods of excess electricity production from wind power and reduce the charging rate or discharge on deficit of power in the grid, supporting system stability and reliability. By providing such grid services......The prospects of Electric Vehicles (EVs) in providing clean transportation and supporting renewable electricity is widely discussed in sustainable energy forums worldwide. The battery storage of EVs could be used to address the variability and unpredictability of electricity produced from renewable......, the vehicle owner, vehicle fleet operator and other parties involved in the process could economically benefit from the process. This paper investigates an optimal EV charging plan in Danish residential distribution grids in view of supporting high volumes of wind power in electricity grids. The results...

  11. Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need

    Directory of Open Access Journals (Sweden)

    Faul, Mark


    Full Text Available Introduction: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care.   Methods: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443. The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need” as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need.     Results: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need.  Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the

  12. Does mental health staffing level affect antipsychotic prescribing? Analysis of Italian national statistics. (United States)

    Starace, Fabrizio; Mungai, Francesco; Barbui, Corrado


    In mental healthcare, one area of major concern identified by health information systems is variability in antipsychotic prescribing. While most studies have investigated patient- and prescriber-related factors as possible reasons for such variability, no studies have investigated facility-level characteristics. The present study ascertained whether staffing level is associated with antipsychotic prescribing in community mental healthcare. A cross-sectional analysis of data extracted from the Italian national mental health information system was carried out. For each Italian region, it collects data on the availability and use of mental health facilities. The rate of individuals exposed to antipsychotic drugs was tested for evidence of association with the rate of mental health staff availability by means of univariate and multivariate analyses. In Italy there were on average nearly 60 mental health professionals per 100,000 inhabitants, with wide regional variations (range 21 to 100). The average rate of individuals prescribed antipsychotic drugs was 2.33%, with wide regional variations (1.04% to 4.01%). Univariate analysis showed that the rate of individuals prescribed antipsychotic drugs was inversely associated with the rate of mental health professionals available in Italian regions (Kendall's tau -0.438, p = 0.006), with lower rates of antipsychotic prescriptions in regions with higher rates of mental health professionals. After adjustment for possible confounders, the total availability of mental health professionals was still inversely associated with the rate of individuals exposed to antipsychotic drugs. The evidence that staffing level was inversely associated with antipsychotic prescribing indicates that any actions aimed at decreasing variability in antipsychotic prescribing need to take into account aspects related to the organization of the mental health system.

  13. The Implications of Flexible Staffing Arrangements for Job Stability. Upjohn Institute Staff Working Paper No. 99-056. Revised. (United States)

    Houseman, Susan N.; Polivka, Anne E.

    A study examined the job stability of workers in the following flexible staffing arrangements: agency temporary, direct-hire temporary, on-call, contract company, independent contractor, and regular part-time work. Two data sources were used in the analysis. The first was a nationwide survey of employers on their use of flexible staffing…

  14. 75 FR 77665 - Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing and... (United States)


    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,593] Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing and Andrews International, Fort Smith... subject firm. The workers are engaged in the production of refrigerators and trash compactors. The company...

  15. The effects of ownership, staffing level and organisational justice on nurse commitment, involvement, and satisfaction: a questionnaire study. (United States)

    Heponiemi, Tarja; Elovainio, Marko; Kouvonen, Anne; Kuusio, Hannamaria; Noro, Anja; Finne-Soveri, Harriet; Sinervo, Timo


    Elderly care systems have undergone a lot of changes in many European countries, including Finland. Most notably, the number of private for-profit firms has increased. Previous studies suggest that employee well-being and the quality of care might differ according to the ownership type. The present study examined whether the ownership type and the staffing level were associated with organisational commitment, job involvement, and job satisfaction. In addition, we examined the potential moderating effect of organisational justice on these associations. Cross-sectional questionnaire study. 1047 Finnish female staff members aged 18-69 years working in sheltered housing or nursing homes (units n=179). The relationships were studied with analyses of covariance (ANCOVA), adjusting for the effects of age and case-mix. Organisational commitment and job satisfaction levels were low in for-profit sheltered homes when justice levels were low, but when justice levels were high, for-profit sheltered homes did not differ from other ownership types. Similarly, organisational justice acted as a buffer against low commitment resulting from low staffing levels. Staffing levels were lowest in public sheltered homes and highest in not-for-profit sheltered homes. The results show that organisational justice can act as a buffer against low organisational commitment that results from low staffing levels and working in for-profit sheltered homes. Increasing justice in regard to the management, outcomes, and procedures in the organisation would thus be important. 2011 Elsevier Ltd. All rights reserved.

  16. Characteristics and Working Conditions of Moonlighting Teachers: Evidence from the 2011-2012 Schools and Staffing Survey (United States)

    Fitchett, Paul G.; Heafner, Tina L.; Harden, Susan B.


    Moonlighting, an employment practice where individuals work outside of their primary job, is popular within the public education sector. Using data from the National Center for Education Statistics Schools and Staffing Survey, this study examined both the characteristics and motivations of public school teachers across moonlighting categories.…

  17. 77 FR 63873 - Johnson Controls, Inc. Including On-Site Leased Workers of Valley Staffing and AZ Quality Hudson... (United States)


    ... workers of Johnson Controls, Inc., including on-site leased workers from Valley Staffing, Hudson..., Wisconsin location of Johnson Controls, Inc. The Department has determined that these workers were sufficiently under the control of the subject firm to be considered leased workers. Based on these findings...

  18. Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy. (United States)

    Balakrishnan, Karthik; Goico, Brian; Arjmand, Ellis M


    (1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy. Prospective cost analysis case study. Tertiary pediatric hospital. All otolaryngology providers and otolaryngology operating room staff at our institution. Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements. Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  19. Seniority Rules: Do Staffing Reforms Help Redistribute Teacher Quality and Reduce Teacher Turnover? CRPE Working Paper 2010-1 (United States)

    Gross, Betheny; DeArmond, Michael; Goldhaber, Dan


    Education reformers routinely call on school districts to stop hiring teachers based on seniority, which they argue interferes with effective staffing, especially in disadvantaged schools. The few researchers who have empirically studied the issue, however, disagree about whether seniority-based hiring is systematically associated with staffing…

  20. Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria

    Directory of Open Access Journals (Sweden)

    Karien Jooste


    Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

  1. Factors that guide nurse managers regarding the staffing of agency nurses in intensive care units at private hospitals in Pretoria

    Directory of Open Access Journals (Sweden)

    Karien Jooste


    Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.

  2. 75 FR 43556 - Badger Meter, Inc., Including On-Site Leased Workers From Sourcepoint Staffing, Seek, and... (United States)


    ... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,666] Badger Meter, Inc... of Badger Meter, Inc., including on-site leased workers from Sourcepoint Staffing, Milwaukee... workers are engaged in the production of flow measurement devices and automatic meter reading equipment...

  3. Residential Satisfaction in the Informal Neighborhoods of Ulaanbaatar, Mongolia

    Directory of Open Access Journals (Sweden)

    Jean Caldieron


    Full Text Available Residential satisfaction is a very important factor in determining the quality of life, housing improvement proposals, and adequate housing policies. This paper reports on the findings of a study in four informal neighborhoods or “ger districts” of Ulaanbaatar, the Mongolian capital. Mongolia has been facing an onslaught of rural migration to the urban areas because of two reasons. First, rural nomads have lost their livestock due to recent harsh climate conditions, and second because of the transition from communism to a democratic market economy, based on the exploitation of Mongolia’s rich mineral resources. In the cities, migrants have invaded land and erected rural nomadic “ger” (felt tents or yurts. The traditional ger (as they are called in the Mongolian language are sustainable structures well adapted for a nomadic society. However, when they are located in high-density, unplanned shantytowns, they create many issues. The country’s capital, Ulaanbaatar, is the coldest capital in the world; ger’ household use coal for heating which causes dense air pollution, especially in the winter. These informal urban areas lack sanitation, adequate vehicular access and other services. Eventually residents build small permanent houses, but they still lack for basic services. This paper presents the findings of more than one hundred household surveys related to housing conditions in three informal ger districts of Ulaanbaatar. The surveys were held in the summer of 2011. This paper discusses some of the characteristics of the settlements as well as the residential satisfaction of its inhabitants.

  4. Using alternative segmentation techniques to examine residential customer`s energy needs, wants, and preferences

    Energy Technology Data Exchange (ETDEWEB)

    Hollander, C.; Kidwell, S. [Union Electric Co., St. Louis, MO (United States); Banks, J.; Taylor, E. [Cambridge Reports/Research International, MA (United States)


    The primary objective of this study was to examine residential customers` attitudes toward energy usage, conservation, and efficiency, and to examine the implications of these attitudes for how the utility should design and communicate about programs and services in these areas. This study combined focus groups and customer surveys, and utilized several customer segmentation schemes -- grouping customers by geodemographics, as well as customers` energy and environmental values, beliefs, and opinions -- to distinguish different segments of customers.

  5. Transport attitudes, residential preferences, and urban form effects on cycling and car use

    DEFF Research Database (Denmark)

    Transport attitudes, residential preferences, and urban form effects on cycling and car use. Promotion of walking and cycling is part of policies at multiple levels and reasoned in public health as well as environmental sustainability outcomes. Urban form and neighborhood characteristics are thou....... Reduced car use seems to require a high degree of convenience of not driving – by means of very short, walkable distances to services...

  6. Residential Location Preferences. The Significance of Socio-Cultural and Religious Attributes


    Gobi Krishna Sinniah; Muhammad Zaly Shah; Geoff Vigar; Paulus Teguh Aditjandrad


    The objective of this paper is to explore residential location preferences and how they are related to travel behavior. The literature focuses on the preferences in relation to physical and demographic aspects, such as land uses, facilities, transportation facilities, transportation services, car ownership, income, household size and travel accessibility. However, this study suggests social and cultural issue such as racial diversity which is literally to be a significance context. The case s...

  7. 78 FR 17777 - Proposed Information Collection (Application for Furnishing Long-Term Care Service to... (United States)


    ... (Application for Furnishing Long- Term Care Service to Beneficiaries of Veterans Affairs, and Residential Care.... Application for Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, VA Form 10-1170. b. Residential Care Home Program--Sponsor Application, VA Form 2407. OMB Control Number: 2900-0616. Type of...

  8. 75 FR 2595 - Proposed Information Collection (Application for Furnishing Long-Term Care Services to... (United States)


    ... (Application for Furnishing Long- Term Care Services to Beneficiaries of Veterans Affairs, and Residential Care... comments for information needed to determine non-Federal nursing home or residential care home... information technology. Titles: a. Application for Furnishing Long-Term Care Services to Beneficiaries of...

  9. Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

    Directory of Open Access Journals (Sweden)

    Erhabor Osaro


    There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

  10. Residents' barometer 2010. Residents' survey on residential environments in Finland; Asukasbarometri 2010. Asukaskysely suomalaisista asuinympaeristoeistae

    Energy Technology Data Exchange (ETDEWEB)

    Strandell, A.


    The Residents' Barometer 2010 is a survey on the quality of Finnish residential environments in settlements with a population of 10,000 or more. The survey was carried out in cooperation with Statistics Finland. Implemented for the third time, the Residents' Barometer is used by the environmental administration to monitor the quality of the living environment. The first Residents' Barometer survey was conducted in 1998, and the second in 2004. While the majority of questions remained the same, new topical questions were included, such as those on the environmental friendliness of housing choices. In general, residents are highly satisfied with their living environment: of the respondents, 97 per cent find their residential area pleasant and the degree of satisfaction has increased. Key factors in this include peacefulness, natural environment, location and transport connections, alongside the supply of services and leisure activities. Factors causing most discomfort are traffic-related disturbances and problems. The supply of basic services in residential areas remained largely unchanged in large, densely populated areas targeted by the survey. The most sought-after additional services include a grocery store, other shops and public transport. There was a considerable decline in the number of people wishing for banking and postal services, whereas the number of those expressing the desire for public transport almost doubled. In general, people are satisfied with parks and outdoor recreation areas and more dissatisfied with the condition of their yards. Residents of densely built areas with blocks of flats, particularly residents of rented apartments, are most dissatisfied with their yard. Car ownership, the possibility to use a car, and using a car for commuting to work and shops has become more common, as the share of walking and public transport has decreased. The average distance commuted to work has increased. Dissatisfaction with public

  11. Development and Pilot Testing of a Food Safety Curriculum for Managers and Staff of Residential Childcare Institutions (RCCIs) (United States)

    Pivarnik, Lori F.; Patnoad, Martha S.; Nyachuba, David; McLandsborough, Lynne; Couto, Stephen; Hagan, Elsina E.; Breau, Marti


    Food safety training materials, targeted for residential childcare institution (RCCI) staff of facilities of 20 residents or less, were developed, piloted, and evaluated. The goal was to assist in the implementation of a Hazard Analysis Critical Control Points (HACCP)-based food safety plan as required by Food and Nutrition Service/United States…

  12. Outcomes of a New Residential Scheme for Adults with Intellectual Disabilities in Taiwan: A 2-Year Follow-Up (United States)

    Chou, Y-C.; Pu, C.; Kroger, T.; Lee, W.; Chang, S.


    Background: The Taiwanese government launched a new programme in November 2004 to support adults with intellectual disabilities living in smaller facilities. This paper aims to evaluate the service outcomes of this new residential scheme over 2 years including those residents who moved from an institution and those who moved from their family.…

  13. Residential location choice of knowledge-workers in a "startup metropolis": the role of amenities, workplace and lifestyle

    DEFF Research Database (Denmark)

    Frenkel, Amnon; Bendit, Edward; Kaplan, Sigal


    This study investigates the residential location choice of knowledge-workers at the intra-metropolitan level by applying discrete choice models. The models represent housing choices of 833 knowledge-workers in high-technology and financial services and analyze the relative importance of lifestyle...

  14. Considering a Private Residential Treatment Program for a Troubled Teen? Questions for Parents and Guardians to Ask (United States)

    Federal Trade Commission, 2008


    Private residential treatment programs for young people offer a range of services, including drug and alcohol treatment, confidence building, military-style discipline, and psychological counseling for a variety of addiction, behavioral, and emotional problems. Many of these programs are intended to provide a less-restrictive alternative to…

  15. Parenting training for women in residential substance abuse treatment. Results of a demonstration project. (United States)

    Camp, J M; Finkelstein, N


    This paper presents findings on the impact of implementing a parenting component in two urban residential treatment programs in Massachusetts for pregnant and parenting chemically-dependent women. The parenting component consisted of multiple services for both women and their infants while they were in residential treatment as well as aftercare services after discharge from treatment. Findings presented focus on: (a) the characteristics of the 170 pregnant and parenting women who participated in the parenting component during its 48 months of implementation; (b) changes in the parenting skills and self-esteem of women who completed parenting training; (c) the quality of mother-child interaction; and (d) the participants' perceptions about the impact of the parenting training. Women in both programs made dramatic improvements in self-esteem and experienced significant gains in parenting knowledge and attitudes. The participants were also overwhelmingly positive about the impact of the parenting training on their lives. Study findings underline the importance of parenting services for pregnant and parenting women in residential substance abuse treatment.

  16. Dynamic management of integrated residential energy systems (United States)

    Muratori, Matteo

    This study combines principles of energy systems engineering and statistics to develop integrated models of residential energy use in the United States, to include residential recharging of electric vehicles. These models can be used by government, policymakers, and the utility industry to provide answers and guidance regarding the future of the U.S. energy system. Currently, electric power generation must match the total demand at each instant, following seasonal patterns and instantaneous fluctuations. Thus, one of the biggest drivers of costs and capacity requirement is the electricity demand that occurs during peak periods. These peak periods require utility companies to maintain operational capacity that often is underutilized, outdated, expensive, and inefficient. In light of this, flattening the demand curve has long been recognized as an effective way of cutting the cost of producing electricity and increasing overall efficiency. The problem is exacerbated by expected widespread adoption of non-dispatchable renewable power generation. The intermittent nature of renewable resources and their non-dispatchability substantially limit the ability of electric power generation of adapting to the fluctuating demand. Smart grid technologies and demand response programs are proposed as a technical solution to make the electric power demand more flexible and able to adapt to power generation. Residential demand response programs offer different incentives and benefits to consumers in response to their flexibility in the timing of their electricity consumption. Understanding interactions between new and existing energy technologies, and policy impacts therein, is key to driving sustainable energy use and economic growth. Comprehensive and accurate models of the next-generation power system allow for understanding the effects of new energy technologies on the power system infrastructure, and can be used to guide policy, technology, and economic decisions. This

  17. Panethnicity, Ethnic Diversity and Residential Segregation (United States)

    Kim, Ann H.; White, Michael J.


    We consider the theoretical and empirical implications of the structural basis of panethnicity and of the layering of ethnic boundaries in residential patterns while simultaneously evaluating the ‘panethnic hypothesis’, that is, the extent to which homogeneity within panethnic categories can be assumed. Our results do show a panethnic effect – greater residential proximity is evident within panethnic boundaries than between, net of ethnic group size and metropolitan area, but this association clearly depends on immigration. While findings generally show a lower degree of social distance between panethnic subgroups, particularly for blacks, whites and Latinos and less for Asians, ethno-national groups continue to maintain some degree of distinctiveness within a racialized context. PMID:20503650

  18. MICRO-CHP System for Residential Applications

    Energy Technology Data Exchange (ETDEWEB)

    Joseph Gerstmann


    This is the final report of progress under Phase I of a project to develop and commercialize a micro-CHP system for residential applications that provides electrical power, heating, and cooling for the home. This is the first phase of a three-phase effort in which the residential micro-CHP system will be designed (Phase I), developed and tested in the laboratory (Phase II); and further developed and field tested (Phase III). The project team consists of Advanced Mechanical Technology, Inc. (AMTI), responsible for system design and integration; Marathon Engine Systems, Inc. (MES), responsible for design of the engine-generator subsystem; AO Smith, responsible for design of the thermal storage and water heating subsystems; Trane, a business of American Standard Companies, responsible for design of the HVAC subsystem; and AirXchange, Inc., responsible for design of the mechanical ventilation and dehumidification subsystem.

  19. Electricity demand for South Korean residential sector

    International Nuclear Information System (INIS)

    Sa'ad, Suleiman


    This study estimates the electricity demand function for the residential sector of South Korea with the aim of examining the effects of improved energy efficiency, structural factors and household lifestyles on electricity consumption. In the study, time series data for the period from 1973 to 2007 is used in a structural time series model to estimate the long-term price and income elasticities and annual growth of underlying energy demand trend (UEDT) at the end of the estimation period. The result shows a long-term income elasticity of 1.33 and a long-term price elasticity of -0.27% with -0.93% as the percentage growth of UEDT at the end of the estimation period. This result suggests that, in order to encourage energy efficiency in the residential sector, the government should complement the market based pricing policies with non-market policies such as minimum energy efficiency standards and public enlightenment.

  20. Residential indoor air quality guideline : carbon monoxide

    International Nuclear Information System (INIS)


    Carbon monoxide (CO) is a tasteless, odourless, and colourless gas that can be produced by both natural and anthropogenic processes, but is most often formed during the incomplete combustion of organic materials. In the indoor environment, CO occurs directly as a result of emissions from indoor sources or as a result of infiltration from outdoor air containing CO. Studies have shown that the use of specific sources can lead to increased concentrations of CO indoors. This residential indoor air quality guideline examined the factors influencing the introduction, dispersion and removal of CO indoors. The health effects of exposure to low and higher concentrations of CO were discussed. Residential maximum exposure limits for CO were presented. Sources and concentrations in indoor environments were also examined. 17 refs., 2 tabs.