WorldWideScience

Sample records for state department decision

  1. 8 CFR 208.11 - Comments from the Department of State.

    Science.gov (United States)

    2010-01-01

    ....11 Section 208.11 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS... Department of State. (a) U.S. Citizenship and Immigration Services (USCIS) may request, at its discretion... provided an opportunity to review and respond to such comments prior to the issuance of any decision to...

  2. What Factors Affect Physicians’ Decisions to Prescribe Opioids in Emergency Departments?

    Directory of Open Access Journals (Sweden)

    Lauren E. Sinnenberg BA

    2017-01-01

    Full Text Available Objective: With 42% of all emergency department visits in the United States related to pain, physicians who work in this setting are tasked with providing adequate pain management to patients with varying primary complaints and medical histories. Complicating this, the United States is in the midst of an opioid overdose epidemic. State governments and national organizations have developed guidelines and legislation to curtail opioid prescriptions in acute care settings, while also incentivizing providers for patient satisfaction and completeness of pain control. In order to inform future policies that focus on provider pain medication prescribing, we sought to characterize the factors physicians weigh when considering treating pain with opioids in the emergency department. Methods: We conducted and transcribed open-ended, semistructured qualitative interviews with 52 physicians at a national emergency medicine conference. Results: Participants reported a wide range of factors contributing to their opioid prescribing patterns related to three domains: 1 provider assessment of pain characteristics, 2 patient-based considerations, and 3 practice environment. Pain characteristics include the characteristics of various acute and chronic pain syndromes, including physicians’ empathy due to their own experiences with pain. Patient characteristics include “trustworthiness,” race and ethnicity, and the concern for risk of misuse. Factors related to the practice environment include hospital policy, legislation/regulation, and guidelines. Conclusion: The decision to prescribe opioids to patients in the emergency department is complex and nuanced. Physicians are interested in guidance and are concerned about the competing pressures placed on their opioid prescribing due to incentives related to patient satisfaction scores on one hand and inflexible policies that do not allow for individualized, patient-centered decisions on the other.

  3. Reasons for (not) signing the state registry: surveying Department of Motor Vehicles customers in New York state.

    Science.gov (United States)

    Feeley, Thomas Hugh; Reynolds-Tylus, Tobias; Anker, Ashley E; Evans, Melanie

    2014-03-01

    Prior research examining rationales for enrolling as an organ donor is biased because of its reliance on college student samples and retrospective recall. To characterize New York state residents' registry enrollment decisions in close proximity to a registration opportunity. -Surveys were conducted with customers exiting Department of Motor Vehicle offices. A total of 1325 customers were surveyed upon exiting 1 of 18 Department of Motor Vehicle offices spanning 9 counties. Customers making donation-relevant transactions (ie, license renewal/registration) reported whether they had registered as a donor that day, and all other customers reported whether they had registered as a donor in the past. Customers reported reasons to justify their enrollment decision through short interview questions. Among current donation-relevant transactions (n = 299), 27% reported enrolling in the registry. Of remaining customers, 39% reported enrolling in the state registry in the past. For those who elected not to enroll, many failed to communicate a reason for their decision, or reported a lack of opportunity to sign or decisional uncertainty. Among enrollees, reasons for registration included the altruistic benefits of donation, prior registration, personal experience with donation, and rational arguments for donation. The value of point-of-decision survey data are discussed in relation to strategic efforts to promote organ donor registration.

  4. STATE DEPARTMENT: Sale of Unneeded Overseas Property Has Increased, but Further Improvements Are Necessary

    National Research Council Canada - National Science Library

    2002-01-01

    .... In 1996, we reported that the State Department did not have an effective process for identifying and selling unneeded overseas real estate, and that decisions concerning the sale of some properties...

  5. Decision-Making Styles of Department Chairs at Public Jordanian Universities: A High-Expectancy Workforce

    Science.gov (United States)

    Khasawneh, Samer; Alomari, Aiman; Abu-tineh, Abdullah

    2011-01-01

    The primary purpose of this study was to determine the decision-making styles of department chairs employed by three public institutions in Jordan. A total of 95 department chairs participated in the study by completing the General Decision-Making Styles survey. The results indicated that department chairs under study have the rational…

  6. Assessing electronic health record systems in emergency departments: Using a decision analytic Bayesian model.

    Science.gov (United States)

    Ben-Assuli, Ofir; Leshno, Moshe

    2016-09-01

    In the last decade, health providers have implemented information systems to improve accuracy in medical diagnosis and decision-making. This article evaluates the impact of an electronic health record on emergency department physicians' diagnosis and admission decisions. A decision analytic approach using a decision tree was constructed to model the admission decision process to assess the added value of medical information retrieved from the electronic health record. Using a Bayesian statistical model, this method was evaluated on two coronary artery disease scenarios. The results show that the cases of coronary artery disease were better diagnosed when the electronic health record was consulted and led to more informed admission decisions. Furthermore, the value of medical information required for a specific admission decision in emergency departments could be quantified. The findings support the notion that physicians and patient healthcare can benefit from implementing electronic health record systems in emergency departments. © The Author(s) 2015.

  7. The role of NEPA in agency decision-making: Department of Energy reconfiguration programmatic environmental impact statement

    International Nuclear Information System (INIS)

    Webb, M.D.

    1992-01-01

    The National Environmental Policy Act (NEPA) was drafted as a decision-making tool to ensure that Federal agencies make open, informed decisions. Equally effective as planning tool, NEPA can be applied to support an agency's planning process while providing requisite environmental analysis of specific proposals. The Department of Energy (DOE) Weapons Complex Reconfiguration Office is preparing a Programmatic Environmental Impact Statement (PEIS) as a means to assist in its long-range planning for the future of the Nation's nuclear weapons complex. The Secretary of Energy has proposed to reconfigure the weapons complex to be smaller, less diverse and more efficient to operate. The Reconfiguration PEIS will analyze the potential environmental impacts of alternative configurations, involving 13 sites in 12 states, and compare these to the current configuration. The Council on Environmental Quality regulations implementing NEPA [40 CFR 1500] provide for Federal agencies to prepare PEISs for broad agency actions, including generically connected actions. Planning for the future weapons complex falls into such a category, involving complex-wide decisions to be made at a national level. DOE's long-range decisions regarding the future of the weapons complex will be based upon environmental considerations as well as other factors such as cost and technical feasibility. The NEPA process will serve to document the identification and analysis of the environmental impacts. In addition, the PEIS will be a key component in developing the Department's Reconfiguration Plan, which will guide the Department in preparing for the future complex. The Reconfiguration Plan will identify follow-on projects needed to implement the programmatic decisions and provide specific guidance for subsequence 'tiered' NEPA analyses

  8. Power to Do...What? Department Heads' Decision Autonomy and Strategic Priorities

    Science.gov (United States)

    Bozeman, Barry; Fay, Daniel; Gaughan, Monica

    2013-01-01

    Using questionnaire data from the 2010 Survey of Academic Chairs, the study focuses on decision autonomy, a component of the power wielded by science, technology, engineering and mathematics (STEM) department chairs in U.S. research extensive universities. A "power index" is developed to measure chairs' decision autonomy, specifically their…

  9. Clinical trial or standard treatment? Shared decision making at the department of oncology

    DEFF Research Database (Denmark)

    Gregersen, Trine Ammentorp; Birkelund, Regner; Ammentorp, Jette

    2016-01-01

    Title: Clinical trial or standard treatment? Shared decision making at the department of oncology. Authors: Ph.d. student, Trine A. Gregersen. Trine.gregersen@rsyd.dk. Department of Oncology. Health Services Research Unit Lillebaelt Hospital / IRS University of Southern Denmark. Professor, Regner...... are involved in difficult treatment decisions including participation in clinical trials. The literature indicates that the decision is very often based on little knowledge about the treatment and that many patients who have consented to participate in a clinical trial are not always aware...... that they are participating in a trial. This place great demand on the healthcare providers’ ability to involve and advise patients in the decisions. The aim of this study is to investigate the characteristics of the communication when decisions about participation in clinical oncology trial are made and the patients...

  10. A geoscientist in the State Department

    Science.gov (United States)

    Prather, Michael J.

    2006-12-01

    It must have been in a fit of idealism, à la Jimmy Stewart, that I applied to be a Jefferson Science Fellow (JSF) at the U.S. Department of State in the summer of 2004. The flyer was appealing, offering an opportunity to become "directly involved with the State Department, applying current knowledge of science and technology in support of the development of U.S. international policy. The Jefferson Science Fellowships enable academic scientists and engineers to act as consultants to the State Department on matters of science, technology, and engineering as they affect foreign policy."My own science—elating to ozone depletion, climate change, and aviation environmental impacts—often has been at the science-policy interface. As a result, I have attended governmental and intergovernmental meetings, particularly the international assessments on climate change and ozone depletion. I had even come to know the State Department team on climate negotiations, although I had never been inside the State Department. The appeal of working on the inside of negotiations within the United Nations Framework Convention on Climate Change was strong—if only to find out what an 'interlocutor' was.

  11. A Department of Motor Vehicle-Based Intervention to Promote Organ Donor Registrations in New York State.

    Science.gov (United States)

    Feeley, Thomas Hugh; Anker, Ashley E; Evans, Melanie; Reynolds-Tylus, Tobias

    2017-09-01

    Examination of efficacy of motor vehicle representative educational training and dissemination of promotional materials as a means to promote organ donation enrollments in New York State. To increase the number of New York State residents who consent to donation through the department of motor vehicle transactions during project period. County-run motor vehicle offices across New York State. Customers who present to New York Department of Motor Vehicle offices and the representative who work at designated bureaus. point-of-decision materials including promotional posters, brochures, website, and the motor vehicle representative training sessions. Reasons for enrollment decision, knowledge/experience with donation, monthly consent rates, enrollment in state organ, and tissue registry. Customers who elected not to register reported no reason or uncertainty surrounding enrollment. The representatives reported experience with donation, discussion with customers, and need for additional education on organ donation. Enrollment cards were mailed to 799 project staff; counties where offices participated in intervention did not indicate significantly higher monthly enrollments when comparing pre- to postenrollment rates. Use of point-of-decision materials and enrollment cards proved inexpensive method to register customers with a 3.6% return rate. Customers report low (27%) enrollment rate and reticence to consent to donation. Educational training sessions with representatives did not yield significant enrollment increases when evaluating data at county-level enrollment.

  12. Decision-making contexts involving Earth observations in federal and state government agencies

    Science.gov (United States)

    Kuwayama, Y.; Thompson, A.

    2017-12-01

    National and international organizations are placing greater emphasis on the societal and economic benefits that can be derived from applications of Earth observations, yet improvements are needed to connect to the decision processes that produce actions with direct societal benefits. The Consortium for the Valuation of Applications Benefits Linked with Earth Science (VALUABLES), a cooperative agreement between Resources for the Future (RFF) and the National Aeronautics and Space Administration (NASA), has the goal of advancing methods for the valuation and communication of the applied benefits linked with Earth observations. One of the Consortium's activities is a set of Policy Briefs that document the use of Earth observations for decision making in federal and state government agencies. In developing these Policy Briefs, we pay special attention to documenting the entire information value chain associated with the use of Earth observations in government decision making, namely (a) the specific data product, modeling capability, or information system used by the agency, (b) the decision context that employs the Earth observation information and translates it into an agency action, (c) the outcomes that are realized as a result of the action, and (d) the beneficiaries associated with the outcomes of the decision. Two key examples include the use of satellite data for informing the US Drought Monitor (USDM), which is used to determine the eligibility of agricultural communities for drought disaster assistance programs housed at the US Department of Agriculture (USDA), and the use of satellite data by the Florida Department of Environmental Protection to develop numeric nutrient water quality standards and monitoring methods for chlorophyll-a, which is codified in Florida state code (62-302.532).

  13. A Utility Model for Teaching Load Decisions in Academic Departments.

    Science.gov (United States)

    Massey, William F.; Zemsky, Robert

    1997-01-01

    Presents a utility model for academic department decision making and describes the structural specifications for analyzing it. The model confirms the class-size utility asymmetry predicted by the authors' academic rachet theory, but shows that marginal utility associated with college teaching loads is always negative. Curricular structure and…

  14. 77 FR 38388 - Notice of Decision to Grant Buy America Waiver to Washington Department of Transportation to...

    Science.gov (United States)

    2012-06-27

    ... DEPARTMENT OF TRANSPORTATION Federal Railroad Administration Notice of Decision to Grant Buy America Waiver to Washington Department of Transportation to Purchase Vossloh 101-LV Concrete Rail Ties...: Notice of decision to grant Buy America waiver. SUMMARY: FRA is issuing this notice to advise the public...

  15. HCUP State Emergency Department Databases (SEDD) - Restricted Access File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The State Emergency Department Databases (SEDD) contain the universe of emergency department visits in participating States. Restricted access data files are...

  16. Terrorism preparedness in state health departments--United States, 2001-2003.

    Science.gov (United States)

    2003-10-31

    The anthrax attacks in fall 2001 highlighted the role of infectious disease (ID) epidemiologists in terrorism preparedness and response. Beginning in 2002, state health departments (SHDs) received approximately 1 billion dollars in new federal funding to prepare for and respond to terrorism, infectious disease outbreaks, and other public health threats and emergencies. This funding is being used in part to improve epidemiologic and surveillance capabilities. To determine how states have used a portion of their new funding to increase ID epidemiology capacity, the Iowa Department of Public Health's Center for Acute Disease Epidemiology and the Iowa State University Department of Microbiology conducted two surveys of U.S. state epidemiologists during September 2000-August 2001 and October 2002-June 2003. This report summarizes the results of these surveys, which determined that although the number of SHD epidemiology workers assigned to ID and terrorism preparedness increased by 132%, concerns remained regarding the ability of SHDs to hire qualified personnel. These findings underscore the need to develop additional and more diverse training venues for current and future ID epidemiologists.

  17. Designing a data-driven decision support tool for nurse scheduling in the emergency department: a case study of a southern New Jersey emergency department.

    Science.gov (United States)

    Otegbeye, Mojisola; Scriber, Roslyn; Ducoin, Donna; Glasofer, Amy

    2015-01-01

    A health system serving Burlington and Camden Counties, New Jersey, sought to improve labor productivity for its emergency departments, with emphasis on optimizing nursing staff schedules. Using historical emergency department visit data and operating constraints, a decision support tool was designed to recommend the number of emergency nurses needed in each hour for each day of the week. The pilot emergency department nurse managers used the decision support tool's recommendations to redeploy nurse hours from weekends into a float pool to support periods of demand spikes on weekdays. Productivity improved significantly, with no unfavorable impact on patient throughput, and patient and staff satisfaction. Today's emergency department manager can leverage the increasing ease of access to the emergency department information system's data repository to successfully design a simple but effective tool to support the alignment of its nursing schedule with demand patterns. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  18. 78 FR 13743 - Department of State FY11 Service Contract Inventory

    Science.gov (United States)

    2013-02-28

    ... DEPARTMENT OF STATE [Public Notice 8207] Department of State FY11 Service Contract Inventory... Contract Inventory. SUMMARY: The Department of State has publically released its Service Contract Inventory... Act, Public Law 111-117, requires Department of State, and other civilian agencies, to submit an...

  19. 76 FR 76757 - States' Decisions on Participating in Accounting and Auditing Relief for Federal Oil and Gas...

    Science.gov (United States)

    2011-12-08

    ... DEPARTMENT OF THE INTERIOR Office of Natural Resources Revenue [Docket No. ONRR-2011-0002] States' Decisions on Participating in Accounting and Auditing Relief for Federal Oil and Gas Marginal Properties... published September 13, 2004 (69 FR 55076), provide two types of accounting and auditing relief for Federal...

  20. Cardiopulmonary resuscitation decisions in the emergency department: An ethnography of tacit knowledge in practice.

    Science.gov (United States)

    Brummell, Stephen P; Seymour, Jane; Higginbottom, Gina

    2016-05-01

    Despite media images to the contrary, cardiopulmonary resuscitation in emergency departments is often unsuccessful. The purpose of this ethnographic study was to explore how health care professionals working in two emergency departments in the UK, make decisions to commence, continue or stop resuscitation. Data collection involved participant observation of resuscitation attempts and in-depth interviews with nurses, medical staff and paramedics who had taken part in the attempts. Detailed case examples were constructed for comparative analysis. Findings show that emergency department staff use experience and acquired tacit knowledge to construct a typology of cardiac arrest categories that help them navigate decision making. Categorisation is based on 'less is more' heuristics which combine explicit and tacit knowledge to facilitate rapid decisions. Staff then work as a team to rapidly assimilate and interpret information drawn from observations of the patient's body and from technical, biomedical monitoring data. The meaning of technical data is negotiated during staff interaction. This analysis was informed by a theory of 'bodily' and 'technical' trajectory alignment that was first developed from an ethnography of death and dying in intensive care units. The categorisation of cardiac arrest situations and trajectory alignment are the means by which staff achieve consensus decisions and determine the point at which an attempt should be withdrawn. This enables them to construct an acceptable death in highly challenging circumstances. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Patient Preferences regarding Shared Decision-making in the Emergency Department: Findings from a multi-site survey.

    Science.gov (United States)

    Schoenfeld, Elizabeth M; Kanzaria, Hemal K; Quigley, Denise D; Marie, Peter St; Nayyar, Nikita; Sabbagh, Sarah H; Gress, Kyle L; Probst, Marc A

    2018-06-13

    As Shared Decision-Making (SDM) has received increased attention as a method to improve the patient-centeredness of emergency department (ED) care, we sought to determine patients' desired level of involvement in medical decisions and their perceptions of potential barriers and facilitators to SDM in the ED. We surveyed a cross-sectional sample of adult ED patients at three academic medical centers across the United States. The survey included 32 items regarding patient involvement in medical decisions including a modified Control Preference Scale (CPS) and questions about barriers and facilitators to SDM in the ED. Items were developed and refined based on prior literature and qualitative interviews with ED patients. Research assistants administered the survey in person. Of 797 patients approached, 661 (83%) agreed to participate. Participants were 52% female, 45% white, and 30% Hispanic. The majority of respondents (85-92%, depending on decision type) expressed a desire for some degree of involvement in decision-making in the ED, while 8-15% preferred to leave decision-making to their physician alone. Ninety-eight percent wanted to be involved with decisions when "something serious is going on." The majority of patients (94%) indicated that self-efficacy was not a barrier to SDM in the ED. However, most patients (55%) reported a tendency to defer to the physician's decision-making during an ED visit, with about half reporting they would wait for a physician to ask them to be involved. We found the majority of ED patients in our large, diverse sample wanted to be involved in medical decisions, especially in the case of a "serious" medical problem, and felt that they had the ability to do so. Nevertheless, many patients were unlikely to actively seek involvement and defaulted to allowing the physician to make decisions during the ED visit. After fully explaining the consequences of a decision, clinicians should make an effort to explicitly ascertain patients

  2. 77 FR 39996 - Department of Mechanical Engineering, Texas A&M University, Notice of Decision on Application for...

    Science.gov (United States)

    2012-07-06

    ... DEPARTMENT OF COMMERCE International Trade Administration Department of Mechanical Engineering, Texas A&M University, Notice of Decision on Application for Duty-Free Entry of Scientific Instruments...: Department of Mechanical Engineering, Texas A&M University, College Station, TX 77843-3123. Instrument: Arc...

  3. Alaska Public Offices Commission, Department of Administration, State of

    Science.gov (United States)

    Visiting Alaska State Employees State of Alaska Department of Administration Alaska Public Offices Commission Alaska Department of Administration, Alaska Public Offices Commission APOC Home Commission Filer ; AO's Contact Us Administration > Alaska Public Offices Commission Alaska Public Offices Commission

  4. Shared Decision-making in the Emergency Department: Respecting Patient Autonomy When Seconds Count.

    Science.gov (United States)

    Hess, Erik P; Grudzen, Corita R; Thomson, Richard; Raja, Ali S; Carpenter, Christopher R

    2015-07-01

    Shared decision-making (SDM), a collaborative process in which patients and providers make health care decisions together, taking into account the best scientific evidence available, as well as the patient's values and preferences, is being increasingly advocated as the optimal approach to decision-making for many health care decisions. The rapidly paced and often chaotic environment of the emergency department (ED), however, is a unique clinical setting that offers many practical and contextual challenges. Despite these challenges, in a recent survey emergency physicians reported there to be more than one reasonable management option for over 50% of their patients and that they take an SDM approach in 58% of such patients. SDM has also been selected as the topic on which to develop a future research agenda at the 2016 Academic Emergency Medicine consensus conference, "Shared Decision-making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda" (http://www.saem.org/annual-meeting/education/2016-aem-consensus-conference). In this paper the authors describe the conceptual model of SDM as originally conceived by Charles and Gafni and highlight aspects of the model relevant to the practice of emergency medicine. In addition, through the use of vignettes from the authors' clinical practices, the applicability of SDM to contemporary EM practice is illustrated and the ethical and pragmatic implications of taking an SDM approach are explored. It is hoped that this document will be read in advance of the 2016 Academic Emergency Medicine consensus conference, to facilitate group discussions at the conference. © 2015 by the Society for Academic Emergency Medicine.

  5. 23 CFR 1.3 - Federal-State cooperation; authority of State highway departments.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Federal-State cooperation; authority of State highway... MANAGEMENT AND ADMINISTRATION GENERAL § 1.3 Federal-State cooperation; authority of State highway departments... State in all matters relating to, and to enter into, on behalf of the State, all contracts and...

  6. 77 FR 5614 - Department of State FY11 Service Contract Inventory

    Science.gov (United States)

    2012-02-03

    ... DEPARTMENT OF STATE [Public Notice 7785] Department of State FY11 Service Contract Inventory... Contract Inventory. SUMMARY: The Department of State has publically released its Service Contract Inventory.../ . Section 743 of Division C of the FY 2010 Consolidated Appropriations Act, Public Law 111-117, requires...

  7. Home, Office of Public Advocacy, Department of Administration, State of

    Science.gov (United States)

    Visiting Alaska State Employees State of Alaska Department of Administration Division of Office of Public Advocacy Alaska Department of Administration, Office of Public Advocacy Home Programs Sections Forms Vendor Support Search Office of Public Advocacy State of Alaska Administration > Office of Public Advocacy

  8. 76 FR 9399 - Department of State FY10 Service Contract Inventory

    Science.gov (United States)

    2011-02-17

    ... DEPARTMENT OF STATE [Public Notice 7321] Department of State FY10 Service Contract Inventory... Contract Inventory. SUMMARY: The Department of State has publically released its Service Contract Inventory for FY10. Section 743 of Division C of the FY 2010 Consolidated Appropriations Act, Public Law 111-117...

  9. 77 FR 70875 - Department of State Performance Review Board Members

    Science.gov (United States)

    2012-11-27

    ..., Department of State; Kevin P. O'Keefe, Director, Office of Plans, Policy, and Analysis, Bureau of Political...-Greenfield, Director General of the Foreign Service and Director of Human Resources, Department of State. [FR...

  10. HIV Services Provided by STD Programs in State and Local Health Departments - United States, 2013-2014.

    Science.gov (United States)

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

    2017-04-07

    The incidence of human immunodeficiency virus (HIV) infection in the United States is higher among persons with other sexually transmitted diseases (STDs), and the incidence of other STDs is increased among persons with HIV infection (1). Because infection with an STD increases the risk for HIV acquisition and transmission (1-4), successfully treating STDs might help reduce the spread of HIV among persons at high risk (1-4). Because health department STD programs provide services to populations who are at risk for HIV, ensuring service integration and coordination could potentially reduce the incidence of STDs and HIV. Program integration refers to the combining of STD and HIV prevention programs through structural, service, or policy-related changes such as combining funding streams, performing STD and HIV case matching, or integrating staff members (5). Some STD programs in U.S. health departments are partially or fully integrated with an HIV program (STD/HIV program), whereas other STD programs are completely separate. To assess the extent of provision of HIV services by state and local health department STD programs, CDC analyzed data from a sample of 311 local health departments and 56 state and directly funded city health departments derived from a national survey of STD programs. CDC found variation in the provision of HIV services by STD programs at the state and local levels. Overall, 73.1% of state health departments and 16.1% of local health departments matched STD case report data with HIV data to analyze possible syndemics (co-occurring epidemics that exacerbate the negative health effects of any of the diseases) and overlaps. Similarly, 94.1% of state health departments and 46.7% of local health departments performed site visits to HIV care providers to provide STD information or public health updates. One fourth of state health departments and 39.4% of local health departments provided HIV testing in nonclinical settings (field testing) for STD

  11. 77 FR 1474 - Decision and Order Granting a Waiver to Samsung From the Department of Energy Residential...

    Science.gov (United States)

    2012-01-10

    .... RF-019] Decision and Order Granting a Waiver to Samsung From the Department of Energy Residential... of the decision and order (Case Nos. RF-018, RF-019) that grants to Samsung Electronics America, Inc. (Samsung) a waiver from the DOE electric refrigerator and refrigerator-freezer test procedures for the...

  12. 76 FR 13931 - Department of State Retrospective Review under E.O. 13563

    Science.gov (United States)

    2011-03-15

    ... DEPARTMENT OF STATE 22 CFR Chapter I 28 CFR Chapter XI [Public Notice: 7351] Department of State Retrospective Review under E.O. 13563 AGENCY: Department of State. ACTION: Request for information and comment. SUMMARY: As part of its implementation of Executive Order 13563, ``Improving Regulation and Regulatory...

  13. Contextual factors associated with hospitals' decision to operate freestanding emergency departments.

    Science.gov (United States)

    Patidar, Nitish; Weech-Maldonado, Robert; O'Connor, Stephen J; Sen, Bisakha; Trimm, J M Mickey; Camargo, Carlos A

    Freestanding emergency departments (FSEDs) are fast growing entities in health care, delivering emergency care outside of hospitals. Hospitals may benefit in several ways by opening FSEDs. The study used the resource dependence theory as a means to analyze the relationship between market and organizational factors and the likelihood of hospitals to operate FSEDs. All acute care hospitals in 14 states with FSEDs present during the study period from 2002 to 2011. Data on FSEDs were merged with American Hospital Association Annual Survey, Centers for Medicare and Medicaid Services' Cost Reports, and Area Resource File data. The outcome variable consists of whether or not the hospital operates an FSED. Independent variables include per capita income, percent population over age of 65 years, primary care and specialist physicians per capita, urban location, change in the unemployment rate, change in the population, change in poverty level, market competition, total satellite and autonomous FSEDs in the market, Medicare-managed care penetration rate, hospital beds, total margin, and system membership. We used logistic regression analysis with state and year fixed effects. Standard errors in the regression were clustered by hospital. The number of hospitals operating satellite FSEDs increased from 32 (2.33%) in 2002 to 91 (5.76%) hospitals in 2011 among the 14 states included in the study sample. The results support the hypothesis that hospitals located in munificent environments and more competitive environments (presence of other FSEDs) are more likely to operate an FSED. Organizational level factors such as bed size and system membership are associated with a hospital operating an FSED. The findings may be used by policy makers in developing regulations for hospitals opening FSEDs. Also, study findings of this study may be used by hospitals to make informed decisions when formulating strategies regarding FSEDs.

  14. The effects of emotional states and traits on risky decision-making.

    Energy Technology Data Exchange (ETDEWEB)

    Bernard, Michael Lewis; Smith, Bruce W., 1959- (,University of New Mexico, Albuquerque, NM-)

    2006-12-01

    Understanding the role of emotional states is critical for predicting the kind of decisions people will make in risky situations. Currently, there is little understanding as to how emotion influences decision-making in situations such as terrorist attacks, natural disasters, pandemics, and combat. To help address this, we used behavioral and neuroimaging methods to examine how emotion states and traits influence decisions. Specifically, this study used a wheel of fortune behavioral task and functional magnetic resonance imaging (fMRI) to examine the effects of emotional states and traits on decision-making pertaining to the degree of risk people are willing to make in specific situations. The behavioral results are reported here. The neural data requires additional time to analyze and will be reported at a future date. Biases caused by emotion states and traits were found regarding the likelihood of making risky decisions. The behavioral results will help provide a solid empirical foundation for modeling the effects of emotion on decision in risky situations.

  15. 44 CFR 351.26 - The United States Department of Agriculture.

    Science.gov (United States)

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false The United States Department of Agriculture. 351.26 Section 351.26 Emergency Management and Assistance FEDERAL EMERGENCY... PREPAREDNESS Interagency Assignments § 351.26 The United States Department of Agriculture. (a) Assist FEMA in...

  16. Effect of Emergency Department and ICU Occupancy on Admission Decisions and Outcomes for Critically Ill Patients.

    Science.gov (United States)

    Mathews, Kusum S; Durst, Matthew S; Vargas-Torres, Carmen; Olson, Ashley D; Mazumdar, Madhu; Richardson, Lynne D

    2018-05-01

    ICU admission delays can negatively affect patient outcomes, but emergency department volume and boarding times may also affect these decisions and associated patient outcomes. We sought to investigate the effect of emergency department and ICU capacity strain on ICU admission decisions and to examine the effect of emergency department boarding time of critically ill patients on in-hospital mortality. A retrospective cohort study. Single academic tertiary care hospital. Adult critically ill emergency department patients for whom a consult for medical ICU admission was requested, over a 21-month period. None. Patient data, including severity of illness (Mortality Probability Model III on Admission), outcomes of mortality and persistent organ dysfunction, and hourly census reports for the emergency department, for all ICUs and all adult wards were compiled. A total of 854 emergency department requests for ICU admission were logged, with 455 (53.3%) as "accept" and 399 (46.7%) as "deny" cases, with median emergency department boarding times 4.2 hours (interquartile range, 2.8-6.3 hr) and 11.7 hours (3.2-20.3 hr) and similar rates of persistent organ dysfunction and/or death 41.5% and 44.6%, respectively. Those accepted were younger (mean ± SD, 61 ± 17 vs 65 ± 18 yr) and more severely ill (median Mortality Probability Model III on Admission score, 15.3% [7.0-29.5%] vs 13.4% [6.3-25.2%]) than those denied admission. In the multivariable model, a full medical ICU was the only hospital-level factor significantly associated with a lower probability of ICU acceptance (odds ratio, 0.55 [95% CI, 0.37-0.81]). Using propensity score analysis to account for imbalances in baseline characteristics between those accepted or denied for ICU admission, longer emergency department boarding time after consult was associated with higher odds of mortality and persistent organ dysfunction (odds ratio, 1.77 [1.07-2.95]/log10 hour increase). ICU admission decisions for

  17. Metabolic state alters economic decision making under risk in humans.

    Directory of Open Access Journals (Sweden)

    Mkael Symmonds

    2010-06-01

    Full Text Available Animals' attitudes to risk are profoundly influenced by metabolic state (hunger and baseline energy stores. Specifically, animals often express a preference for risky (more variable food sources when below a metabolic reference point (hungry, and safe (less variable food sources when sated. Circulating hormones report the status of energy reserves and acute nutrient intake to widespread targets in the central nervous system that regulate feeding behaviour, including brain regions strongly implicated in risk and reward based decision-making in humans. Despite this, physiological influences per se have not been considered previously to influence economic decisions in humans. We hypothesised that baseline metabolic reserves and alterations in metabolic state would systematically modulate decision-making and financial risk-taking in humans.We used a controlled feeding manipulation and assayed decision-making preferences across different metabolic states following a meal. To elicit risk-preference, we presented a sequence of 200 paired lotteries, subjects' task being to select their preferred option from each pair. We also measured prandial suppression of circulating acyl-ghrelin (a centrally-acting orexigenic hormone signalling acute nutrient intake, and circulating leptin levels (providing an assay of energy reserves. We show both immediate and delayed effects on risky decision-making following a meal, and that these changes correlate with an individual's baseline leptin and changes in acyl-ghrelin levels respectively.We show that human risk preferences are exquisitely sensitive to current metabolic state, in a direction consistent with ecological models of feeding behaviour but not predicted by normative economic theory. These substantive effects of state changes on economic decisions perhaps reflect shared evolutionarily conserved neurobiological mechanisms. We suggest that this sensitivity in human risk-preference to current metabolic state has

  18. Embedding a State Space Model Into a Markov Decision Process

    DEFF Research Database (Denmark)

    Nielsen, Lars Relund; Jørgensen, Erik; Højsgaard, Søren

    2011-01-01

    In agriculture Markov decision processes (MDPs) with finite state and action space are often used to model sequential decision making over time. For instance, states in the process represent possible levels of traits of the animal and transition probabilities are based on biological models...

  19. 31 CFR 597.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 597.705 Section 597.705 Money and Finance: Treasury... collection; referral to United States Department of Justice. In the event that the respondent does not pay... Department of the Treasury or to the United States Department of Justice for appropriate action to recover...

  20. 31 CFR 587.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 587.705 Section 587.705 Money and Finance: Treasury... § 587.705 Administrative collection; referral to United States Department of Justice. In the event that... Department of the Treasury or to the United States Department of Justice for appropriate action to recover...

  1. Use of evidence-based interventions in state health departments: a qualitative assessment of barriers and solutions.

    Science.gov (United States)

    Dodson, Elizabeth A; Baker, Elizabeth A; Brownson, Ross C

    2010-01-01

    Existing knowledge on chronic disease prevention is not systematically disseminated and applied. State-level public health practitioners are in positions to implement programs and services related to chronic disease control. To advance dissemination science, this study sought to evaluate how and why evidence-based decision making (EBDM) is occurring. Specifically, it identified barriers to using EBDM commonly faced by state-level chronic disease practitioners and solutions for increasing the use of EBDM. Descriptive research using online survey methods. State health departments. Members of the National Association of Chronic Disease Directors. Barriers to using EBDM and solutions to increase the use of EBDM. In total, 469 people completed the survey (64% response rate). More than 60% of respondents described their position as project managers or coordinators. Nearly 80% of respondents were women, and 39% reported at least a master's degree as their highest degree. The survey elicited responses from every US state and the District of Columbia. Commonly-cited barriers to using EBDM included lack of time, resources, funding, and data. Participants noted that promising solutions to increase the use of EBDM include improved leadership, training, and collaboration. These results identify several modifiable barriers to EBDM among state-level public health practitioners. This information may improve state health departments' abilities to facilitate and encourage EBDM. In turn, this may assist chronic disease practitioners in implementing chronic disease interventions that have been proven effective. The use of such interventions will improve public health through the prevention of chronic diseases.

  2. 31 CFR 540.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 540.705 Section 540.705 Money and Finance: Treasury... Administrative collection; referral to United States Department of Justice. In the event that the respondent does... Treasury or to the United States Department of Justice for appropriate action to recover the penalty in a...

  3. 31 CFR 586.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 586.705 Section 586.705 Money and Finance: Treasury....705 Administrative collection; referral to United States Department of Justice. In the event that the... Treasury or to the United States Department of Justice for appropriate action to recover the penalty in a...

  4. An agent-based simulation combined with group decision-making technique for improving the performance of an emergency department

    Directory of Open Access Journals (Sweden)

    M. Yousefi

    Full Text Available This study presents an agent-based simulation modeling in an emergency department. In a traditional approach, a supervisor (or a manager allocates the resources (receptionist, nurses, doctors, etc. to different sections based on personal experience or by using decision-support tools. In this study, each staff agent took part in the process of allocating resources based on their observation in their respective sections, which gave the system the advantage of utilizing all the available human resources during the workday by being allocated to a different section. In this simulation, unlike previous studies, all staff agents took part in the decision-making process to re-allocate the resources in the emergency department. The simulation modeled the behavior of patients, receptionists, triage nurses, emergency room nurses and doctors. Patients were able to decide whether to stay in the system or leave the department at any stage of treatment. In order to evaluate the performance of this approach, 6 different scenarios were introduced. In each scenario, various key performance indicators were investigated before and after applying the group decision-making. The outputs of each simulation were number of deaths, number of patients who leave the emergency department without being attended, length of stay, waiting time and total number of discharged patients from the emergency department. Applying the self-organizing approach in the simulation showed an average of 12.7 and 14.4% decrease in total waiting time and number of patients who left without being seen, respectively. The results showed an average increase of 11.5% in total number of discharged patients from emergency department.

  5. 31 CFR 593.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 593.705 Section 593.705 Money and Finance: Treasury... collection; referral to United States Department of Justice. In the event that the respondent does not pay... United States Department of Justice for appropriate action to recover the penalty in a civil suit in a...

  6. 31 CFR 538.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 538.705 Section 538.705 Money and Finance: Treasury... States Department of Justice. In the event that the respondent does not pay the penalty imposed pursuant... United States Department of Justice for appropriate action to recover the penalty in a civil suit in a...

  7. 31 CFR 595.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 595.705 Section 595.705 Money and Finance: Treasury... States Department of Justice. In the event that the person named does not pay the penalty imposed... United States Department of Justice for appropriate action to recover the penalty in a civil suit in a...

  8. 31 CFR 539.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 539.705 Section 539.705 Money and Finance: Treasury... collection; referral to United States Department of Justice. In the event that the respondent does not pay... United States Department of Justice for appropriate action to recover the penalty in a civil suit in a...

  9. Engaging patients in health care decisions in the emergency department through shared decision-making: a systematic review.

    Science.gov (United States)

    Flynn, Darren; Knoedler, Meghan A; Hess, Erik P; Murad, M Hassan; Erwin, Patricia J; Montori, Victor M; Thomson, Richard G

    2012-08-01

    Many decisions in the emergency department (ED) may benefit from patient involvement, even though this setting has been considered least conducive to shared decision-making (SDM). The objective was to conduct a systematic review to evaluate the approaches, methods, and tools used to engage patients or their surrogates in SDM in the ED. Five electronic databases were searched in conjunction with contacting content experts, reviewing selected bibliographies, and conducting citation searches using the Web of Knowledge database. Two reviewers independently selected eligible studies that addressed patient involvement and engagement in decision-making in the ED setting via the use of decision support interventions (DSIs), defined as decision aids or decision support designed to communicate probabilistic information on the risks and benefits of treatment options to patients as part of an SDM process. Eligible studies described and assessed at least one of the following outcomes: patient knowledge, experiences and perspectives on participating in treatment or management decisions, clinician or patient satisfaction, preference for involvement and/or degree of engagement in decision-making and treatment preferences, and clinical outcomes (e.g., rates of hospital admission/readmission, rates of medical or surgical interventions). Two reviewers extracted data on study characteristics, methodologic quality, and outcomes. The authors also assessed the extent to which SDM interventions adhered to good practice for the presentation of information on outcome probabilities (eight probability items from the International Patient Decision Aid Standards Instrument [IPDASi]) and had comprehensive development processes. Five studies met inclusion criteria and were synthesized using a narrative approach. Each study was of satisfactory methodologic quality and used a DSI to engage patients or their surrogates in decision-making in the ED across four domains: 1) management options for

  10. The Total Quality Management Model Department of Personnel State of Colorado,

    Science.gov (United States)

    A panel of three members will present the Total Quality Management model recently designed for the Department of Personnel, State of Colorado. This model was selected to increase work quality and productivity of the Department and to exemplify Governor Romer’s commitment to quality work within state government.

  11. 30 CFR 227.108 - How will MMS notify a State of its decision?

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false How will MMS notify a State of its decision... MINERALS REVENUE MANAGEMENT DELEGATION TO STATES Delegation Process § 227.108 How will MMS notify a State of its decision? MMS will notify you in writing of its decision on your delegation proposal. If MMS...

  12. 31 CFR 585.705 - Referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... of Justice. 585.705 Section 585.705 Money and Finance: Treasury Regulations Relating to Money and... HERZEGOVINA SANCTIONS REGULATIONS Penalties § 585.705 Referral to United States Department of Justice. In the... States Department of Justice for appropriate action to recover the penalty in a civil suit in a Federal...

  13. Empirical Evaluation of a Decision-Analytic Aid.

    Science.gov (United States)

    1980-05-01

    Morris, Smallwood , Lansford, and Gibbons (1980) state: "In the traditional paradigm, the decision-maker must decide to accept or reject the model. If he... Smallwood , R. D., Langford, R. K., & Gibbons, R. S. Analytic Procedures for Evaluating Decision Aids. Applied Decision Analysis, Inc. (Menlo Park, CA...Menlo Park, CA 94025 Department of Psychology University of Oklahoma Dr. Jesse Orlansky 455 West Lindsey Institute for Defense Analyses Norman , OK 73069

  14. 76 FR 14055 - Notice of Inventory Completion: California State Department of Transportation (Caltrans...

    Science.gov (United States)

    2011-03-15

    ...: California State Department of Transportation (Caltrans), Sacramento, CA, and California State University, Sacramento, CA AGENCY: National Park Service, Interior. ACTION: Notice. Notice is here given in accordance... Department of Transportation (Caltrans), Sacramento, CA, and in the possession of California State University...

  15. 31 CFR 575.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 575.705 Section 575.705 Money and Finance: Treasury... States Department of Justice. In the event that the person named does not pay the penalty imposed... Department of Justice for appropriate action to recover the penalty in a civil suit in a Federal district...

  16. 31 CFR 536.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 536.705 Section 536.705 Money and Finance: Treasury...; referral to United States Department of Justice. In the event that the respondent does not pay the penalty... Department of Justice for appropriate action to recover the penalty in a civil suit in a Federal district...

  17. 31 CFR 592.605 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 592.605 Section 592.605 Money and Finance: Treasury... United States Department of Justice. In the event that the respondent does not pay the penalty imposed... Department of Justice for appropriate action to recover the penalty in a civil suit in a federal district...

  18. 31 CFR 588.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 588.705 Section 588.705 Money and Finance: Treasury... to United States Department of Justice. In the event that the respondent does not pay the penalty... Department of Justice for appropriate action to recover the penalty in a civil suit in a federal district...

  19. 31 CFR 594.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 594.705 Section 594.705 Money and Finance: Treasury... United States Department of Justice. In the event that the respondent does not pay the penalty imposed... Department of Justice for appropriate action to recover the penalty in a civil suit in a federal district...

  20. 31 CFR 598.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 598.705 Section 598.705 Money and Finance: Treasury...; referral to United States Department of Justice. In the event that the respondent does not pay a penalty... Department of Justice for appropriate action to recover the penalty in a civil suit in a Federal district...

  1. 31 CFR 535.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 535.705 Section 535.705 Money and Finance: Treasury... United States Department of Justice. In the event that the person named does not pay the penalty imposed... Department of Justice for appropriate action to recover the penalty in a civil suit in a Federal district...

  2. Informatics and communication in a state public health department: a case study.

    Science.gov (United States)

    Hills, Rebecca A; Turner, Anne M

    2008-11-06

    State and local health departments are witnessing growth in the area of informatics. As new informatics projects commence, existing methods of communication within the health department may not be sufficient. We gathered information about roles and communication between a development team and a user group working simultaneously on an informatics project in a state public health department in an effort to better define how communication and role definition is best used within an informatics project.

  3. 32 CFR 728.57 - Department of State and associated agencies.

    Science.gov (United States)

    2010-07-01

    ...) Department of Justice—Drug Enforcement Agency. (10) Department of Treasury—U.S. Customs, U.S. Secret Service... (JECOR), and the Internal Revenue Service. (11) National Aeronautics and Space Administration. (12... State Medical Program. (b) Care authorized—(1) General. The Foreign Service Act of 1946, as amended...

  4. Role of a state health department in an underground nuclear experiment

    Energy Technology Data Exchange (ETDEWEB)

    Gerusky, T M [Department of Health, Harrisburg, PA (United States)

    1969-07-01

    When Project Ketch was first announced to Pennsylvania state officials, the Department of Health, under its legal responsibility to protect the health of the citizens of the state, was quick to realize that a thorough, independent review of the proposal was indeed necessary. Although the project was terminated by the sponsoring company before on-site preliminary evaluation work was begun, it is believed that the Department's approach was sound and practical. This study and the planned joint effort of the state and the Bureau of Radiological health will be discussed in detail. (author)

  5. Role of a state health department in an underground nuclear experiment

    International Nuclear Information System (INIS)

    Gerusky, T.M.

    1969-01-01

    When Project Ketch was first announced to Pennsylvania state officials, the Department of Health, under its legal responsibility to protect the health of the citizens of the state, was quick to realize that a thorough, independent review of the proposal was indeed necessary. Although the project was terminated by the sponsoring company before on-site preliminary evaluation work was begun, it is believed that the Department's approach was sound and practical. This study and the planned joint effort of the state and the Bureau of Radiological health will be discussed in detail. (author)

  6. Physician Confidence in Dental Trauma Treatment and the Introduction of a Dental Trauma Decision-Making Pathway for the Pediatric Emergency Department.

    Science.gov (United States)

    Cully, Matthew; Cully, Jennifer; Nietert, Paul J; Titus, M Olivia

    2018-04-24

    The objectives of this study were to (1) survey and report the awareness and confidence of pediatric emergency medicine physicians in the management of dental trauma and (2) determine the prevalence of dental trauma decision-making pathway utilization in the pediatric emergency department. A survey was distributed through e-mail to the pediatric emergency medicine discussion list via Brown University LISTSERV. The survey study included 10 questions and was multiple-choice. The survey contained questions about physician confidence and their use of a dental trauma decision-making pathway. A total of 285 individuals responded to the survey. Somewhat confident was the most common response (61%) followed by not confident (20%) and confident (19%) by respondents in treating dental trauma. Forty-one percent of respondents felt comfortable, 39% somewhat comfortable, 19% not comfortable, and 1% not sure in replanting an avulsed tooth. Only 6% of respondents reported that their pediatric emergency department always or sometimes uses a dental trauma decision-making pathway, whereas 78% of pediatric emergency departments do not. We believe that the adoption of a decision-making pathway will provide timely management, improve emergency physician comfort, and enhance outcomes for pediatric patients presenting with a dental trauma. A future multicenter review will aim to evaluate these goals based on the utilization of our dental trauma decision-making pathway.

  7. 48 CFR 652.219-72 - Department of State Mentor-Protégé Program.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Department of State Mentor....219-72 Department of State Mentor-Protégé Program. As prescribed in 619.202-70(o)(1), insert the following provision: Department of State Mentor-Protégé Program (APR 2004) (a) Large and small businesses...

  8. State Emergency Department Opioid Guidelines: Current Status.

    Science.gov (United States)

    Broida, Robert I; Gronowski, Tanner; Kalnow, Andrew F; Little, Andrew G; Lloyd, Christopher M

    2017-04-01

    The purpose of this study was to evaluate and categorize current state-sponsored opioid guidelines for the practice of emergency medicine (EM). We conducted a comprehensive search of EM-specific opioid prescribing guidelines and/or policies in each state to determine current state involvement in EM opioid prescribing, as well as to evaluate some of the specifics of each guideline or policy. The search was conducted using an online query and a follow-up email request to each state chapter of ACEP. We found that 17 states had emergency department-specific guidelines. We further organized the guidelines into four categories: limiting prescriptions for opioids with 67 total recommendations; preventing/diverting abuse with 56 total recommendations; addiction-related guidelines with 29 total recommendations; and a community resources section with 24 total recommendations. Our results showed that current state guidelines focus on providers limiting opioid pain prescriptions and vetting patients for possible abuse/diversion. This study highlights the 17 states that have addressed opioid prescribing guidelines and categorizes their efforts to date. It is hoped that this study will provide the basis for similar efforts in other states.

  9. 76 FR 43714 - Notice of Inventory Completion: Oregon State University Department of Anthropology, Corvallis, OR

    Science.gov (United States)

    2011-07-21

    ... State University Department of Anthropology, Corvallis, OR AGENCY: National Park Service, Interior. ACTION: Notice. SUMMARY: The Oregon State University Department of Anthropology has completed an... contact the Oregon State University Department of Anthropology. Repatriation of the human remains to the...

  10. 38 CFR 1.506 - Disclosure of records to Federal Government departments, State unemployment compensation agencies...

    Science.gov (United States)

    2010-07-01

    ... Federal Government departments, State unemployment compensation agencies, and the Office of Servicemembers....506 Disclosure of records to Federal Government departments, State unemployment compensation agencies... official purposes by any department or other agency of the U.S. Government or any state unemployment...

  11. 77 FR 59969 - Notice of Inventory Completion: San Francisco State University, Department of Anthropology, San...

    Science.gov (United States)

    2012-10-01

    ... Inventory Completion: San Francisco State University, Department of Anthropology, San Francisco, CA... Francisco State University, NAGPRA Program (formerly in the Department of Anthropology). The human remains... State University Department of Anthropology records. In the Federal Register (73 FR 30156-30158, May 23...

  12. Scientific Framework for Stormwater Monitoring by the Washington State Department of Transportation

    Science.gov (United States)

    Sheibley, R.W.; Kelly, V.J.; Wagner, R.J.

    2009-01-01

    The Washington State Department of Transportation municipal stormwater monitoring program, in operation for about 8 years, never has received an external, objective assessment. In addition, the Washington State Department of Transportation would like to identify the standard operating procedures and quality assurance protocols that must be adopted so that their monitoring program will meet the requirements of the new National Pollutant Discharge Elimination System municipal stormwater permit. As a result, in March 2009, the Washington State Department of Transportation asked the U.S. Geological Survey to assess their pre-2009 municipal stormwater monitoring program. This report presents guidelines developed for the Washington State Department of Transportation to meet new permit requirements and regional/national stormwater monitoring standards to ensure that adequate processes and procedures are identified to collect high-quality, scientifically defensible municipal stormwater monitoring data. These include: (1) development of coherent vision and cooperation among all elements of the program; (2) a comprehensive approach for site selection; (3) an effective quality assurance program for field, laboratory, and data management; and (4) an adequate database and data management system.

  13. National Agricultural Library | United States Department of Agriculture

    Science.gov (United States)

    Skip to main content Home National Agricultural Library United States Department of Agriculture Ag Terms of Service Frequently Asked Questions Policies and Documentation Ag Data Commons Monthly Metrics News Contact Us Search  Log inRegister Home Home About Policies and Documentation Ag Data Commons

  14. 22 CFR 23.5 - Claims for settlement by Department of State or General Accounting Office.

    Science.gov (United States)

    2010-04-01

    ... General Accounting Office. 23.5 Section 23.5 Foreign Relations DEPARTMENT OF STATE FEES AND FUNDS FINANCE AND ACCOUNTING § 23.5 Claims for settlement by Department of State or General Accounting Office. Claims for settlement by the Department of State or by the General Accounting Office shall be submitted...

  15. State and use of monitoring and evaluation systems in national and provincial departments

    Directory of Open Access Journals (Sweden)

    Futhi Umlaw

    2015-09-01

    Full Text Available Since 2009, South Africa has seen a major shift in emphasis concerning monitoring and evaluation (M&E systems. This shift was partially stimulated by the South African government being faced with a number of pressures, key amongst which were persistent poverty and inequality and widespread service delivery protests. These pressures resulted ina greater willingness by government to address the poor quality of public services, and other governance problems that needed a greater focus on M&E to address these challenges. This led to the establishment of the Department of Performance Monitoring and Evaluation (DPME in early 2010. A comprehensive survey on the state and use of M&E systems in national and provincial government was conducted by the DPME as an attempt to understand the M&E landscape since 1994. The results were used to make informed policy and programme decisions. This paper outlines the findings of the survey.

  16. Joint federal research and development process to meet state and local needs. Part 1. Science and technology and political decision making

    Energy Technology Data Exchange (ETDEWEB)

    Wise, H F; Smith, L K; Einsweiler, R C; Jensen, D E

    1980-10-01

    This part of the handbook addresses the basic how to do it - how states and local governments can identify complex and cross-cutting issues and develop and manage scientific and technical resources in seeking policy solutions to such issues. The following subjects are discussed: background statement of the issue; the research/decision-making process; defining problems and identifying research components; research and decision-making strategies; how to identify existing knowledge or ongoing research in the area of policy concern; and managing multi-disciplinary research. The fourteen agencies involved in this effort include: US Departments of Energy, Agriculture, Transportation, Housing and Urban Development, Environmental Protection Agency, and National Science Foundation. (PSB)

  17. 76 FR 20249 - Department of State Acquisition Regulation

    Science.gov (United States)

    2011-04-12

    ... number 1405-0050. List of Subjects in 48 CFR Parts 604, 637 and 652 Government procurement, Electronic... Latvanas, Procurement Analyst, Department of State, Office of the Procurement Executive, 2201 C Street, NW..., local, and tribal governments, in the aggregate, or by the private sector, of $100 million or more in...

  18. 8 CFR 215.4 - Procedure in case of alien prevented from departing from the United States.

    Science.gov (United States)

    2010-01-01

    ... departing from the United States. 215.4 Section 215.4 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS CONTROLS OF ALIENS DEPARTING FROM THE UNITED STATES § 215.4 Procedure in case of alien prevented from departing from the United States. (a) Any alien, other than an enemy alien, whose departure...

  19. The Implementation Analysis of Intellectual Capital to Department Performance in Padang State University

    Directory of Open Access Journals (Sweden)

    Sulastri sulastri

    2015-09-01

    Full Text Available The purpose of this research was to observe the effect of the age of the organization department in Padang State University on performance through human capital, structural capital and relational capital. The sample is all of department in Padang State University, which is 33 departments. The data were collected through questionnaires and analyzed using partial least squares (PLS. The results showed that the age of the department is not direct and significant impact on the department performance. While the age departments significantly affect the department's human capital, structural capital and relational capital. Furthermore, the human capital, structural capital and relational capital significantly positive affect the department performance. This research failed to prove the existence of variable human capital, structural capital and relational capital as a mediating variable but serves as an intervening variable. Its means that age of department performance cannot determine performance without increasing the human capital, structural capital and relational capital.

  20. The state of shared decision making in Malaysia.

    Science.gov (United States)

    Lee, Yew Kong; Ng, Chirk Jenn

    2017-06-01

    Shared decision making (SDM) activities in Malaysia began around 2010. Although the concept is not widespread, there are opportunities to implement SDM in both the public and private healthcare sectors. Malaysia has a multicultural society and cultural components (such as language differences, medical paternalism, strong family involvement, religious beliefs and complementary medicine) influence medical decision making. In terms of policy, the Ministry of Health has increasingly mentioned patient-centered care as a component of healthcare delivery while the Malaysian Medical Council's guidelines on doctors' duties mentioned collaborative partnerships as a goal of doctor-patient relationships. Current research on SDM comprises baseline surveys of decisional role preferences, development and implementation of locally developed patient decision aids, and conducting of SDM training workshops. Most of this research is carried out by public research universities. In summary, the current state of SDM in Malaysia is still at its infancy. However, there are increasing recognition and efforts from the academic institutions and Ministry of Health to conduct research in SDM, develop patient decision support tools and initiate national discussion on patient involvement in decision making. Copyright © 2017. Published by Elsevier GmbH.

  1. 78 FR 35899 - Decision and Order Granting a Waiver to Samsung From the Department of Energy Residential...

    Science.gov (United States)

    2013-06-14

    ... and Order Granting a Waiver to Samsung From the Department of Energy Residential Refrigerator and... decision and order (Case No. RF-026) that grants to Samsung Electronics America, Inc. (Samsung) a waiver... forth in its petition for waiver. In its petition, Samsung provides an alternate test procedure to...

  2. 78 FR 35898 - Decision and Order Granting a Waiver to Samsung From the Department of Energy Residential...

    Science.gov (United States)

    2013-06-14

    ... and Order Granting a Waiver to Samsung From the Department of Energy Residential Refrigerator and... decision and order in Case No. RF-027 that grants to Samsung Electronics America, Inc. (Samsung) a waiver... set forth in its petition for waiver. In its petition, Samsung provides an alternate test procedure...

  3. 78 FR 65623 - Decision and Order Granting a Waiver to Samsung From the Department of Energy Residential...

    Science.gov (United States)

    2013-11-01

    ... and Order Granting a Waiver to Samsung From the Department of Energy Residential Refrigerator and... decision and order in Case No. RF-032 that grants to Samsung Electronics America, Inc. (Samsung) a waiver... set forth in its petition for waiver. In its petition, Samsung provides an alternate test procedure...

  4. 78 FR 35901 - Decision and Order Granting a Waiver to Samsung From the Department of Energy Residential...

    Science.gov (United States)

    2013-06-14

    ... and Order Granting a Waiver to Samsung From the Department of Energy Residential Refrigerator and... decision and order in Case No. RF-025 that grants to Samsung Electronics America, Inc. (Samsung) a waiver... set forth in its petition for waiver. In its petition, Samsung provides an alternate test procedure...

  5. Chronic motivational state interacts with task reward structure in dynamic decision-making.

    Science.gov (United States)

    Cooper, Jessica A; Worthy, Darrell A; Maddox, W Todd

    2015-12-01

    Research distinguishes between a habitual, model-free system motivated toward immediately rewarding actions, and a goal-directed, model-based system motivated toward actions that improve future state. We examined the balance of processing in these two systems during state-based decision-making. We tested a regulatory fit hypothesis (Maddox & Markman, 2010) that predicts that global trait motivation affects the balance of habitual- vs. goal-directed processing but only through its interaction with the task framing as gain-maximization or loss-minimization. We found support for the hypothesis that a match between an individual's chronic motivational state and the task framing enhances goal-directed processing, and thus state-based decision-making. Specifically, chronic promotion-focused individuals under gain-maximization and chronic prevention-focused individuals under loss-minimization both showed enhanced state-based decision-making. Computational modeling indicates that individuals in a match between global chronic motivational state and local task reward structure engaged more goal-directed processing, whereas those in a mismatch engaged more habitual processing. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Data.gov (United States)

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

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

    Data.gov (United States)

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

  8. 31 CFR 542.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 542.705 Section 542.705 Money and Finance: Treasury... States Department of Justice. In the event that the respondent does not pay the penalty imposed pursuant... Justice for appropriate action to recover the penalty in a civil suit in a Federal District Court. ...

  9. 31 CFR 537.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 537.705 Section 537.705 Money and Finance: Treasury... States Department of Justice. In the event that the respondent does not pay the penalty imposed pursuant... Justice for appropriate action to recover the penalty in a civil suit in a federal district court. ...

  10. 31 CFR 541.705 - Administrative collection; referral to United States Department of Justice.

    Science.gov (United States)

    2010-07-01

    ... to United States Department of Justice. 541.705 Section 541.705 Money and Finance: Treasury... States Department of Justice. In the event that the respondent does not pay the penalty imposed pursuant... Justice for appropriate action to recover the penalty in a civil suit in a federal district court. ...

  11. State of the art in marketing hospital foodservice departments.

    Science.gov (United States)

    Pickens, C W; Shanklin, C W

    1985-11-01

    The purposes of this study were to identify the state of the art relative to the utilization of marketing techniques within hospital foodservice departments throughout the United States and to determine whether any relationships existed between the degree of utilization of marketing techniques and selected demographic characteristics of the foodservice administrators and/or operations. A validated questionnaire was mailed to 600 randomly selected hospital foodservice administrators requesting information related to marketing in their facilities. Forty-five percent of the questionnaires were returned and analyzed for frequency of response and significant relationship between variables. Chi-square was used for nominal data and Spearman rho for ranked data. Approximately 73% of the foodservice administrators stated that marketing was extremely important in the success of a hospital foodservice department. Respondents (79%) further indicated that marketing had become more important in their departments in the past 2 years. Departmental records, professional journals, foodservice suppliers, observation, and surveys were the sources most often used to obtain marketing data, a responsibility generally assumed by the foodservice director (86.2%). Merchandising, public relations, and word-of-mouth reputation were regarded as the most important aspects of marketing. Increased sales, participation, good will, departmental recognition, and employee satisfaction were used most frequently to evaluate the success of implemented marketing techniques. Marketing audits as a means of evaluating the success of marketing were used to a limited extent by the respondents.

  12. 77 FR 75428 - Decision and Order Granting a Waiver to Samsung From the Department of Energy Residential...

    Science.gov (United States)

    2012-12-20

    ... and Order Granting a Waiver to Samsung From the Department of Energy Residential Refrigerator and... decision and order (Case No. RF-021) that grants to Samsung Electronics America, Inc. (Samsung) a waiver... forth in its petition for waiver in Case RF-021. In its petition, Samsung provides an alternate test...

  13. Culture and medical decision making: Healthcare consumer perspectives in Japan and the United States.

    Science.gov (United States)

    Alden, Dana L; Friend, John M; Lee, Angela Y; de Vries, Marieke; Osawa, Ryosuke; Chen, Qimei

    2015-12-01

    Two studies identified core value influences on medical decision-making processes across and within cultures. In Study 1, Japanese and American adults reported desired levels of medical decision-making influence across conditions that varied in seriousness. Cultural antecedents (interdependence, independence, and power distance) were also measured. In Study 2, American adults reviewed a colorectal cancer screening decision aid. Decision preparedness was measured along with interdependence, independence, and desire for medical information. In Study 1, higher interdependence predicted stronger desire for decision-making information in both countries, but was significantly stronger in Japan. The path from information desire to decision-making influence desire was significant only in Japan. The independence path to desire for decision-making influence was significant only in the United States. Power distance effects negatively predicted desire for decision-making influence only in the United States. For Study 2, high (low) interdependents and women (men) in the United States felt that a colorectal cancer screening decision aid helped prepare them more (less) for a medical consultation. Low interdependent men were at significantly higher risk for low decision preparedness. Study 1 suggests that Japanese participants may tend to view medical decision-making influence as an interdependent, information sharing exchange, whereas American respondents may be more interested in power sharing that emphasizes greater independence. Study 2 demonstrates the need to assess value influences on medical decision-making processes within and across cultures and suggests that individually tailored versions of decision aids may optimize decision preparedness. (c) 2015 APA, all rights reserved).

  14. Decision-making authority and substance abuse treatment for adolescents: a survey of state laws.

    Science.gov (United States)

    Lallemont, Tori; Mastroianni, Anna; Wickizer, Thomas M

    2009-04-01

    State laws concerning decision-making authority for voluntary inpatient substance abuse (SA) treatment of minors may be a potential barrier to appropriate treatment. We sought to identify and classify relevant laws related to the provision of voluntary inpatient SA treatment to adolescents 12 to 17 years (minors) as an exploratory assessment to improve understanding of how these laws might affect treatment decisions. In summer 2006, we conducted a survey of statutes, regulations, and legal cases in the 50 states and the District of Columbia regarding the authority of parents (or guardians) and minors to make treatment decisions for voluntary inpatient SA treatment. All 50 states have laws applicable to voluntary inpatient SA treatment for adolescents, and the laws vary significantly throughout the nation. If a minor and parent disagree about SA treatment, some states defer to the decision-making authority of the minor, whereas other states defer to the parent. Most significantly, the majority of states fail to specify whether the minor's or the parent's decision will control in the event of a conflict. The lack of clarity in state laws regarding decision-making authority for voluntary inpatient SA treatment of minors may create a potential barrier to treatment for adolescents, especially those with more serious SA problems. This lack of clarity could lead to confusion among parents, adolescents, healthcare professionals, and treatment facilities, and ultimately could result in a failure to treat adolescents in need of medical attention. Policymakers should ensure that state laws clearly specify procedures to enable treatment if a conflict arises between adolescents and parents, including procedures to ensure that the due process rights of adolescents are protected.

  15. 76 FR 43716 - Notice of Inventory Completion: Oregon State University Department of Anthropology, Corvallis, OR

    Science.gov (United States)

    2011-07-21

    ... State University Department of Anthropology, Corvallis, OR AGENCY: National Park Service, Interior. ACTION: Notice. SUMMARY: The Oregon State University Department of Anthropology has completed an... contact [[Page 43717

  16. Linking public relations processes and organizational effectiveness at a state health department.

    Science.gov (United States)

    Wise, Kurt

    2003-01-01

    This qualitative case study explored a state health department's relationships with strategic constituencies from a public relations perspective. The relationships were explored within the theoretical framework of the Excellence Theory, the dominant paradigm in public research. Findings indicate application of the Excellence Theory has the potential to increase organizational effectiveness at public health entities. With respect to the case investigated, findings indicate that the state health department could increase its organizational effectiveness through the adoption of recommendations based on the Excellence Theory.

  17. State departments for the selection and control of school textbooks

    Directory of Open Access Journals (Sweden)

    María López García

    2012-02-01

    Full Text Available The article studies the State Commissions for the regulation of Schoolbooks, instituted in Argentine at the beginning of the 20th-century. The analysis exhibits a gradual liberalization of the prescriptions and a reassignment of decisions to the publishers, as well as the institution of schoolbooks as ineludible tool of the pedagogical methodology throughout that century. The growing of the publishing industry resulted in a displacement of the functions of control and selection of the produced teaching materials from the State on teachers and publishing companies. The bonds between State proposals and market technologies entailed a state validation of the companies’ conveniences; one of its more harmful consequences was their increasing meddling in the pedagogical methodology to implement in the school.

  18. United States Department of Energy radiological emergency response programme - a national capability

    International Nuclear Information System (INIS)

    Gordon-Hagerty, L.E.

    1993-01-01

    In order to respond to a radiological emergency, the United States Department of Energy (USDOE) maintains seven emergency response assets and capabilities in support of a radiological emergency of any proportion within the continental United States and abroad. The seven emergency response assets and capabilities include: Accident Response Group; Aerial Measuring Systems; Atmospheric Release Advisory Capability; Federal Radiological Monitoring and Assessment Center; Nuclear Emergency Search Team; Radiation Emergency Assistance Center/Training Site; and Radiological Assistance Program. Presently, USDOE maintains the most comprehensive national radiological emergency response assets in the United States, capable of dealing with any type of emergency involving nuclear materials. In all, the Department's assets are available to support any type of accident/incident involving radioactive materials in coordination with other United States Federal agencies, as well as state and local governments, as required. (author)

  19. 20 CFR 655.1245 - Who can appeal the ALJ's decision and what is the process?

    Science.gov (United States)

    2010-04-01

    ..., DEPARTMENT OF LABOR TEMPORARY EMPLOYMENT OF FOREIGN WORKERS IN THE UNITED STATES What are the Department's... what is the process? (a) The Administrator or any interested party desiring review of the decision and...

  20. Evaluation of Syndromic Surveillance Systems in 6 US State and Local Health Departments.

    Science.gov (United States)

    Thomas, Mathew J; Yoon, Paula W; Collins, James M; Davidson, Arthur J; Mac Kenzie, William R

    Evaluating public health surveillance systems is critical to ensuring that conditions of public health importance are appropriately monitored. Our objectives were to qualitatively evaluate 6 state and local health departments that were early adopters of syndromic surveillance in order to (1) understand the characteristics and current uses, (2) identify the most and least useful syndromes to monitor, (3) gauge the utility for early warning and outbreak detection, and (4) assess how syndromic surveillance impacted their daily decision making. We adapted evaluation guidelines from the Centers for Disease Control and Prevention and gathered input from the Centers for Disease Control and Prevention subject matter experts in public health surveillance to develop a questionnaire. We interviewed staff members from a convenience sample of 6 local and state health departments with syndromic surveillance programs that had been in operation for more than 10 years. Three of the 6 interviewees provided an example of using syndromic surveillance to identify an outbreak (ie, cluster of foodborne illness in 1 jurisdiction) or detect a surge in cases for seasonal conditions (eg, influenza in 2 jurisdictions) prior to traditional, disease-specific systems. Although all interviewees noted that syndromic surveillance has not been routinely useful or efficient for early outbreak detection or case finding in their jurisdictions, all agreed that the information can be used to improve their understanding of dynamic disease control environments and conditions (eg, situational awareness) in their communities. In the jurisdictions studied, syndromic surveillance may be useful for monitoring the spread and intensity of large outbreaks of disease, especially influenza; enhancing public health awareness of mass gatherings and natural disasters; and assessing new, otherwise unmonitored conditions when real-time alternatives are unavailable. Future studies should explore opportunities to

  1. 22 CFR 92.2 - Description of overseas notarial functions of the Department of State, record of acts.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Description of overseas notarial functions of the Department of State, record of acts. 92.2 Section 92.2 Foreign Relations DEPARTMENT OF STATE LEGAL... officers of the Department of State is similar to the function of a notary public in the United States. See...

  2. 76 FR 70996 - Decision and Order Granting a Waiver to Samsung From the Department of Energy Residential Clothes...

    Science.gov (United States)

    2011-11-16

    ... and Order Granting a Waiver to Samsung From the Department of Energy Residential Clothes Washer Test... No. CW-020) that grants to Samsung Electronics America, Inc. (Samsung) a waiver from the DOE clothes... forth in its petition for waiver. Under today's decision and order, Samsung shall be required to test...

  3. 76 FR 50207 - Decision and Order Granting a Waiver to Samsung From the Department of Energy Residential Clothes...

    Science.gov (United States)

    2011-08-12

    ... and Order Granting a Waiver to Samsung From the Department of Energy Residential Clothes Washer Test... No. CW-019) that grants to Samsung Electronics America, Inc. (Samsung) a waiver from the DOE clothes... forth in its petition for waiver. Under today's decision and order, Samsung shall be required to test...

  4. 20 CFR 655.655 - Secretary's review of administrative law judge's decision.

    Science.gov (United States)

    2010-04-01

    ..., DEPARTMENT OF LABOR TEMPORARY EMPLOYMENT OF FOREIGN WORKERS IN THE UNITED STATES Enforcement of the... Secretary's review of administrative law judge's decision. (a) The Administrator or any interested party...

  5. Relationship between Organizational Climate, Job Stress and Job Performance Officer at State Education Department

    Science.gov (United States)

    Suandi, Turiman; Ismail, Ismi Arif; Othman, Zulfadli

    2014-01-01

    This research aims at finding out the relationship between Organizational Climate, job stress and job performance among State Education Department (JPN) officers . The focus of the research is to determine the job performance of state education department officers, level of job stress among the officers, level of connection between organizational…

  6. Impact of a computerized provider radiography order entry system without clinical decision support on emergency department medical imaging requests.

    Science.gov (United States)

    Claret, Pierre-Géraud; Bobbia, Xavier; Macri, Francesco; Stowell, Andrew; Motté, Antony; Landais, Paul; Beregi, Jean-Paul; de La Coussaye, Jean-Emmanuel

    2016-06-01

    The adoption of computerized physician order entry is an important cornerstone of using health information technology (HIT) in health care. The transition from paper to computer forms presents a change in physicians' practices. The main objective of this study was to investigate the impact of implementing a computer-based order entry (CPOE) system without clinical decision support on the number of radiographs ordered for patients admitted in the emergency department. This single-center pre-/post-intervention study was conducted in January, 2013 (before CPOE period) and January, 2014 (after CPOE period) at the emergency department at Nîmes University Hospital. All patients admitted in the emergency department who had undergone medical imaging were included in the study. Emergency department admissions have increased since the implementation of CPOE (5388 in the period before CPOE implementation vs. 5808 patients after CPOE implementation, p=.008). In the period before CPOE implementation, 2345 patients (44%) had undergone medical imaging; in the period after CPOE implementation, 2306 patients (40%) had undergone medical imaging (p=.008). In the period before CPOE, 2916 medical imaging procedures were ordered; in the period after CPOE, 2876 medical imaging procedures were ordered (p=.006). In the period before CPOE, 1885 radiographs were ordered; in the period after CPOE, 1776 radiographs were ordered (pmedical imaging did not vary between the two periods. Our results show a decrease in the number of radiograph requests after a CPOE system without clinical decision support was implemented in our emergency department. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department

    NARCIS (Netherlands)

    D.H.F. Geurts (Dorien); E. De Vos-Kerkhof (Evelien); S. Polinder (Suzanne); E.W. Steyerberg (Ewout); J. van der Lei (Johan); H.A. Moll (Henriëtte); R. Oostenbrink (Rianne)

    2017-01-01

    textabstractAcute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on

  8. 75 FR 51619 - Privacy Act of 1974: Implementation of Exemptions; Department of Homeland Security/United States...

    Science.gov (United States)

    2010-08-23

    ... regulations to exempt portions of a Department of Homeland Security/United States Citizenship and Immigration system of records entitled the ``United States Citizenship and Immigration Services--009 Compliance... of 1974: Implementation of Exemptions; Department of Homeland Security/United States Citizenship and...

  9. Usability Testing of a Complex Clinical Decision Support Tool in the Emergency Department: Lessons Learned.

    Science.gov (United States)

    Press, Anne; McCullagh, Lauren; Khan, Sundas; Schachter, Andy; Pardo, Salvatore; McGinn, Thomas

    2015-09-10

    As the electronic health record (EHR) becomes the preferred documentation tool across medical practices, health care organizations are pushing for clinical decision support systems (CDSS) to help bring clinical decision support (CDS) tools to the forefront of patient-physician interactions. A CDSS is integrated into the EHR and allows physicians to easily utilize CDS tools. However, often CDSS are integrated into the EHR without an initial phase of usability testing, resulting in poor adoption rates. Usability testing is important because it evaluates a CDSS by testing it on actual users. This paper outlines the usability phase of a study, which will test the impact of integration of the Wells CDSS for pulmonary embolism (PE) diagnosis into a large urban emergency department, where workflow is often chaotic and high stakes decisions are frequently made. We hypothesize that conducting usability testing prior to integration of the Wells score into an emergency room EHR will result in increased adoption rates by physicians. The objective of the study was to conduct usability testing for the integration of the Wells clinical prediction rule into a tertiary care center's emergency department EHR. We conducted usability testing of a CDS tool in the emergency department EHR. The CDS tool consisted of the Wells rule for PE in the form of a calculator and was triggered off computed tomography (CT) orders or patients' chief complaint. The study was conducted at a tertiary hospital in Queens, New York. There were seven residents that were recruited and participated in two phases of usability testing. The usability testing employed a "think aloud" method and "near-live" clinical simulation, where care providers interacted with standardized patients enacting a clinical scenario. Both phases were audiotaped, video-taped, and had screen-capture software activated for onscreen recordings. Phase I: Data from the "think-aloud" phase of the study showed an overall positive outlook on

  10. The legislative work in an authoritarian regime: the case of the São Paulo administrative department

    Directory of Open Access Journals (Sweden)

    Adriano Codato

    2014-04-01

    Full Text Available This article describes the legislative process of the Administrative Department of the state of São Paulo (DAESP during the Estado Novo dictatorship and seeks to answer three questions: i what were its real attributions? ii what was its place among the state-level government agencies? iii what was its role in the dictatorial regime's public decision-making structure? Ordering and interpreting information on the DAESP's deliberative process will allow us to establish whether or not it exercised power (understood as the capacity by those who controlled it to impose their preferences, what was the magnitude of this power, what type of power was exercised, over what and whom. The frequency of its meetings, the coordination of the agendas of the dictatorial State's apparatuses involved in the decision chain, the activism of each councillor of DAESP and a sample of the legal opinions produced by it between 1939-1947 were all analysed. The findings can be summarised into three propositions: i DAESP was not a decision-making arena per se as it did not make important decisions, but instead produced a huge amount of decisions regarding the formal aspects of the decree-laws issued by the Interventoria Federal (appointed governors; ii therefore, the president of the DAESP did not have greater political or bureaucratic power than the interventor, and iii although the Department mimicked some legislative routines, it cannot be considered a substitute of the state legislature.

  11. Motivational states influence effort-based decision making in rats: the role of dopamine in the nucleus accumbens.

    Science.gov (United States)

    Mai, Bettina; Sommer, Susanne; Hauber, Wolfgang

    2012-03-01

    Decision-making policies are subject to modulation by changing motivational states. However, so far, little is known about the neurochemical mechanisms that bridge motivational states with decision making. Here we examined whether dopamine (DA) in the nucleus accumbens core (AcbC) modulates the effects of motivational states on effort-based decision making. Using a cost-benefit T-maze task in rats, we examined the effects of AcbC DA depletions on effort-based decision making, in particular on the sensitivity of effort-based decision making to a shift from a hungry to a sated state. The results demonstrated that, relative to sham controls, rats with AcbC DA depletion in a hungry as well as in a sated state had a reduced preference for effortful but large-reward action. This finding provides further support for the notion that AcbC DA regulates how much effort to invest for rewards. Importantly, our results further revealed that effort-based decision making in lesioned rats, as in sham controls, was still sensitive to a shift from a hungry to a sated state; that is, their preferences for effortful large-reward actions became lower after a shift from a restricted to a free-feeding regimen. These finding indicate that AcbC DA is not necessarily involved in mediating the effects of a shift in motivational state on decision-making policies.

  12. 75 FR 504 - U.S. Department of State Advisory Committee on Private International Law: Organization of...

    Science.gov (United States)

    2010-01-05

    ... on consumer rights as part of its program on private international law. Three proposals have been put... DEPARTMENT OF STATE [Public Notice 6255] U.S. Department of State Advisory Committee on Private International Law: Organization of American States (OAS) Specialized Conference on Private International Law...

  13. 76 FR 7623 - Department of State Performance Review Board Members

    Science.gov (United States)

    2011-02-10

    ...: February 2, 2011. Nancy J. Powell, Director General of the Foreign Service and Director of Human Resources... following individuals to the Department of State Performance Review Board for Non-Career Senior Executive Service members: Jeanne-Marie Smith, Chairperson, Senior Advisor, Deputy Secretary for Management and...

  14. Impact of Prior Therapeutic Opioid Use by Emergency Department Providers on Opioid Prescribing Decisions

    Directory of Open Access Journals (Sweden)

    Adam C Pomerleau

    2016-11-01

    Full Text Available INTRODUCTION: Our study sought to examine the opioid analgesic (OA prescribing decisions of emergency department (ED providers who have themselves used OA therapeutically and those who have not. A second objective was to determine if OA prescribing decisions would differ based on the patient's relationship to the provider. METHODS: We distributed an electronic survey to a random sample of ED providers at participating centers in a nationwide research consortium. Question topics included provider attitudes about OA prescribing, prior personal therapeutic use of OAs (indications, dosing, and disposal of leftover medication, and hypothetical analgesic-prescribing decisions for their patients, family members, and themselves for different painful conditions. RESULTS: The total survey population was 957 individuals; 515 responded to the survey, a 54% response rate. Prior personal therapeutic OA use was reported in 63% (95% CI = [58-68]. A majority of these providers (82%; 95% CI = [77-87] took fewer than half the number of pills prescribed. Regarding provider attitudes towards OA prescribing, 66% (95% CI = [61-71] agreed that OA could lead to addiction even with short-term use. When providers were asked if they would prescribe OA to a patient with 10/10 pain from an ankle sprain, 21% (95% CI = [17-25] would for an adult patient, 13% (95% CI = [10-16] would for an adult family member, and 6% (95% CI = [4-8] indicated they themselves would take an opioid for the same pain. When the scenario involved an ankle fracture, 86% (95% CI = [83-89] would prescribe OA for an adult patient, 75% (95% CI = [71-79] for an adult family member, and 52% (95% CI = [47-57] would themselves take OA. Providers who have personally used OA to treat their pain were found to make similar prescribing decisions compared to those who had not. CONCLUSION: No consistent differences in prescribing decisions were found between ED providers based on their prior therapeutic use of OA

  15. 20 CFR 655.445 - Secretary's review of administrative law judge's decision.

    Science.gov (United States)

    2010-04-01

    ..., DEPARTMENT OF LABOR TEMPORARY EMPLOYMENT OF FOREIGN WORKERS IN THE UNITED STATES Enforcement of H-1A... interested party desiring review of the decision and order of an administrative law judge shall petition the...

  16. Online decision support tools for the Office of Science and Technology

    International Nuclear Information System (INIS)

    Johnson, S.W.; Marshall, M.G.; Harrington, M.W.

    1996-01-01

    The United States Department of Energy's Office of Environmental Management Office of Science and Technology (OST) has established a program responsible for collecting, administering, continuously updating, and disseminating data on developing technologies intended for the clean-up of the department's weapons complex. The basis of this program originated from information related activities begun in 1991 and has grown to become a state-of-the-art data and information infrastructure, providing a broad range of capabilities that harmonize both the internal and external data and communication requirements of this office. A decision assistance functionality has been maintained and incorporated for use in coordination with a broader information management concept. The OST information inventory maintains operational data sets and information representative of OST activities. The following paper summarizes the operational activities of the Information for Decisions program

  17. A Hierarchical Analysis of Bridge Decision Makers ... The Role of New Technology Adoption in the Timber Bridge Market: Special Project

    Science.gov (United States)

    Robert L. Smith; Robert J. Bush; Daniel L. Schmoldt

    1995-01-01

    Bridge design engineers and local highway officials make bridge replacement decisions across the United States. The Analytical Hierarchy Process was used to characterize the bridge material selection decision of these individuals. State Department of Transportation engineers, private consulting engineers, and local highway officials were personally interviewed in...

  18. Complex decision making in patients with dementia in an internal medicine department.

    Science.gov (United States)

    Kabelka, Ladislav

    2017-10-01

    With the increase of polymorbidity, extending life expectancy and improving treatment options for chronic diseases, the care for dementia is moving into other areas of medicine. The length and quality of life with advanced dementia is directly dependent on the quality of medical and nursing care, early detection and treatment of complications, nutritional support and palliative care plan. Significant is also the support for family carers. The key coordinators of care for patients with dementia are general practitioners (GPs), geriatricians, psychiatrists, and an increasingly important role play internists. Case reports of patients admitted to an internal medicine department. Description of clinical experiences with caring on patients with dementia. In the internal departments of regional hospitals, there is a room for adjustment of the care plan, for comprehensive assessment of the patient and for making crucial decisions regarding nutrition, treatment of chronic diseases, consideration of previously expressed wishes in the context of the patient condition, and potential prognostic indicators. This assessment must result in a comprehensive documentation and communication with patients, and in the case of advanced dementia with their family members. The general internal medicine is very often the first place where the patient has a chance to hear about indication for palliative care. Without the availability of a multidisciplinary assessment, good communication and documentation, it is unrealistic to expect that the hospital would provide comprehensive care for patients with dementia.

  19. Fire Ground Decision-Making: Transferring Virtual Knowledge to the Physical Environment

    Science.gov (United States)

    Gillespie, Steven

    2013-01-01

    The primary purpose of this quantitative study was to examine if simulation training correlated with the decision-making abilities of firefighters from two departments (one in a mountain state and one in a southwest state). The other purposes were to determine if firefighter demographics were correlated with the completion of the simulation…

  20. Assessing STD Partner Services in State and Local Health Departments.

    Science.gov (United States)

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

    2018-02-07

    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.

  1. 75 FR 60159 - Determination Concerning the Bolivian Military and Police Under the Department of State, Foreign...

    Science.gov (United States)

    2010-09-29

    ... DEPARTMENT OF STATE [Public Notice 7189] Determination Concerning the Bolivian Military and Police Under the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2010... investigating, prosecuting, and punishing military and police personnel who have been credibly alleged to have...

  2. Utilization of head CT during injury visits to United States emergency departments: 2012-2015.

    Science.gov (United States)

    Yun, Brian J; Borczuk, Pierre; Zachrison, Kori S; Goldstein, Joshua N; Berlyand, Yosef; Raja, Ali S

    2018-05-18

    Studies have shown increasing utilization of head computed tomography (CT) imaging of emergency department (ED) patients presenting with an injury-related visit. Multiple initiatives, including the Choosing Wisely™ campaign and evidence-based clinical decision support based on validated decision rules, have targeted head CT use in patients with injuries. Therefore, we investigated national trends in the use of head CT during injury-related ED visits from 2012 to 2015. This was a secondary analysis of data from the annual United States (U.S.) National Hospital Ambulatory Medical Care Survey from 2012 to 2015. The study population was defined as injury-related ED visits, and we sought to determine the percentage in which a head CT was ordered and, secondarily, to determine both the diagnostic yield of clinically significant intracranial findings and hospital characteristics associated with increased head CT utilization. Between 2012 and 2015, 12.25% (95% confidence interval [CI] 11.48-13.02%) of injury-related visits received at least one head CT. Overall head CT utilization showed an increased trend during the study period (2012: 11.7%, 2015: 13.23%, p = 0.09), but the results were not statistically significant. The diagnostic yield of head CT for a significant intracranial injury over the period of four years was 7.4% (9.68% in 2012 vs. 7.67% in 2015, p = 0.23). Head CT use along with diagnostic yield has remained stable from 2012 to 2015 among patients presenting to the ED for an injury-related visit. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Controlling Chronic Diseases Through Evidence-Based Decision Making: A Group-Randomized Trial.

    Science.gov (United States)

    Brownson, Ross C; Allen, Peg; Jacob, Rebekah R; deRuyter, Anna; Lakshman, Meenakshi; Reis, Rodrigo S; Yan, Yan

    2017-11-30

    Although practitioners in state health departments are ideally positioned to implement evidence-based interventions, few studies have examined how to build their capacity to do so. The objective of this study was to explore how to increase the use of evidence-based decision-making processes at both the individual and organization levels. We conducted a 2-arm, group-randomized trial with baseline data collection and follow-up at 18 to 24 months. Twelve state health departments were paired and randomly assigned to intervention or control condition. In the 6 intervention states, a multiday training on evidence-based decision making was conducted from March 2014 through March 2015 along with a set of supplemental capacity-building activities. Individual-level outcomes were evidence-based decision making skills of public health practitioners; organization-level outcomes were access to research evidence and participatory decision making. Mixed analysis of covariance models was used to evaluate the intervention effect by accounting for the cluster randomized trial design. Analysis was performed from March through May 2017. Participation 18 to 24 months after initial training was 73.5%. In mixed models adjusted for participant and state characteristics, the intervention group improved significantly in the overall skill gap (P = .01) and in 6 skill areas. Among the 4 organizational variables, only access to evidence and skilled staff showed an intervention effect (P = .04). Tailored and active strategies are needed to build capacity at the individual and organization levels for evidence-based decision making. Our study suggests several dissemination interventions for consideration by leaders seeking to improve public health practice.

  4. Terrorism and emergency preparedness in state and territorial public health departments--United States, 2004.

    Science.gov (United States)

    2005-05-13

    After the events of September 11, 2001, federal funding for state public health preparedness programs increased from $67 million in fiscal year (FY) 2001 to approximately $1 billion in FY 2002. These funds were intended to support preparedness for and response to terrorism, infectious disease outbreaks, and other public health threats and emergencies. The Council of State and Territorial Epidemiologists (CSTE) assessed the impact of funding on epidemiologic capacity, including terrorism preparedness and response, in state health departments in November 2001 and again in May 2004, after distribution of an additional $1 billion in FY 2003. This report describes the results of those assessments, which indicated that increased funding for terrorism preparedness and emergency response has rapidly increased the number of epidemiologists and increased capacity for preparedness at the state level. However, despite the increase in epidemiologists, state public health officials estimate that 192 additional epidemiologists, an increase of 45.3%, are needed nationwide to fully staff terrorism preparedness programs.

  5. 8 CFR 1240.12 - Decision of the immigration judge.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Decision of the immigration judge. 1240.12 Section 1240.12 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PROCEEDINGS TO DETERMINE REMOVABILITY OF ALIENS IN THE UNITED STATES Removal...

  6. 8 CFR 1240.50 - Decision of the immigration judge.

    Science.gov (United States)

    2010-01-01

    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Decision of the immigration judge. 1240.50 Section 1240.50 Aliens and Nationality EXECUTIVE OFFICE FOR IMMIGRATION REVIEW, DEPARTMENT OF JUSTICE IMMIGRATION REGULATIONS PROCEEDINGS TO DETERMINE REMOVABILITY OF ALIENS IN THE UNITED STATES Proceedings To...

  7. Clean Energy Financing Programs: A Decision Resource for States and Communities

    Science.gov (United States)

    Describes financing-program options, key components of financing programs, and factors for states and communities to consider as they make decisions about getting started or updating their clean energy financing programs.

  8. A case study examination of structure and function in a state health department chronic disease unit.

    Science.gov (United States)

    Alongi, Jeanne

    2015-04-01

    I explored the structural and operational practices of the chronic disease prevention and control unit of a state health department and proposed a conceptual model of structure, function, and effectiveness for future study. My exploratory case study examined 7 elements of organizational structure and practice. My interviews with staff and external stakeholders of a single chronic disease unit yielded quantitative and qualitative data that I coded by perspective, process, relationship, and activity. I analyzed these for patterns and emerging themes. Chi-square analysis revealed significant correlations among collaboration with goal ambiguity, political support, and responsiveness, and evidence-based decisions with goal ambiguity and responsiveness. Although my study design did not permit conclusions about causality, my findings suggested that some elements of the model might facilitate effectiveness for chronic disease units and should be studied further. My findings might have important implications for identifying levers around which capacity can be built that may strengthen effectiveness.

  9. U.S. Department of Energy Regional Resource Centers Report: State of the Wind Industry in the Regions

    Energy Technology Data Exchange (ETDEWEB)

    Baranowski, Ruth [National Renewable Energy Lab. (NREL), Golden, CO (United St; Oteri, Frank [National Renewable Energy Lab. (NREL), Golden, CO (United St; Baring-Gould, Ian [National Renewable Energy Lab. (NREL), Golden, CO (United St; Tegen, Suzanne [National Renewable Energy Lab. (NREL), Golden, CO (United St

    2016-03-01

    The wind industry and the U.S. Department of Energy (DOE) are addressing technical challenges to increasing wind energy's contribution to the national grid (such as reducing turbine costs and increasing energy production and reliability), and they recognize that public acceptance issues can be challenges for wind energy deployment. Wind project development decisions are best made using unbiased information about the benefits and impacts of wind energy. In 2014, DOE established six wind Regional Resource Centers (RRCs) to provide information about wind energy, focusing on regional qualities. This document summarizes the status and drivers for U.S. wind energy development on regional and state levels. It is intended to be a companion to DOE's 2014 Distributed Wind Market Report, 2014 Wind Technologies Market Report, and 2014 Offshore Wind Market and Economic Analysis that provide assessments of the national wind markets for each of these technologies.

  10. Impact of point-of-care ultrasound on clinical decision-making at an urban emergency department in Tanzania.

    Science.gov (United States)

    Reynolds, Teri Ann; Amato, Stas; Kulola, Irene; Chen, Chuan-Jay Jeffrey; Mfinanga, Juma; Sawe, Hendry Robert

    2018-01-01

    Point of care ultrasound (PoCUS) is an efficient, inexpensive, safe, and portable imaging modality that can be particularly useful in resource-limited settings. However, its impact on clinical decision making in such settings has not been well studied. The objective of this study is to describe the utilization and impact of PoCUS on clinical decision making at an urban emergency department in Dar es Salaam, Tanzania. This was a prospective descriptive cross-sectional study of patients receiving PoCUS at Muhimbili National Hospital's Emergency Medical Department (MNH EMD). Data on PoCUS studies during a period of 10 months at MNH EMD was collected on consecutive patients during periods when research assistants were available. Data collected included patient age and sex, indications for ultrasound, findings, interpretations, and provider-reported diagnostic impression and disposition plan before and after PoCUS. Descriptive statistics, including medians and interquartile ranges, and counts and percentages, are reported. Pearson chi squared tests and p-values were used to evaluate categorical data for significant differences. PoCUS data was collected for 986 studies performed on 784 patients. Median patient age was 32 years; 56% of patients were male. Top indications for PoCUS included trauma, respiratory presentations, and abdomino-pelvic pain. The most frequent study types performed were eFAST, cardiac, and obstetric or gynaecologic studies. Overall, clinicians reported that the use of PoCUS changed either diagnostic impression or disposition plan in 29% of all cases. Rates of change in diagnostic impression or disposition plan increased to 45% in patients for whom more than one PoCUS study type was performed. In resource-limited emergency care settings, PoCUS can be utilized for a wide range of indications and has substantial impact on clinical decision making, especially when more than one study type is performed.

  11. Public Health Departments

    Data.gov (United States)

    Department of Homeland Security — State and Local Public Health Departments in the United States Governmental public health departments are responsible for creating and maintaining conditions that...

  12. Shared Decision Making in Education Governance Using Business Portals

    Science.gov (United States)

    Peoples, Adrian L.

    2009-01-01

    The purpose of this study was to address a high-volume problem for the Delaware Department of Education Office of Professional Accountability (OPA). This problem was addressed by sharing the certification decision with qualified personnel located at each of the four teacher preparation programs located in Delaware at Delaware State University…

  13. Use of mobile devices in the emergency department: A scoping review.

    Science.gov (United States)

    Dexheimer, Judith W; Borycki, Elizabeth M

    2015-12-01

    Electronic health records are increasingly used in regional health authorities, healthcare systems, hospitals, and clinics throughout North America. The emergency department provides care for urgent and critically ill patients. Over the past several years, emergency departments have become more computerized. Tablet computers and Smartphones are increasingly common in daily use. As part of the computerization trend, we have seen the introduction of handheld computers, tablets, and Smartphones into practice as a way of providing health professionals (e.g. physicians, nurses) with access to patient information and decision support in the emergency department. In this article, we present a scoping review and outline the current state of the research using mobile devices in the emergency departments. Our findings suggest that there is very little research evidence that supports the use of these mobile devices, and more research is needed to better understand and optimize the use of mobile devices. Given the prevalence of handheld devices, it is inevitable that more decision support, charting, and other activities will be performed on these devices. These developments have the potential to improve the quality and timeliness of care but should be thoroughly evaluated. © The Author(s) 2014.

  14. The Use of Economic Evaluation to Inform Newborn Screening Policy Decisions: The Washington State Experience.

    Science.gov (United States)

    Grosse, Scott D; Thompson, John D; Ding, Yao; Glass, Michael

    2016-06-01

    Newborn screening not only saves lives but can also yield net societal economic benefit, in addition to benefits such as improved quality of life to affected individuals and families. Calculations of net economic benefit from newborn screening include the monetary equivalent of avoided deaths and reductions in costs of care for complications associated with late-diagnosed individuals minus the additional costs of screening, diagnosis, and treatment associated with prompt diagnosis. Since 2001 the Washington State Department of Health has successfully implemented an approach to conducting evidence-based economic evaluations of disorders proposed for addition to the state-mandated newborn screening panel. Economic evaluations can inform policy decisions on the expansion of newborn screening panels. This article documents the use of cost-benefit models in Washington State as part of the rule-making process that resulted in the implementation of screening for medium-chain acyl-CoA dehydrogenase (MCAD) deficiency and 4 other metabolic disorders in 2004, cystic fibrosis (CF) in 2006, 15 other metabolic disorders in 2008, and severe combined immune deficiency (SCID) in 2014. We reviewed Washington State Department of Health internal reports and spreadsheet models of expected net societal benefit of adding disorders to the state newborn screening panel. We summarize the assumptions and findings for 2 models (MCAD and CF) and discuss them in relation to findings in the peer-reviewed literature. The MCAD model projected a benefit-cost ratio of 3.4 to 1 based on assumptions of a 20.0 percentage point reduction in infant mortality and a 13.9 percentage point reduction in serious developmental disability. The CF model projected a benefit-cost ratio of 4.0-5.4 to 1 for a discount rate of 3%-4% and a plausible range of 1-2 percentage point reductions in deaths up to age 10 years. The Washington State cost-benefit models of newborn screening were broadly consistent with peer

  15. Development of an Automated Decision-Making Tool for Supervisory Control System

    Energy Technology Data Exchange (ETDEWEB)

    Cetiner, Sacit M. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Muhlheim, Michael David [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Flanagan, George F. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Fugate, David L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Kisner, Roger A. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2014-09-01

    This technical report was generated as a product of the Supervisory Control for Multi-Modular Small Modular Reactor (SMR) Plants project within the Instrumentation, Control and Human-Machine Interface technology area under the Advanced Small Modular Reactor (AdvSMR) Research and Development Program of the US Department of Energy. The report documents the definition of strategies, functional elements, and the structural architecture of a supervisory control system for multi-modular AdvSMR plants. This research activity advances the state of the art by incorporating real-time, probabilistic-based decision-making into the supervisory control system architectural layers through the introduction of a tiered-plant system approach. The report provides background information on the state of the art of automated decision-making, including the description of existing methodologies. It then presents a description of a generalized decision-making framework, upon which the supervisory control decision-making algorithm is based. The probabilistic portion of automated decision-making is demonstrated through a simple hydraulic loop example.

  16. The Effects of Management Information System toward Decision Making in Food and Beverage Service Department in X Resorts and Hotels Bandung

    Directory of Open Access Journals (Sweden)

    Agung Gita Subakti

    2015-11-01

    Full Text Available In an organization, decision making hold an important role. That is why a decision made by managers should be a final decision that should be done by their subordinates or those who are related with the organization. In the effort to increase the quality of management information system, a research was held in X Resorts and Hotels Bandung to analyze management information system in the relation to decision making especially in Food and Beverage Service Department and recommendation of how to handle the problem occurred. From the questioner with data analyzing technique of spearman rank gained correlation result 0,84, with determination coefficient 71% which means the management information system has 71% level of influence to decision making, meanwhile the rest of the result (29% shows other factors, which also were related with the decision making other than management information system. To solve with the problem, it is recommended that X Resorts and Hotels decrease the level of information product error in management information used and fasten the delivery of provided information.

  17. An Integrated Agent Model Addressing Situation Awareness and Functional State in Decision Making

    NARCIS (Netherlands)

    Hoogendoorn, M.; van Lambalgen, R.M.; Treur, J.

    2011-01-01

    In this paper, an integrated agent model is introduced addressing mutually interacting Situation Awareness and Functional State dynamics in decision making. This shows how a human's functional state, more specific a human's exhaustion and power, can influence a human's situation awareness, and in

  18. On the state of the art: risk communication to decision-makers

    International Nuclear Information System (INIS)

    Bier, V.M.

    2001-01-01

    This paper reviews the state of the art on risk communication to decision-makers, with an emphasis on issues involved in communicating technical results. In particular, the paper discusses the treatment of uncertainty, variability, and dependence. It also reviews suggestions from the literature regarding the appropriate format of risk communication messages to decision-makers. Due to the lack of detailed empirical investigations and definitive results about this topic, the paper is not intended to be a comprehensive review, but rather as an exploration of key issues in this area

  19. A Markovian state-space framework for integrating flexibility into space system design decisions

    Science.gov (United States)

    Lafleur, Jarret M.

    The past decades have seen the state of the art in aerospace system design progress from a scope of simple optimization to one including robustness, with the objective of permitting a single system to perform well even in off-nominal future environments. Integrating flexibility, or the capability to easily modify a system after it has been fielded in response to changing environments, into system design represents a further step forward. One challenge in accomplishing this rests in that the decision-maker must consider not only the present system design decision, but also sequential future design and operation decisions. Despite extensive interest in the topic, the state of the art in designing flexibility into aerospace systems, and particularly space systems, tends to be limited to analyses that are qualitative, deterministic, single-objective, and/or limited to consider a single future time period. To address these gaps, this thesis develops a stochastic, multi-objective, and multi-period framework for integrating flexibility into space system design decisions. Central to the framework are five steps. First, system configuration options are identified and costs of switching from one configuration to another are compiled into a cost transition matrix. Second, probabilities that demand on the system will transition from one mission to another are compiled into a mission demand Markov chain. Third, one performance matrix for each design objective is populated to describe how well the identified system configurations perform in each of the identified mission demand environments. The fourth step employs multi-period decision analysis techniques, including Markov decision processes from the field of operations research, to find efficient paths and policies a decision-maker may follow. The final step examines the implications of these paths and policies for the primary goal of informing initial system selection. Overall, this thesis unifies state-centric concepts of

  20. 48 CFR 653.219-71 - DOS form DS-4053, Department of State Mentor-Protégé Program Application.

    Science.gov (United States)

    2010-10-01

    ..., Department of State Mentor-Protégé Program Application. 653.219-71 Section 653.219-71 Federal Acquisition...-4053, Department of State Mentor-Protégé Program Application. As prescribed in 619.102-70(i), DS-4053 is prescribed for use in applying for an agreement under the Department of State Mentor-Protégé...

  1. 76 FR 66940 - Privacy Act of 1974; Department of Homeland Security/United States Secret Service-004 Protection...

    Science.gov (United States)

    2011-10-28

    ... DEPARTMENT OF HOMELAND SECURITY Office of the Secretary [Docket No. DHS-2011-0083] Privacy Act of 1974; Department of Homeland Security/United States Secret Service--004 Protection Information System... Security (DHS)/United States Secret Service (USSS)-004 System name: DHS/USSS-004 Protection Information...

  2. Exploring the Iran-Hezbollah Relationship: A Case Study of how State Sponsorship affects Terrorist Group Decision-Making

    Directory of Open Access Journals (Sweden)

    Marc R. DeVore

    2012-10-01

    Full Text Available Understanding the impact of state sponsorship on the decision-making of violent non-state actors is among the more important issues to scholars of security studies. This article addresses the issue by examining the relationship between Iran and Lebanon’s Hezbollah. To preview its conclusions, there are two main perspectives to consider with regard to the terrorist group – state sponsor relationship. First, state support has a powerful, yet indirect effect on violent non-state actor decision-making by shaping the options available to groups’ leaders.  Second, state sponsors can also directly leverage their aid to shape the strategic decisions of armed non-state actors, forcing their clients to either expand or restrict their activities. Because of inevitable lacunae and contradictions amongst published accounts, this study relies heavily upon primary sources and data collected during field research in Lebanon, including interviews with leaders from Hezbollah, the Lebanese Army, the United Nations' Peacekeeping Mission in Southern Lebanon (UNIFIL and the rival Shia organization, Amal.

  3. INFORMATION SECURITYy: Serious Weaknesses Put State Department and FAA Operations at Risk

    National Research Council Canada - National Science Library

    Dodaro, Gene

    1998-01-01

    We are pleased to be asked to discuss our work in computer security. As requested, our testimony will focus on the results of our recent reviews of the Department of State and the Federal Aviation Administration (FAA...

  4. Analysis and simulation of emergency departments: state of the art and prospects

    OpenAIRE

    Vanbrabant, Lien; Braekers, Kris; Ramaekers, Katrien

    2017-01-01

    This abstract gives a brief overview of the state of the art on the analysis and simulation of emergency departments in hospitals. Based on this, research opportunities which will be addressed during my PhD are identified.

  5. 75 FR 41435 - Ball Bearings and Parts Thereof From Germany: Notice of Court Decision Not in Harmony With Final...

    Science.gov (United States)

    2010-07-16

    ...On July 7, 2010, the United States Court of International Trade sustained the Department of Commerce's results of redetermination on remand concerning the final results of the administrative review of the antidumping duty order on ball bearings and parts thereof from Germany. See SKF USA Inc., v. United States, Slip Op. 10-76 (CIT July 7, 2010). The Department is now issuing this notice of court decision not in harmony with the Department of Commerce's determination.

  6. USIA's Integration into the State Department: Advocating Policy Trumps Promoting Mutual Understanding

    National Research Council Canada - National Science Library

    Klopfenstein, Neil R

    2003-01-01

    ... Jesse Helms on the fate of USIA. The integration of USIA into the State Department is remarkable, not only for the reasons the senior staffer noted above, but also because it ensured that American public diplomacy at the beginning...

  7. CDC's National Environmental Public Health Tracking Program in Action: Case Studies From State and Local Health Departments.

    Science.gov (United States)

    Eatman, Shana; Strosnider, Heather M

    The Centers for Disease Control and Prevention's (CDC's) National Environmental Public Health Tracking Program (Tracking Program) is a multidisciplinary collaboration that involves the ongoing collection, integration, analysis, interpretation, and dissemination of data from environmental hazard monitoring, human exposure surveillance, and health effects surveillance. With a renewed focus on data-driven decision-making, the CDC's Tracking Program emphasizes dissemination of actionable data to public health practitioners, policy makers, and communities. The CDC's National Environmental Public Health Tracking Network (Tracking Network), a Web-based system with components at the national, state, and local levels, houses environmental public health data used to inform public health actions (PHAs) to improve community health. This article serves as a detailed landscape on the Tracking Program and Tracking Network and the Tracking Program's leading performance measure, "public health actions." Tracking PHAs are qualitative statements addressing a local problem or situation, the role of the state or local Tracking Program, how the problem or situation was addressed, and the action taken. More than 400 PHAs have been reported by funded state and local health departments since the Tracking Program began collecting PHAs in 2005. Three case studies are provided to illustrate the use of the Tracking Program resources and data on the Tracking Network, and the diversity of actions taken. Through a collaborative network of experts, data, and tools, the Tracking Program and its Tracking Network are actively informing state and local PHAs. In a time of competing priorities and limited funding, PHAs can serve as a powerful tool to advance environmental public health practice.

  8. 76 FR 36150 - Notice of Inventory Completion: Florida Department of State/Division of Historical Resources...

    Science.gov (United States)

    2011-06-21

    ....A. Pound Human Identification Laboratory and Dr. John Krigbaum, University of Florida, Department of... described as a multi-component black earth midden deposit on a relict Everglades tree island, associated... to the Florida Department of State/Division of Historical Resources for identification pending...

  9. The economic impact of the Department of Energy on the State of New Mexico Fiscal Year 1995

    Energy Technology Data Exchange (ETDEWEB)

    Lansford, R.R. [New Mexico State Univ., Las Cruces, NM (United States). New Mexico Agricultural Experiment Station; Adcock, L.D.; Gentry, L.M. [Dept. of Energy, Albuquerque, NM (United States). Office of Energy, Science and Technology; Ben-David, S. [Univ. of New Mexico, Albuquerque, NM (United States). Dept. of Economics

    1996-08-01

    The U.S. Department of Energy (DOE) provides a major source of economic benefits in New Mexico, second only to the activities of the U.S. Department of Defense. The agency`s far-reaching economic influence within the state is the focus of this report. Economic benefits arising from the various activities and functions of both the Department and its contractors have accrued to the state continuously for over 45 years. For several years, DOE/Albuquerque Operations Office (AL) and New Mexico State University (NMSU) have maintained inter-industry, input-output modeling capabilities to assess DOE`s impacts on the state of New Mexico and the other substate regions most directly impacted by DOE activities. One of the major uses of input-output techniques is to assess the effects of developments initiated outside the economy such as federal DOE monies that flow into the state, on an economy.

  10. The economic impact of the Department of Energy on the State of New Mexico Fiscal Year 1995

    International Nuclear Information System (INIS)

    Lansford, R.R.; Adcock, L.D.; Gentry, L.M.; Ben-David, S.

    1996-08-01

    The U.S. Department of Energy (DOE) provides a major source of economic benefits in New Mexico, second only to the activities of the U.S. Department of Defense. The agency's far-reaching economic influence within the state is the focus of this report. Economic benefits arising from the various activities and functions of both the Department and its contractors have accrued to the state continuously for over 45 years. For several years, DOE/Albuquerque Operations Office (AL) and New Mexico State University (NMSU) have maintained inter-industry, input-output modeling capabilities to assess DOE's impacts on the state of New Mexico and the other substate regions most directly impacted by DOE activities. One of the major uses of input-output techniques is to assess the effects of developments initiated outside the economy such as federal DOE monies that flow into the state, on an economy

  11. Explaining Unethical Business Decisions : The role of personality, environment, and states

    NARCIS (Netherlands)

    de Vries, Reinout E.; Pathak, Raghuvar D.; van Gelder, Jean Louis; Singh, Gurmeet

    2017-01-01

    A trait-environment-state model of Unethical Business Decisions was developed and tested in two studies in a Pacific Islands setting (i.e., Fiji and the Marshall Islands). In Study 1 (N = 212), we conceptualized and operationalized the environment using two situational variables named ‘Perceived

  12. United States of America Department of Energy Environmental Management Advisory Committee Public Meeting

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-01

    This reports contains documentation of presentations given at the United States of America Department of Energy Environmental Management Advisory Committee Public Meeting held December 14--15, 1993 in Alexandria, Virginia.

  13. 7 CFR 1945.18 - United States Department of Agriculture (USDA) Food and Agriculture Council (FAC).

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 13 2010-01-01 2009-01-01 true United States Department of Agriculture (USDA) Food and Agriculture Council (FAC). 1945.18 Section 1945.18 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE...

  14. 78 FR 39279 - United States Department of Energy; Bonneville Power Administration; Notice of Petition for...

    Science.gov (United States)

    2013-07-01

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. NJ13-10-000] United States Department of Energy; Bonneville Power Administration; Notice of Petition for Declaratory Order Take notice... (OATT) and a Petition for Declaratory Order requesting the Commission find that Bonneville's OATT, as...

  15. Leadership and management of academic anesthesiology departments in the United States.

    Science.gov (United States)

    Mets, Berend; Galford, Jennifer A

    2009-03-01

    To characterize the approach of academic chairs of anesthesiology in leading and managing their departments, and to gain insights into what they considered the most difficult challenges as chairs. Internet-based survey instrument conducted during July and August of 2006. Academic medical center. Department chairs of 132 academic anesthesiology programs who were listed on the Society of Academic Anesthesiology Chairs Listserv, were surveyed. The overall number of respondents were reported. However, as all questions were voluntary, not all were answered by each respondent. Observations are therefore reported as absolute numbers and percentages on a question-by-question basis. Respondents were asked to rank responses to some questions in order of importance (eg, 1 = most important). These data are presented as rank ordered median values, determined by the Kruskal-Wallis Test. Significant differences between groups were determined by Dunn's post test. A P-value Visionary and Coaching styles of leadership as most important. Seventy-nine percent had developed "Vision" statements for the department and 64% of respondents had set goals for divisions. To communicate within departments, 74% of Chairs had at least monthly faculty meetings and 50% held at least yearly faculty retreats. Chairs preferred communicating contentious issues face to face. Ninety-five percent of Chairs held at least yearly performance appraisals and 85% had an established incentive system in the department. Academic productivity (73%) and clinical time (68%) were the most common components of the incentive system. In 65% of departments, Chairs delegated the program directorship and in 73%, the running of the National Residency Matching Program. The financial state of the department was shared at least annually in 93% of departments. In most departments (77%), faculty salary ranges were known but individual faculty salaries were not shared. Chairs considered the most important leadership challenge to

  16. Building Stronger State Energy Partnerships with the U.S. Department of Energy

    Energy Technology Data Exchange (ETDEWEB)

    Marks, Kate

    2011-09-30

    This final technical report details the results of total work efforts and progress made from October 2007 – September 2011 under the National Association of State Energy Officials (NASEO) cooperative agreement DE-FC26-07NT43264, Building Stronger State Energy Partnerships with the U.S. Department of Energy. Major topical project areas in this final report include work efforts in the following areas: Energy Assurance and Critical Infrastructure, State and Regional Technical Assistance, Regional Initiative, Regional Coordination and Technical Assistance, and International Activities in China. All required deliverables have been provided to the National Energy Technology Laboratory and DOE program officials.

  17. 75 FR 32834 - U.S. Department of State Advisory Committee on Private International Law Study Group Notice of...

    Science.gov (United States)

    2010-06-09

    ... DEPARTMENT OF STATE [Public Notice 7041] U.S. Department of State Advisory Committee on Private International Law Study Group Notice of Meeting on the United Nations Commission on International Trade Law (UNCITRAL) Draft Legislative Guide on Secured Transactions and Its Treatment of Security Rights in...

  18. Internal States and Behavioral Decision-Making: Toward an Integration of Emotion and Cognition.

    Science.gov (United States)

    Kennedy, Ann; Asahina, Kenta; Hoopfer, Eric; Inagaki, Hidehiko; Jung, Yonil; Lee, Hyosang; Remedios, Ryan; Anderson, David J

    2014-01-01

    Social interactions, such as an aggressive encounter between two conspecific males or a mating encounter between a male and a female, typically progress from an initial appetitive or motivational phase, to a final consummatory phase. This progression involves both changes in the intensity of the animals' internal state of arousal or motivation and sequential changes in their behavior. How are these internal states, and their escalating intensity, encoded in the brain? Does this escalation drive the progression from the appetitive/motivational to the consummatory phase of a social interaction and, if so, how are appropriate behaviors chosen during this progression? Recent work on social behaviors in flies and mice suggests possible ways in which changes in internal state intensity during a social encounter may be encoded and coupled to appropriate behavioral decisions at appropriate phases of the interaction. These studies may have relevance to understanding how emotion states influence cognitive behavioral decisions at higher levels of brain function. Copyright © 2014 Cold Spring Harbor Laboratory Press; all rights reserved.

  19. Troponin testing in the emergency department: a longitudinal study to assess the impact and sustainability of decision support strategies.

    Science.gov (United States)

    Georgiou, Andrew; Lam, Mary; Allardice, Jane; Hart, Graeme K; Westbrook, Johanna I

    2012-06-01

    To evaluate the impact of decision support on the proportion of troponin I (cTnI) tests and associated costs over the period 2000-7 for patients presenting with chest pain in an emergency department (ED) setting. A longitudinal study using linked data for patients presenting with chest pain from the ED and laboratory information systems of a metropolitan teaching hospital in Melbourne, Australia. The study period was divided into a pre-intervention period (2000-2), which contained no decision support; an initial post period (2003-4) after the introduction of a quality improvement initiative (utilising a paper-based guideline, education, audit and feedback) about cTnI test ordering and the incorporation of the guideline as a decision support feature of the computerised provider order entry system; followed by a post-modification period (2005-7) after the electronic decision support feature was modified to allow clinicians to bypass viewing the complete guideline. There was a significant fall in the proportion of cTnI tests ordered per patient presentation across the three periods-pre (2000-2), post (2003-4) and post-modification (2005-7)-from 7.3% to 4.1% and 2.8%, respectively. Analysis of costs showed significant reductions in the mean costs for cTnI tests per patient presentation from $A9.28 to $A8.54 and $A8.18, respectively, which amounted to a modest saving of $A13,251 since the initiation of decision support in 2003. Decision support systems are often part of multifaceted implementations undertaken over time. They require continuous monitoring and modifications to ensure optimal performance.

  20. Decision strategies to reduce teenage and young adult deaths in the United States.

    Science.gov (United States)

    Keeney, Ralph L; Palley, Asa B

    2013-09-01

    This article uses decision analysis concepts and techniques to address an extremely important problem to any family with children, namely, how to avoid the tragic death of a child during the high-risk ages of 15-24. Descriptively, our analysis indicates that of the 35,000 annual deaths among this age group in the United States, approximately 20,000 could be avoided if individuals chose readily available alternatives for decisions relating to these deaths. Prescriptively, we develop a decision framework for parents and a child to both identify and proactively pursue decisions that can lower that child's exposure to life-threatening risks and positively alter decisions when facing such risks. Applying this framework for parents and the youth themselves, we illustrate the logic and process of generating proactive alternatives with numerous examples that each could pursue to lower these life-threatening risks and possibly avoid a tragic premature death, and discuss some public policy implications of our findings. © 2013 Society for Risk Analysis.

  1. Audit Report on "The Department of Energy's American Recovery and Reinvestment Act -- Florida State Energy Program"

    Energy Technology Data Exchange (ETDEWEB)

    None

    2010-06-01

    The Department of Energy's Office of Energy Efficiency and Renewable Energy (EERE) provides grants to states, territories, and the District of Columbia to support their energy priorities through the State Energy Program (SEP). The SEP provides Federal financial assistance to carry out energy efficiency and renewable energy projects that meet each state's unique energy needs while also addressing national goals such as energy security. Federal funding is based on a grant formula that takes into account population and energy consumption. The SEP emphasizes the state's role as the decision maker and administrator for the program. The American Recovery and Reinvestment Act of 2009 (Recovery Act) expanded the SEP, authorizing $3.1 billion in grants. Based on existing grant formulas and after reviewing state-level plans, EERE made awards to states. The State of Florida's Energy Office (Florida) was allocated $126 million - a 90-fold increase over Florida's average annual SEP grant of $1.4 million. Per the Recovery Act, this funding must be obligated by September 30, 2010, and spent by April 30, 2012. As of March 10, 2010, Florida had expended $13.2 million of the SEP Recovery Act funds. Florida planned to use its grant funds to undertake activities that would preserve and create jobs; save energy; increase renewable energy sources; and, reduce greenhouse gas emissions. To accomplish Recovery Act objectives, states could either fund new or expand existing projects. As a condition of the awards, EERE required states to develop and implement sound internal controls over the use of Recovery Act funds. Based on the significant increase in funding from the Recovery Act, we initiated this review to determine whether Florida had internal controls in place to provide assurance that the goals of the SEP and Recovery Act will be met and accomplished efficiently and effectively. We identified weaknesses in the implementation of SEP Recovery Act projects that

  2. On teaching computer ethics within a computer science department.

    Science.gov (United States)

    Quinn, Michael J

    2006-04-01

    The author has surveyed a quarter of the accredited undergraduate computer science programs in the United States. More than half of these programs offer a 'social and ethical implications of computing' course taught by a computer science faculty member, and there appears to be a trend toward teaching ethics classes within computer science departments. Although the decision to create an 'in house' computer ethics course may sometimes be a pragmatic response to pressure from the accreditation agency, this paper argues that teaching ethics within a computer science department can provide students and faculty members with numerous benefits. The paper lists topics that can be covered in a computer ethics course and offers some practical suggestions for making the course successful.

  3. 1993 Annual performance report for Environmental Oversight and Monitoring at Department of Energy facilities in New Mexico

    International Nuclear Information System (INIS)

    1993-01-01

    In October of 1990, the New Mexico Environment Department entered into an agreement with the US Department of Energy (DOE) to create the Department of Energy Oversight and Monitoring Program. This program is designed to create an avenue for the State to ensure DOE facilities are in compliance with applicable environmental regulations, to allow the State oversight and monitoring independent of the DOE, to allow the State valuable input into remediation decision making, and to protect the environment and the public health and safety of New Mexicans concerning DOE facility activities. This agreement, called the Agreement in Principle (AIP), includes all four of New Mexico's DOE facilities: Los Alamos National Laboratory in Los Alamos; Sandia National Laboratories and the Inhalation Toxicology Research Institute on Kirtland Air Force Base in Albuquerque; and the Waste Isolation Pilot Plant near Carlsbad

  4. 75 FR 23274 - Privacy Act of 1974; Department of Homeland Security United States Immigration Customs and...

    Science.gov (United States)

    2010-05-03

    ... 1974; Department of Homeland Security United States Immigration Customs and Enforcement--011 Immigration and Enforcement Operational Records System of Records AGENCY: Privacy Office, DHS. ACTION: Notice... the Department of Homeland Security U.S. Immigration and Customs Enforcement is updating an existing...

  5. 75 FR 9238 - Privacy Act of 1974; Department of Homeland Security United States Immigration Customs and...

    Science.gov (United States)

    2010-03-01

    ... 1974; Department of Homeland Security United States Immigration Customs and Enforcement--011 Immigration and Enforcement Operational Records System of Records AGENCY: Privacy Office, DHS. ACTION: Notice... the Department of Homeland Security U.S. Immigration and Customs Enforcement is updating an existing...

  6. Mainstreaming climate change adaptation strategies into New York State Department of Transportation's operations.

    Science.gov (United States)

    2011-10-31

    This study identifies climate change adaptation strategies and recommends ways of mainstreaming them into planned actions, including legislation, policies, programs and projects in all areas and at all levels within the New York State Department of T...

  7. 20 CFR 655.845 - What rules apply to appeal of the decision of the administrative law judge?

    Science.gov (United States)

    2010-04-01

    ... ADMINISTRATION, DEPARTMENT OF LABOR TEMPORARY EMPLOYMENT OF FOREIGN WORKERS IN THE UNITED STATES Enforcement of H... appeal of the decision of the administrative law judge? (a) The Administrator or any interested party...

  8. Measuring the Extent of European State Aid Control : An Econometric Analysis of the European Commission Decisions

    NARCIS (Netherlands)

    Brouwer, E.; Ozbugday, F.C.

    2011-01-01

    This paper provides an analysis of the European Commission (EC) decisions on state aid control using data on 550 state aid cases approved by the EC between 1998 and 2009. More specifically, we measure the determinants of the duration of state aid, total budget of state aid and daily budget of state

  9. Measuring the Extent of European State Aid Control : An Econometric Analysis of the European Commission Decisions

    NARCIS (Netherlands)

    Brouwer, E.; Ozbugday, F.C.

    2010-01-01

    This paper provides an analysis of the European Commission (EC) decisions on state aid control using data on 550 state aid cases approved by the EC between 1998 and 2009. More specifically, we measure the determinants of the duration of state aid, total budget of state aid and daily budget of state

  10. Nuclear waste: Department of Energy's program for financial assistance

    International Nuclear Information System (INIS)

    1986-01-01

    The Department of Energy's existing grant guidelines for financial assistance to first and second repository states do not clearly establish a basis for determining who is funded, what activities are funded, and how much funding is provided each activity. Because the guidelines do not cover all funding circumstances, DOE has interpreted them differently when making both mandatory and discretionary grant decisions. In addition, DOE has not considered state and Indian tribe needs in establishing its budget request for grant awards. Instead, the requests are based on the amounts of grants awarded in prior years and DOE planned activities. Finally, both grantee compliance with certain reporting requirements of DOE's financial assistance regulations and DOE's enforcement of them has been inconsistent

  11. 75 FR 7562 - Certain Steel Concrete Reinforcing Bars From Turkey: Notice of Court Decision Not in Harmony With...

    Science.gov (United States)

    2010-02-22

    ... Reinforcing Bars From Turkey: Notice of Court Decision Not in Harmony With Final Results of Administrative...: On January 19, 2010, the United States Court of International Trade (CIT) sustained the Department of... Corporation, Gerdau Ameristeel Corporation, and Commercial Metals Company v. United States and Icdas Celik...

  12. 22 CFR 72.25 - Transfer of personal estate to Department of State.

    Science.gov (United States)

    2010-04-01

    ... sentimental value, to be held in trust for the legal claimant(s). (c) After receipt of a personal estate, the... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Transfer of personal estate to Department of..., THEIR PROPERTY AND ESTATES DEATHS AND ESTATES Personal Estates of Deceased United States Citizens and...

  13. Decision-making in state lotteries: half now or all of it later?

    Science.gov (United States)

    Baker, Forest; Johnson, Matthew W; Bickel, Warren K

    2003-12-01

    Many state lotteries offer players a choice between receiving roughly half of the jackpot immediately and receiving the entire jackpot over 25 annual payments. This requires players to make a decision that involves uncertainty, delay, and large amounts of real money. Archival data on lottery players' jackpot payment decisions were collected from seven state and three multistate lotteries. Players' jackpot payment preferences were assessed at the time of ticket purchase and after winning a jackpot. Preference for the annuity payment option significantly decreased as jackpot size increased, both at the time of ticket purchase and after winning. Furthermore, a significant proportion of winners who selected the annuity payment option at ticket purchase switched to the cash payment option after winning, whereas no winners switched from the cash to the annuity option after winning. These findings suggest that real-world choices involving large sums of money may be subject to diminishing marginal utility and probability and delay discounting.

  14. What happens in a merger? Experiences of the State Department for Water Resources in Khorezm, Uzbekistan

    NARCIS (Netherlands)

    Wegerich, K.

    2005-01-01

    The paper focuses on the organisational problems of the state Department of Water Resources at the district level in the Khorezm Province, Uzbekistan. The study opens the organisational `black box¿ and looks inside the organisational structure of the Department of Water Resources. The analysis goes

  15. BUILDING STRONGER STATE ENERGY PARTNERSHIPS WITH THE U.S. DEPARTMENT OF ENERGY

    Energy Technology Data Exchange (ETDEWEB)

    Kate Burke

    2002-11-01

    This technical progress report includes an update of the progress during the second year of cooperative agreement DE-FC26-00NT40802, Building Stronger State Energy Partnerships with the U.S. Department of Energy. The report also describes the barriers in conduct of the effort, and our assessment of future progress and activities.

  16. 76 FR 67099 - Forwarding of Asylum Applications to the Department of State

    Science.gov (United States)

    2011-10-31

    ... #0;notices is to give interested persons an opportunity to participate in #0;the rule making prior to... Immigration Review 8 CFR Parts 1208 and 1240 [EOIR Docket No. 173; AG Order No. 3307-2011] RIN 1125-AA65 Forwarding of Asylum Applications to the Department of State AGENCY: Executive Office for Immigration Review...

  17. 78 FR 69171 - 60-Day Notice of Proposed Information Collection: Department of State Mentor Protégé Program...

    Science.gov (United States)

    2013-11-18

    ...: Department of State Mentor Prot[eacute]g[eacute] Program Application ACTION: Notice of request for public... [email protected] . SUPPLEMENTARY INFORMATION: Title of Information Collection: Department of State Mentor... planning to team together in an official mentor-prot[eacute]g[eacute] capacity to enhance the capabilities...

  18. Water sample data set from the State of Hawaii, Department of Health, 1999-2006 in Hawaiian waters (NODC Accession 0013723)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Water quality data from were collected by the Monitoring Section of the State of Hawaii, Department of Health. Data were obtained from 373 state-wide coastal...

  19. [Department of Otorhinolaryngology of the I.P. Pavlov Saint-Peterburg First State Medical University].

    Science.gov (United States)

    Karpishchenko, S A

    This article is designed to report the results of the analysis ofacademic, scientific, and clinical activities of the Department of Otorhinolaryngology of the I.P. Pavlov Saint-Peterburg First State Medical University.

  20. Resolving issues at the Department of Energy/Oak Ridge operations facilities

    International Nuclear Information System (INIS)

    Row, T.H.; Adams, W.D.

    1988-01-01

    The development of the US Department of Energy Oak Ridge Operations Office's model for waste management and its application in the Oak Ridge Reservation are discussed. The concept simply stated is to assure that all stakeholders in waste management decisions have the opportunity to be participants from the first step. The paper discusses the advisory committees involved in the process, subcontracting support, college and university relation, technology demonstrations and planning, other federal agency interaction, and the model meeting

  1. 应用团体伦理决策培养急诊科护士的伦理决策能力%To Cultivate the Ethical Decision -making Capacity of Nurses of Emergency Department by Group Ethical Decision- making

    Institute of Scientific and Technical Information of China (English)

    陈英

    2011-01-01

    目的 提高急诊科护士的伦理决策能力.方法 通过伦理决策过程,由护理团体对以往在急诊救治中的护理困境作出最佳伦理决策.结果使护士知晓伦理相关的理论,掌握应对护理实践中的护理伦理困惑的方法,提高护理伦理决策能力.结论 通过应用团体伦理决策法,培养和提高急诊科护士的伦理决策能力,有效地减少了护患医疗纠纷.%Objective: To increase the ethical decision - making capacity of nurses of emergency department. Method: Optimal ethical decisions are made by nursing group s discussion of the experience gathered from past ethical predicaments in emergency nursing. Result; Nurses are equipped with relevant ethical theories, measures of coping with possible ethical predicaments in future nursing practice, and increased capacity of nursing ethical decision - making. Conclusion: The ethical decision - making capacity of nurses of emergency department has been cultivated and increased by the approach of group ethical decision - making, resulting in a decrease in medical disputes between nurses and doctors.

  2. Involving the public in decision-making at federal facilities: The Department of Energy experience

    International Nuclear Information System (INIS)

    Gesalman, C.M.

    1996-01-01

    The Department of Energy is involved in cleanup of a wide variety of sites used in the development and production of nuclear weapons. Substantial and increasing efforts have been made to involve the public in the planning and implementation of the cleanup projects. Early in the program, public participation was mainly an information transfer effort. More recently, innovative techniques have been used to increase public understanding of the tradeoffs required in making cleanup decisions (e.g., more stringent cleanup standards lead to higher costs). Sites now realize that relationships are key and are working to develop them. Advisory boards have been established at several sites. The methods of forming the boards have varied from site to site, as have the size of the group and the issues addressed. The effectiveness of the boards in their goal of improving public participation at the sites will be evaluated in the next fiscal year. DOE has sought public input on an increasing number of issues, such as future use of its facilities, environmental justice concerns, and budget development. Assumptions about future use of sites are crucial to setting realistic cleanup standards and controlling costs. Decisions made in the early phases of the budget process are now based in part on stakeholder input regarding priorities; for example, stakeholder concerns about and support for emphasizing plutonium cleanup at Rocky Flats have led to changes in priorities between the materials stabilization and environmental restoration programs. Environmental justice has become an increasing issue; sites must ensure that public participation programs effectively reach minority and low-income populations

  3. 77 FR 58488 - Hawaii State Plan for Occupational Safety and Health

    Science.gov (United States)

    2012-09-21

    ... DEPARTMENT OF LABOR Occupational Safety and Health Administration 29 CFR Part 1952 [Docket ID. OSHA 2012-0029] RIN 1218-AC78 Hawaii State Plan for Occupational Safety and Health AGENCY: Occupational... announces the Occupational Safety and Health Administration's (OSHA) decision to modify the Hawaii State...

  4. Optimal Implementation of Prescription Drug Monitoring Programs in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Garrett DePalma

    2018-02-01

    Full Text Available The opioid epidemic is the most significant modern-day, public health crisis. Physicians and lawmakers have developed methods and practices to curb opioid use. This article describes one method, prescription drug monitoring programs (PDMP, through the lens of how to optimize use for emergency departments (ED. EDs have rapidly become a central location to combat opioid abuse and drug diversion. PDMPs can provide emergency physicians with comprehensive prescribing information to improve clinical decisions around opioids. However, PDMPs vary tremendously in their accessibility and usability in the ED, which limits their effectiveness at the point of care. Problems are complicated by varying state-to-state requirements for data availability and accessibility. Several potential solutions to improving the utility of PDMPs in EDs include integrating PDMPs with electronic health records, implementing unsolicited reporting and prescription context, improving PDMP accessibility, data analytics, and expanding the scope of PDMPs. These improvements may help improve clinical decision-making for emergency physicians through better data, data presentation, and accessibility.

  5. 77 FR 8860 - Pesticide Emergency Exemptions; Agency Decisions and State and Federal Agency Crisis Declarations

    Science.gov (United States)

    2012-02-15

    ...; Agency Decisions and State and Federal Agency Crisis Declarations AGENCY: Environmental Protection Agency... agencies. The emergency exemptions may take the following form: Crisis, public health, quarantine, or.... These are rarely requested. 3. A ``crisis exemption'' is initiated by a State or Federal agency (and is...

  6. Implementation of decision support system in the central AQUATOOL Department of Valle del Cauca

    International Nuclear Information System (INIS)

    Gutierrez Enriquez, Maria Mercedes; Aristizabal Rodriguez, Hector Fabio

    2007-01-01

    The decision support system AQUATOOL, created by the Polytechnic University of Valencia (Spain), represents an alternative for water resources management for it makes it possible to evaluate planning scenarios for the use of both surface and groundwater. For the evaluation of this tool, the application zone chosen was the Central Region of the Valle del Cauca State in Colombia. With the mathematical model AQUATOOL technical scenarios were formulated focused on the efficient satisfaction of demands in the zone, based on a supply - demand scheme, in which only real demand was included in the regulations for the use of every stream. As far as surface waters are concerned, a special feature of the State concerns its torrential flow rivers, not regulated. Though there are feasibility studies for regulation dams in the zone. Based on this initial scheme several alternatives were presented: aquifer swell and study of dams projected as complementary supply resources, aiming to greater satisfaction of present and future demands.

  7. 76 FR 28795 - Privacy Act of 1974; Department of Homeland Security United States Coast Guard-024 Auxiliary...

    Science.gov (United States)

    2011-05-18

    ... 1974; Department of Homeland Security United States Coast Guard-024 Auxiliary Database System of... Security/United States Coast Guard-024 Auxiliary Database (AUXDATA) System of Records.'' This system of...: United States Coast Guard Auxiliary Database (AUXDATA). Security classification: Unclassified. System...

  8. Idle reduction assessment for the New York State Department of Transportation region 4 fleet.

    Science.gov (United States)

    2015-03-01

    Energetics Incorporated conducted a study to evaluate the operational, economic, and environmental impacts of advanced technologies to reduce idling in : the New York State Department of Transportation (NYSDOT) Region 4 fleet without compromising fun...

  9. CDC’s National Environmental Public Health Tracking Program in Action: Case Studies From State and Local Health Departments

    Science.gov (United States)

    Eatman, Shana; Strosnider, Heather M.

    2017-01-01

    The Centers for Disease Control and Prevention’s (CDC’s) National Environmental Public Health Tracking Program (Tracking Program) is a multidisciplinary collaboration that involves the ongoing collection, integration, analysis, interpretation, and dissemination of data from environmental hazard monitoring, human exposure surveillance, and health effects surveillance. With a renewed focus on data-driven decision-making, the CDC’s Tracking Program emphasizes dissemination of actionable data to public health practitioners, policy makers, and communities. The CDC’s National Environmental Public Health Tracking Network (Tracking Network), a Web-based system with components at the national, state, and local levels, houses environmental public health data used to inform public health actions (PHAs) to improve community health. This article serves as a detailed landscape on the Tracking Program and Tracking Network and the Tracking Program’s leading performance measure, “public health actions.” Tracking PHAs are qualitative statements addressing a local problem or situation, the role of the state or local Tracking Program, how the problem or situation was addressed, and the action taken. More than 400 PHAs have been reported by funded state and local health departments since the Tracking Program began collecting PHAs in 2005. Three case studies are provided to illustrate the use of the Tracking Program resources and data on the Tracking Network, and the diversity of actions taken. Through a collaborative network of experts, data, and tools, the Tracking Program and its Tracking Network are actively informing state and local PHAs. In a time of competing priorities and limited funding, PHAs can serve as a powerful tool to advance environmental public health practice. PMID:28763381

  10. The effect of state dependent mandate laws on the labor supply decisions of young adults.

    Science.gov (United States)

    Depew, Briggs

    2015-01-01

    Prior to the Affordable Care Act, the majority of states in the U.S. had already implemented state laws that extended the age that young adults could enroll as dependents on their parent's employer-based health insurance plans. Because of the fundamental link between health insurance and employment in the U.S., such policies may effect the labor supply decisions of young adults. Although the interaction between labor supply and health insurance has been extensively studied for other subpopulations, little is known about the role of health insurance in the labor supply decisions of young adults. I use the variation from the implementation and changes in state policies that expanded dependent health insurance coverage to examine how young adults adjusted their labor supply when they were able to be covered as a dependent on their parent's plan. I find that these state mandates led to a decrease in labor supply on the intensive margin. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Personal involvement as a special style of Department of Psychology, Lomonosov Moscow State University

    Directory of Open Access Journals (Sweden)

    Takhir Yu. Bazarov

    2016-09-01

    Full Text Available The author, being a former student of the Department of Psychology, Lomonosov Moscow State University, and now is teacher, professor, remembers those who created and maintained such traditions of the Department as depth of knowledge and coherence of ideas, methodological clarity and dialogue, holistic view of the issue and using problem solving in teaching, and also the joint work of professors and students in the way of perceiving the truth. According to the author the 50th anniversary of the Department of Psychology is an occasion to both recall the path members of the Department went over the years, including several epochs, and to outline the prospects for further development. Considerable attention is paid to the personality of G.M. Andreeva, who is a gifted teacher, a brilliant scholar, and one of the founders of social psychology in the Russia. Particular attention is drawn to Galina Andreeva collecting the brightest staff of the Chair of Social Psychology, whose key feature was involvement in both the scientific and also collective life of the Department, which contributed to the development of the new important branch of psychology. The author also singles out the figure of the wonderful teacher L.A. Petrovskaya who encouraged the students to cherish their individuality as she believed it to be the main tool of the professional psychologist. With much gratitude the author recalls tips for organizing the teaching process received from A.U. Kharash. The paper characterizes the current state and the importance of the Department, and outlines the prospects for further development. In particular, the author speaks of the need for developing student personal involvement in professional activities, and also of creating favourable conditions at the Deaprtment for a student successful transition from training to real life.

  12. Administering an Academic Department.

    Science.gov (United States)

    Hicks, Donald W.; Sperry, John B.

    1986-01-01

    Clarifies the possible forms of leadership taken by the administrator of an academic department. Discusses such elements as authoritarian leadership, faculty consensus, power and responsibility, input factors, types of decision making, faculty recruiting, and authoritarian versus democratic approach. (CT)

  13. 28 CFR 24.307 - Department review.

    Science.gov (United States)

    2010-07-01

    ... review. The decision of the adjudicative officer will be reviewed to the extent permitted by law by the... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Department review. 24.307 Section 24.307 Judicial Administration DEPARTMENT OF JUSTICE IMPLEMENTATION OF THE EQUAL ACCESS TO JUSTICE ACT IN...

  14. Effective Decision Maker-Scientist Engagement:Climate Change Vulnerability Analysis of California's Water System to Using Decision Scaling.

    Science.gov (United States)

    Schwarz, A. M.; Ray, P.; Brown, C.; Wi, S.

    2016-12-01

    For nearly 2 years the California Department of Water Resources (CDWR) has been working with the University of Massachusetts Amherst (UMass) to evaluate climate change vulnerabilities to the California State Water Project. Working cooperatively, the team has developed tools and methods to employ a decision scaling approach to CDWR's existing water system model (CalSim-II/CalLite 3.0). This presentation will discuss how and why this partnership came to be, the co-production model the team has developed to share expertise, the new understanding of the system that has been gained through the process, and current and future efforts to influence planning and investments based on the findings of the work. This cooperative decision-maker-with-scientist engagement is unique in that CDWR has not outsourced the application of the science to their systems, and instead has worked directly with UMass researchers to develop the process, produce results, and interpret findings. Further, CDWR staff has worked with UMass researchers to present results in ways that are more useable and actionable for decision-makers. As will be shown, many of these graphics allow the team to use the science differently to improve decision making.

  15. Navigating the boundary of science for decision making at the state and local level

    Science.gov (United States)

    Gonzales, L. M.; Wood, C.; Boland, M. A.; Rose, C. A.

    2015-12-01

    Scientific information should play a vital role in many decision making processes, yet issues incorporating geoscience information often arise due to inherent differences between how scientists and decision makers operate. Decision makers and scientists have different priorities, produce work at different rates, and often lack an understanding of each others' institutional constraints. Boundary organizations, entities that facilitate collaboration and information flow across traditional boundaries such as that between scientists and decision makers, are in a unique position to improve the dialogue between disparate groups. The American Geosciences Institute (AGI), a nonprofit federation of 50 geoscience societies and organizations, is linking the geoscience and decision-making communities through its Critical Issues Program. AGI's Critical Issues program has first-hand experience in improving the transfer of information across the science-decision making boundary, particularly in areas pertaining to water resources and hazards. This presentation will focus on how, by collaborating with organizations representing the decision making and geoscience communities to inform our program development, we have created our three main content types - website, webinar series, and research database - to better meet the needs of the decision-making process. The program presents existing geoscience information in a way that makes the interconnected nature of geoscience topics more easily understood, encourages discussion between the scientific and decision-making communities, and has established a trusted source of impartial geoscience information. These efforts have focused on state and local decision makers—groups that increasingly influence climate and risk-related decisions, yet often lack the resources to access and understand geoscience information.

  16. Current Law Limits the State Department's Authority to Manage Certain Overseas Properties Cost Effectively

    National Research Council Canada - National Science Library

    Ford, Jess

    2002-01-01

    The Department of State is the central manager for real estate at U.S. embassies and consulates and has the statutory authority to sell properties and use the sales proceeds to acquire and maintain other overseas properties...

  17. Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department.

    Science.gov (United States)

    Geurts, Dorien; de Vos-Kerkhof, Evelien; Polinder, Suzanne; Steyerberg, Ewout; van der Lei, Johan; Moll, Henriëtte; Oostenbrink, Rianne

    2017-02-01

    Acute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children's hospital in The Netherlands ( 2010-2012). Outcome included (1) feasibility, measured by compliance of the nurses, and (2) length of stay (LOS) at the ED, the number of diagnostic tests, treatment, follow-up, and costs. Due to failure of post-ED weight measurement, we could not evaluate weight difference as measure for dehydration. Patient characteristics were comparable between the intervention (N = 113) and the usual care group (N = 109). Implementation of the clinical decision support system proved a high compliance rate. The standardized use of oral ORS (oral rehydration solution) significantly increased from 52 to 65%(RR2.2, 95%CI 1.09-4.31 p children with AGE showed high compliance and increase standardized use of ORS, without differences in other outcome measures. What is Known: • Acute gastroenteritis is one of the most frequently encountered problems in pediatric emergency departments. • Guidelines advocate standardized oral treatment in children with mild to moderate dehydration, but appear to be applied infrequently in clinical practice. What is New: • Implementation of a nurse-guided clinical decision support system on treatment of AGE in young children showed good feasibility, resulting in a more standardized ORS use in children with mild to moderate dehydration, compared to usual care. • Given the challenges to perform research in emergency care setting, the ED should be experienced and adequately equipped, especially during peak times.

  18. Municipal Officials’ Perceived Barriers to Consideration of Physical Activity in Community Design Decision Making

    Science.gov (United States)

    Goins, Karin Valentine; Schneider, Kristin L.; Brownson, Ross; Carnoske, Cheryl; Evenson, Kelly; Eyler, Amy; Heinrich, Katie; Litt, Jill; Lyn, Rodney; Maddock, Jay; Reed, Hannah; Tompkins, Nancy O’Hara; Lemon, Stephenie C.

    2016-01-01

    Context Built environment-focused interventions and policies are recommended as sustainable approaches for promoting physical activity. Physical activity has not traditionally been considered in land use and transportation decision making. Effective collaboration with non-public health partners requires knowledge of their perceived barriers to consideration of physical activity in decision making. Objective This study aimed to 1) identify barriers to the consideration of physical activity in community design and planning decisions among municipal decision makers and 2) explore differences in these barriers among a wide range of job functions and departments in a geographically diverse sample. Design A web-based survey was conducted among municipal officials in 94 cities and towns with populations of at least 50,000 residents in eight states. Participants 453 municipal officials from public health, planning, transportation/public works, community and economic development, parks and recreation, city management, and municipal legislatures responded to the survey. Main Outcome Measures Five barriers to consideration of physical activity in community design and layout were assessed. Results The most common barriers included lack of political will (23.5%), limited staff (20.4%) and lack of collaboration across municipal departments (16.2%). Fewer participants reported opposition from the business community or residents as barriers. Compared to other professionals, public health department personnel were more likely to report the barriers of limited staff and lack of collaboration across municipal departments. They were also more likely to report lack of political will compared to city managers or mayors and municipal legislators. Conclusions Barriers to increasing consideration of physical activity in decision making about community design and layout are encouragingly low. Implications for public health practice include the need to strategically increase political will

  19. [Outsourcing of clinical laboratory department].

    Science.gov (United States)

    Murai, T

    2000-03-01

    Recently, to improve financial difficulties at various hospitals, outsourcing of the laboratory department is be coming more wide spread. At the department of clinical pathology of St. Luke's International Hospital, the system, so called, "Branch labo" which is one of the outsourcing laboratory conditions, was adopted in March 1999. In this reports. We described the decision procedure for accepting the situation and the circumstances of operation.

  20. 49 CFR 17.7 - How does the Secretary communicate with state and local officials concerning the Department's...

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false How does the Secretary communicate with state and local officials concerning the Department's programs and activities? 17.7 Section 17.7 Transportation Office of the Secretary of Transportation INTERGOVERNMENTAL REVIEW OF DEPARTMENT OF TRANSPORTATION...

  1. Psychiatric Boarding in Washington State and the Inadequacy of Mental Health Resources.

    Science.gov (United States)

    Bloom, Joseph D

    2015-06-01

    Psychiatric boarding is a term derived from emergency medicine that describes the holding of patients deemed in need of hospitalization in emergency departments for extended periods because psychiatric beds are not available. Such boarding has occurred for many years in the shadows of mental health care as both inpatient beds and community services have decreased. This article focuses on a 2014 Washington State Supreme Court decision that examined the interpretation of certain sections of the Washington state civil commitment statute that had been used to justify the extended boarding of detained psychiatric patients in general hospital emergency departments. The impact of this decision on the state of Washington should be significant and could spark a national debate about the negative impacts of psychiatric boarding on patients and on the nation's general hospital emergency services. © 2015 American Academy of Psychiatry and the Law.

  2. Decisive Markov Chains

    OpenAIRE

    Abdulla, Parosh Aziz; Henda, Noomene Ben; Mayr, Richard

    2007-01-01

    We consider qualitative and quantitative verification problems for infinite-state Markov chains. We call a Markov chain decisive w.r.t. a given set of target states F if it almost certainly eventually reaches either F or a state from which F can no longer be reached. While all finite Markov chains are trivially decisive (for every set F), this also holds for many classes of infinite Markov chains. Infinite Markov chains which contain a finite attractor are decisive w.r.t. every set F. In part...

  3. Woody biomass policies and location decisions of the woody bioenergy industry in the southern United States

    International Nuclear Information System (INIS)

    Guo, Zhimei; Hodges, Donald G.; Young, Timothy M.

    2013-01-01

    Woody biomass for bioenergy production has been included in relatively few renewable energy policies since the 1970s. Recently, however, several states have implemented a variety of new woody biomass policies to spur the establishment of new bioenergy industry. Establishing new woody biomass-based facilities in a specific state is affected by a number of factors such as the strength of these new policy incentives, resource availability, business tax climate, and the available labor force. This study employs a conditional logit model (CLM) to explore the effects of woody biomass policies on the siting decisions of new bioenergy projects relative to some of these other state attributes. The CLM results suggest that state government incentives are significantly related to state success in attracting new plants. The results have substantial implications regarding woody biomass policies and the creation of a new bioenergy industry. -- Highlights: •This study explores the effects of state attributes on the siting decisions of new woody bioenergy projects. •Results suggest that state woody biomass policies are significantly related to state success in attracting new plants. •Other factors related to the siting of woody bioenergy facilities include resource availability, taxes, and wage rate

  4. 76 FR 1658 - 60-Day Notice of Proposed Information Collection: DS 4053, Department of State Mentor-Protégé...

    Science.gov (United States)

    2011-01-11

    ... 4053, Department of State Mentor-Prot[eacute]g[eacute] Program Application, OMB 1405-0161 ACTION... Collection: Department of State Mentor-Prot[eacute]g[eacute] Program Application. OMB Control Number: OMB...: Small and large for-profit companies planning to team together in an official mentor-prot[eacute]g...

  5. 76 FR 25733 - 30-Day Notice of Proposed Information Collection DS 4053, Department of State Mentor-Protégé...

    Science.gov (United States)

    2011-05-05

    ... Collection DS 4053, Department of State Mentor-Prot[eacute]g[eacute] Program Application ACTION: Notice of... Information Collection: Department of State Mentor-Prot[eacute]g[eacute] Program Application. OMB Control...-4053. Respondents: Small and large for-profit companies planning to team together in an official mentor...

  6. Climate change/variability science and adaptive strategies for state and regional transportation decision making.

    Science.gov (United States)

    2010-04-01

    The objective of this study was to generate a baseline understanding of current policy responses to climate : change/variability at the state and regional transportation-planning and -decision levels. Specifically, : researchers were interested in th...

  7. Ohio Department of Transportation State Infrastructure Bank Annual Financial Report : Federal Fiscal Year 2009

    Science.gov (United States)

    2009-01-01

    The Ohio Department of Transportation is pleased to present the Federal : Fiscal Year (FFY) 2009 State Infrastructure Bank (SIB) Annual Financial : Report. : The portfolio of the FFY 2009 SIB had a total of nine loans totaling $9.0 : million and one ...

  8. Test and Evaluation Metrics of Crew Decision-Making And Aircraft Attitude and Energy State Awareness

    Science.gov (United States)

    Bailey, Randall E.; Ellis, Kyle K. E.; Stephens, Chad L.

    2013-01-01

    NASA has established a technical challenge, under the Aviation Safety Program, Vehicle Systems Safety Technologies project, to improve crew decision-making and response in complex situations. The specific objective of this challenge is to develop data and technologies which may increase a pilot's (crew's) ability to avoid, detect, and recover from adverse events that could otherwise result in accidents/incidents. Within this technical challenge, a cooperative industry-government research program has been established to develop innovative flight deck-based counter-measures that can improve the crew's ability to avoid, detect, mitigate, and recover from unsafe loss-of-aircraft state awareness - specifically, the loss of attitude awareness (i.e., Spatial Disorientation, SD) or the loss-of-energy state awareness (LESA). A critical component of this research is to develop specific and quantifiable metrics which identify decision-making and the decision-making influences during simulation and flight testing. This paper reviews existing metrics and methods for SD testing and criteria for establishing visual dominance. The development of Crew State Monitoring technologies - eye tracking and other psychophysiological - are also discussed as well as emerging new metrics for identifying channelized attention and excessive pilot workload, both of which have been shown to contribute to SD/LESA accidents or incidents.

  9. Multiple Case Studies of Public Library Systems in New York State: Service Decision-Making Processes

    Science.gov (United States)

    Ren, Xiaoai

    2012-01-01

    This research examined the functions and roles of public library systems in New York State and the services they provide for individual libraries and the public. The dissertation further studied the service decision-making processes at three selected New York State cooperative public library systems. Public library systems have played an important…

  10. An Evaluation of the Cybersecurity Policies for the United States Health & Human Services Department: Criteria, Regulations, and Improvements

    OpenAIRE

    Derek Mohammed; Ronda Mariani

    2014-01-01

    This paper examines the criteria necessary for the evaluation of the cybersecurity policies for the United States Health and Human Services Department of the Federal Government. The overall purpose of cybersecurity policies and procedures is supported through compliance with Federal mandated regulation and standards, which serve to protect the organizational services and goals of the United States Health and Human Services Department, and to promote the best possible security practices in the...

  11. Understanding the decision-making environment for people in minimally conscious state.

    Science.gov (United States)

    Yelden, Kudret; Sargent, Sarah; Samanta, Jo

    2017-04-11

    Patients in minimally conscious state (MCS) show minimal, fluctuating but definitive signs of awareness of themselves and their environments. They may exhibit behaviours ranging from the ability to track objects or people with their eyes, to the making of simple choices which requires the ability to recognise objects and follow simple commands. While patients with MCS have higher chances of further recovery than people in vegetative states, this is not guaranteed and their prognosis is fundamentally uncertain. Therefore, patients with MCS need regular input from healthcare professionals to monitor their progress (or non-progress) and to address their needs for rehabilitation, for the provision of an appropriate environment and equipment. These requirements form a backdrop to the potentially huge variety of ethical-legal dilemmas that may be faced by their families, caregivers and ultimately, the courts. This paper analyses the decision-making environment for people with MCS using data obtained through four focus groups which included the input of 29 senior decision makers in the area. The results of the focus group study are presented and further explored with attention on recurrent and strong themes such as lack of expertise, resource issues, and the influence of families and friends of people with MCS.

  12. Public involvement in radioactive waste management decisions

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-04-01

    Current repository siting efforts focus on Yucca Mountain, Nevada, where DOE`s Office of Civilian Radioactive Waste Management (OCRWM) is conducting exploratory studies to determine if the site is suitable. The state of Nevada has resisted these efforts: it has denied permits, brought suit against DOE, and publicly denounced the federal government`s decision to study Yucca Mountain. The state`s opposition reflects public opinion in Nevada, and has considerably slowed DOE`s progress in studying the site. The Yucca Mountain controversy demonstrates the importance of understanding public attitudes and their potential influence as DOE develops a program to manage radioactive waste. The strength and nature of Nevada`s opposition -- its ability to thwart if not outright derail DOE`s activities -- indicate a need to develop alternative methods for making decisions that affect the public. This report analyzes public participation as a key component of this openness, one that provides a means of garnering acceptance of, or reducing public opposition to, DOE`s radioactive waste management activities, including facility siting and transportation. The first section, Public Perceptions: Attitudes, Trust, and Theory, reviews the risk-perception literature to identify how the public perceives the risks associated with radioactivity. DOE and the Public discusses DOE`s low level of credibility among the general public as the product, in part, of the department`s past actions. This section looks at the three components of the radioactive waste management program -- disposal, storage, and transportation -- and the different ways DOE has approached the problem of public confidence in each case. Midwestern Radioactive Waste Management Histories focuses on selected Midwestern facility-siting and transportation activities involving radioactive materials.

  13. Ohio Department of Transportation State Infrastructure Bank Annual Financial Report : Federal Fiscal Year 2004

    Science.gov (United States)

    2004-01-01

    The Ohio Department of Transportation is pleased to present the Federal Fiscal : Year 2004 State Infrastructure Bank (SIB) Annual Financial Report. The portfolio of : the FFY 04 SIB had a total of nineteen loans in the amount of $47,340,891. : A comp...

  14. Ohio Department of Transportation State Infrastructure Bank Annual Financial Report : Federal Fiscal Year 2008

    Science.gov (United States)

    2008-01-01

    The Ohio Department of Transportation is pleased to present the Federal Fiscal Year (FFY) 2008 State Infrastructure Bank (SIB) Annual Financial Report. The portfolio of the FFY 2008 SIB had a total of five loans totaling $22.1 million. Since the begi...

  15. Ohio Department of Transportation State Infrastructure Bank Annual Financial Report : Federal Fiscal Year 2007

    Science.gov (United States)

    2007-01-01

    The Ohio Department of Transportation is pleased to present the Federal : Fiscal Year (FFY) 2007 State Infrastructure Bank (SIB) Annual Financial : Report. : The portfolio of the FFY 2007 SIB had a total of 13 loans and 1 bond in the : amount of $17....

  16. Self-Esteem in Decision Making and Decision-Making Styles of Teachers

    Science.gov (United States)

    Temel, Veysel; Birol, Sefa Sahan; Nas, Kazim; Akpinar, Selahattin; Tekin, Murat

    2015-01-01

    The aim of the study was to examine the self-esteem in decision-making and decision-making styles of the teachers in various branches of Çat town of Erzurum Province, Turkey in terms of some variables in 2014-2015 year. A total of 153 teachers (84 females and 69 males) (age (? = 1.6536 ± 0.72837) from different departments participated in the…

  17. State of Alaska Department of Environmental Conservation oil spill research and development program

    International Nuclear Information System (INIS)

    Pearson, L.A.

    1992-01-01

    In 1990, the Sixteenth Alaska Legislature reviewed issues related to response action and planning involved in the release or threatened release of oil or hazardous substance. One of the outcomes of that review was the passage of House Bill 566, which established the Alaska State Emergency Response Commission (SERC) and within the SERC the Hazardous Substance Spill Technology Review Council. The Council was organized in the spring of 1991 and meets quarterly. The Council is responsible to assist in the identification of containment and clean up products and procedures for arctic and sub-arctic hazardous substance releases and to make recommendations to state agencies regarding their use and deployment. Appendix I explains additional duties of the Council. Members of the Council include the deputy commissioner of the Alaska Department of Environmental Conservation, representatives of the Department of Military and Veterans Affairs, the governor's senior science advisor, the U.S. Coast Guard, the Environmental Protection Agency, the University of Alaska, Prince William Sound Science Center and representatives from Alaska judicial districts

  18. 75 FR 4440 - Meeting of the Working group on Environmental Cooperation Pursuant to the United States-Morocco...

    Science.gov (United States)

    2010-01-27

    ... decision making. Ongoing work includes: Assistance to Morocco on enhanced compliance with the Convention on... participation in environmental decision-making and enforcement. For more information, interested parties are... DEPARTMENT OF STATE [Public Notice 6885] Meeting of the Working group on Environmental Cooperation...

  19. United States Department of Energy: a history

    Energy Technology Data Exchange (ETDEWEB)

    Holl, J.M.

    1982-11-01

    This pamphlet traces the origins of the Department of Energy and outlines the history of the Department as reflected in the energy policies of Presidents Nixon, Ford, Carter, and Reagan. It attempts to place recent energy policy into historical perspective by describing the evolution of the federal Government's role in energy research, development, and regulation.

  20. Using the Five-Level Taiwan Triage and Acuity Scale Computerized System: Factors in Decision Making by Emergency Department Triage Nurses.

    Science.gov (United States)

    Chang, Wen; Liu, Hsueh-Erh; Goopy, Suzanne; Chen, Li-Chin; Chen, Hsiao-Jung; Han, Chin-Yen

    2017-10-01

    Triage classifies and prioritizes patients' care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses' decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients' health status, and nurses' experiences. This study suggests ensuring the patient's privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public's understanding of the ED visits. These will make ED triage more efficient.

  1. ENVIRONMENTAL RESEARCH BRIEF: WASTE REDUCTION ACTIVITIES AND OPTIONS FOR A STATE DEPARTMENT OF TRANSPORTATION.

    Science.gov (United States)

    The U.S. Environmental Protection Agency (EPA) funded a project with the New Jersey Department of Environmental Protection and Energy (NJDEPE) to assist in conducting waste minimization assessments at thirty small- to medium-sized businesses in the State of New Jersey. One of th...

  2. The United States Department of Energy's Environmental Restoration Program

    International Nuclear Information System (INIS)

    Whitfield, P.; Lehr, J.C.

    1993-01-01

    The Department of Energy (DOE) operates a large industrial complex which includes various production, processing, testing, and research and development installations across the country. This complex has generated, and continues to generate, significant quantities of radioactive, hazardous, and mixtures of radioactive and hazardous (mixed) waste. Over the past 40 + years of operation, the waste generated by this complex has been managed to then-current standards of technology and regulation. However, some of these waste management practices have subsequently been proven to be inadequate for long-term environmental protection. To improve these practices, DOE must first manage the tasks of characterizing and remediating waste sites and facilities at more than 120 locations in 34 states and one location in Puerto Rico. To accomplish this mission, DOE's Environmental Restoration (ER) Program within the Office of Environmental Restoration and Waste Management (EM) was established in 1989, when DOE's top priority changed from nuclear weapons production to environmental cleanup. The ER Program was created to ensure that risks to human health and the environment posed by DOE's past operations are eliminated or reduced to prescribed, safe levels. This paper gives details on the philosophy of the Environmental Restoration Program. It includes information on how the Department is managing this Program to assure cost efficiency and good stewardship of the taxpayer's dollars

  3. Moving toward comprehensive acute heart failure risk assessment in the emergency department: the importance of self-care and shared decision making.

    Science.gov (United States)

    Collins, Sean P; Storrow, Alan B

    2013-08-01

    Nearly 700,000 emergency department (ED) visits were due to acute heart failure (AHF) in 2009. Most visits result in a hospital admission and account for the largest proportion of a projected $70 billion to be spent on heart failure care by 2030. ED-based risk prediction tools in AHF rarely impact disposition decision making. This is a major factor contributing to the 80% admission rate for ED patients with AHF, which has remained unchanged over the last several years. Self-care behaviors such as symptom monitoring, medication taking, dietary adherence, and exercise have been associated with decreased hospital readmissions, yet self-care remains largely unaddressed in ED patients with AHF and thus represents a significant lost opportunity to improve patient care and decrease ED visits and hospitalizations. Furthermore, shared decision making encourages collaborative interaction between patients, caregivers, and providers to drive a care path based on mutual agreement. The observation that “difficult decisions now will simplify difficult decisions later” has particular relevance to the ED, given this is the venue for many such issues. We hypothesize patients as complex and heterogeneous as ED patients with AHF may need both an objective evaluation of physiologic risk as well as an evaluation of barriers to ideal self-care, along with strategies to overcome these barriers. Combining physician gestalt, physiologic risk prediction instruments, an evaluation of self-care, and an information exchange between patient and provider using shared decision making may provide the critical inertia necessary to discharge patients home after a brief ED evaluation.

  4. Collaborative Decision Making in METOC

    Science.gov (United States)

    2002-01-01

    desired effect (Eagly, & Chaiken, 1993). Arguably, artificial intelligence is representative of the best of approaches in rational decision - making ...2001), The quantum of social action and the function of emotion in decision - making , Emotional and Intelligent II: The Tangled Knot of Social...Collaborative decision making in METOC W.F. Lawless Paine College, Departments of Mathematics and Psychology Augusta, GA 30901-3182 ph: 706

  5. 32 CFR 989.21 - Record of decision (ROD).

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Record of decision (ROD). 989.21 Section 989.21 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE ENVIRONMENTAL PROTECTION ENVIRONMENTAL IMPACT ANALYSIS PROCESS (EIAP) § 989.21 Record of decision (ROD). (a) The proponent and the EPF...

  6. 29 CFR 1905.41 - Summary decision.

    Science.gov (United States)

    2010-07-01

    ... OCCUPATIONAL SAFETY AND HEALTH ACT OF 1970 Summary Decisions § 1905.41 Summary decision. (a) No genuine issue... 29 Labor 5 2010-07-01 2010-07-01 false Summary decision. 1905.41 Section 1905.41 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR RULES OF...

  7. A hierarchical Markov decision process modeling feeding and marketing decisions of growing pigs

    DEFF Research Database (Denmark)

    Pourmoayed, Reza; Nielsen, Lars Relund; Kristensen, Anders Ringgaard

    2016-01-01

    Feeding is the most important cost in the production of growing pigs and has a direct impact on the marketing decisions, growth and the final quality of the meat. In this paper, we address the sequential decision problem of when to change the feed-mix within a finisher pig pen and when to pick pigs...... for marketing. We formulate a hierarchical Markov decision process with three levels representing the decision process. The model considers decisions related to feeding and marketing and finds the optimal decision given the current state of the pen. The state of the system is based on information from on...

  8. Radioactive solid waste inventories at United States Department of Energy burial and storage sites

    International Nuclear Information System (INIS)

    Watanabe, T.

    1987-06-01

    Radioactive solid waste inventories are given for United States Department of Energy (DOE) burial and storage sites. These data are obtained from the Solid Waste Information Management System (SWIMS) and reflect the inventories as of the end of the calendar year 1986. 4 figs., 7 tabs

  9. 75 FR 65461 - Renewal of Department of Defense Federal Advisory Committee; United States Naval Academy Board of...

    Science.gov (United States)

    2010-10-25

    ... the United States Naval Academy Board of Visitors (hereafter referred to as the ``Board''). FOR FURTHER INFORMATION CONTACT: Jim Freeman, Deputy Committee Management Officer for the Department of... equipment, fiscal affairs, academic methods and other matters relating to the United States Naval Academy...

  10. An Evaluation of the Cybersecurity Policies for the United States Health & Human Services Department: Criteria, Regulations, and Improvements

    Directory of Open Access Journals (Sweden)

    Derek Mohammed

    2014-04-01

    Full Text Available This paper examines the criteria necessary for the evaluation of the cybersecurity policies for the United States Health and Human Services Department of the Federal Government. The overall purpose of cybersecurity policies and procedures is supported through compliance with Federal mandated regulation and standards, which serve to protect the organizational services and goals of the United States Health and Human Services Department, and to promote the best possible security practices in the protection of information systems from unauthorized actors and cyber-threats. The criteria of the cybersecurity evaluation is identified and analyzed for quality, strengths, weaknesses, and future applicability. Topics within the criteria include organizational operation, regulations and industrial standards compliance, service delivery to national customers, and the prevention and mitigation of IT system and security failure. This analysis determines the strengths and weaknesses, and makes recommendations for revising the cybersecurity policies within the United States Health and Human Services Department.

  11. A model for emergency department end-of-life communications after acute devastating events--part I: decision-making capacity, surrogates, and advance directives.

    Science.gov (United States)

    Limehouse, Walter E; Feeser, V Ramana; Bookman, Kelly J; Derse, Arthur

    2012-09-01

    Making decisions for a patient affected by sudden devastating illness or injury traumatizes a patient's family and loved ones. Even in the absence of an emergency, surrogates making end-of-life treatment decisions may experience negative emotional effects. Helping surrogates with these end-of-life decisions under emergent conditions requires the emergency physician (EP) to be clear, making medical recommendations with sensitivity. This model for emergency department (ED) end-of-life communications after acute devastating events comprises the following steps: 1) determine the patient's decision-making capacity; 2) identify the legal surrogate; 3) elicit patient values as expressed in completed advance directives; 4) determine patient/surrogate understanding of the life-limiting event and expectant treatment goals; 5) convey physician understanding of the event, including prognosis, treatment options, and recommendation; 6) share decisions regarding withdrawing or withholding of resuscitative efforts, using available resources and considering options for organ donation; and 7) revise treatment goals as needed. Emergency physicians should break bad news compassionately, yet sufficiently, so that surrogate and family understand both the gravity of the situation and the lack of long-term benefit of continued life-sustaining interventions. EPs should also help the surrogate and family understand that palliative care addresses comfort needs of the patient including adequate treatment for pain, dyspnea, or anxiety. Part I of this communications model reviews determination of decision-making capacity, surrogacy laws, and advance directives, including legal definitions and application of these steps; Part II (which will appear in a future issue of AEM) covers communication moving from resuscitative to end-of-life and palliative treatment. EPs should recognize acute devastating illness or injuries, when appropriate, as opportunities to initiate end-of-life discussions and to

  12. Are gains in decision-making autonomy during early adolescence beneficial for emotional functioning? The case of the United States and china.

    Science.gov (United States)

    Qin, Lili; Pomerantz, Eva M; Wang, Qian

    2009-01-01

    This research examined the role of children's decision-making autonomy in their emotional functioning during early adolescence in the United States and China. Four times over the 7th and 8th grades, 825 American and Chinese children (M = 12.73 years) reported on the extent to which they versus their parents make decisions about issues children often deem as under their authority. Children also reported on their emotional functioning. American children made greater gains over time in decision-making autonomy than did Chinese children. Initial decision-making autonomy predicted enhanced emotional functioning similarly among American and Chinese children. However, gains over time in decision-making autonomy predicted enhanced emotional functioning more in the United States (vs. China) where such gains were normative.

  13. Decision-support tools for Extreme Weather and Climate Events in the Northeast United States

    Science.gov (United States)

    Kumar, S.; Lowery, M.; Whelchel, A.

    2013-12-01

    Decision-support tools were assessed for the 2013 National Climate Assessment technical input document, "Climate Change in the Northeast, A Sourcebook". The assessment included tools designed to generate and deliver actionable information to assist states and highly populated urban and other communities in assessment of climate change vulnerability and risk, quantification of effects, and identification of adaptive strategies in the context of adaptation planning across inter-annual, seasonal and multi-decadal time scales. State-level adaptation planning in the Northeast has generally relied on qualitative vulnerability assessments by expert panels and stakeholders, although some states have undertaken initiatives to develop statewide databases to support vulnerability assessments by urban and local governments, and state agencies. The devastation caused by Superstorm Sandy in October 2012 has raised awareness of the potential for extreme weather events to unprecedented levels and created urgency for action, especially in coastal urban and suburban communities that experienced pronounced impacts - especially in New Jersey, New York and Connecticut. Planning approaches vary, but any adaptation and resiliency planning process must include the following: - Knowledge of the probable change in a climate variable (e.g., precipitation, temperature, sea-level rise) over time or that the climate variable will attain a certain threshold deemed to be significant; - Knowledge of intensity and frequency of climate hazards (past, current or future events or conditions with potential to cause harm) and their relationship with climate variables; - Assessment of climate vulnerabilities (sensitive resources, infrastructure or populations exposed to climate-related hazards); - Assessment of relative risks to vulnerable resources; - Identification and prioritization of adaptive strategies to address risks. Many organizations are developing decision-support tools to assist in the urban

  14. 45 CFR 400.9 - Administrative review of decisions on approval of State plans and plan amendments.

    Science.gov (United States)

    2010-10-01

    ... Welfare OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Grants to States for Refugee Resettlement The State Plan...

  15. 28 CFR 16.27 - Procedure in the event a department decision concerning a demand is not made prior to the time a...

    Science.gov (United States)

    2010-07-01

    ... Section 16.27 Judicial Administration DEPARTMENT OF JUSTICE PRODUCTION OR DISCLOSURE OF MATERIAL OR INFORMATION Production or Disclosure in Federal and State Proceedings § 16.27 Procedure in the event a... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Procedure in the event a department...

  16. Mainstreaming climate change adaptation strategies into New York State Department of Transportation's operations : final report.

    Science.gov (United States)

    2011-10-31

    This study identifies climate change adaptation strategies and recommends ways of mainstreaming them into planned actions, including legislation, policies, programs and projects in all areas and at all levels within the New York State Department of T...

  17. 6 CFR 13.37 - Initial Decision.

    Science.gov (United States)

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Initial Decision. 13.37 Section 13.37 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROGRAM FRAUD CIVIL REMEDIES § 13.37 Initial Decision. (a) The ALJ will issue an Initial Decision based only on the record, which will contain...

  18. Environmental programs for grades K-12 sponsored by the Westinghouse Waste Isolation Division Educational Programs Department

    International Nuclear Information System (INIS)

    Mikel, C.J.

    1993-01-01

    The Waste Isolation Pilot Plant (WIPP) created its educational programs department in 1990 as a result of the Secretary of Energy's focus on education stated in SEN-23-90. This Secretary of Energy Notice reflects the focus for US Department of Energy facilities to enhance education through their resources (both human and financial) with an emphasis on math and science. The mission of the Westinghouse Waste Isolation Division (WID) educational programs department is to enhance education at all levels and to promote educational experiences that give students the opportunity to make decisions and develop skills for productive lives. Programs have been developed around the environmental monitoring department, to give students from different grade levels hands on experiences in the environmental sciences field to stimulate their interest in the natural sciences

  19. 76 FR 66937 - Privacy Act of 1974; Department of Homeland Security/United States Secret Service-003 Non...

    Science.gov (United States)

    2011-10-28

    ... 1974; Department of Homeland Security/United States Secret Service--003 Non-Criminal Investigation... Security/United States Secret Service--003 Non-Criminal Investigation Information System.'' As a result of... Secret Service, 245 Murray Lane SW., Building T-5, Washington, DC 20223. For privacy issues please...

  20. Wildfire risk reduction in the United States: Leadership staff perceptions of local fire department roles and responsibilities

    Science.gov (United States)

    Rachel S. Madsen; Hylton J. G. Haynes; Sarah M. McCaffrey

    2018-01-01

    As wildland fires have had increasing negative impacts on a range of human values, in many parts of the United States (U.S.) and around the world, collaborative risk reduction efforts among agencies, homeowners, and fire departments are needed to improve wildfire safety and mitigate risk. Using interview data from 46 senior officers from local fire departments around...

  1. The Epidemiology of Emergency Department Trauma Discharges in the United States.

    Science.gov (United States)

    DiMaggio, Charles J; Avraham, Jacob B; Lee, David C; Frangos, Spiros G; Wall, Stephen P

    2017-10-01

    Injury-related morbidity and mortality is an important emergency medicine and public health challenge in the United States. Here we describe the epidemiology of traumatic injury presenting to U.S. emergency departments (EDs), define changes in types and causes of injury among the elderly and the young, characterize the role of trauma centers and teaching hospitals in providing emergency trauma care, and estimate the overall economic burden of treating such injuries. We conducted a secondary retrospective, repeated cross-sectional study of the Nationwide Emergency Department Data Sample (NEDS), the largest all-payer ED survey database in the United States. Main outcomes and measures were survey-adjusted counts, proportions, means, and rates with associated standard errors (SEs) and 95% confidence intervals. We plotted annual age-stratified ED discharge rates for traumatic injury and present tables of proportions of common injuries and external causes. We modeled the association of Level I or II trauma center care with injury fatality using a multivariable survey-adjusted logistic regression analysis that controlled for age, sex, injury severity, comorbid diagnoses, and teaching hospital status. There were 181,194,431 (SE = 4,234) traumatic injury discharges from U.S. EDs between 2006 and 2012. There was a mean year-to-year decrease of 143 (95% CI = -184.3 to -68.5) visits per 100,000 U.S. population during the study period. The all-age, all-cause case-fatality rate for traumatic injuries across U.S. EDs during the study period was 0.17% (SE = 0.001%). The case-fatality rate for the most severely injured averaged 4.8% (SE = 0.001%), and severely injured patients were nearly four times as likely to be seen in Level I or II trauma centers (relative risk = 3.9 [95% CI = 3.7 to 4.1]). The unadjusted risk ratio, based on group counts, for the association of Level I or II trauma centers with mortality was risk ratio = 4.9 (95% CI = 4.5 to 5.3); however, after sex, age

  2. Putting Chronic Disease on the Map: Building GIS Capacity in State and Local Health Departments

    Science.gov (United States)

    Casper, Michele; Tootoo, Joshua; Schieb, Linda

    2013-01-01

    Techniques based on geographic information systems (GIS) have been widely adopted and applied in the fields of infectious disease and environmental epidemiology; their use in chronic disease programs is relatively new. The Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention is collaborating with the National Association of Chronic Disease Directors and the University of Michigan to provide health departments with capacity to integrate GIS into daily operations, which support priorities for surveillance and prevention of chronic diseases. So far, 19 state and 7 local health departments participated in this project. On the basis of these participants’ experiences, we describe our training strategy and identify high-impact GIS skills that can be mastered and applied over a short time in support of chronic disease surveillance. We also describe the web-based resources in the Chronic Disease GIS Exchange that were produced on the basis of this training and are available to anyone interested in GIS and chronic disease (www.cdc.gov/DHDSP/maps/GISX). GIS offers diverse sets of tools that promise increased productivity for chronic disease staff of state and local health departments. PMID:23786907

  3. Putting chronic disease on the map: building GIS capacity in state and local health departments.

    Science.gov (United States)

    Miranda, Marie Lynn; Casper, Michele; Tootoo, Joshua; Schieb, Linda

    2013-06-20

    Techniques based on geographic information systems (GIS) have been widely adopted and applied in the fields of infectious disease and environmental epidemiology; their use in chronic disease programs is relatively new. The Centers for Disease Control and Prevention's Division for Heart Disease and Stroke Prevention is collaborating with the National Association of Chronic Disease Directors and the University of Michigan to provide health departments with capacity to integrate GIS into daily operations, which support priorities for surveillance and prevention of chronic diseases. So far, 19 state and 7 local health departments participated in this project. On the basis of these participants' experiences, we describe our training strategy and identify high-impact GIS skills that can be mastered and applied over a short time in support of chronic disease surveillance. We also describe the web-based resources in the Chronic Disease GIS Exchange that were produced on the basis of this training and are available to anyone interested in GIS and chronic disease (www.cdc.gov/DHDSP/maps/GISX). GIS offers diverse sets of tools that promise increased productivity for chronic disease staff of state and local health departments.

  4. Effect of the Affordable Care Act Medicaid Expansion on Emergency Department Visits: Evidence From State-Level Emergency Department Databases.

    Science.gov (United States)

    Nikpay, Sayeh; Freedman, Seth; Levy, Helen; Buchmueller, Tom

    2017-08-01

    We assess whether the expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA) results in changes in emergency department (ED) visits or ED payer mix. We also test whether the size of the change in ED visits depends on the change in the size of the Medicaid population. Using all-capture, longitudinal, state data from the Agency for Healthcare Research and Quality's Fast Stats program, we implemented a difference-in-difference analysis, which compared changes in ED visits per capita and the share of ED visits by payer (Medicaid, uninsured, and private insurance) in 14 states that did and 11 states that did not expand Medicaid in 2014. Analyses controlled for state-level demographic and economic characteristics. We found that total ED use per 1,000 population increased by 2.5 visits more in Medicaid expansion states than in nonexpansion states after 2014 (95% confidence interval [CI] 1.1 to 3.9). Among the visit types that could be measured, increases in ED visits were largest for injury-related visits and for states with the largest changes in Medicaid enrollment. Compared with nonexpansion states, in expansion states the share of ED visits covered by Medicaid increased 8.8 percentage points (95% CI 5.0 to 12.6), whereas the uninsured share decreased by 5.3 percentage points (95% CI -1.7 to -8.9). The ACA's Medicaid expansion has resulted in changes in payer mix. Contrary to other studies of the ACA's effect on ED visits, our study found that the expansion also increased use of the ED, consistent with polls of emergency physicians. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  5. 7 CFR 1900.56 - Non-appealable decisions.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false Non-appealable decisions. 1900.56 Section 1900.56 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS... REGULATIONS GENERAL Adverse Decisions and Administrative Appeals § 1900.56 Non-appealable decisions. The...

  6. Guide to Graduate Departments of Geography in the United States and Canada 1982-1983.

    Science.gov (United States)

    Association of American Geographers, Washington, DC.

    Information is presented about requirements, course offerings, financial aid, and personnel for 147 graduate departments of geography in the United States and Canada. Seventy-three offer a Ph.D. in geography, and 77 award the Master's degree. Information provided for each institution includes: date founded; degrees offered; number of degrees…

  7. Recent Patterns in Shared Decision Making for Prostate-Specific Antigen Testing in the United States.

    Science.gov (United States)

    Fedewa, Stacey A; Gansler, Ted; Smith, Robert; Sauer, Ann Goding; Wender, Richard; Brawley, Otis W; Jemal, Ahmedin

    2018-03-01

    Previous studies report infrequent use of shared decision making for prostate-specific antigen (PSA) testing. It is unknown whether this pattern has changed recently considering increased emphasis on shared decision making in prostate cancer screening recommendations. Thus, the objective of this study is to examine recent changes in shared decision making. We conducted a retrospective cross-sectional study among men aged 50 years and older in the United States using 2010 and 2015 National Health Interview Survey (NHIS) data (n = 9,598). Changes in receipt of shared decision making were expressed as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Analyses were stratified on PSA testing (recent [in the past year] or no testing). Elements of shared decision making assessed included the patient being informed about the advantages only, advantages and disadvantages, and full shared decision making (advantages, disadvantages, and uncertainties). Among men with recent PSA testing, 58.5% and 62.6% reported having received ≥1 element of shared decision making in 2010 and 2015, respectively ( P = .054, aPR = 1.04; 95% CI, 0.98-1.11). Between 2010 and 2015, being told only about the advantages of PSA testing significantly declined (aPR = 0.82; 95% CI, 0.71-0.96) and full shared decision making prevalence significantly increased (aPR = 1.51; 95% CI, 1.28-1.79) in recently tested men. Among men without prior PSA testing, 10% reported ≥1 element of shared decision making, which did not change with time. Between 2010 and 2015, there was no increase in shared decision making among men with recent PSA testing though there was a shift away from only being told about the advantages of PSA testing towards full shared decision making. Many men receiving PSA testing did not receive shared decision making. © 2018 Annals of Family Medicine, Inc.

  8. The Problem of Women in the Department:  Sex and Gender Discrimination in the 1960s United States Foreign Diplomatic Service

    OpenAIRE

    McKenzie, Beatrice Loftus

    2015-01-01

    Alison Palmer, a United States Foreign Service Officer from 1959 to 1981, brought a gender equity complaint against the U.S. State Department in the late 1960s and then led a class action lawsuit by female officers that lasted until 2010.  Examining the records of Palmer’s grievances against the Department of State reveals linkages between gender, sex, and race in the U.S. Foreign Service.  U.S. Ambassadors to three African nations justified their rejection of her from their staffs by stating...

  9. An integrated probabilistic risk analysis decision support methodology for systems with multiple state variables

    International Nuclear Information System (INIS)

    Sen, P.; Tan, John K.G.; Spencer, David

    1999-01-01

    Probabilistic risk analysis (PRA) methods have been proven to be valuable in risk and reliability analysis. However, a weak link seems to exist between methods for analysing risks and those for making rational decisions. The integrated decision support system (IDSS) methodology presented in this paper attempts to address this issue in a practical manner. In consists of three phases: a PRA phase, a risk sensitivity analysis (SA) phase and an optimisation phase, which are implemented through an integrated computer software system. In the risk analysis phase the problem is analysed by the Boolean representation method (BRM), a PRA method that can deal with systems with multiple state variables and feedback loops. In the second phase the results obtained from the BRM are utilised directly to perform importance and risk SA. In the third phase, the problem is formulated as a multiple objective decision making problem in the form of multiple objective reliability optimisation. An industrial example is included. The resultant solutions of a five objective reliability optimisation are presented, on the basis of which rational decision making can be explored

  10. ABC estimation of unit costs for emergency department services.

    Science.gov (United States)

    Holmes, R L; Schroeder, R E

    1996-04-01

    Rapid evolution of the health care industry forces managers to make cost-effective decisions. Typical hospital cost accounting systems do not provide emergency department managers with the information needed, but emergency department settings are so complex and dynamic as to make the more accurate activity-based costing (ABC) system prohibitively expensive. Through judicious use of the available traditional cost accounting information and simple computer spreadsheets. managers may approximate the decision-guiding information that would result from the much more costly and time-consuming implementation of ABC.

  11. 45 CFR 99.32 - Decisions following hearing.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Decisions following hearing. 99.32 Section 99.32 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROCEDURE FOR HEARINGS FOR THE CHILD CARE AND DEVELOPMENT FUND Posthearing Procedures, Decisions § 99.32 Decisions following...

  12. 75 FR 66420 - U.S. Department of State Advisory Committee on Private International Law (ACPIL): Online Dispute...

    Science.gov (United States)

    2010-10-28

    ... B2C e-commerce contract disputes on the basis of a state-sponsored cooperative framework and model... International Law (ACPIL): Online Dispute Resolution (ODR) Study Group The Department of State, Office of Legal... upcoming work in UNCITRAL on the development of legal instruments regarding online dispute resolution for...

  13. THORP and after - challenging state decisions

    International Nuclear Information System (INIS)

    Bowden, P.; Lawrence, J.

    1994-01-01

    This article looks at an increasing trend for European Community law to be used by those seeking to challenge decisions taken at a national level which effect the environment. The debate over the future operation of British Nuclear Fuels Ltd's Thermal Oxide Reprocessing Plant at the Sellafield site (THORP) is used as an example of this trend. The United Kingdom government's energy policy authorised the construction and operation of the THORP plant. The decision to continue with the project has been challenged by Greenpeace and Lancashire County Council acting cooperatively. Their challenge was based on Community law and legislation. (UK)

  14. Quantum field inspired model of decision making: Asymptotic stabilization of belief state via interaction with surrounding mental environment

    OpenAIRE

    Bagarello, Fabio; Basieva, Irina; Khrennikov, Andrei

    2017-01-01

    This paper is devoted to justification of quantum-like models of the process of decision making based on the theory of open quantum systems, i.e. decision making is considered as decoherence. This process is modeled as interaction of a decision maker, Alice, with a mental (information) environment ${\\cal R}$ surrounding her. Such an interaction generates "dissipation of uncertainty" from Alice's belief-state $\\rho(t)$ into ${\\cal R}$ and asymptotic stabilization of $\\rho(t)$ to a steady belie...

  15. Summary of State Policy Regulations for Public Sector Labor Relations: Statutes, Attorney Generals' Opinions and Selected Court Decisions.

    Science.gov (United States)

    Labor Management Services Administration (DOL), Washington, DC. Div. of Public Employee Labor Relations.

    This chart represents a state-by-state compilation of the numerous statutes, executive orders, attorney general opinions, and court decisions which govern state and local government labor relations. Where available, information on each authority includes: (1) administrative body, (2) bargaining rights, (3) recognition rights and procedure, (4)…

  16. State of Hawaii Department of Education Financial Report, July 1, 2003-June 30, 2004.

    Science.gov (United States)

    State of Hawaii Department of Education, 2005

    2005-01-01

    This annual financial report of the Department of Education is prepared each year to inform interested persons of the total cost of public education in the state of Hawaii. The financial report provides both Operating and Capital Improvement Project fund information that is useful in presenting our educational system financing, expenditures and…

  17. State procurement law: facilitating the collaboration between health department and school of public health.

    Science.gov (United States)

    Huber, George A; Barron, Gerald M; Duchak, Linda S; Raniowski, Martin; Alsahlani, Hazem S; Potter, Margaret A

    2014-01-01

    The mark of an "academic health department" includes shared activity by academic and practice partners sustained over time. Despite a long history of productive interactivity, the Pennsylvania Department of Health and the University of Pittsburgh's Graduate School of Public Health often faced administrative hurdles in contracting for projects of mutual interest. Seeking to overcome these hurdles, the Commonwealth of Pennsylvania and the University of Pittsburgh's Graduate School of Public Health negotiated a Master Agreement on the basis of statutes designating both as "public procurement units." This provided a template for project specifications, standard financial terms, and a contracting process. Since taking effect, the Master Agreement has supported projects in policy development, capacity building, workforce development, program evaluation, data analysis, and program planning. This experience suggests an approach potentially useful for other states and localities seeking to solidify academic health department partnerships either envisioned for the future or already in place.

  18. Incidence and Cost of Ankle Sprains in United States Emergency Departments

    Science.gov (United States)

    Shah, Shweta; Thomas, Abbey C.; Noone, Joshua M.; Blanchette, Christopher M.; Wikstrom, Erik A.

    2016-01-01

    Background: Ankle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments. Hypothesis: There will be a higher incidence of ankle sprains among younger populations (≤25 years old) and in female patients. Complications and procedures will differ between ankle sprain types. Lateral ankle sprains will have lower health care charges relative to medial and high ankle sprains. Study Design: Descriptive epidemiological study. Level of Evidence: Level 3. Methods: A cross-sectional study of the 2010 Nationwide Emergency Department Sample was conducted. Outcomes such as charges, complications, and procedures were compared using propensity score matching between lateral and medial as well as lateral and high ankle sprains. Results: The sample contained 225,114 ankle sprains. Female patients sustained more lateral ankle sprains (57%). After propensity score adjustment, lateral sprains incurred greater charges than medial ankle sprains (median [interquartile range], $1008 [$702-$1408] vs $914 [$741-$1108]; P sprain of the foot (2.96% vs 0.70%, P ankle sprain events. Among procedures, medial ankle sprains were more likely to include diagnostic radiology (97.91% vs 83.62%, P ankle sprains (0.87% vs 2.79%, P ankle sprains than lateral ankle sprains (24 [6.06%] vs 1 [0.25%], P Ankle sprain emergency department visits account for significant health care charges in the United States. Age- and sex-related differences persist among the types of ankle sprains. Clinical Relevance: The health care charges associated with ankle sprains indicate the need for additional preventive measures. There are age- and sex-related differences in the prevalence of ankle sprains that suggest these demographics may be risk factors for ankle sprains. PMID:27474161

  19. Supporting management decisions with ex ante accounting information

    NARCIS (Netherlands)

    Wouters, Marc; Verdaasdonk, Peter

    2002-01-01

    This paper is about the relationship between management decisions and accounting information. Management decisions have consequences in different functional areas, departments, and different companies along the value chain. Accounting information regarding decisions aims to translate as many as

  20. 75 FR 28188 - Schedule of Fees for Consular Services, Department of State and Overseas Embassies and Consulates

    Science.gov (United States)

    2010-05-20

    ... allow a consular officer to waive the physical appearance of an applicant in the J-1 visa class, but... Department of State visa adjudicator to both determine whether the employment falls under the E-3 program...'' increase for petition-based employment visas, and stated that adjudication of these petition-based visa...

  1. Applying advanced analytics to guide emergency department operational decisions: A proof-of-concept study examining the effects of boarding.

    Science.gov (United States)

    Andrew Taylor, R; Venkatesh, Arjun; Parwani, Vivek; Chekijian, Sharon; Shapiro, Marc; Oh, Andrew; Harriman, David; Tarabar, Asim; Ulrich, Andrew

    2018-01-04

    Emergency Department (ED) leaders are increasingly confronted with large amounts of data with the potential to inform and guide operational decisions. Routine use of advanced analytic methods may provide additional insights. To examine the practical application of available advanced analytic methods to guide operational decision making around patient boarding. Retrospective analysis of the effect of boarding on ED operational metrics from a single site between 1/2015 and 1/2017. Times series were visualized through decompositional techniques accounting for seasonal trends, to determine the effect of boarding on ED performance metrics and to determine the impact of boarding "shocks" to the system on operational metrics over several days. There were 226,461 visits with the mean (IQR) number of visits per day was 273 (258-291). Decomposition of the boarding count time series illustrated an upward trend in the last 2-3 quarters as well as clear seasonal components. All performance metrics were significantly impacted (pstudy regarding the use of advanced analytics in daily ED operations, time series analysis provided multiple useful insights into boarding and its impact on performance metrics. Copyright © 2018. Published by Elsevier Inc.

  2. Impact of a clinical decision model for febrile children at risk for serious bacterial infections at the emergency department: a randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Evelien de Vos-Kerkhof

    Full Text Available To assess the impact of a clinical decision model for febrile children at risk for serious bacterial infections (SBI attending the emergency department (ED.Randomized controlled trial with 439 febrile children, aged 1 month-16 years, attending the pediatric ED of a Dutch university hospital during 2010-2012. Febrile children were randomly assigned to the intervention (clinical decision model; n = 219 or the control group (usual care; n = 220. The clinical decision model included clinical symptoms, vital signs, and C-reactive protein and provided high/low-risks for "pneumonia" and "other SBI". Nurses were guided by the intervention to initiate additional tests for high-risk children. The clinical decision model was evaluated by 1 area-under-the-receiver-operating-characteristic-curve (AUC to indicate discriminative ability and 2 feasibility, to measure nurses' compliance to model recommendations. Primary patient outcome was defined as correct SBI diagnoses. Secondary process outcomes were defined as length of stay; diagnostic tests; antibiotic treatment; hospital admission; revisits and medical costs.The decision model had good discriminative ability for both pneumonia (n = 33; AUC 0.83 (95% CI 0.75-0.90 and other SBI (n = 22; AUC 0.81 (95% CI 0.72-0.90. Compliance to model recommendations was high (86%. No differences in correct SBI determination were observed. Application of the clinical decision model resulted in less full-blood-counts (14% vs. 22%, p-value < 0.05 and more urine-dipstick testing (71% vs. 61%, p-value < 0.05.In contrast to our expectations no substantial impact on patient outcome was perceived. The clinical decision model preserved, however, good discriminatory ability to detect SBI, achieved good compliance among nurses and resulted in a more standardized diagnostic approach towards febrile children, with less full blood-counts and more rightfully urine-dipstick testing.Nederlands Trial Register NTR2381.

  3. 75 FR 71415 - Notice of Decision To Issue Permits for the Importation of Wall Rocket Leaves From the United...

    Science.gov (United States)

    2010-11-23

    ... DEPARTMENT OF AGRICULTURE Animal and Plant Health Inspection Service [Docket No. APHIS-2010-0027] Notice of Decision To Issue Permits for the Importation of Wall Rocket Leaves From the United Kingdom Into the Continental United States AGENCY: Animal and Plant Health Inspection Service, USDA. ACTION...

  4. Scholar and teacher: V.A. Kitaev at the history department of Volgograd State University

    Directory of Open Access Journals (Sweden)

    Kuznetsov Oleg Viktorovich

    2013-11-01

    Full Text Available Vladimir A. Kitaev was born 1941. He was the first dean of the Faculty of History and the first head of the Department of History of the USSR (now the Department of History of Russia of Volgograd State University, reputable scientist, recognized expert in the history of the Russian social thought. The article shows the role of V.A. Kitaev in the formation and development of the faculty and the department. A characteristic of V.A. Kitaev’ sresearch and teaching activities is given. Kitaev’s featuresas a scholar and teacher such as great erudition, science scrupulosity, exactingness to himself andto his disciples, are marked. V.A. Kitaev worked at Volgograd State University for 16 years. All the while, he headed the Department andwas the dean for the first four years. The main thing is what he wanted in those positions – along with their colleagues was to lay and develop the traditions of the classical university, university atmosphere of the faculty and the university. The major scientific issues that are developed by V.A. Kitaev were: the history of liberalism and the fate of liberal reforms (modernization in Russia, the history of the Russian conservative thought, the problem of revolutionary violence as an inevitable result of the practical realization of socialist ideas. As an advocate of “establishing full-fledged liberal order”, V.A. Kitaev had, in essence, to ascertain: in Russia XIX – early XX century did not yet develop the historical conditions for the triumph of liberal ideas. The weakness and indecision of Russian liberals and their fear of the revolutionary movement, the constant fluctuation between the reform and reaction did not allow them to become independent of the political force that would determine the fate of the country in the end.

  5. Billing third party payers for vaccines: state and local health department perspectives.

    Science.gov (United States)

    Quintanilla, Carlos; Duncan, Lorraine; Luther, Lydia

    2009-01-01

    The cost of adequately immunizing a child has risen steadily with recommendations of new, more expensive vaccines. The Vaccines for Children (VFC) program, a federal entitlement, has continued to fund all recommended vaccines for eligible children. The one other federal vaccine-funding source, Section 317 of the Public Health Service Act, has not kept pace with rising vaccine costs. For local health departments to immunize children not eligible for VFC, but whose families are underinsured or otherwise unable to pay for vaccines, state immunization programs have often relied on Section 317 funds. Recognizing this funding challenge and having learned that children covered by health insurance were being immunized in public clinics with publicly supplied vaccines, the Oregon Immunization Program (OIP) launched a project to expand billing of health plans by local health departments for vaccines administered to covered persons. This has resulted in significant savings of Section 317 funds, allowing the Oregon program to provide more vaccines for high-need persons.

  6. Decision Rightness and Emotional Responses to Abortion in the United States: A Longitudinal Study.

    Directory of Open Access Journals (Sweden)

    Corinne H Rocca

    Full Text Available Arguments that abortion causes women emotional harm are used to regulate abortion, particularly later procedures, in the United States. However, existing research is inconclusive. We examined women's emotions and reports of whether the abortion decision was the right one for them over the three years after having an induced abortion.We recruited a cohort of women seeking abortions between 2008-2010 at 30 facilities across the United States, selected based on having the latest gestational age limit within 150 miles. Two groups of women (n=667 were followed prospectively for three years: women having first-trimester procedures and women terminating pregnancies within two weeks under facilities' gestational age limits at the same facilities. Participants completed semiannual phone surveys to assess whether they felt that having the abortion was the right decision for them; negative emotions (regret, anger, guilt, sadness about the abortion; and positive emotions (relief, happiness. Multivariable mixed-effects models were used to examine changes in each outcome over time, to compare the two groups, and to identify associated factors.The predicted probability of reporting that abortion was the right decision was over 99% at all time points over three years. Women with more planned pregnancies and who had more difficulty deciding to terminate the pregnancy had lower odds of reporting the abortion was the right decision (aOR=0.71 [0.60, 0.85] and 0.46 [0.36, 0.64], respectively. Both negative and positive emotions declined over time, with no differences between women having procedures near gestational age limits versus first-trimester abortions. Higher perceived community abortion stigma and lower social support were associated with more negative emotions (b=0.45 [0.31, 0.58] and b=-0.61 [-0.93, -0.29], respectively.Women experienced decreasing emotional intensity over time, and the overwhelming majority of women felt that termination was the right

  7. Department of Energy depleted uranium recycle

    International Nuclear Information System (INIS)

    Kosinski, F.E.; Butturini, W.G.; Kurtz, J.J.

    1994-01-01

    With its strategic supply of depleted uranium, the Department of Energy is studying reuse of the material in nuclear radiation shields, military hardware, and commercial applications. the study is expected to warrant a more detailed uranium recycle plan which would include consideration of a demonstration program and a program implementation decision. Such a program, if implemented, would become the largest nuclear material recycle program in the history of the Department of Energy. The bulk of the current inventory of depleted uranium is stored in 14-ton cylinders in the form of solid uranium hexafluoride (UF 6 ). The radioactive 235 U content has been reduced to a concentration of 0.2% to 0.4%. Present estimates indicate there are about 55,000 UF 6 -filled cylinders in inventory and planned operations will provide another 2,500 cylinders of depleted uranium each year. The United States government, under the auspices of the Department of Energy, considers the depleted uranium a highly-refined strategic resource of significant value. A possible utilization of a large portion of the depleted uranium inventory is as radiation shielding for spent reactor fuels and high-level radioactive waste. To this end, the Department of Energy study to-date has included a preliminary technical review to ascertain DOE chemical forms useful for commercial products. The presentation summarized the information including preliminary cost estimates. The status of commercial uranium processing is discussed. With a shrinking market, the number of chemical conversion and fabrication plants is reduced; however, the commercial capability does exist for chemical conversion of the UF 6 to the metal form and for the fabrication of uranium radiation shields and other uranium products. Department of Energy facilities no longer possess a capability for depleted uranium chemical conversion

  8. 76 FR 69729 - Pesticide Emergency Exemptions; Agency Decisions and State and Federal Agency Crisis Declarations

    Science.gov (United States)

    2011-11-09

    ...; Agency Decisions and State and Federal Agency Crisis Declarations AGENCY: Environmental Protection Agency... following form: Crisis, public health, quarantine, or specific. EPA has also listed denied emergency... or public health purposes. These are rarely requested. 3. A ``crisis exemption'' is initiated by a...

  9. 24 CFR 55.20 - Decision making process.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Decision making process. 55.20 Section 55.20 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development FLOODPLAIN MANAGEMENT Procedures for Making Determinations on Floodplain Management § 55.20 Decision making process. The decision making...

  10. Departmental Appeals Board Decisions

    Data.gov (United States)

    U.S. Department of Health & Human Services — Decisions issued by the Chair and Board Members of the Departmental Appeals Board concerning determinations in discretionary, project grant programs, including...

  11. Decision making and imperfection

    CERN Document Server

    Karny, Miroslav; Wolpert, David

    2013-01-01

    Decision making (DM) is ubiquitous in both natural and artificial systems. The decisions made often differ from those recommended by the axiomatically well-grounded normative Bayesian decision theory, in a large part due to limited cognitive and computational resources of decision makers (either artificial units or humans). This state of a airs is often described by saying that decision makers are imperfect and exhibit bounded rationality. The neglected influence of emotional state and personality traits is an additional reason why normative theory fails to model human DM process.   The book is a joint effort of the top researchers from different disciplines to identify sources of imperfection and ways how to decrease discrepancies between the prescriptive theory and real-life DM. The contributions consider:   ·          how a crowd of imperfect decision makers outperforms experts' decisions;   ·          how to decrease decision makers' imperfection by reducing knowledge available;   ...

  12. Medicare Appeals Council Decisions

    Data.gov (United States)

    U.S. Department of Health & Human Services — Decisions of the Departmental Appeals Board's Medicare Appeals Council involving claims for entitlement to Medicare and individual claims for Medicare coverage and...

  13. Motorcycle Safety Education Programs: Report of a Survey of State Departments of Education and of Colleges and Universities.

    Science.gov (United States)

    American Driver and Traffic Safety Education Association, Washington, DC.

    A survey of State departments of education and colleges and universities, conducted by the Motorcycle Industry Council Safety and Education Foundation, revealed the need for more teacher education programs, instructional materials, and organized workshops that promote motorcycle safety education. The primary interest indicated by State departments…

  14. Parental decision making involvement and decisional conflict: a descriptive study.

    Science.gov (United States)

    Boland, Laura; Kryworuchko, Jennifer; Saarimaki, Anton; Lawson, Margaret L

    2017-06-13

    Decisional conflict is a state of uncertainty about the best treatment option among competing alternatives and is common among adult patients who are inadequately involved in the health decision making process. In pediatrics, research shows that many parents are insufficiently involved in decisions about their child's health. However, little is known about parents' experience of decisional conflict. We explored parents' perceived decision making involvement and its association with parents' decisional conflict. We conducted a descriptive survey study in a pediatric tertiary care hospital. Our survey was guided by validated decisional conflict screening items (i.e., the SURE test). We administered the survey to eligible parents after an ambulatory care or emergency department consultation for their child. Four hundred twenty-nine respondents were included in the analysis. Forty-eight percent of parents reported not being offered treatment options and 23% screened positive for decisional conflict. Parents who reported being offered options experienced less decisional conflict than parents who reported not being offered options (5% vs. 42%, p conflict after their clinical consultation. Involving parents in the decision making process might reduce their risk of decisional conflict. Evidence based interventions that support parent decision making involvement, such as shared decision making, should be evaluated and implemented in pediatrics as a strategy to reduce parents' decisional conflict.

  15. 41 CFR 50-203.21 - Decisions.

    Science.gov (United States)

    2010-07-01

    ... PUBLIC CONTRACTS, DEPARTMENT OF LABOR 203-RULES OF PRACTICE Minimum Wage Determinations Under the Walsh..., and (2) any proposed wage determination. Any tentative decision shall be published in the Federal... wage determination. Any final decision shall be published in the Federal Register. [26 FR 8945, Sept...

  16. U.S. Department of Energy operational experience with shipments of foreign research reactor spent nuclear fuel

    International Nuclear Information System (INIS)

    Messick, Charles E.; Massey, Charles D.; Mustin, Tracy P.

    1998-01-01

    On May 13, 1996, the U.S. Department of Energy issued a Record of Decision on a Nuclear Weapons Nonproliferation Policy Concerning Foreign Research Reactor Spent Nuclear Fuel. The goal of the long-term policy is to recover enriched uranium exported from the United States, while giving foreign research reactor operators sufficient time to develop their own long-term solutions for storage and disposal of spent fuel. The spent fuel accepted by the U.S. DOE under the policy must be out of the research reactors by May 12, 2006 and returned to the United States by May 12, 2009. (author)

  17. 75 FR 65460 - Renewal of Department of Defense Federal Advisory Committee; United States Military Academy Board...

    Science.gov (United States)

    2010-10-25

    ... the United States Military Academy Board of Visitors (hereafter referred to as the ``Board''). FOR FURTHER INFORMATION CONTACT: Jim Freeman, Deputy Committee Management Officer for the Department of... on matters relating to the U.S. Military Academy, including the following: morale and discipline...

  18. The emergency patient's participation in medical decision-making.

    Science.gov (United States)

    Wang, Li-Hsiang; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Han, Chin-Yen; Liu, Hsueh-Erh

    2016-09-01

    The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. The findings fill a gap in knowledge about the decision-making process among emergency patients. The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff. © 2016 John Wiley & Sons Ltd.

  19. The economic impact of the Department of Energy on the State of New Mexico Fiscal Year 1998

    Energy Technology Data Exchange (ETDEWEB)

    Lansford, Robert R.; Adcock, Larry D.; Gentry, Lucille M.; Ben-David, Shaul; Temple, John

    1999-08-05

    The U.S. Department of Energy (DOE) provides a major source of economic benefits in New Mexico, second only to the activities of the U.S. Department of Defense. The agency's far-reaching economic influence within the state is the focus of this report. Economic benefits arising from the various activities and functions of both the Department and its contractors have accrued to the state continuously for over 50 years. For several years, DOE/Albuquerque Operations Office (AL) and New Mexico State University (NMSU) have maintained inter-industry, input-output modeling capabilities to assess DOE's impacts on the state of New Mexico and the other substate regions most directly impacted by DOE activities. One of the major uses of input-output techniques is to assess the effects of developments initiated outside the economy such as Federal DOE monies that flow into the state, on an economy. The information on which the models are based is updated periodically to ensure the most accurate depiction possible of the economy for the period of reference. For this report, the reference periods are Fiscal Year (FY) 1997 (October 1, 1996, through September 30, 1997), and FY 1998 (October 1, 1997, through September 30, 1998). Total impact represents both direct and indirect impacts (resending by business), including induced (resending by households) effects. The standard multipliers used in determining impacts result from the inter-industry, input-output models uniquely developed for New Mexico. This report includes seven main sections: (1) Introduction; (2) Profile of DOE Activities in New Mexico; (3) DOE Expenditure Patterns; (4) Measuring DOE/New Mexico's Economic Impact: (5) Technology Transfer within the Federal Labs funded by DOE/New Mexico; (6) Glossary of Terms; and (7) Technical Appendix containing a description of the model.

  20. The economic impact of the Department of Energy on the State of New Mexico Fiscal Year 1998

    International Nuclear Information System (INIS)

    Lansford, Robert R.; Adcock, Larry D.; Gentry, Lucille M.; Ben-David, Shaul; Temple, John

    1999-01-01

    The U.S. Department of Energy (DOE) provides a major source of economic benefits in New Mexico, second only to the activities of the U.S. Department of Defense. The agency's far-reaching economic influence within the state is the focus of this report. Economic benefits arising from the various activities and functions of both the Department and its contractors have accrued to the state continuously for over 50 years. For several years, DOE/Albuquerque Operations Office (AL) and New Mexico State University (NMSU) have maintained inter-industry, input-output modeling capabilities to assess DOE's impacts on the state of New Mexico and the other substate regions most directly impacted by DOE activities. One of the major uses of input-output techniques is to assess the effects of developments initiated outside the economy such as Federal DOE monies that flow into the state, on an economy. The information on which the models are based is updated periodically to ensure the most accurate depiction possible of the economy for the period of reference. For this report, the reference periods are Fiscal Year (FY) 1997 (October 1, 1996, through September 30, 1997), and FY 1998 (October 1, 1997, through September 30, 1998). Total impact represents both direct and indirect impacts (resending by business), including induced (resending by households) effects. The standard multipliers used in determining impacts result from the inter-industry, input-output models uniquely developed for New Mexico. This report includes seven main sections: (1) Introduction; (2) Profile of DOE Activities in New Mexico; (3) DOE Expenditure Patterns; (4) Measuring DOE/New Mexico's Economic Impact: (5) Technology Transfer within the Federal Labs funded by DOE/New Mexico; (6) Glossary of Terms; and (7) Technical Appendix containing a description of the model

  1. Dashboard visualizations: Supporting real-time throughput decision-making.

    Science.gov (United States)

    Franklin, Amy; Gantela, Swaroop; Shifarraw, Salsawit; Johnson, Todd R; Robinson, David J; King, Brent R; Mehta, Amit M; Maddow, Charles L; Hoot, Nathan R; Nguyen, Vickie; Rubio, Adriana; Zhang, Jiajie; Okafor, Nnaemeka G

    2017-07-01

    Providing timely and effective care in the emergency department (ED) requires the management of individual patients as well as the flow and demands of the entire department. Strategic changes to work processes, such as adding a flow coordination nurse or a physician in triage, have demonstrated improvements in throughput times. However, such global strategic changes do not address the real-time, often opportunistic workflow decisions of individual clinicians in the ED. We believe that real-time representation of the status of the entire emergency department and each patient within it through information visualizations will better support clinical decision-making in-the-moment and provide for rapid intervention to improve ED flow. This notion is based on previous work where we found that clinicians' workflow decisions were often based on an in-the-moment local perspective, rather than a global perspective. Here, we discuss the challenges of designing and implementing visualizations for ED through a discussion of the development of our prototype Throughput Dashboard and the potential it holds for supporting real-time decision-making. Copyright © 2017. Published by Elsevier Inc.

  2. Parental Decisions regarding pre-hospital therapy and costing of the Emergency Department Visit

    LENUS (Irish Health Repository)

    McGovern, M

    2017-02-01

    Paediatric patients represent a large percentage of Emergency Department (ED) visits and there is often a perception that the acuity of these presentations is low. The decision-making process that results in parents attending the ED is poorly understood. We designed a cross-sectional cohort study to explore the reasons for attendance, the treatment initiated at home and to assess parental perception of the economic cost of attendance. Data was collected on 200 patients using a survey administered to parents in ED with a follow-up phone call 4-6 weeks later. Our results suggest that attendances are often prompted by parental anxiety rather than clinical deterioration and that prior ED usage is common among those presenting for assessment. Many parents had attempted community therapy with 128\\/200 patients (64%) having been referred by a healthcare professional and medical therapy at home having been employed by 114\\/200 (57%) parents before attendance. Parental knowledge of the safety of over-the-counter medications was variable the economic cost of an ED visit was poorly understood by participants. The results of our study suggest that parental desire for control over worrisome symptoms drives much of their management strategy prior to hospital attendance. Strategies in the ED may need to focus more on managing parental expectations than on managing the illness itself and management strategies employed should focus not only on medical therapy of the child’s illness but on educating and empowering the parent.

  3. The AFFORD clinical decision aid to identify emergency department patients with atrial fibrillation at low risk for 30-day adverse events.

    Science.gov (United States)

    Barrett, Tyler W; Storrow, Alan B; Jenkins, Cathy A; Abraham, Robert L; Liu, Dandan; Miller, Karen F; Moser, Kelly M; Russ, Stephan; Roden, Dan M; Harrell, Frank E; Darbar, Dawood

    2015-03-15

    There is wide variation in the management of patients with atrial fibrillation (AF) in the emergency department (ED). We aimed to derive and internally validate the first prospective, ED-based clinical decision aid to identify patients with AF at low risk for 30-day adverse events. We performed a prospective cohort study at a university-affiliated tertiary-care ED. Patients were enrolled from June 9, 2010, to February 28, 2013, and followed for 30 days. We enrolled a convenience sample of patients in ED presenting with symptomatic AF. Candidate predictors were based on ED data available in the first 2 hours. The decision aid was derived using model approximation (preconditioning) followed by strong bootstrap internal validation. We used an ordinal outcome hierarchy defined as the incidence of the most severe adverse event within 30 days of the ED evaluation. Of 497 patients enrolled, stroke and AF-related death occurred in 13 (3%) and 4 (aid included the following: age, triage vitals (systolic blood pressure, temperature, respiratory rate, oxygen saturation, supplemental oxygen requirement), medical history (heart failure, home sotalol use, previous percutaneous coronary intervention, electrical cardioversion, cardiac ablation, frequency of AF symptoms), and ED data (2 hours heart rate, chest radiograph results, hemoglobin, creatinine, and brain natriuretic peptide). The decision aid's c-statistic in predicting any 30-day adverse event was 0.7 (95% confidence interval 0.65, 0.76). In conclusion, in patients with AF in the ED, Atrial Fibrillation and Flutter Outcome Risk Determination provides the first evidence-based decision aid for identifying patients who are at low risk for 30-day adverse events and candidates for safe discharge. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. A perspective on the states` role in the Department of Energy`s Office of Environmental Management budget process

    Energy Technology Data Exchange (ETDEWEB)

    Carter, J.P.; Hinman, P. [Carter, Brock & Hinman, Boise, ID (United States)

    1995-12-31

    Responding in 1994 to proposed budget reductions and predicted funding shortfalls, the Office of Environmental Management at the Department of Energy began working closely with its regulators and stakeholders to prioritize activities. In a series of national and site specific meetings held with representatives of states, the Environmental Protection Agency, Indian tribes and the public, the Department of Energy brought regulators and other stakeholders into its budget development process in a {open_quotes}bottoms up{close_quotes} approach to the prioritization of activities at each of its sites. This paper presents an overview of this process which began last year and will highlight its unique cooperative nature. This paper will assess ways of institutionalizing this process. It also identifies issues to be addressed in resolving matters related to future budgets. Areas of concern to the Department of Energy`s host states and their regulators will be identified as they relate to waste management, cleanup and facility transition activities.

  5. Planning and Implementing Immunization Billing Programs at State and Local Health Departments: Barriers and Possible Solutions.

    Science.gov (United States)

    Corriero, Rosemary; Redmon, Ginger

    Before participating in a project funded by the Centers for Disease Control and Prevention, most state and local health departments (LHDs) were not seeking reimbursement or being fully reimbursed by insurance plans for the cost of immunization services (including vaccine costs and administration fees) they provided to insured patients. Centers for Disease Control and Prevention's Billables Project was designed to enable state and LHDs to bill public and private insurance plans for immunization services provided to insured patients. Identify and describe key barriers state and LHDs may encounter while planning and implementing a billing program, as well as possible solutions for overcoming those barriers. This study used reports from Billables Project participants to explore barriers they encountered when planning and implementing a billing program and steps taken to address those barriers. Thirty-eight state immunization programs. Based on project participants' reports, barriers were noted in 7 categories: (1) funding and costs, (2) staff, (3) health department characteristics, (4) third-party payers and insurance plans, (5) software, (6) patient insurance status, and (7) other barriers. Possible solutions for overcoming those barriers included hiring or seeking external help, creating billing guides and training modules, streamlining workflows, and modifying existing software systems. Overcoming barriers during planning and implementation of a billing program can be challenging for state and LHDs, but the experiences and suggestions of past Billables Project participants can help guide future billing program efforts.

  6. 38 CFR 26.7 - VA environmental decision making and documents.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA environmental decision making and documents. 26.7 Section 26.7 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) ENVIRONMENTAL EFFECTS OF THE DEPARTMENT OF VETERANS AFFAIRS (VA) ACTIONS § 26.7 VA environmental decision making and document...

  7. Accuracy of 'My Gut Feeling:' Comparing System 1 to System 2 Decision-Making for Acuity Prediction, Disposition and Diagnosis in an Academic Emergency Department.

    Science.gov (United States)

    Cabrera, Daniel; Thomas, Jonathan F; Wiswell, Jeffrey L; Walston, James M; Anderson, Joel R; Hess, Erik P; Bellolio, M Fernanda

    2015-09-01

    Current cognitive sciences describe decision-making using the dual-process theory, where a System 1 is intuitive and a System 2 decision is hypothetico-deductive. We aim to compare the performance of these systems in determining patient acuity, disposition and diagnosis. Prospective observational study of emergency physicians assessing patients in the emergency department of an academic center. Physicians were provided the patient's chief complaint and vital signs and allowed to observe the patient briefly. They were then asked to predict acuity, final disposition (home, intensive care unit (ICU), non-ICU bed) and diagnosis. A patient was classified as sick by the investigators using previously published objective criteria. We obtained 662 observations from 289 patients. For acuity, the observers had a sensitivity of 73.9% (95% CI [67.7-79.5%]), specificity 83.3% (95% CI [79.5-86.7%]), positive predictive value 70.3% (95% CI [64.1-75.9%]) and negative predictive value 85.7% (95% CI [82.0-88.9%]). For final disposition, the observers made a correct prediction in 80.8% (95% CI [76.1-85.0%]) of the cases. For ICU admission, emergency physicians had a sensitivity of 33.9% (95% CI [22.1-47.4%]) and a specificity of 96.9% (95% CI [94.0-98.7%]). The correct diagnosis was made 54% of the time with the limited data available. System 1 decision-making based on limited information had a sensitivity close to 80% for acuity and disposition prediction, but the performance was lower for predicting ICU admission and diagnosis. System 1 decision-making appears insufficient for final decisions in these domains but likely provides a cognitive framework for System 2 decision-making.

  8. State of Hawaii, Department of Health, Clean Water Branch Special Surveys for Bellow Beach, Oahu, Hawaii 1992-1999 (NODC Accession 0014264)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Monitoring Section of the State of Hawaii, Department of Health, Clean Water Branch collected water quality samples at six sites near the mouth of streams and...

  9. Risk analysis as a decision tool

    International Nuclear Information System (INIS)

    Yadigaroglu, G.; Chakraborty, S.

    1985-01-01

    From 1983 - 1985 a lecture series entitled ''Risk-benefit analysis'' was held at the Swiss Federal Institute of Technology (ETH), Zurich, in cooperation with the Central Department for the Safety of Nuclear Installations of the Swiss Federal Agency of Energy Economy. In that setting the value of risk-oriented evaluation models as a decision tool in safety questions was discussed on a broad basis. Experts of international reputation from the Federal Republic of Germany, France, Canada, the United States and Switzerland have contributed to report in this joint volume on the uses of such models. Following an introductory synopsis on risk analysis and risk assessment the book deals with practical examples in the fields of medicine, nuclear power, chemistry, transport and civil engineering. Particular attention is paid to the dialogue between analysts and decision makers taking into account the economic-technical aspects and social values. The recent chemical disaster in the Indian city of Bhopal again signals the necessity of such analyses. All the lectures were recorded individually. (orig./HP) [de

  10. Analysis of emergency department waiting lines

    Directory of Open Access Journals (Sweden)

    Urška Močnik

    2014-10-01

    Full Text Available Background: Steady increase in the numbers of patients seeking medical assistance has recently been observed at the emergency department of the health center under study. This has led to increases in waiting times for patients. The management of the health center has been considering to implement certain measures to remedy this situation. One proposed solution is to add an additional physician to the emergency department. A computer model was constructed to simulate waiting lines and analyze the economic feasibility of employing an additional physician.Aim: This paper analyzes the waiting lines at the emergency department and performs an economic feasibility study to determine whether adding an additional physician to the department would be economically justified.Methods: Data about waiting times at the emergency department were collected to study the situation. For each patient, the arrival time at the waiting room and the starting and ending times of the examination were registered. The data were collected from 13 June 2011 to 25 September 2011. The sample included data on 65 nightly standbys, nine standbys on Saturdays, and 16 standbys on Sundays. Due to incomplete entries, data for nine weekly standbys and six Saturday standbys were excluded from the sample. Based on the data collected, we calculated the waiting and examination times per patient, average number of patients, average waiting time, average examination time, share of active standby teams in total standby time, and number of patients in different time periods. The study involved 1,039 patients. Using a synthesis method, we designed a computer model of waiting lines and economic feasibility. The model was validated using comparative analysis. A what-if analysis was performed using various computer simulations with various scenarios to consider the outcomes of decision alternatives. We applied economic analysis to select the best possible solution.Results: The research results

  11. Adaptation by Stealth: Understanding climate information use across scales and decision spaces in water management in the United States

    Science.gov (United States)

    Kirchhoff, C.; Vang Rasmussen, L.; Lemos, M. C.

    2016-12-01

    While there has been considerable focus on understanding how factors related to the creation of climate knowledge affect its uptake and use, less attention has been paid to the actors, decisions, and processes through which climate information supports, or fails to support, action. This is particularly the case concerning how different scales of decision-making influence information uptake. In this study, we seek to understand how water and resource managers' decision space influences climate information use in two Great Lakes watersheds. We find that despite the availability of tailored climate information, actual use of information in decision making remains low. Reasons include: a) lack of willingness to place climate on agendas because local managers perceive climate change as politically risky and a difficult and intangible problem; b) lack of formal mandate or authority at the city and county scale to translate climate information into on-the-ground action, c) problems with the information itself, and d) perceived lack of demand for climate information by those managers who have the mandate and authority (e.g. at the state level) to use (or help others use) climate information. Our findings suggest that 1) climate scientists and information brokers should produce information that meets a range of decision needs and reserve intensive tailoring efforts for decision makers who have authority and willingness to employ climate information, 2) without support from higher levels of decision-making (e.g. state) it is unlikely that climate information use for adaptation decisions will accelerate significantly in the next few years, and 3) the trend towards adopting more sustainability and resilience practices over climate-specific actions should be supported as an important component of the climate adaptation repertoire.

  12. FAMS DECOMMISSIONING END-STATE ALTERNATIVE EVALUATION

    International Nuclear Information System (INIS)

    Grimm, B; Stephen Chostner, S; Brenda Green, B

    2006-01-01

    Nuclear Material Management (NMM) completed a comprehensive study at the request of the Department of Energy Savannah River Operations Office (DOE-SR) in 2004 (Reference 11.1). The study evaluated the feasibility of removal and/or mitigation of the Pu-238 source term in the F-Area Material Storage (FAMS) facility during on-going material storage operations. The study recommended different options to remove and/or mitigate the Pu-238 source term depending on its location within the facility. During April 2005, the Department of Energy (DOE) sent a letter of direction (LOD) to Washington Savannah River Company (WSRC) directing WSRC to implement a new program direction that would enable an accelerated shutdown and decommissioning of FAMS (Reference 11.2). Further direction in the LOD stated that effective December 1, 2006 the facility will be transitioned to begin deactivation and decommissioning (D and D) activities. To implement the LOD, Site D and D (SDD) and DOE agreed the planning end-state would be demolition of the FAMS structure to the building slab. SDD developed the D and D strategy, preliminary cost and schedule, and issued the deactivation project plan in December 2005 (Reference 11.3). Due to concerns and questions regarding the FAMS planning end-state and in support of the project's Critical Decision 1, an alternative study was performed to evaluate the various decommissioning end-states and the methods by which those end-states are achieved. This report documents the results of the alternative evaluation which was performed in a structured decision-making process as outlined in the E7 Manual, Procedure 2.15, ''Alternative Studies'' (Reference 11.4)

  13. A task-based support architecture for developing point-of-care clinical decision support systems for the emergency department.

    Science.gov (United States)

    Wilk, S; Michalowski, W; O'Sullivan, D; Farion, K; Sayyad-Shirabad, J; Kuziemsky, C; Kukawka, B

    2013-01-01

    The purpose of this study was to create a task-based support architecture for developing clinical decision support systems (CDSSs) that assist physicians in making decisions at the point-of-care in the emergency department (ED). The backbone of the proposed architecture was established by a task-based emergency workflow model for a patient-physician encounter. The architecture was designed according to an agent-oriented paradigm. Specifically, we used the O-MaSE (Organization-based Multi-agent System Engineering) method that allows for iterative translation of functional requirements into architectural components (e.g., agents). The agent-oriented paradigm was extended with ontology-driven design to implement ontological models representing knowledge required by specific agents to operate. The task-based architecture allows for the creation of a CDSS that is aligned with the task-based emergency workflow model. It facilitates decoupling of executable components (agents) from embedded domain knowledge (ontological models), thus supporting their interoperability, sharing, and reuse. The generic architecture was implemented as a pilot system, MET3-AE--a CDSS to help with the management of pediatric asthma exacerbation in the ED. The system was evaluated in a hospital ED. The architecture allows for the creation of a CDSS that integrates support for all tasks from the task-based emergency workflow model, and interacts with hospital information systems. Proposed architecture also allows for reusing and sharing system components and knowledge across disease-specific CDSSs.

  14. The Wipp Disposal Decision Plan: the Successful Road Map for Transparent and Credible Decision-Making

    International Nuclear Information System (INIS)

    Eriksson, Leif G.

    2001-01-01

    The Waste Isolation Pilot Plant (WIPP) deep geological repository for long-lived, transuranic radioactive waste (TRUW) opened on the 26th of March 1999. Beginning on the 4th of April 1994, the United States Department of Energy (DOE), implemented the WIPP Disposal Decision Plan (DDP), which embodied the five-year vision and intents of the then DOE Manager of the Carlsbad Area Office (CAO), presently the Carlsbad Field Office (CBFO). The successful design and implementation of the DDP ensured good science, enhanced regulator and stake holder (affected and interested parties) interactions and acceptance of programmatic decisions, which resulted in the certification of the WIPP TRUW repository by the U.S. Environmental Protection Agency (EPA) on the 18th of May 1998, almost three years earlier than projected in November 1993. The present paper contains three sections: A concise background information on the CBFO's TRUW disposal program, incl. the legal framework, current status, and author-envisioned challenges and solutions; A description of the main components and attributes of the WIPP DDP. A summary of the lessons learned during and after the 1994 through 1998 implementation of the WIPP DDP

  15. The Wipp Disposal Decision Plan: the Successful Road Map for Transparent and Credible Decision-Making

    Energy Technology Data Exchange (ETDEWEB)

    Eriksson, Leif G. [GRAM, Inc., Albuquerque, NM (United States)

    2001-07-01

    The Waste Isolation Pilot Plant (WIPP) deep geological repository for long-lived, transuranic radioactive waste (TRUW) opened on the 26th of March 1999. Beginning on the 4th of April 1994, the United States Department of Energy (DOE), implemented the WIPP Disposal Decision Plan (DDP), which embodied the five-year vision and intents of the then DOE Manager of the Carlsbad Area Office (CAO), presently the Carlsbad Field Office (CBFO). The successful design and implementation of the DDP ensured good science, enhanced regulator and stake holder (affected and interested parties) interactions and acceptance of programmatic decisions, which resulted in the certification of the WIPP TRUW repository by the U.S. Environmental Protection Agency (EPA) on the 18th of May 1998, almost three years earlier than projected in November 1993. The present paper contains three sections: A concise background information on the CBFO's TRUW disposal program, incl. the legal framework, current status, and author-envisioned challenges and solutions; A description of the main components and attributes of the WIPP DDP. A summary of the lessons learned during and after the 1994 through 1998 implementation of the WIPP DDP.

  16. State Department Progress and Challenges in Addressing Management Issues

    National Research Council Canada - National Science Library

    Nelson, Benjamin

    2000-01-01

    .... The Department is the principal agency for advancing and protecting U.S. interests overseas. The Department maintains a worldwide network of operations at over 250 overseas locations to support its mission and that of about 35 other U.S...

  17. United States Department of Energy Nuclear Materials Stewardship

    International Nuclear Information System (INIS)

    Newton, J. W.

    2002-01-01

    The Department of Energy launched the Nuclear Materials Stewardship Initiative in January 2000 to accelerate the work of achieving integration and cutting long-term costs associated with the management of the Department's nuclear materials, with the principal focus on excess materials. Management of nuclear materials is a fundamental and enduring responsibility that is essential to meeting the Department's national security, nonproliferation, energy, science, and environmental missions into the distant future. The effective management of nuclear materials is important for a set of reasons: (1) some materials are vital to our national defense; (2) the materials pose physical and security risks; (3) managing them is costly; and (4) costs are likely to extend well into the future. The Department currently manages nuclear materials under eight programs, with offices in 36 different locations. Through the Nuclear Materials Stewardship Initiative, progress was during calendar year 20 00 in achieving better coordination and integration of nuclear materials management responsibilities and in evaluating opportunities to further coordinate and integrate cross-program responsibilities for the treatment, storage, and disposition of excess nuclear materials. During CY 2001 the Departmental approach to nuclear materials stewardship changed consistent with the business processes followed by the new administration. This paper reports on the progress of the Nuclear Materials Stewardship Initiative in evaluating and implementing these opportunities, and the remaining challenges in integrating the long-term management of nuclear materials

  18. Bureaucratic, engineering and economic men: decision-making for technology in tanzania's state-owned enterprises.

    OpenAIRE

    James, J

    1983-01-01

    ILO pub-WEP pub. Study of the relationship between national planning objectives and capital intensive choice of technology by public enterprises in Tanzania - gives theoretical models of decision making behaviour; includes case studies based on the textile industry, sugar industry, an edible oil mill, detergent industry, printing ink factory, maize mill and shoe factory; outlines problems of state intervention, bureaucracy and industrial policy alternatives.

  19. Municipal officials' perceived barriers to consideration of physical activity in community design decision making.

    Science.gov (United States)

    Goins, Karin Valentine; Schneider, Kristin L; Brownson, Ross; Carnoske, Cheryl; Evenson, Kelly R; Eyler, Amy; Heinrich, Katie; Litt, Jill; Lyn, Rodney; Maddock, Jay; Reed, Hannah; Tompkins, Nancy Oʼhara; Lemon, Stephenie C

    2013-01-01

    Built environment-focused interventions and policies are recommended as sustainable approaches for promoting physical activity. Physical activity has not traditionally been considered in land use and transportation decision making. Effective collaboration with non-public health partners requires knowledge of their perceived barriers to such consideration. This analysis sought to (a) establish prevalence estimates of selected barriers to the consideration of physical activity in community design and layout decisions and (b) describe how barrier reporting by public health officials differs from other municipal officials among a wide range of job functions and departments in a geographically diverse sample. A Web-based survey was conducted among municipal officials in 94 cities and towns with populations of at least 50 000 residents in 8 states. A total of 453 municipal officials from public health, planning, transportation/public works, community and economic development, parks and recreation, city management, and municipal legislatures in 83 cities and towns responded to the survey. Five barriers to consideration of physical activity in community design and layout were assessed. The most common barriers included lack of political will (23.5%), limited staff (20.4%), and lack of collaboration across municipal departments (16.2%). Fewer participants reported opposition from the business community or residents as barriers. Public health department personnel were more likely to report the barriers of limited staff and lack of collaboration across municipal departments than other professionals. They were also more likely to report lack of political will than city managers or mayors and municipal legislators. Barriers to increasing consideration of physical activity in decision making about community design and layout are encouragingly low. Implications for public health practice include the need to strategically increase political will despite public health staffing

  20. Clinical Decision Support (CDS) Inventory

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Clinical Decision Support (CDS) Inventory contains descriptions of past and present CDS projects across the Federal Government. It includes Federal projects,...

  1. HUD Administrative Law Judges Decisions

    Data.gov (United States)

    Department of Housing and Urban Development — This site contains substantive and precedential decisions issued by the Office of Administrative Law Judges. The site does not contain subsequent rulings or...

  2. Decision or no decision: how do patient-physician interactions end and what matters?

    Science.gov (United States)

    Tai-Seale, Ming; Bramson, Rachel; Bao, Xiaoming

    2007-03-01

    A clearly stated clinical decision can induce a cognitive closure in patients and is an important investment in the end of patient-physician communications. Little is known about how often explicit decisions are made in primary care visits. To use an innovative videotape analysis approach to assess physicians' propensity to state decisions explicitly, and to examine the factors influencing decision patterns. We coded topics discussed in 395 videotapes of primary care visits, noting the number of instances and the length of discussions on each topic, and how discussions ended. A regression analysis tested the relationship between explicit decisions and visit factors such as the nature of topics under discussion, instances of discussion, the amount of time the patient spoke, and competing demands from other topics. About 77% of topics ended with explicit decisions. Patients spoke for an average of 58 seconds total per topic. Patients spoke more during topics that ended with an explicit decision, (67 seconds), compared with 36 seconds otherwise. The number of instances of a topic was associated with higher odds of having an explicit decision (OR = 1.73, p decisions. Although discussions often ended with explicit decisions, there were variations related to the content and dynamics of interactions. We recommend strengthening patients' voice and developing clinical tools, e.g., an "exit prescription," to improving decision making.

  3. Decision making under uncertainty and information processing in positive and negative mood states.

    Science.gov (United States)

    Mohanty, Sachi Nandan; Suar, Damodar

    2014-08-01

    This study examines whether mood states (a) influence decision making under uncertainty and (b) affect information processing. 200 students at the Indian Institute of Technology Kharagpur participated in this study. Positive mood was induced by showing comedy movie clips to 100 participants and negative mood was induced by showing tragedy movie clips to another 100 participants. The participants were administered a questionnaire containing hypothetical situations of financial gains and losses, and a health risk problem. The participants selected a choice for each situation, and stated the reasons for their choice. Results suggested that the participants preferred cautious choices in the domain of gain and in health risk problems and risky choices in the domain of loss. Analysis of the reasons for the participants' choices suggested more fluency, originality, and flexibility of information in a negative mood compared to a positive mood. A negative (positive) mood state facilitated systematic (heuristic) information processing.

  4. 75 FR 79068 - 60-Day Notice of Proposed Information Collection: Form- DS-1950, Department of State Application...

    Science.gov (United States)

    2010-12-17

    .... Moore, Bureau of Human Resources, Recruitment Division, Student Programs, U.S. Department of State... a currently approved collection. Originating Office: Bureau of Human Resources, Office of Recruitment, Examination, Employment (HR/REE) Form Number: DS-1950. Respondents: U.S. Citizens seeking entry...

  5. Temporal characteristics of decisions in hospital encounters: a threshold for shared decision making? A qualitative study.

    Science.gov (United States)

    Ofstad, Eirik H; Frich, Jan C; Schei, Edvin; Frankel, Richard M; Gulbrandsen, Pål

    2014-11-01

    To identify and characterize physicians' statements that contained evidence of clinically relevant decisions in encounters with patients in different hospital settings. Qualitative analysis of 50 videotaped encounters from wards, the emergency room (ER) and outpatient clinics in a department of internal medicine at a Norwegian university hospital. Clinical decisions could be grouped in a temporal order: decisions which had already been made, and were brought into the encounter by the physician (preformed decisions), decisions made in the present (here-and-now decisions), and decisions prescribing future actions given a certain course of events (conditional decisions). Preformed decisions were a hallmark in the ward and conditional decisions a main feature of ER encounters. Clinical decisions related to a patient-physician encounter spanned a time frame exceeding the duration of the encounter. While a distribution of decisions over time and space fosters sharing and dilution of responsibility between providers, it makes the decision making process hard to access for patients. In order to plan when and how to involve patients in decisions, physicians need increased awareness of when clinical decisions are made, who usually makes them, and who should make them. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. United States Department of Energy Richland Field Office Environmental Protection Implementation Plan, November 9, 1991--November 9, 1992

    International Nuclear Information System (INIS)

    1992-02-01

    The US Department of Energy (DOE) Order 5400.1 (DOE 1988a), General Environmental Protection Program, establishes environmental protection program requirements, authorities, and responsibilities to ensure that DOE operations are in compliance with applicable Federal, State and local environmental protection laws and regulations, executive orders, and internal department policies. Chapter 3 of DOE Order 5400.1 requires that each DOE Field Office prepare a plan for implementing the requirements of this order and update the plan annually. Therefore, this update to the US Department of Energy -- Richland Operations Office Environmental Protection Implementation Plan (DOE-RL 1989a), initially prepared November 9, 1989, is being issued

  7. United States Department of Energy Richland Field Office Environmental Protection Implementation Plan, November 9, 1992--November 9, 1993

    International Nuclear Information System (INIS)

    1992-11-01

    The US Department of Energy (DOE) Order 5400.1 (DOE 1988a), General Environmental Protection Program, establishes environmental protection program requirements, authorities, and responsibilities to ensure that DOE operations are in compliance with applicable Federal, State and local environmental protection laws and regulations, executive orders, and internal department policies. Chapter 3 of DOE Order 5400.1 requires that each DOE Field Office prepare a plan for implementing the requirements of this order and update the plan annually. This update to the US Department of Energy-Richland Operations Office Environmental Protection Implementation Plan (DOE-RL 1989a), initially prepared November 9, 1989, is being issued to comply with the order

  8. United States Department of Energy Field Office, Richland, Environmental Protection Implementation Plan, November 9, 1990--November 9, 1991

    International Nuclear Information System (INIS)

    Paasch, R.A.

    1991-09-01

    The US Department of Energy (DOE) Order 5400.1 (DOE 1988a), General Environmental Protection Program, establishes environmental protection program requirements, authorities, and responsibilities to ensure that DOE operations are in compliance with applicable federal, state and local environmental protection laws and regulations, executive orders, and internal department policies. Chapter 3 of DOE Order 5400.1 requires that each field organization prepare a plan for implementing the requirements of this order and update this plan annually. Therefore, this update to the US Department of Energy -- Richland Operations Office Environmental Protection Implementation Plan for the Hanford Site, Richland, Washington, initially prepared November 9, 1989, is being issued. Responsibility for coordinating preparation of the annual update of this plan is assigned to the US Department of Energy Field Office, Richland, Safety and Environment Division's Environmental Oversight Branch

  9. Interpersonal influence among public health leaders in the United States department of health and human services.

    Science.gov (United States)

    Harris, Jenine K; Carothers, Bobbi J; Wald, Lana M; Shelton, Sarah C; Leischow, Scott J

    2012-02-17

    In public health, interpersonal influence has been identified as an important factor in the spread of health information, and in understanding and changing health behaviors. However, little is known about influence in public health leadership. Influence is important in leadership settings, where public health professionals contribute to national policy and practice agendas. Drawing on social theory and recent advances in statistical network modeling, we examined influence in a network of tobacco control leaders at the United States Department of Health and Human Services (DHHS). Fifty-four tobacco control leaders across all 11 agencies in the DHHS were identified; 49 (91%) responded to a web-based survey. Participants were asked about communication with other tobacco control leaders, who influenced their work, and general job characteristics. Exponential random graph modeling was used to develop a network model of influence accounting for characteristics of individuals, their relationships, and global network structures. Higher job ranks, more experience in tobacco control, and more time devoted to tobacco control each week increased the likelihood of influence nomination, as did more frequent communication between network members. Being in the same agency and working the same number of hours per week were positively associated with mutual influence nominations. Controlling for these characteristics, the network also exhibited patterns associated with influential clusters of network members. Findings from this unique study provide a perspective on influence within a government agency that both helps to understand decision-making and also can serve to inform organizational efforts that allow for more effective structuring of leadership.

  10. Interpersonal influence among public health leaders in the United States Department of Health and Human Services

    Directory of Open Access Journals (Sweden)

    Jenine K. Harris

    2012-02-01

    Full Text Available Background. In public health, interpersonal influence has been identified as an important factor in the spread of health information, and in understanding and changing health behaviors. However, little is known about influence in public health leadership. Influence is important in leadership settings, where public health professionals contribute to national policy and practice agendas. Drawing on social theory and recent advances in statistical network modeling, we examined influence in a network of tobacco control leaders at the United States Department of Health and Human Services (DHHS. Design and Methods. Fifty-four tobacco control leaders across all 11 agencies in the DHHS were identified; 49 (91% responded to a web-based survey. Participants were asked about communication with other tobacco control leaders, who influenced their work, and general job characteristics. Exponential random graph modeling was used to develop a network model of influence accounting for characteristics of individuals, their relationships, and global network structures. Results. Higher job ranks, more experience in tobacco control, and more time devoted to tobacco control each week increased the likelihood of influence nomination, as did more frequent communication between network members. Being in the same agency and working the same number of hours per week were positively associated with mutual influence nominations. Controlling for these characteristics, the network also exhibited patterns associated with influential clusters of network members. Conclusions. Findings from this unique study provide a perspective on influence within a government agency that both helps to understand decision-making and also can serve to inform organizational efforts that allow for more effective structuring of leadership.

  11. Implementation of adapted PECARN decision rule for children with minor head injury in the pediatric emergency department.

    Science.gov (United States)

    Bressan, Silvia; Romanato, Sabrina; Mion, Teresa; Zanconato, Stefania; Da Dalt, Liviana

    2012-07-01

    Of the currently published clinical decision rules for the management of minor head injury (MHI) in children, the Pediatric Emergency Care Applied Research Network (PECARN) rule, derived and validated in a large multicenter prospective study cohort, with high methodologic standards, appears to be the best clinical decision rule to accurately identify children at very low risk of clinically important traumatic brain injuries (ciTBI) in the pediatric emergency department (PED). This study describes the implementation of an adapted version of the PECARN rule in a tertiary care academic PED in Italy and evaluates implementation success, in terms of medical staff adherence and satisfaction, as well as its effects on clinical practice. The adapted PECARN decision rule algorithms for children (one for those younger than 2 years and one for those older than 2 years) were actively implemented in the PED of Padova, Italy, for a 6-month testing period. Adherence and satisfaction of medical staff to the new rule were calculated. Data from 356 visits for MHI during PECARN rule implementation and those of 288 patients attending the PED for MHI in the previous 6 months were compared for changes in computed tomography (CT) scan rate, ciTBI rate (defined as death, neurosurgery, intubation for longer than 24 hours, or hospital admission at least for two nights associated with TBI) and return visits for symptoms or signs potentially related to MHI. The safety and efficacy of the adapted PECARN rule in clinical practice were also calculated. Adherence to the adapted PECARN rule was 93.5%. The percentage of medical staff satisfied with the new rule, in terms of usefulness and ease of use for rapid decision-making, was significantly higher (96% vs. 51%, puse of the adapted PECARN rule in clinical practice was 100% (95% CI=36.8 to 100; three of three patients with ciTBI who received CT scan at first evaluation), while efficacy was 92.3% (95% CI=89 to 95; 326 of 353 patients without ci

  12. The Department of the Interior Southeast Climate Science Center synthesis report 2011–15—Projects, products, and science priorities

    Science.gov (United States)

    Varela Minder, Elda; Lascurain, Aranzazu R.; McMahon, Gerard

    2016-09-28

    IntroductionIn 2009, the U.S. Department of the Interior (DOI) Secretary Ken Salazar established a network of eight regional Climate Science Centers (CSCs) that, along with the Landscape Conservation Cooperatives (LCCs), would help define and implement the Department's climate adaptation response. The Southeast Climate Science Center (SE CSC) was established at North Carolina State University (NCSU) in Raleigh, North Carolina, in 2010, under a 5-year cooperative agreement with the U.S. Geological Survey (USGS), to identify and address the regional challenges presented by climate change and variability in the Southeastern United States. All eight regional CSC hosts, including NCSU, were selected through a competitive process.Since its opening, the focus of the SE CSC has been on working with partners in the identification and development of research-based information that can assist managers, including cultural and natural resource managers, in adapting to global change processes, such as climate and land use change, that operate at local to global scales and affect resources important to the DOI mission. The SE CSC was organized to accomplish three goals:Provide co-produced, researched based, actionable science that supports transparent global change adaptation decisions.Convene conversations among decision makers, scientists, and managers to identify key ecosystem adaptation decisions driven by climate and land use change, the values and objectives that will be used to make decisions, and the research-based information needed to assess adaptation options.Build the capacity of natural resource professionals, university faculty, and students to understand and frame natural resource adaptation decisions and develop and use research-based information to make adaptation decisions.This report provides an overview of the SE CSC and the projects developed by the SE CSC since its inception. An important goal of this report is to provide a framework for understanding the

  13. Robust Decision Making

    Energy Technology Data Exchange (ETDEWEB)

    Christopher A. Dieckmann, PE, CSEP-Acq

    2010-07-01

    The Idaho National Laboratory (INL) is funded through the Department of Energy (DOE) Office of Nuclear Energy and other customers who have direct contracts with the Laboratory. The people, equipment, facilities and other infrastructure at the laboratory require continual investment to maintain and improve the laboratory’s capabilities. With ever tightening federal and customer budgets, the ability to direct investments into the people, equipment, facilities and other infrastructure which are most closely aligned with the laboratory’s mission and customers’ goals grows increasingly more important. The ability to justify those investment decisions based on objective criteria that can withstand political, managerial and technical criticism also becomes increasingly more important. The Systems Engineering tools of decision analysis, risk management and roadmapping, when properly applied to such problems, can provide defensible decisions.

  14. Supply chain optimization for pediatric perioperative departments.

    Science.gov (United States)

    Davis, Janice L; Doyle, Robert

    2011-09-01

    Economic challenges compel pediatric perioperative departments to reduce nonlabor supply costs while maintaining the quality of patient care. Optimization of the supply chain introduces a framework for decision making that drives fiscally responsible decisions. The cost-effective supply chain is driven by implementing a value analysis process for product selection, being mindful of product sourcing decisions to reduce supply expense, creating logistical efficiency that will eliminate redundant processes, and managing inventory to ensure product availability. The value analysis approach is an analytical methodology for product selection that involves product evaluation and recommendation based on consideration of clinical benefit, overall financial impact, and revenue implications. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  15. San Jose, California: Evaluating Local Solar Energy Generation Potential (City Energy: From Data to Decisions)

    Energy Technology Data Exchange (ETDEWEB)

    Office of Strategic Programs, Strategic Priorities and Impact Analysis Team

    2017-09-29

    This fact sheet "San Jose, California: Evaluating Local Solar Energy Generation Potential" explains how the City of San Jose used data from the U.S. Department of Energy's Cities Leading through Energy Analysis and Planning (Cities-LEAP) and the State and Local Energy Data (SLED) programs to inform its city energy planning. It is one of ten fact sheets in the "City Energy: From Data to Decisions" series.

  16. New Haven, Connecticut: Targeting Low-Income Household Energy Savings (City Energy: From Data to Decisions)

    Energy Technology Data Exchange (ETDEWEB)

    Strategic Priorities and Impact Analysis Team, Office of Strategic Programs

    2017-11-01

    This fact sheet "New Haven, Connecticut: Targeting Low-Income Household Energy Savings" explains how the City of New Haven used data from the U.S. Department of Energy's Cities Leading through Energy Analysis and Planning (Cities-LEAP) and the State and Local Energy Data (SLED) programs to inform its city energy planning. It is one of ten fact sheets in the "City Energy: From Data to Decisions" series.

  17. Denton, Texas: Using Transportation Data to Reduce Fuel Consumption (City Energy: From Data to Decisions)

    Energy Technology Data Exchange (ETDEWEB)

    Office of Strategic Programs, Strategic Priorities and Impact Analysis Team

    2017-09-29

    This fact sheet "Denton, Texas: Using Transportation Data to Reduce Fuel Consumption" explains how the City of Denton used data from the U.S. Department of Energy's Cities Leading through Energy Analysis and Planning (Cities-LEAP) and the State and Local Energy Data (SLED) programs to inform its city energy planning. It is one of ten fact sheets in the "City Energy: From Data to Decisions" series.

  18. 12 CFR 508.13 - Decision of the Office.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Decision of the Office. 508.13 Section 508.13 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY REMOVALS, SUSPENSIONS, AND PROHIBITIONS WHERE A CRIME IS CHARGED OR PROVEN § 508.13 Decision of the Office. (a) Within 30 days after the recommended decision has been certifie...

  19. 45 CFR 99.28 - Record for decision.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Record for decision. 99.28 Section 99.28 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROCEDURE FOR HEARINGS FOR THE CHILD CARE AND DEVELOPMENT FUND Hearing Procedures § 99.28 Record for decision. The transcript of...

  20. State of Hawaii, Department of Health, Clean Water Branch Hanalei, Kauai Water Quality Sampling Dataset October 2005 - November 2006 (NODC Accession 0020391)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Monitoring Section of the State of Hawaii, Department of Health, Clean Water Branch collected water quality data at 8 sites centered on Hanalei Bay on the north...

  1. A methodology and decision support tool for informing state-level bioenergy policymaking: New Jersey biofuels as a case study

    Science.gov (United States)

    Brennan-Tonetta, Margaret

    This dissertation seeks to provide key information and a decision support tool that states can use to support long-term goals of fossil fuel displacement and greenhouse gas reductions. The research yields three outcomes: (1) A methodology that allows for a comprehensive and consistent inventory and assessment of bioenergy feedstocks in terms of type, quantity, and energy potential. Development of a standardized methodology for consistent inventorying of biomass resources fosters research and business development of promising technologies that are compatible with the state's biomass resource base. (2) A unique interactive decision support tool that allows for systematic bioenergy analysis and evaluation of policy alternatives through the generation of biomass inventory and energy potential data for a wide variety of feedstocks and applicable technologies, using New Jersey as a case study. Development of a database that can assess the major components of a bioenergy system in one tool allows for easy evaluation of technology, feedstock and policy options. The methodology and decision support tool is applicable to other states and regions (with location specific modifications), thus contributing to the achievement of state and federal goals of renewable energy utilization. (3) Development of policy recommendations based on the results of the decision support tool that will help to guide New Jersey into a sustainable renewable energy future. The database developed in this research represents the first ever assessment of bioenergy potential for New Jersey. It can serve as a foundation for future research and modifications that could increase its power as a more robust policy analysis tool. As such, the current database is not able to perform analysis of tradeoffs across broad policy objectives such as economic development vs. CO2 emissions, or energy independence vs. source reduction of solid waste. Instead, it operates one level below that with comparisons of kWh or

  2. DOE states reheat nuclear waste debate

    International Nuclear Information System (INIS)

    Crawford, M.

    1985-01-01

    After decades of struggling with the issue, Congress in late 1982 established a firm plan for burying growing volumes of nuclear reactor wastes. But 2 l/2 years later the waste disposal debate is as hot as ever. Utility companies, environmentalists, federal officials, and state governments are again clashing - this time over the way the program is proceeding. The Nuclear Waste Policy Act calls for the Department of Energy to start accepting wastes in 1998 at the first of two planned repositories. Selection of this first repository site was mandated for early 1987, but program delays at DOE have pushed the decision back to March 1991. Despite this postponement and other schedule slips, the Department still aims to meet Congress's 1998 deadline. But states, Indian tribes, and environmentalists fear the site selection process will be compromised and want the start up date rolled back

  3. 29 CFR 801.73 - Final decision of the Secretary.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Final decision of the Secretary. 801.73 Section 801.73 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR OTHER LAWS... Vacation of Decision and Order of Administrative Law Judge § 801.73 Final decision of the Secretary. The...

  4. Opinion paper on utility of point-of-care biomarkers in the emergency department pathways decision making.

    Science.gov (United States)

    Di Somma, Salvatore; Zampini, Giorgio; Vetrone, Francesco; Soto-Ruiz, Karina M; Magrini, Laura; Cardelli, Patrizia; Ronco, Claudio; Maisel, Alan; Peacock, Frank W

    2014-10-01

    Overcrowding of the emergency department (ED) is rapidly becoming a global challenge and a major source of concern for emergency physicians. The evaluation of cardiac biomarkers is critical for confirming diagnoses and expediting treatment decisions to reduce overcrowding, however, physicians currently face the dilemma of choosing between slow and accurate central-based laboratory tests, or faster but imprecise assays. With improvements in technology, point-of-care testing (POCT) systems facilitate the efficient and high-throughput evaluation of biomarkers, such as troponin (cTn), brain natriuretic peptide (BNP) and neutrophil gelatinase-associated lipocalin (NGAL). In this context, POCT may help ED physicians to confirm a diagnosis of conditions, such as acute coronary syndrome, heart failure or kidney damage. Compared with classic laboratory methods, the use of cTn, BNP, and NGAL POCT has shown comparable sensitivity, specificity and failure rate, but with the potential to provide prompt and accurate diagnosis, shorten hospital stay, and alleviate the burden on the ED. Despite this potential, the full advantages of rapid delivery results will only be reached if POCT is implemented within hospital standardized procedures and ED staff receive appropriate training.

  5. 76 FR 77584 - U.S. Department of State Advisory Committee on Private International Law (ACPIL): Public Meeting...

    Science.gov (United States)

    2011-12-13

    ... International Law (ACPIL): Public Meeting on Electronic Commerce The Department of State, Office of Legal... electronic transferable records. Working Group IV (international electronic commerce) of the United Nations... electronic transferable records. A report from that meeting, once it is published, should be available at...

  6. 76 FR 65318 - U.S. Department of State Advisory Committee on Private International Law (ACPIL)-Online Dispute...

    Science.gov (United States)

    2011-10-20

    ... International Law (ACPIL)--Online Dispute Resolution Study Group Meeting (ODR) The Department of State, Office of Legal Adviser, Office of Private International Law ACPIL online dispute resolution (ODR) study... development of legal instruments for resolving both business to business and business to consumer cross-border...

  7. Bayesian framework for managing preferences in decision-making

    International Nuclear Information System (INIS)

    Maes, Marc A.; Faber, Michael H.

    2006-01-01

    A rational decision-making process does not exclude the possibility of decision makers expressing different preferences and disagreeing regarding the effects of consequences and optimal course of actions. This point of view is explored in depth in this paper. A framework is developed that includes several decision makers (instead of just one) and allows for the variability of preferences among these decision makers. The information provided by the varying opinions of decision makers can be used to optimize our own decision-making. To achieve this, likelihood functions are developed for stated preferences among both discrete and continuous alternatives, and stated preference rankings of alternatives. Two applications are pursued: the optimization of the lifecycle utility of a structural system subject to consequences of failure proportional to the intensity of hazards exceeding a variable threshold, and to follow-up consequences. Also, the problem of tight decisions or close calls is investigated in order to explore the efficiency of a Bayesian approach using stated preferences and stated rankings

  8. Providing Decision-Relevant Information for a State Climate Change Action Plan

    Science.gov (United States)

    Wake, C.; Frades, M.; Hurtt, G. C.; Magnusson, M.; Gittell, R.; Skoglund, C.; Morin, J.

    2008-12-01

    Carbon Solutions New England (CSNE), a public-private partnership formed to promote collective action to achieve a low carbon society, has been working with the Governor appointed New Hampshire Climate Change Policy Task Force (NHCCTF) to support the development of a state Climate Change Action Plan. CSNE's role has been to quantify the potential carbon emissions reduction, implementation costs, and cost savings at three distinct time periods (2012, 2025, 2050) for a range of strategies identified by the Task Force. These strategies were developed for several sectors (transportation and land use, electricity generation and use, building energy use, and agriculture, forestry, and waste).New Hampshire's existing and projected economic and population growth are well above the regional average, creating additional challenges for the state to meet regional emission reduction targets. However, by pursuing an ambitious suite of renewable energy and energy efficiency strategies, New Hampshire may be able to continue growing while reducing emissions at a rate close to 3% per year up to 2025. This suite includes efficiency improvements in new and existing buildings, a renewable portfolio standard for electricity generation, avoiding forested land conversion, fuel economy gains in new vehicles, and a reduction in vehicle miles traveled. Most (over 80%) of these emission reduction strategies are projected to provide net economic savings in 2025.A collaborative and iterative process was developed among the key partners in the project. The foundation for the project's success included: a diverse analysis team with leadership that was committed to the project, an open source analysis approach, weekly meetings and frequent communication among the partners, interim reporting of analysis, and an established and trusting relationship among the partners, in part due to collaboration on previous projects.To develop decision-relevant information for the Task Force, CSNE addressed

  9. 15 CFR 785.18 - Record for decision.

    Science.gov (United States)

    2010-01-01

    ...) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE ADDITIONAL PROTOCOL REGULATIONS ENFORCEMENT § 785..., Bureau of Industry and Security, U.S. Department of Commerce. The Office of Administration does not... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false Record for decision. 785.18 Section...

  10. Medical Decision-Making for Adults Who Lack Decision-Making Capacity and a Surrogate: State of the Science.

    Science.gov (United States)

    Kim, Hyejin; Song, Mi-Kyung

    2018-01-01

    Adults who lack decision-making capacity and a surrogate ("unbefriended" adults) are a vulnerable, voiceless population in health care. But little is known about this population, including how medical decisions are made for these individuals. This integrative review was to examine what is known about unbefriended adults and identify gaps in the literature. Six electronic databases were searched using 4 keywords: "unbefriended," "unrepresented patients," "adult orphans," and "incapacitated patients without surrogates." After screening, the final sample included 10 data-based articles for synthesis. Main findings include the following: (1) various terms were used to refer to adults who lack decision-making capacity and a surrogate; (2) the number of unbefriended adults was sizable and likely to grow; (3) approaches to medical decision-making for this population in health-care settings varied; and (4) professional guidelines and laws to address the issues related to this population were inconsistent. There have been no studies regarding the quality of medical decision-making and its outcomes for this population or societal impact. Extremely limited empirical data exist on unbefriended adults to develop strategies to improve how medical decisions are made for this population. There is an urgent need for research to examine the quality of medical decision-making and its outcomes for this vulnerable population.

  11. State Waste Discharge Permit application, 183-N Backwash Discharge Pond

    Energy Technology Data Exchange (ETDEWEB)

    1994-06-01

    As part of the Hanford Federal Facility Agreement and Consent Order negotiations (Ecology et al. 1994), the US Department of Energy, Richland Operations Office, the US Environmental Protection Agency, and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground on the Hanford Site which affect groundwater or have the potential to affect groundwater would be subject to permitting under the structure of Chapter 173--216 (or 173--218 where applicable) of the Washington Administrative Code, the State Waste Discharge Permit Program. As a result of this decision, the Washington State Department of Ecology and the US Department of Energy, Richland Operations Office entered into Consent Order No. DE91NM-177, (Ecology and DOE-RL 1991). The Consent Order No. DE91NM-177 requires a series of permitting activities for liquid effluent discharges. Liquid effluents on the Hanford Site have been classified as Phase I, Phase II, and Miscellaneous Streams. The Consent Order No. DE91NM-177 establishes milestones for State Waste Discharge Permit application submittals for all Phase I and Phase II streams, as well as the following 11 Miscellaneous Streams as identified in Table 4 of the Consent Order No. DE91NM-177.

  12. Procedure of preliminary decision as a supranational judicial keynote of the European Union member states

    Directory of Open Access Journals (Sweden)

    Delia Magherescu

    2017-10-01

    Full Text Available The procedure of preliminary decision has been for a long time agreed unanimously both by doctrine and jurisprudence and considered as a keynote in developing notional law systems of the European Communities. In the national frame, it is similarly with submitting unconstitutional exception, regulated in several national jurisdictions of the EU Member States. The current paper aims at providing some argues based on a jurisprudence frame of the procedure of preliminary decision made by the Court of Justice of the European Union, as being directory for the national EU Member States’ courts of justice. It also focuses on the judicial issues whose solution is needed in order for the national justice to solve the cases they were invested with.

  13. Being safe: making the decision to have a planned home birth in the United States.

    Science.gov (United States)

    Lothian, Judith A

    2013-01-01

    Although there is evidence that supports the safety of planned home birth for healthy women, less than 1 percent of women in the United States choose to have their baby at home. An ethnographic study of the experience of planned home birth provided rich descriptions of women's experiences planning, preparing for, and having a home birth.This article describes findings related to how women make the decision to have a planned home birth. For these women, being safe emerged as central in making the decision. For them, being safe included four factors: avoiding technological birth interventions, knowing the midwife and the midwife knowing them, feeling comfortable and protected at home, and knowing that backup hospital medical care was accessible if needed.

  14. 8 CFR 1003.37 - Decisions.

    Science.gov (United States)

    2010-01-01

    ... decision of the Immigration Judge may be rendered orally or in writing. If the decision is oral, it shall be stated by the Immigration Judge in the presence of the parties and a memorandum summarizing the oral decision shall be served on the parties. If the decision is in writing, it shall be served on the...

  15. Comparison of USDA Forest Service and stakeholder motivations and experiences in collaborative federal forest governance in the Western United States

    Science.gov (United States)

    Emily Jane Davis; Eric M. White; Lee K. Cerveny; David Seesholtz; Meagan L. Nuss; Donald R. Ulrich

    2017-01-01

    In the United States, over 191 million acres of land is managed by the United States Department of Agriculture Forest Service, a federal government agency. In several western U.S. states, organized collaborative groups have become a de facto governance approach to providing sustained input on management decisions on much public land. This is most extensive in Oregon,...

  16. Affective state and decision-making in the Ultimatum Game

    NARCIS (Netherlands)

    Wout, M. van 't; Kahn, R.S.; Sanfey, A.G.; Aleman, A.

    2006-01-01

    The emerging field of neuroeconomics has provided evidence that emotional as well as cognitive processes may contribute to economic decision-making. Indeed, activation of the anterior insula, a brain area involved in emotional processing, has been shown to predict decision-making in the Ultimatum

  17. Affective state and decision-making in the Ultimatum Game

    NARCIS (Netherlands)

    van't Wout, M; Kahn, RS; Sanfey, AG; Aleman, A

    The emerging field of neuroeconomics has provided evidence that emotional as well as cognitive processes may contribute to economic decision-making. Indeed, activation of the anterior insula, a brain area involved in emotional processing, has been shown to predict decision-making in the Ultimatum

  18. Radioactive solid waste inventories at United States Department of Energy burial and storage sites

    International Nuclear Information System (INIS)

    Watanabe, T.

    1986-06-01

    Radioactive solid waste inventories are given for United States Department of Energy (DOE) burial and storage sites. These data are obtained from the Solid Waste Information Management System (SWIMS) and reflect the inventories as of the end of the calendar year 1985. This report differs from previous issues in that the data cutoff date is December 31, 1985, rather than the fiscal year end. Another difference from previous issues is that data for the TRU categories 1 and 6 have been omitted

  19. Withholding and withdrawing life-support therapy in an Emergency Department: prospective survey.

    Science.gov (United States)

    Le Conte, Philippe; Baron, Denis; Trewick, David; Touzé, Marie Dominique; Longo, Céline; Vial, Irshaad; Yatim, Danielle; Potel, Gille

    2004-12-01

    Few studies have focused on decisions to withdraw or withhold life-support therapies in the emergency department. Our objectives were to identify clinical situations where life-support was withheld or withdrawn, the criteria used by physicians to justify their decisions, the modalities necessary to implement these decisions, patient disposition, and outcome. Prospective unicenter survey in an Emergency Department of a tertiary care teaching hospital. All non-trauma patients (n=119) for whom a decision to withhold or withdraw life-sustaining treatments was taken between January and September 1998. Choice of criteria justifying the decision to withhold or withdraw life-sustaining treatments, time interval from ED admission to the decision; type of decision implemented, outcome. Fourteen thousand eight hundred and seventy-five non-trauma patients were admitted during the study period, 119 were included, mean age 75+/-13 years. Resuscitation procedures were instituted for 96 (80%) patients before a subsequent decision was taken. Physicians chose on average 6+/-2 items to justify their decision; the principal acute medical disorder and futility of care were the two criteria most often used. Median time interval to reach the decision was 187 min. Withdrawal involved 37% of patients and withholding 63% of patients. The family was involved in the decision-making process in 72% of patients. The median time interval from the decision to death was 16 h (5 min to 140 days). Withdrawing and withholding life-support therapy involved elderly patients with underlying chronic cardiopulmonary disease or metastatic cancer or patients with acute non-treatable illness.

  20. An extension of fuzzy decision maps for multi-criteria decision-making

    OpenAIRE

    Elomda, Basem Mohamed; Hefny, Hesham Ahmed; Hassan, Hesham Ahmed

    2013-01-01

    This paper presents a new extension to Fuzzy Decision Maps (FDMs) by allowing use of fuzzy linguistic values to represent relative importance among criteria in the preference matrix as well as representing relative influence among criteria for computing the steady-state matrix in the stage of Fuzzy Cognitive Map (FCM). The proposed model is called the Linguistic Fuzzy Decision Networks (LFDNs). The proposed LFDN provides considerable flexibility to decision makers when solving real world Mult...

  1. 77 FR 530 - Department of State Advisory Committee on Private International Law: Notice of Renewal of Charter

    Science.gov (United States)

    2012-01-05

    ... transactions; online dispute resolution; international leasing and franchising; and other topics of current... International Law: Notice of Renewal of Charter The Charter of the Department of State's Advisory Committee on Private International Law has been renewed, effective for a two-year period. Pursuant to the Federal...

  2. 77 FR 23318 - U.S. Department of State Advisory Committee on Private International Law (ACPIL); Online Dispute...

    Science.gov (United States)

    2012-04-18

    ... International Law (ACPIL); Online Dispute Resolution (ODR) Study Group Meeting The Office of Private International Law, Office of the Legal Adviser, Department of State hereby gives notice that the ACPIL Online... charged with the development of legal instruments for resolving both business to business and business to...

  3. Introduction of new technologies and decision making processes: a framework to adapt a Local Health Technology Decision Support Program for other local settings

    Directory of Open Access Journals (Sweden)

    Poulin P

    2013-11-01

    Full Text Available Paule Poulin,1 Lea Austen,1 Catherine M Scott,2 Michelle Poulin,1 Nadine Gall,2 Judy Seidel,3 René Lafrenière1 1Department of Surgery, 2Knowledge Management, 3Public Health Innovation and Decision Support, Alberta Health Services, Calgary, AB, Canada Purpose: Introducing new health technologies, including medical devices, into a local setting in a safe, effective, and transparent manner is a complex process, involving many disciplines and players within an organization. Decision making should be systematic, consistent, and transparent. It should involve translating and integrating scientific evidence, such as health technology assessment (HTA reports, with context-sensitive evidence to develop recommendations on whether and under what conditions a new technology will be introduced. However, the development of a program to support such decision making can require considerable time and resources. An alternative is to adapt a preexisting program to the new setting. Materials and methods: We describe a framework for adapting the Local HTA Decision Support Program, originally developed by the Department of Surgery and Surgical Services (Calgary, AB, Canada, for use by other departments. The framework consists of six steps: 1 development of a program review and adaptation manual, 2 education and readiness assessment of interested departments, 3 evaluation of the program by individual departments, 4 joint evaluation via retreats, 5 synthesis of feedback and program revision, and 6 evaluation of the adaptation process. Results: Nine departments revised the Local HTA Decision Support Program and expressed strong satisfaction with the adaptation process. Key elements for success were identified. Conclusion: Adaptation of a preexisting program may reduce duplication of effort, save resources, raise the health care providers' awareness of HTA, and foster constructive stakeholder engagement, which enhances the legitimacy of evidence

  4. Implications of the Bangor Hydro decision on FERC relicensings

    Science.gov (United States)

    Pizzi, L.

    1997-01-01

    In the next 15 years, over 400 existing nonfederal dams will require new licenses by the Federal Energy Regulatory Commission (FERC) in order to continue operations. In many cases, state or federal agencies have a unique opportunity to condition the hydropower licenses to protect environmental values. In 1996, the Court of Appeals for the District of Columbia Circuit issued an opinion striking down a mandatory license condition imposed by the U.S. Department of the Interior in a FERC relicensing. The case, Bangor Hydro-Electric Company v.Federal Energy Regulatory Commission, is instructive for agencies regarding the procedures to be followed in imposing mandatory FERC licensing conditions in the future. After Bangor Hydro, agencies should: (1) support their decisions by substantial evidence in the FERC record, (2) request applicant studies to support agency decisions and allow public comment on the decisions as a means to test the facts and analysis, and (3) consider intervening in a case to defend the condition on appeal. Bangor Hydro also raises, but does not decide, the issue of whether the agency imposing the mandatory condition should engage in balancing the economics of the hydropower project with the public resources affected by the project.

  5. Decision support system for health care resources allocation.

    Science.gov (United States)

    Sebaa, Abderrazak; Nouicer, Amina; Tari, AbdelKamel; Tarik, Ramtani; Abdellah, Ouhab

    2017-06-01

    A study about healthcare resources can improve decisions regarding the allotment and mobilization of medical resources and to better guide future investment in the health sector. The aim of this work was to design and implement a decision support system to improve medical resources allocation of Bejaia region. To achieve the retrospective cohort study, we integrated existing clinical databases from different Bejaia department health sector institutions (an Algerian department) to collect information about patients from January 2015 through December 2015. Data integration was performed in a data warehouse using the multi-dimensional model and OLAP cube. During implementation, we used Microsoft SQL server 2012 and Microsoft Excel 2010. A medical decision support platform was introduced, and was implemented during the planning stages allowing the management of different medical orientations, it provides better apportionment and allotment of medical resources, and ensures that the allocation of health care resources has optimal effects on improving health. In this study, we designed and implemented a decision support system which would improve health care in Bejaia department to especially assist in the selection of the optimum location of health center and hospital, the specialty of the health center, the medical equipment and the medical staff.

  6. Department of Nuclear Methods in the Solid State Physics

    International Nuclear Information System (INIS)

    2002-01-01

    Full text: The activity of the Department of Nuclear Methods in the Solid State Physics is focused on experimental research in condensed matter physics. Thermal neutron scattering and Moessbauer effect are the main techniques mastered in the laboratory. Most of the studies aim at better understanding of properties and processes observed in modern materials. Some applied research and theoretical studies were also performed. Research activities of the Department in 2001 can be summarized as follows: Neutron scattering studies concerned the magnetic ordering in TbB 12 and TmIn 3 and some special features of magnetic excitations in antiferromagnetic γ-Mn-alloys. Some work was devoted to optimization of the neutron single crystal monochromators and polarizers grown in Crystal Growth Laboratory. Small angle scattering studies on the surfactant - water ternary system were performed in cooperation with JINR Dubna. Moessbauer effect investigations of dysprosium intermetallic compounds yielded the new data for Pauling-Slater curves. The same technique applied to perovskites and ferrocene adduct to fullerene helped to resolve their structure. X-ray topographic and diffractometric studies were performed on hydrogen implanted semiconductor surfaces employing the synchrotron radiation sources. The X-ray method was applied also to investigations of plasma spraying process and phase composition of ceramic oxide coatings. Large part of studies concerned the structure of biologically active, pharmacologically important organic complexes, supported by modeling of their electron structure. Crystal growth of large size single-crystals of metals and alloys was used for preparation of specimens with mosaic structure suitable for neutron monochromator and polarizer systems. The construction work of the Neutron and Gamma Radiography Station has been completed. The results of first tests and studies proved the expected abilities of the systems. The possibility to visualize inner structures

  7. Asheville, North Carolina: Reducing Electricity Demand through Building Programs & Policies (City Energy: From Data to Decisions)

    Energy Technology Data Exchange (ETDEWEB)

    Office of Strategic Programs, Strategic Priorities and Impact Analysis Team

    2017-09-29

    This fact sheet "Asheville, North Carolina: Reducing Electricity Demand through Building Programs & Policies" explains how the City of Asheville used data from the U.S. Department of Energy's Cities Leading through Energy Analysis and Planning (Cities-LEAP) and the State and Local Energy Data (SLED) programs to inform its city energy planning. It is one of ten fact sheets in the "City Energy: From Data to Decisions" series.

  8. Carrboro, North Carolina: Achieving Building Efficiencies for Low-Income Households (City Energy: From Data to Decisions)

    Energy Technology Data Exchange (ETDEWEB)

    Office of Strategic Programs, Strategic Priorities and Impact Analysis Team

    2017-09-29

    This fact sheet "Carrboro, North Carolina: Achieving Building Efficiencies for Low-Income Households" explains how the Town of Carrboro used data from the U.S. Department of Energy's Cities Leading through Energy Analysis and Planning (Cities-LEAP) and the State and Local Energy Data (SLED) programs to inform its city energy planning. It is one of ten fact sheets in the "City Energy: From Data to Decisions" series.

  9. Lafayette, Colorado: Using Energy Data for Electric Vehicle Infrastructure Planning (City Energy: From Data to Decisions)

    Energy Technology Data Exchange (ETDEWEB)

    Office of Strategic Programs, Strategic Priorities and Impact Analysis Team

    2017-09-29

    This fact sheet "Lafayette, Colorado: Using Energy Data for Electric Vehicle Infrastructure Planning" explains how the City of Lafayette used data from the U.S. Department of Energy's Cities Leading through Energy Analysis and Planning (Cities-LEAP) and the State and Local Energy Data (SLED) programs to inform its city energy planning. It is one of ten fact sheets in the "City Energy: From Data to Decisions" series.

  10. Integrated environmental decision support tool based on GIS technology

    International Nuclear Information System (INIS)

    Doctor, P.G.; O'Neil, T.K.; Sackschewsky, M.R.; Becker, J.M.; Rykiel, E.J.; Walters, T.B.; Brandt, C.A.; Hall, J.A.

    1995-01-01

    Environmental restoration and management decisions facing the US Department of Energy require balancing trade-offs between diverse land uses and impacts over multiple spatial and temporal scales. Many types of environmental data have been collected for the Hanford Site and the Columbia River in Washington State over the past fifty years. Pacific Northwest National Laboratory (PNNL) is integrating these data into a Geographic Information System (GIS) based computer decision support tool. This tool provides a comprehensive and concise description of the current environmental landscape that can be used to evaluate the ecological and monetary trade-offs between future land use, restoration and remediation options before action is taken. Ecological impacts evaluated include effects to individual species of concern and habitat loss and fragmentation. Monetary impacts include those associated with habitat mitigation. The tool is organized as both a browsing tool for educational purposes, and as a framework that leads a project manager through the steps needed to be in compliance with environmental requirements

  11. External audit on the clinical practice and medical decision-making at the departments of radiotherapy in Budapest and Vienna

    International Nuclear Information System (INIS)

    Esik, O.; Seitz, W.; Loevey, J.; Knocke, T.H.; Gaudi, I.; Nemeth, G.; Poetter, R.

    1999-01-01

    Purpose: To present an example of how to study and analyze the clinical practice and the quality of medical decision-making under daily routine working conditions in a radiotherapy department, with the aims of detecting deficiencies and improving the quality of patient care.Methods: Two departments, each with a divisional organization structure and an established internal audit system, the University Clinic of Radiotherapy and Radiobiology in Vienna (Austria), and the Department of Radiotherapy at the National Institute of Oncology in Budapest (Hungary), conducted common external audits. The descriptive parameters of the external audit provided information on the auditing (auditor and serial number of the audit), the cohorts (diagnosis, referring institution, serial number and intention of radiotherapy) and the staff responsible for the treatment (division and physician). During the ongoing external audits, the qualifying parameters were (1) the sound foundation of the indication of radiotherapy, (2) conformity to the institution protocol (3), the adequacy of the choice of radiation equipment, (4) the appropriateness of the treatment plan, and the correspondence of the latter with (5) the simulation and (6) verification films. Various degrees of deviation from the treatment principles were defined and scored on the basis of the concept of Horiot et al. (Horiot JC, Schueren van der E, Johansson KA, Bernier J, Bartelink H. The program of quality assurance of the EORTC radiotherapy group. A historical overview. Radiother. Oncol. 1993;29:81-84), with some modifications. The action was regarded as adequate (score 1) in the event of no deviation or only a small deviation with presumably no alteration of the desired end-result of the treatment. A deviation adversely influencing the result of the therapy was considered a major deviation (score 3). Cases involving a minor deviation (score 2) were those only slightly affecting the therapeutic end-results, with effects

  12. External audit on the clinical practice and medical decision-making at the departments of radiotherapy in Budapest and Vienna.

    Science.gov (United States)

    Esik, O; Seitz, W; Lövey, J; Knocke, T H; Gaudi, I; Németh, G; Pötter, R

    1999-04-01

    To present an example of how to study and analyze the clinical practice and the quality of medical decision-making under daily routine working conditions in a radiotherapy department, with the aims of detecting deficiencies and improving the quality of patient care. Two departments, each with a divisional organization structure and an established internal audit system, the University Clinic of Radiotherapy and Radiobiology in Vienna (Austria), and the Department of Radiotherapy at the National Institute of Oncology in Budapest (Hungary), conducted common external audits. The descriptive parameters of the external audit provided information on the auditing (auditor and serial number of the audit), the cohorts (diagnosis, referring institution, serial number and intention of radiotherapy) and the staff responsible for the treatment (division and physician). During the ongoing external audits, the qualifying parameters were (1) the sound foundation of the indication of radiotherapy, (2) conformity to the institution protocol (3), the adequacy of the choice of radiation equipment, (4) the appropriateness of the treatment plan, and the correspondence of the latter with (5) the simulation and (6) verification films. Various degrees of deviation from the treatment principles were defined and scored on the basis of the concept of Horiot et al. (Horiot JC, Schueren van der E. Johansson KA, Bernier J, Bartelink H. The program of quality assurance of the EORTC radiotherapy group. A historical overview. Radiother. Oncol. 1993,29:81-84), with some modifications. The action was regarded as adequate (score 1) in the event of no deviation or only a small deviation with presumably no alteration of the desired end-result of the treatment. A deviation adversely influencing the result of the therapy was considered a major deviation (score 3). Cases involving a minor deviation (score 2) were those only slightly affecting the therapeutic end-results, with effects between those of cases

  13. 77 FR 52317 - Record of Decision for Surveillance Towed Array Sensor System Low Frequency Active Sonar

    Science.gov (United States)

    2012-08-29

    ... DEPARTMENT OF DEFENSE Department of the Navy Record of Decision for Surveillance Towed Array Sensor System Low Frequency Active Sonar AGENCY: Department of the Navy, DoD. ACTION: Notice of decision... to employ up to four Surveillance Towed Array Sensor System Low Frequency Active (SURTASS LFA) sonar...

  14. 76 FR 56865 - U.S. Department of State Advisory Committee on Private International Law (ACPIL): Public Meeting...

    Science.gov (United States)

    2011-09-14

    ... International Law (ACPIL): Public Meeting on Electronic Commerce The Department of State, Office of Legal... future work of Working Group IV (international electronic commerce) of the United Nations Commission on... electronic commerce. The report of the Forty-fourth session of UNCITRAL describes the future work of Group IV...

  15. 76 FR 6171 - U.S. Department of State Advisory Committee on Private International Law (ACPIL): Public Meeting...

    Science.gov (United States)

    2011-02-03

    ... International Law (ACPIL): Public Meeting on Family Law The Department of State, Office of Legal Adviser, Office of Private International Law would like to give notice of a public meeting to discuss preparations for the upcoming Special Commission of the Hague Conference on Private International Law on the 1980...

  16. Introduction of new technologies and decision making processes: a framework to adapt a Local Health Technology Decision Support Program for other local settings.

    Science.gov (United States)

    Poulin, Paule; Austen, Lea; Scott, Catherine M; Poulin, Michelle; Gall, Nadine; Seidel, Judy; Lafrenière, René

    2013-01-01

    Introducing new health technologies, including medical devices, into a local setting in a safe, effective, and transparent manner is a complex process, involving many disciplines and players within an organization. Decision making should be systematic, consistent, and transparent. It should involve translating and integrating scientific evidence, such as health technology assessment (HTA) reports, with context-sensitive evidence to develop recommendations on whether and under what conditions a new technology will be introduced. However, the development of a program to support such decision making can require considerable time and resources. An alternative is to adapt a preexisting program to the new setting. We describe a framework for adapting the Local HTA Decision Support Program, originally developed by the Department of Surgery and Surgical Services (Calgary, AB, Canada), for use by other departments. The framework consists of six steps: 1) development of a program review and adaptation manual, 2) education and readiness assessment of interested departments, 3) evaluation of the program by individual departments, 4) joint evaluation via retreats, 5) synthesis of feedback and program revision, and 6) evaluation of the adaptation process. Nine departments revised the Local HTA Decision Support Program and expressed strong satisfaction with the adaptation process. Key elements for success were identified. Adaptation of a preexisting program may reduce duplication of effort, save resources, raise the health care providers' awareness of HTA, and foster constructive stakeholder engagement, which enhances the legitimacy of evidence-informed recommendations for introducing new health technologies. We encourage others to use this framework for program adaptation and to report their experiences.

  17. Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence.

    Science.gov (United States)

    Wilkins, Natalie; Myers, Lindsey; Kuehl, Tomei; Bauman, Alice; Hertz, Marci

    Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, "siloed" approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states.

  18. Treatment decision-making among breast cancer patients in Malaysia

    Directory of Open Access Journals (Sweden)

    Nies YH

    2017-10-01

    Full Text Available Yong Hui Nies,1 Farida Islahudin,1 Wei Wen Chong,1 Norlia Abdullah,2 Fuad Ismail,3 Ros Suzanna Ahmad Bustamam,4 Yoke Fui Wong,5 JJ Saladina,2 Noraida Mohamed Shah1 1Faculty of Pharmacy, 2Department of Surgery, 3Department of Radiotherapy and Oncology, Universiti Kebangsaan Malaysia Medical Centre, 4Department of Radiotherapy and Oncology, Hospital Kuala Lumpur, Kuala Lumpur, 5Department of Radiotherapy and Oncology, National Cancer Institute, Putrajaya, Malaysia Purpose: This study investigated breast cancer patients’ involvement level in the treatment decision-making process and the concordance between patients’ and physician’s perspectives in decision-making. Participants and methods: A cross-sectional study was conducted involving physicians and newly diagnosed breast cancer patients from three public/teaching hospitals in Malaysia. The Control Preference Scale (CPS was administered to patients and physicians, and the Krantz Health Opinion Survey (KHOS was completed by the patients alone. Binary logistic regression was used to determine the association between sociodemographic characteristics, the patients’ involvement in treatment decision-making, and patients’ preference for behavioral involvement and information related to their disease. Results: The majority of patients preferred to share decision-making with their physicians (47.5%, while the second largest group preferred being passive (42.6% and a small number preferred being active (9.8%. However, the physicians perceived that the majority of patients preferred active decision-making (56.9%, followed by those who desired shared decision-making (32.8%, and those who preferred passive decision-making (10.3%. The overall concordance was 26.5% (54 of 204 patient–physician dyads. The median of preference for information score and behavioral involvement score was 4 (interquartile range [IQR] =3–5 and 2 (IQR =2–3, respectively. In univariate analysis, the ethnicity and

  19. Are Gains in Decision-Making Autonomy during Early Adolescence Beneficial for Emotional Functioning? The Case of the United States and China

    Science.gov (United States)

    Qin, Lili; Pomerantz, Eva M.; Wang, Qian

    2009-01-01

    This research examined the role of children's decision-making autonomy in their emotional functioning during early adolescence in the United States and China. Four times over the 7th and 8th grades, 825 American and Chinese children (M = 12.73 years) reported on the extent to which they versus their parents make decisions about issues children…

  20. Guidelines for Libraries of Government Departments. IFLA Professional Reports, No. 106

    Science.gov (United States)

    Bolt, Nancy, Ed.; Burge, Suzanne, Ed.

    2008-01-01

    Libraries of government departments provide information to policymakers, to government staff and employees, and, sometimes, to the general public. It is essential that libraries of government departments are organised and managed so as to collect and provide the information most needed by government decision makers, government workers, and the…

  1. 77 FR 71448 - States' Decisions on Participating in Accounting and Auditing Relief for Federal Oil and Gas...

    Science.gov (United States)

    2012-11-30

    ...' Decisions on Participating in Accounting and Auditing Relief for Federal Oil and Gas Marginal Properties... types of accounting and auditing relief for Federal onshore or Outer Continental Shelf lease production... auditing requirements. States make an annual determination of whether or not to allow relief. Two options...

  2. Hippocampal Theta-Gamma Coupling Reflects State-Dependent Information Processing in Decision Making.

    Science.gov (United States)

    Amemiya, Seiichiro; Redish, A David

    2018-03-20

    During decision making, hippocampal activity encodes information sometimes about present and sometimes about potential future plans. The mechanisms underlying this transition remain unknown. Building on the evidence that gamma oscillations at different frequencies (low gamma [LG], 30-55 Hz; high gamma [HG], 60-90 Hz; and epsilon, 100-140 Hz) reflect inputs from different circuits, we identified how changes in those frequencies reflect different information-processing states. Using a unique noradrenergic manipulation by clonidine, which shifted both neural representations and gamma states, we found that future representations depended on gamma components. These changes were identifiable on each cycle of theta as asymmetries in the theta cycle, which arose from changes within the ratio of LG and HG power and the underlying phases of those gamma rhythms within the theta cycle. These changes in asymmetry of the theta cycle reflected changes in representations of present and future on each theta cycle. Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

  3. 6 CFR 13.38 - Reconsideration of Initial Decision.

    Science.gov (United States)

    2010-01-01

    ... 6 Domestic Security 1 2010-01-01 2010-01-01 false Reconsideration of Initial Decision. 13.38 Section 13.38 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROGRAM FRAUD CIVIL REMEDIES § 13.38 Reconsideration of Initial Decision. (a) Except as provided in paragraph (d) of...

  4. A 1% Solution: Establishing and Reaching Enrollment Goals in Geoscience Departments

    Science.gov (United States)

    Rhodes, D. D.

    2005-12-01

    Because of the small number of recent graduates, the Department of Geology and Geography at Georgia Southern University was placed on the list of programs to be monitored by the University System of Georgia's Board of Regents in August 1998. With only 23 majors at the time, the need to grow the program was obvious to everyone. Facing the reality that the survival of the Department was at stake, the faculty made enhancing enrollments its highest priority. After consulting a variety of published information and talking to faculty from the incredibly successful Department of Geology and Geography at Northwest Missouri State University, the faculty adopted a goal of having the combined number of geology and geography majors in the department equal 1% of the university's undergraduate enrollment, which then stood at 12,400. The most important move toward the goal occurred when the Department began actively recruiting majors from all introductory geology and geography courses. Recruiting took a variety of forms that ranged from suggesting that students doing well in a course consider majoring in the field to formal presentations on geology and geography as careers. Since the Spring 2001 semester, recruiting talks have been given in every introductory level geography and geology class by a member of the faculty other than the course's instructor. The presentations emphasize how geology and geography promote the development of important marketable skills (e.g., critical thinking, problem solving, writing, public speaking, cultural awareness) and technical expertise (especially GIS) that are essential in obtaining employment and in career advancement. The presentations occur during the week preceding the Thanksgiving holidays, so students will have the opportunity to discuss this important choice with their parents. This schedule also gives students time to make their decision before registration for the spring semester. Soon after the recruitment efforts started the number

  5. A Qualitative Analysis of Patients' Perceptions of Shared Decision Making in the Emergency Department: "Let Me Know I Have a Choice".

    Science.gov (United States)

    Schoenfeld, Elizabeth M; Goff, Sarah L; Downs, Gwendolyn; Wenger, Robert J; Lindenauer, Peter K; Mazor, Kathleen M

    2018-03-25

    Despite increasing attention to the use of shared decision making (SDM) in the emergency department (ED), little is known about ED patients' perspectives regarding this practice. We sought to explore the use of SDM from the perspectives of ED patients, focusing on what affects patients' desired level of involvement and what barriers and facilitators patients find most relevant to their experience. We conducted semistructured interviews with a purposive sample of ED patients or their proxies at two sites. An interview guide was developed from existing literature and expert consensus and based on a framework underscoring the importance of both knowledge and power. Interviews were recorded, transcribed, and analyzed in an iterative process by a three-person coding team. Emergent themes were identified, discussed, and organized. Twenty-nine patients and proxies participated. The mean age of participants was 56 years (range, 20 to 89 years), and 13 were female. Participants were diverse in regard to race/ethnicity, education, number of previous ED visits, and presence of chronic conditions. All participants wanted some degree of involvement in decision making. Participants who made statements suggesting high self-efficacy and those who expressed mistrust of the health care system or previous negative experiences wanted a greater degree of involvement. Facilitators to involvement included familiarity with the decision at hand, physicians' good communication skills, and clearly delineated options. Some participants felt that their own relative lack of knowledge, compared to that of the physicians, made their involvement inappropriate or unwanted. Many participants had no expectation for SDM and although they did want involvement when asked explicitly, they were otherwise likely to defer to physicians without discussion. Many did not recognize opportunities for SDM in their clinical care. This exploration of ED patients' perceptions of SDM suggests that most patients want

  6. Nevada State plan; final approval determination. Occupational Safety and Health Administration (OSHA), U.S. Department of Labor. Final State plan approval--Nevada.

    Science.gov (United States)

    2000-04-18

    This document amends OSHA's regulations to reflect the Assistant Secretary's decision granting final approval to the Nevada State plan. As a result of this affirmative determination under section 18(e) of the Occupational Safety and Health Act of 1970, Federal OSHA's standards and enforcement authority no longer apply to occupational safety and health issues covered by the Nevada plan, and authority for Federal concurrent jurisdiction is relinquished. Federal enforcement jurisdiction is retained over any private sector maritime employment, private sector employers on Indian land, and any contractors or subcontractors on any Federal establishment where the land is exclusive Federal jurisdiction. Federal jurisdiction remains in effect with respect to Federal government employers and employees. Federal OSHA will also retain authority for coverage of the United States Postal Service (USPS), including USPS employees, contract employees, and contractor-operated facilities engaged in USPS mail operations.

  7. ED Triage Decision-Making With Mental Health Presentations: A "Think Aloud" Study.

    Science.gov (United States)

    Clarke, Diana E; Boyce-Gaudreau, Krystal; Sanderson, Ana; Baker, John A

    2015-11-01

    Triage is the process whereby persons presenting to the emergency department are quickly assessed by a nurse and their need for care and service is prioritized. Research examining the care of persons presenting to emergency departments with psychiatric and mental health problems has shown that triage has often been cited as the most problematic aspect of the encounter. Three questions guided this investigation: Where do the decisions that triage nurses make fall on the intuitive versus analytic dimensions of decision making for mental health presentations in the emergency department, and does this differ according to comfort or familiarity with the type of mental health/illness presentation? How do "decision aids" (i.e., structured triage scales) help in the decision-making process? To what extent do other factors, such as attitudes, influence triage nurses' decision making? Eleven triage nurses participating in this study were asked to talk out loud about the reasoning process they would engage in while triaging patients in 5 scenarios based on mental health presentations to the emergency department. Themes emerging from the data were tweaking the results (including the use of intuition and early judgments) to arrive at the desired triage score; consideration of the current ED environment; managing uncertainty and risk (including the consideration of physical reasons for presentation); and confidence in communicating with patients in distress and managing their own emotive reactions to the scenario. Findings support the preference for using the intuitive mode of decision making with only tacit reliance on the decision aid. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  8. 77 FR 52784 - U.S. Department of State Advisory Committee on Private International Law: Notice of Annual Meeting

    Science.gov (United States)

    2012-08-30

    ... Choice of Court Agreements; international contract law; developments in major PIL organizations... International Law: Notice of Annual Meeting The Department of State's Advisory Committee on Private International Law (ACPIL) will hold its annual meeting on developments in private international law on Thursday...

  9. Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) survey for hospital outpatient departments - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of the state averages for the OAS CAHPS Survey responses. The OAS CAHPS survey collects information about patients’ experiences of care in hospital outpatient...

  10. A step towards risk-based decision support for ships - Evaluation of limit states using parallel system analysis

    DEFF Research Database (Denmark)

    Nielsen, Ulrik Dam; Friis-Hansen, Peter; Jensen, Jørgen Juncher

    2009-01-01

    Onboard decision support systems (DSS) are used to increase the operational safety of ships. Ideally, DSS can estimate future ship responses within a time scale of the order of 1–3 h taking into account speed and course changes, assuming stationary sea states. In principle, the calculations depen...

  11. Intelligent decision support system for operators of the supply ...

    African Journals Online (AJOL)

    Intelligent decision support system for operators of the supply department of oil and gas extracting industry. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... abnormal situations, pre-crash sensing, industrial drilling, decision-making support systems. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT

  12. Research Productivity and Rankings of Anesthesiology Departments in Canada and the United States: The Relationship Between the h-Index and Other Common Metrics [RETRACTED].

    Science.gov (United States)

    Bunting, Alexandra C; Alavifard, Sepand; Walker, Benjamin; Miller, Donald R; Ramsay, Tim; Boet, Sylvain

    2018-03-05

    To evaluate the relative research productivity and ranking of anesthesiology departments in Canada and the United States, using the Hirsch index (h-index) and 4 other previously validated metrics. We identified 150 anesthesiology departments in Canada and the United States with an accredited residency program. Publications for each of the 150 departments were identified using Thomson's Institute for Scientific Information Web of Science, and the citation report for each department was exported. The bibliometric data were used to calculate publication metrics for 3 time periods: cumulative (1945-2014), 10 years (2005-2014), and 5 years (2010-2014). The following group metrics were then used to determine the publication impact and relative ranking of all 150 departments: h-index, m-index, total number of publications, sum of citations, and average number of citations per article. Ranking for each metric were also stratified by using a proxy for departmental size. The most common journals in which US and Canadian anesthesiology departments publish their work were identified. The majority (23 of the top 25) of top-ranked anesthesiology departments are in the United States, and 2 of the top 25 departments (University of Toronto; McGill University) are in Canada. There was a strong positive relationship between each of h-index, total number of publications, and the sum of citations (0.91-0.97; P productivity on most metrics. The most frequent journals in which US and Canadian anesthesiology departments publish are Anesthesiology, Anesthesia and Analgesia, and the Canadian Journal of Anesthesia. Our study ranked the Canadian and US anesthesiology departmental research productivity using the h-index applied to each department, total number of publications, total number of citations, and average number of citations. The strong relationship between the h-index and both the number of publications and number of citations of anesthesiology departments shows that the departments

  13. Proposed Plan for an amendment to the Environmental Restoration Disposal Facility Record of Decision, Hanford Site, Richland, Washington

    International Nuclear Information System (INIS)

    1997-07-01

    The U.S. Environmental Protection Agency, the Washington State Department of Ecology, and the U.S. Department of Energy (Tri- Parties) are proposing an amendment to the Environmental Restoration Disposal Facility Record of Decision (ERDF ROD). EPA is the lead regulatory agency for the ERDF Project. This Proposed Plan includes two elements intended to promote Hanford Site cleanup activities by broadening utilization and operation of ERDF as follows: (1) Construct the planned Phase II of ERDF using the current disposal cell design and (2) enable centralized treatment of remediation waste at ERDF prior to disposal, as appropriate

  14. Department o

    African Journals Online (AJOL)

    USER

    2016-10-31

    Oct 31, 2016 ... Department of Urban and Regional Planning, University of Ibadan, Oyo State, Nigeria. 2 ... Geospatial techniques were used for this study; data from primary and secondary source ... development, for instance, Nigeria cities .... (road network, road medians and water ..... Countries: A Case Study of Nigeria.

  15. An exploratory study to examine intentions to adopt an evidence-based HIV linkage-to-care intervention among state health department AIDS directors in the United States.

    Science.gov (United States)

    Norton, Wynne E

    2012-04-02

    Widespread dissemination and implementation of evidence-based human immunodeficiency virus (HIV) linkage-to-care (LTC) interventions is essential for improving HIV-positive patients' health outcomes and reducing transmission to uninfected others. To date, however, little work has focused on identifying factors associated with intentions to adopt LTC interventions among policy makers, including city, state, and territory health department AIDS directors who play a critical role in deciding whether an intervention is endorsed, distributed, and/or funded throughout their region. Between December 2010 and February 2011, we administered an online questionnaire with state, territory, and city health department AIDS directors throughout the United States to identify factors associated with intentions to adopt an LTC intervention. Guided by pertinent theoretical frameworks, including the Diffusion of Innovations and the "push-pull" capacity model, we assessed participants' attitudes towards the intervention, perceived organizational and contextual demand and support for the intervention, likelihood of adoption given endorsement from stakeholder groups (e.g., academic researchers, federal agencies, activist organizations), and likelihood of enabling future dissemination efforts by recommending the intervention to other health departments and community-based organizations. Forty-four participants (67% of the eligible sample) completed the online questionnaire. Approximately one-third (34.9%) reported that they intended to adopt the LTC intervention for use in their city, state, or territory in the future. Consistent with prior, related work, these participants were classified as LTC intervention "adopters" and were compared to "nonadopters" for data analysis. Overall, adopters reported more positive attitudes and greater perceived demand and support for the intervention than did nonadopters. Further, participants varied with their intention to adopt the LTC intervention in

  16. An exploratory study to examine intentions to adopt an evidence-based HIV linkage-to-care intervention among state health department AIDS directors in the United States

    Directory of Open Access Journals (Sweden)

    Norton Wynne E

    2012-04-01

    Full Text Available Abstract Background Widespread dissemination and implementation of evidence-based human immunodeficiency virus (HIV linkage-to-care (LTC interventions is essential for improving HIV-positive patients' health outcomes and reducing transmission to uninfected others. To date, however, little work has focused on identifying factors associated with intentions to adopt LTC interventions among policy makers, including city, state, and territory health department AIDS directors who play a critical role in deciding whether an intervention is endorsed, distributed, and/or funded throughout their region. Methods Between December 2010 and February 2011, we administered an online questionnaire with state, territory, and city health department AIDS directors throughout the United States to identify factors associated with intentions to adopt an LTC intervention. Guided by pertinent theoretical frameworks, including the Diffusion of Innovations and the "push-pull" capacity model, we assessed participants' attitudes towards the intervention, perceived organizational and contextual demand and support for the intervention, likelihood of adoption given endorsement from stakeholder groups (e.g., academic researchers, federal agencies, activist organizations, and likelihood of enabling future dissemination efforts by recommending the intervention to other health departments and community-based organizations. Results Forty-four participants (67% of the eligible sample completed the online questionnaire. Approximately one-third (34.9% reported that they intended to adopt the LTC intervention for use in their city, state, or territory in the future. Consistent with prior, related work, these participants were classified as LTC intervention "adopters" and were compared to "nonadopters" for data analysis. Overall, adopters reported more positive attitudes and greater perceived demand and support for the intervention than did nonadopters. Further, participants varied with

  17. Integrating industry nuclear codes and standards into United States Department of Energy facilities

    Energy Technology Data Exchange (ETDEWEB)

    Jacox, J.

    1995-02-01

    Recently the United States Department of Energy (DOE) has mandated facilities under their jurisdiction use various industry Codes and Standards developed for civilian power reactors that operate under U.S. Nuclear Regulatory Commission License. While this is a major step forward in putting all our nuclear facilities under common technical standards there are always problems associated with implementing such advances. This paper will discuss some of the advantages and problems experienced to date. These include the universal challenge of educating new users of any technical documents, repeating errors made by the NRC licensed facilities over the years and some unique problems specific to DOE facilities.

  18. Boise, Idaho: Improving Air Quality through Alternative Fuels & Reduced Vehicular Travel (City Energy: From Data to Decisions)

    Energy Technology Data Exchange (ETDEWEB)

    Strategic Priorities and Impact Analysis Team, Office of Strategic Programs

    2017-11-01

    This fact sheet "Boise, Idaho: Improving Air Quality through Alternative Fuels & Reduced Vehicular Travel" explains how the City of Boise used data from the U.S. Department of Energy's Cities Leading through Energy Analysis and Planning (Cities-LEAP) and the State and Local Energy Data (SLED) programs to inform its city energy planning. It is one of ten fact sheets in the "City Energy: From Data to Decisions" series.

  19. History of the US weapons-usable plutonium disposition program leading to DOE's record of decision

    International Nuclear Information System (INIS)

    Spellman, D.J.; Thomas, J.F.; Bugos, R.G.

    1997-04-01

    This report highlights important events and studies concerning surplus weapons-usable plutonium disposition in the United States. Included are major events that led to the creation of the U.S. Department of Energy (DOE) Office of Fissile Materials Disposition in 1994 and to that DOE office issuing the January 1997 Record of Decision for the Storage and Disposition of Weapons-Useable Fissile Materials Final Programmatic Environmental Impact Statement. Emphasis has been given to reactor-based plutonium disposition alternatives

  20. Accuracy of ‘My Gut Feeling:’ Comparing System 1 to System 2 Decision-Making for Acuity Prediction, Disposition and Diagnosis in an Academic Emergency Department

    Directory of Open Access Journals (Sweden)

    Daniel Cabrera

    2015-10-01

    Full Text Available Introduction: Current cognitive sciences describe decision-making using the dual-process theory, where a System 1 is intuitive and a System 2 decision is hypothetico-deductive. We aim to compare the performance of these systems in determining patient acuity, disposition and diagnosis. Methods: Prospective observational study of emergency physicians assessing patients in the emergency department of an academic center. Physicians were provided the patient’s chief complaint and vital signs and allowed to observe the patient briefly. They were then asked to predict acuity, final disposition (home, intensive care unit (ICU, non-ICU bed and diagnosis. A patient was classified as sick by the investigators using previously published objective criteria. Results: We obtained 662 observations from 289 patients. For acuity, the observers had a sensitivity of 73.9% (95% CI [67.7-79.5%], specificity 83.3% (95% CI [79.5-86.7%], positive predictive value 70.3% (95% CI [64.1-75.9%] and negative predictive value 85.7% (95% CI [82.0-88.9%]. For final disposition, the observers made a correct prediction in 80.8% (95% CI [76.1-85.0%] of the cases. For ICU admission, emergency physicians had a sensitivity of 33.9% (95% CI [22.1-47.4%] and a specificity of 96.9% (95% CI [94.0-98.7%]. The correct diagnosis was made 54% of the time with the limited data available. Conclusion: System 1 decision-making based on limited information had a sensitivity close to 80% for acuity and disposition prediction, but the performance was lower for predicting ICU admission and diagnosis. System 1 decision-making appears insufficient for final decisions in these domains but likely provides a cognitive framework for System 2 decision-making.

  1. HUD Hearings and Appeals Office Decisions

    Data.gov (United States)

    Department of Housing and Urban Development — These all of the Administrative Sanction decisions issued by the Office of Appeals and its predecessor, the HUD Board of Contract Appeals. This Office has included...

  2. Implementing a Decision-Aware System for Loan Contracting Decision Process

    Directory of Open Access Journals (Sweden)

    Razvan PETRUSEL

    2011-01-01

    Full Text Available The paper introduces our work related to the design and implementation of a decision-aware system focused on the loan contracting decision process. A decision-aware system is a software that enables the user to make a decision in a simulated environment and logs all the actions of the decision maker while interacting with the software. By using a mining algorithm on the logs, it creates a model of the decision process and presents it to the user. The main design issue introduced in the paper is the possibility to log the mental actions of the user. The main implementation issues are: user activity logging programming and technologies used. The first section of the paper introduces the state-of-the-art research in process mining and the framework of our research; the second section argues the design of the system; the third section introduces the actual implementation and the fourth section shows a running example.

  3. Perceptions of Emergency Department Physicians Toward Collaborative Practice With Nurse Practitioners in an Emergency Department Setting

    National Research Council Canada - National Science Library

    Wingert, Tracy

    1998-01-01

    Once considered reserved for life-threatening disease or illness, emergency departments in the United States are now described as the primary care clinic and the social work department for many Americans (Grumback, Keane & Bindman, 1993...

  4. Joint-Service Integration: An Organizational Culture Study of the United States Department of Defense Voluntary Education System

    Science.gov (United States)

    Benson, Martin K.

    2010-01-01

    The purpose of the descriptive case study with a multiple case framework was to (a) describe the organizational cultures of education programs and leaders in the United States (U.S.) Department of Defense (DoD) voluntary education system on Oahu, Hawaii; (b) determine if an overlapping common organizational culture exists; and (c) assess the…

  5. United States Department of Education: Annual Accountability Report, Fiscal Year 1995.

    Science.gov (United States)

    Department of Education, Washington, DC.

    Fiscal year 1995 marks the first year during which an independent audit was conducted of the U.S. Department of Education's financial statements. This first annual accountability report describes the department's history, current mission, priorities, and progress. It highlights the department's program and fiscal accomplishments and describes…

  6. 40 CFR 1700.13 - Petition decisions.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Petition decisions. 1700.13 Section... VESSELS OF THE ARMED FORCES Effect on States State Petition for Review § 1700.13 Petition decisions. The Administrator and the Secretary will evaluate the petition and grant or deny the petition no later than two...

  7. Adjudication Decision Support (ADS) System Automated Approval Estimates for NACLC Investigations

    National Research Council Canada - National Science Library

    Lang, Eric L; Youpa, Daniel G; Berman, Sandi; Leggitt, John S

    2007-01-01

    The present research is the second in a series of studies to test preliminary decision rules and provide automated approval estimates for a Department of Defense Adjudication Decision Support (ADS) system...

  8. Guidance Tools for Use in Nuclear Material Management Decisions Making

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, G. V.; Baker, D. J.; Sorenson, K. B.; Boeke, S. G.

    2002-02-26

    This paper describes the results of Recommendation 14 of the Integrated Nuclear Materials Management Plan (INMMP) which was the product of a management initiative at the highest levels of the Department of Energy responding to a congressional directive to accelerate the work of achieving integration and cutting long-term costs associated with the management of nuclear materials, with the principal focus on excess materials. The INMMP provided direction to ''Develop policy-level decision support tools to support long-term planning and decision making.'' To accomplish this goal a team from the Savannah River Site, Sandia National Laboratories, Idaho National Engineering and Environmental Laboratory (INEEL), and the U.S. Department of Energy experienced in the decision-making process developed a Guidebook to Decision-Making Methods. The goal of the team organized to implement Recommendation 14 was to instill transparency, consistency, rigor, and discipline in the DOE decision process. The guidebook introduces a process and a selection of proven methods for disciplined decision-making so that the results are clearer, more transparent, and easier for reviewers to understand and accept. It was written to set a standard for a consistent decision process.

  9. Department of Transportation

    Science.gov (United States)

    ... of Drone Integration Pilot Program MEET THE SECRETARY TRANSPORTATION TUESDAY FEATURED NEWS The Briefing Room Connect With ... Carriers - Get a DOT Number Find Your State Transportation Department 5 Star Automobile Crash Test Ratings Office ...

  10. State waste discharge permit application, 200-E chemical drain field

    Energy Technology Data Exchange (ETDEWEB)

    1994-06-01

    As part of the Hanford Federal Facility Agreement and Consent Order negotiations (Ecology et al. 1994), the US Department of Energy, Richland Operations Office, the US Environmental Protection Agency, and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground on the Hanford Site which affect groundwater or have the potential to affect ground would be subject to permitting under the structure of Chapter 173-216 (or 173-218 where applicable) of the Washington Administrative Code, the State Waste Discharge Permit Program. As a result of this decision, the Washington State Department of Ecology and the US Department of Energy, Richland Operations Office entered into Consent Order No. DE 91NM-177, (Ecology and DOE-RL 1991). The Consent Order No. DE 91NM-177 requires a series of permitting activities for liquid effluent discharges. This document presents the State Waste Discharge Permit (SWDP) application for the 200-E Chemical Drain Field. Waste water from the 272-E Building enters the process sewer line directly through a floor drain, while waste water from the 2703-E Building is collected in two floor drains, (north and south) that act as sumps and are discharged periodically. The 272-E and 2703-E Buildings constitute the only discharges to the process sewer line and the 200-E Chemical Drain Field.

  11. State waste discharge permit application, 200-E chemical drain field

    International Nuclear Information System (INIS)

    1994-06-01

    As part of the Hanford Federal Facility Agreement and Consent Order negotiations (Ecology et al. 1994), the US Department of Energy, Richland Operations Office, the US Environmental Protection Agency, and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground on the Hanford Site which affect groundwater or have the potential to affect ground would be subject to permitting under the structure of Chapter 173-216 (or 173-218 where applicable) of the Washington Administrative Code, the State Waste Discharge Permit Program. As a result of this decision, the Washington State Department of Ecology and the US Department of Energy, Richland Operations Office entered into Consent Order No. DE 91NM-177, (Ecology and DOE-RL 1991). The Consent Order No. DE 91NM-177 requires a series of permitting activities for liquid effluent discharges. This document presents the State Waste Discharge Permit (SWDP) application for the 200-E Chemical Drain Field. Waste water from the 272-E Building enters the process sewer line directly through a floor drain, while waste water from the 2703-E Building is collected in two floor drains, (north and south) that act as sumps and are discharged periodically. The 272-E and 2703-E Buildings constitute the only discharges to the process sewer line and the 200-E Chemical Drain Field

  12. Therapeutic hypothermia following out-of-hospital cardiac arrest; does it start in the emergency department?

    Science.gov (United States)

    Galloway, R; Sherren, P B

    2010-12-01

    The use of therapeutic hypothermia after cardiac arrest is a well-practised treatment modality in the intensive care unit (ICU). However, recent evidence points to advantages in starting the cooling process as soon as possible after the return of spontaneous circulation (ROSC). There are no data on implementation of this treatment in the emergency department. A telephone survey was conducted of the 233 emergency departments in the UK. The most senior available clinician was asked if, in cases where they have a patient with a ROSC after an out-of-hospital cardiac arrest, would therapeutic hypothermia be started in the emergency department. Of the 233 hospitals called, 230 responded, of which 35% would start cooling in the emergency department. Of this 35%, over half (56%) said the decision to start cooling was made by the emergency physician before consultation with the ICU. Also, of the 35% who would begin cooling in the emergency department, 55% would cool only for ventricular fibrillation/ventricular tachycardia, 66% would monitor temperature centrally, and 14% would use specialised cooling equipment. There is often a delay in getting patients to ICU from the emergency department, and thus the decision not to start cooling in the emergency department may impact significantly on patient outcome. The dissemination of these data may persuade emergency physicians that starting treatment in the emergency department is an appropriate and justifiable decision that is becoming a more accepted practice throughout the UK.

  13. Analyzing the United States Department of Transportation's Implementation Strategy for High Speed Rail: Three Case Studies

    Science.gov (United States)

    Robinson, Ryan

    High-speed rail (HSR) has become a major contributor to the transportation sector with a strong push by the Obama Administration and the Department of Transportation to implement high-speed rail in the United States. High-speed rail is a costly transportation alternative that has the potential displace some car and airport travel while increase energy security and environmental sustainability. This thesis will examine the United States high-speed rail implementation strategy by comparing it to the implementation strategies of France, Japan, and Germany in a multiple case study under four main criteria of success: economic profitability, reliability, safety, and ridership. Analysis will conclude with lessons to be taken away from the case studies and applied to the United States strategy. It is important to understand that this project has not been established to create a comprehensive implementation plan for high-speed rail in the United States; rather, this project is intended to observe the depth and quality of the current United States implementation strategy and make additional recommendations by comparing it with France, Japan, and Germany.

  14. Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence

    Science.gov (United States)

    Wilkins, Natalie; Myers, Lindsey; Kuehl, Tomei; Bauman, Alice; Hertz, Marci

    2018-01-01

    Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, “siloed” approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states. PMID:29189502

  15. System for decision analysis support on complex waste management issues

    International Nuclear Information System (INIS)

    Shropshire, D.E.

    1997-01-01

    A software system called the Waste Flow Analysis has been developed and applied to complex environmental management processes for the United States Department of Energy (US DOE). The system can evaluate proposed methods of waste retrieval, treatment, storage, transportation, and disposal. Analysts can evaluate various scenarios to see the impacts to waste slows and schedules, costs, and health and safety risks. Decision analysis capabilities have been integrated into the system to help identify preferred alternatives based on a specific objectives may be to maximize the waste moved to final disposition during a given time period, minimize health risks, minimize costs, or combinations of objectives. The decision analysis capabilities can support evaluation of large and complex problems rapidly, and under conditions of variable uncertainty. The system is being used to evaluate environmental management strategies to safely disposition wastes in the next ten years and reduce the environmental legacy resulting from nuclear material production over the past forty years

  16. Shared leadership and the evolution of "one great department".

    Science.gov (United States)

    Casady, Wanda M; Dowd, Terry A

    2005-01-01

    In 2001, Banner Baywood Medical Center's (BBMC) medical imaging department employed concepts to engage staff in a participative decision-making practice regarding those things that most impacted their jobs. A 5-member Oversight Committee was charged with defining a vision for the department to be achieved by 2005, determining obstacles or challenges that needed to be overcome in order to achieve the vision, and facilitating 12-week teams to find solutions to these obstacles. Several initiatives were implemented to ensure competitive salaries, more effective leadership, and overall greater participation by staff in the decision-making process. Within the project's first 18 months, the department's turnover rate was reduced from 40% to 14.5%. However, as the department continued to grow, it became evident that the structure of the Oversight Committee was no longer sufficient to achieve its goals. The members of the Oversight Committee decided to expand its membership to include a representative from every work group within the department. The new group was called the Strategic Thinking Group (STG). Shared leadership--defined by Conger and Pearce as "a dynamic", interactive process among individuals working in groups in which the objective is to lead one another to the achievement of the group goals--is a vital component of the department's operation. During the past 2 years, BBMC has been actively engaged in creating a workplace environment that promotes shared leadership. BBMC utilizes the Gallup Q12 Workplace Survey and the Press Ganey Patient Satisfaction Survey. These surveys use identical numerical ratings, with "5" (strongly agree/very good) the department's goal for employees and patients. Consequently, the department created a new slogan: "We Strive for 5." The outcomes of shared leadership have proven to have a positive impact on staff retention, the reduction of casual Iabor staff, employee satisfaction, and patient satisfaction.

  17. Lessons learned from applying external input to DOE policy decision making

    International Nuclear Information System (INIS)

    Imholz, R.M.; Hindman, T.B. Jr.; Brubaker, D.M.

    1990-01-01

    Our nation has entered an era in which the public is demanding clean up and restoration of its environment, understandable information, and participation in decision making. The US Department of Energy's (DOE's) culture, which grew out of the Atomic Energy Commission (AEC) culture of classification, compartmentalization, and strict-need-to-know dissemination of information, was in direct conflict with this demand for public involvement. The DOE recognized this and committed to changing their culture into one of openness and public involvement in decision making and policy direction. This paper reports that as a result, DOE created a number of external review groups, one of them being the State and Tribal Government Working Group (STGWG). The STGWG was created to review the first Environmental Restoration and Waste Management Five-Year Plan. The Five-Year Plan establishes an agenda for compliance and cleanup of DOE installations against which progress can be measured

  18. Comparison AHP and SAW to promotion of head major department SMK Muhammadiyah 04 Medan

    Science.gov (United States)

    Saputra, M.; Sitompul, O. S.; Sihombing, P.

    2018-04-01

    Decision Support System (DSS) is a system that can help a person to make informed decisions about various types of choices that are performed accurately and in accordance with the desired goals. Many problems can be solved by using decision support systems. In this journal the decision support system is used to assist the Chief of Muhammadiyah Medan branch in the selection of the department chief. The criteria used for the election of department chiefs are: Loyalty, Job Performance, Responsibility, Obedience, Honesty, Cooperation, Education, and Leadership. The selection promotion process consists of Analytical Hierarchy Process (AHP) and Simple Additive Weighting (SAW) methods. The data were obtained through teacher assessment questionnaires by principals and colleagues. The results of this study used a comparison with two decision methods namely SAW method and AHP method so that the decision maker (principal) is more appropriate in the determination of candidates who will be elected head of department at school. The final result of this research is the first rank obtained by muhammad musa with weight value on AHP method (0.274) and weight value on SAW method (0.993), alvin syahrin with weight value on AHP method (0.241) and weight value on SAW method (0.883), noviyanti with weight value on AHP method (0.193) and weight value on SAW method (0.707). So the conclusion on the research that is by using SAW method the value of weight produced more accurate.

  19. Organization of educational process at the department of human anatomy of Saratov State Medical University n.a. V. I. Razumovsky

    Directory of Open Access Journals (Sweden)

    Bugaeva I0

    2017-06-01

    Full Text Available Human anatomy is one of the basic disciplines in the system of medical education. Knowledge in this area is necessary for the development of related theoretical subjects and constitutes a basis for studying clinical disciplines. Therefore the priority task of department of human anatomy is qualitative training of students at the modern level using classical and innovative pedagogical and computer technologies, being based on competence-based approach to training. In the article the features of organization of educational process at department of Human Anatomy of Saratov State Medical University n.a. V. I. Razumovsky, within the Federal state educational standard of the 3rd generation which key differences are considered: acquisition by students of cultural and professional competences.

  20. Goals and plans in decision making

    Directory of Open Access Journals (Sweden)

    David H. Krantz

    2007-06-01

    Full Text Available We propose a constructed-choice model for general decision making. The model departs from utility theory and prospect theory in its treatment of multiple goals and it suggests several different ways in which context can affect choice. It is particularly instructive to apply this model to protective decisions, which are often puzzling. Among other anomalies, people insure against non-catastrophic events, underinsure against catastrophic risks, and allow extraneous factors to influence insurance purchases and other protective decisions. Neither expected-utility theory nor prospect theory can explain these anomalies satisfactorily. To apply this model to the above anomalies, we consider many different insurance-related goals, organized in a taxonomy, and we consider the effects of context on goals, resources, plans and decision rules. The paper concludes by suggesting some prescriptions for improving individual decision making with respect to protective measures.

  1. Medical Service Corps: Junior Officer and Recent Retiree Stay/Leave Decisions

    National Research Council Canada - National Science Library

    Shepherd, Lillian

    2001-01-01

    .... Since few studies have been conducted on turnover intent in officers within the Navy Medical Department, previous studies, theories, and influencers on stay/leave decisions in Department of Defense...

  2. The Cat and the Pigeons: Some General Comments on (TP) Tax Rulings and State Aid After the Starbucks and Fiat Decisions

    NARCIS (Netherlands)

    Wattel, P.J.; Richelle, I.; Schön, W.; Traversa, E.

    2016-01-01

    The Commission State aid decisions on individual tax rulings have created legal uncertainty, which may have been one of their goals. This article comments on their political and policy merits and effects, it wonders whether EU law requires member States to have—and apply in a certain manner—specific

  3. Error Management Practices Interacting with National and Organizational Culture: The Case of Two State University Departments in Turkey

    Science.gov (United States)

    Göktürk, Söheyda; Bozoglu, Oguzhan; Günçavdi, Gizem

    2017-01-01

    Purpose: Elements of national and organizational cultures can contribute much to the success of error management in organizations. Accordingly, this study aims to consider how errors were approached in two state university departments in Turkey in relation to their specific organizational and national cultures. Design/methodology/approach: The…

  4. National and Regional Representativeness of Hospital Emergency Department Visit Data in the National Syndromic Surveillance Program, United States, 2014

    Science.gov (United States)

    Coates, Ralph J.; Pérez, Alejandro; Baer, Atar; Zhou, Hong; English, Roseanne; Coletta, Michael; Dey, Achintya

    2016-01-01

    Objective We examined the representativeness of the nonfederal hospital emergency department (ED) visit data in the National Syndromic Surveillance Program (NSSP). Methods We used the 2012 American Hospital Association Annual Survey Database, other databases, and information from state and local health departments participating in the NSSP about which hospitals submitted data to the NSSP in October 2014. We compared ED visits for hospitals submitting 15 data with all ED visits in all 50 states and Washington, DC. Results Approximately 60.4 million of 134.6 million ED visits nationwide (~45%) were reported to have been submitted to the NSSP. ED visits in 5 of 10 regions and the majority of the states were substantially underrepresented in the NSSP. The NSSP ED visits were similar to national ED visits in terms of many of the characteristics of hospitals and their service areas. However, visits in hospitals with the fewest annual ED visits, in rural trauma centers, and in hospitals serving populations with high percentages of Hispanics and Asians were underrepresented. Conclusions NSSP nonfederal hospital ED visit data were representative for many hospital characteristics and in some geographic areas but were not very representative nationally and in many locations. Representativeness could be improved by increasing participation in more states and among specific types of hospitals. PMID:26883318

  5. [Are therapeutics decisions homogeneous in multidisciplinary onco-urology staff meeting? Comparison of therapeutic options taken in four departments from Paris].

    Science.gov (United States)

    Audenet, F; Lejay, V; Mejean, A; De La Taille, A; Abbou, C-C; Lebret, T; Botto, H; Bitker, M-O; Roupret, M

    2012-06-01

    One of the priorities of the "Plan against the Cancer" in France is to ensure the discussion of all cancer cases in a multidisciplinary meeting staff (RCP). The multidisciplinary collaboration is proposed to guarantee a discussion between specialists in every cases, particularly in complex cases. The aim of this study was to compare the therapeutic decision taken in four RCP in Paris Île-de-France academic centres for three identical cases. Three cases of urological oncology (prostate cancer [PCa], renal cell carcinoma [RCC] and bladder tumour) were selected by a single urologist, not involved in further discussion. These cases were blindly presented in four academic urology department from Paris: Pitié-Salpêtrière Hospital, Mondor Hospital, the Georges-Pompidou European Hospital and Foch Hospital. The four centres met the criteria of quality of RCP in terms of multidisciplinarity, frequency and standardization. The therapeutic suggestions were similar in the RCC cases, there were differences in the surgical approaches and preoperative work-up in the PCa case and, lastly, the proposals were different for the bladder cancer case. The decisions relies on clinical data and preoperative work-up but also on the experience and habits of the centre of excellence. For complex cases that does not fit with current guidelines, the panel discussion can lead to different therapeutic options from a centre to another and is largely influenced by the local organisation of the RCP. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  6. Emergency nurses' knowledge, attitude and clinical decision making skills about pain.

    Science.gov (United States)

    Ucuzal, Meral; Doğan, Runida

    2015-04-01

    Pain is the most common reason that patients come to the emergency department. Emergency nurses have an indispensable role in the management of this pain. The aim of this study was to examine emergency nurses' knowledge, attitude and clinical decision-making skills about pain. This descriptive study was conducted in a state and a university hospital between September and October 2012 in Malatya, Turkey. Of 98 nurses working in the emergency departments of these two hospitals, 57 returned the questionnaires. The response rate was 58%. Data were collected using the Demographic Information Questionnaire, Knowledge and Attitude Questionnaire about Pain and Clinical Decision Making Survey. Frequency, percentage, mean and standard deviation were used to evaluate data. 75.4% of participant nurses knew that patients' own statement about their pain was the most reliable indicator during pain assessment. Almost half of the nurses believed that patients should be encouraged to endure the pain as much as possible before resorting to a pain relief method. The results also indicate that most of nurses think that a sleeping patient does not have any pain and pain relief should be postponed as it can influence the diagnosis negatively. It is determined that the pain scale was not used frequently. Only 35.1% of nurses reported keeping records of pain. Despite all the recommendations of substantial past research the results of this study indicate that emergency nurses continue to demonstrate inadequate knowledge, clinical decision-making skills and negative attitudes about pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Security, Violent Events, and Anticipated Surge Capabilities of Emergency Departments in Washington State

    Science.gov (United States)

    Weyand, Jonathan S.; Junck, Emily; Kang, Christopher S.; Heiner, Jason D.

    2017-01-01

    Introduction Over the past 15 years, violent threats and acts against hospital patients, staff, and providers have increased and escalated. The leading area for violence is the emergency department (ED) given its 24/7 operations, role in patient care, admissions gateway, and center for influxes during acute surge events. This investigation had three objectives: to assess the current security of Washington State EDs; to estimate the prevalence of and response to threats and violence in Washington State EDs; and to appraise the Washington State ED security capability to respond to acute influxes of patients, bystanders, and media during acute surge events. Methods A voluntary, blinded, 28-question Web-based survey developed by emergency physicians was electronically delivered to all 87 Washington State ED directors in January 2013. We evaluated responses by descriptive statistical analyses. Results Analyses occurred after 90% (78/87) of ED directors responded. Annual censuses of the EDs ranged from violent threats or acts occurring in their ED. Of these, 93% were directed towards nursing staff, 90% towards physicians, 74% towards security personnel, and 51% towards administrative personnel. Nearly half (48%) noted incidents directed towards another patient, and 50% towards a patient’s family or friend. These events were variably reported to the hospital administration. After an acute surge event, 35% believed the initial additional security response would not be adequate, with 26% reporting no additional security would be available within 15 minutes. Conclusion Our study reveals the variability of ED security staffing and a heterogeneity of capabilities throughout Washington State. These deficiencies and vulnerabilities highlight the need for other EDs and regional emergency preparedness planners to conduct their own readiness assessments. PMID:28435498

  8. 20 CFR 725.476 - Issuance of decision and order.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Issuance of decision and order. 725.476 Section 725.476 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR FEDERAL COAL... shall issue a decision and order with respect to the claim making an award to the claimant, rejecting...

  9. The WIPP decision plan: Charting the course for openness in the decision making process

    International Nuclear Information System (INIS)

    Hagers, J.

    1992-01-01

    In June of 1989, the Secretary of Energy requested that a plan be developed that would clearly outline the prerequisites to opening the Waste Isolation Pilot Plant (WIPP). It was to provide the basis for a decision making process that was not only visible to the public, but one which included public participation. It must also be dynamic enough to effectively deal with the changing legislative, regulatory, and technical environments. Based on a recognized need for openness, the Secretary's Draft Decision Plan was developed. The plan charted the course for ultimately making the decision to declare WIPP ready to receive waste for the start of test phase operations. It outlined to critics and supporters alike the rigorous and thorough process by which the internal decisions were made. The plan identified all internal prerequisites to the decision; charted the review cycles, and targeted the completion dates. It also outlined the processes outside the control of the Department, institutional issues, such as legislative land withdrawal, issuance of permits, and designation of transportation routes

  10. Overview of the US Department of Energy Light Water Reactor Sustainability Program

    International Nuclear Information System (INIS)

    McCarthy, K.A.; Williams, D.L.; Reister, R.

    2012-01-01

    The US Department of Energy Light Water Reactor Sustainability (LWRS) Program is focused on enabling the long-term operation of US commercial power plants. Decisions on life extension will be made by commercial power plant owners - the information provided by the research and development activities in the LWRS Program will reduce the uncertainty (and therefore the risk) associated with making those decisions. The LWRS Program encompasses two facets of long-term operation: (1) manage the aging of plant systems, structures, and components so that nuclear power plant lifetimes can be extended and the plants can continue to operate safely, efficiently, and economically; and (2) provide science-based solutions to the nuclear industry that support implementation of performance improvement technologies. An important aspect of the Light Water Reactor Sustainability Program is partnering with industry and the Nuclear Regulatory Commission to support and conduct the long-term research needed to inform major component refurbishment and replacement strategies, performance enhancements, plant license extensions, and age-related regulatory oversight decisions. The Department of Energy research, development, and demonstration role focuses on aging phenomena and issues that require long-term research and/or unique Department of Energy laboratory expertise and facilities and are applicable to all operating reactors. This paper provides an overview of the Department of Energy Light Water Reactor Sustainability Program, including vision, goals, and major deliverables. (author)

  11. 7 CFR 275.2 - State agency responsibilities.

    Science.gov (United States)

    2010-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF... knowledge of either the household or the decision under review. Where there is prior knowledge, the reviewer must disqualify her/himself. Prior knowledge is defined as having: (1) Taken any part in the decision...

  12. State-of-the-art radioecological models implemented in decision support systems for the management of the fresh water environment

    International Nuclear Information System (INIS)

    Monte, Luigi

    2007-01-01

    The present lecture summarises the main results of a review and assessment of state-of-the-art models implemented in computerised decision support systems aimed at assisting the management of fresh water ecosystems contaminated by radioactive substances. The approaches of the various models to simulate the complex behaviour of radionuclides in the aquatic environment were discussed. A critical analysis of the whole sector was carried out in order to frame in a comprehensive perspective several complementary issues: model uncertainty, environmental variability, information incompleteness, multi-model approach, use of models for the decision making. (author)

  13. TECHNICAL ASSESSMENT OF BULK VITRIFICATION PROCESS/ PRODUCT FOR TANK WASTE TREATMENT AT THE DEPARTMENT OF ENERGY HANFORD SITE

    International Nuclear Information System (INIS)

    SCHAUS, P.S.

    2006-01-01

    At the U.S. Department of Energy (DOE) Hanford Site, the Waste Treatment Plant (WTP) is being constructed to immobilize both high-level waste (IUW) for disposal in a national repository and low-activity waste (LAW) for onsite, near-surface disposal. The schedule-controlling step for the WTP Project is vitrification of the large volume of LAW, current capacity of the WTP (as planned) would require 50 years to treat the Hanford tank waste, if the entire LAW volume were to be processed through the WTP. To reduce the time and cost for treatment of Hanford Tank Waste, and as required by the Tank Waste Remediation System Environmental Impact Statement Record of Decision and the Hanford Federal Facility Consent Agreement (Tn-Party Agreement), DOE plans to supplement the LAW treatment capacity of the WTP. Since 2002, DOE, in cooperation with the Environmental Protection Agency and State of Washington Department of Ecology has been evaluating technologies that could provide safe and effective supplemental treatment of LAW. Current efforts at Hanford are intended to provide additional information to aid a joint agency decision on which technology will be used to supplement the WTP. A Research, Development and Demonstration permit has been issued by the State of Washington to build and (for a limited time) operate a Demonstration Bulk Vitrification System (DBVS) facility to provide information for the decision on a supplemental treatment technology for up to 50% of the LAW. In the Bulk Vitrification (BV) process, LAW, soil, and glass-forming chemicals are mixed, dried, and placed in a refractory-lined box, Electric current, supplied through two graphite electrodes in the box, melts the waste feed, producing a durable glass waste-form. Although recent modifications to the process have resulted in significant improvements, there are continuing technical concerns

  14. TECHNICAL ASSESSMENT OF BULK VITRIFICATION PROCESS & PRODUCT FOR TANK WASTE TREATMENT AT THE DEPARTMENT OF ENERGY HANFORD SITE

    Energy Technology Data Exchange (ETDEWEB)

    SCHAUS, P.S.

    2006-07-21

    At the U.S. Department of Energy (DOE) Hanford Site, the Waste Treatment Plant (WTP) is being constructed to immobilize both high-level waste (IUW) for disposal in a national repository and low-activity waste (LAW) for onsite, near-surface disposal. The schedule-controlling step for the WTP Project is vitrification of the large volume of LAW, current capacity of the WTP (as planned) would require 50 years to treat the Hanford tank waste, if the entire LAW volume were to be processed through the WTP. To reduce the time and cost for treatment of Hanford Tank Waste, and as required by the Tank Waste Remediation System Environmental Impact Statement Record of Decision and the Hanford Federal Facility Consent Agreement (Tn-Party Agreement), DOE plans to supplement the LAW treatment capacity of the WTP. Since 2002, DOE, in cooperation with the Environmental Protection Agency and State of Washington Department of Ecology has been evaluating technologies that could provide safe and effective supplemental treatment of LAW. Current efforts at Hanford are intended to provide additional information to aid a joint agency decision on which technology will be used to supplement the WTP. A Research, Development and Demonstration permit has been issued by the State of Washington to build and (for a limited time) operate a Demonstration Bulk Vitrification System (DBVS) facility to provide information for the decision on a supplemental treatment technology for up to 50% of the LAW. In the Bulk Vitrification (BV) process, LAW, soil, and glass-forming chemicals are mixed, dried, and placed in a refractory-lined box, Electric current, supplied through two graphite electrodes in the box, melts the waste feed, producing a durable glass waste-form. Although recent modifications to the process have resulted in significant improvements, there are continuing technical concerns.

  15. United States Department of Energy solar receiver technology development

    Science.gov (United States)

    Klimas, P. C.; Diver, R. B.; Chavez, J. M.

    The United States Department of Energy (DOE), through Sandia National Laboratories, has been conducting a Solar Thermal Receiver Technology Development Program, which maintains a balance between analytical modeling, bench and small scale testing, and experimentation conducted at scales representative of commercially-sized equipment. Central receiver activities emphasize molten salt-based systems on large scales and volumetric devices in the modeling and small scale testing. These receivers are expected to be utilized in solar power plants rated between 100 and 200 MW. Distributed receiver research focuses on liquid metal refluxing devices. These are intended to mate parabolic dish concentrators with Stirling cycle engines in the 5 to 25 kW(sub e) power range. The effort in the area of volumetric receivers is less intensive and highly cooperative in nature. A ceramic foam absorber of Sandia design was successfully tested on the 200 kW(sub t) test bed at Plataforma Solar during 1989. Material integrity during the approximately 90-test series was excellent. Significant progress has been made with parabolic dish concentrator-mounted receivers using liquid metals (sodium or a potassium/sodium mixture) as heat transport media. Sandia has successfully solar-tested a pool boiling reflux receiver sized to power a 25 kW Stirling engine. Boiling stability and transient operation were both excellent. This document describes these activities in detail and will outline plans for future development.

  16. 75 FR 27996 - Record of Decision (ROD) for the Training Land Acquisition (Including Purchase and Lease) at Fort...

    Science.gov (United States)

    2010-05-19

    ... DEPARTMENT OF DEFENSE Department of the Army Record of Decision (ROD) for the Training Land Acquisition (Including Purchase and Lease) at Fort Polk, LA AGENCY: Department of the Army, DoD. ACTION... which summarizes and documents its decision to proceed with Alternative 3, the acquisition of up to 100...

  17. 36 CFR 220.7 - Environmental assessment and decision notice.

    Science.gov (United States)

    2010-07-01

    ... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Environmental assessment and decision notice. 220.7 Section 220.7 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE NATIONAL ENVIRONMENTAL POLICY ACT (NEPA) COMPLIANCE § 220.7 Environmental assessment and decision notice. (a) Environmental assessment...

  18. 15 CFR 785.16 - Decisions.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false Decisions. 785.16 Section 785.16 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE ADDITIONAL PROTOCOL REGULATIONS ENFORCEMENT § 785.16...

  19. Decision Making on the Labor and Delivery Unit: An Investigation of Influencing Factors.

    Science.gov (United States)

    Gregory, Megan E; Sonesh, Shirley C; Feitosa, Jennifer; Benishek, Lauren E; Hughes, Ashley M; Salas, Eduardo

    2017-09-01

    Objective The aim of this study was to describe the relationship between negative affect (NA), decision-making style, time stress, and decision quality in health care. Background Health care providers must often make swift, high-stakes decisions. Influencing factors of the decision-making process in this context have been understudied. Method Within a sample of labor and delivery nurses, physicians, and allied personnel, we used self-report measures to examine the impact of trait factors, including NA, decision-making style, and perceived time stress, on decision quality in a situational judgment test (Study 1). In Study 2, we observed the influence of state NA, state decision-making style, state time stress, and their relationship with decision quality on real clinical decisions. Results In Study 1, we found that trait NA significantly predicted avoidant decision-making style. Furthermore, those who were higher on trait time stress and trait avoidant decision-making style exhibited poorer decisions. In Study 2, we observed associations between state NA with state avoidant and analytical decision-making styles. We also observed that these decision-making styles, when considered in tandem with time stress, were influential in predicting clinical decision quality. Conclusion NA predicts some decision-making styles, and decision-making style can affect decision quality under time stress. This is particularly true for state factors. Application Individual differences, such as affect and decision-making style, should be considered during selection. Training to reduce time stress perceptions should be provided.

  20. Some properties of focus points in one-shot decision theory

    OpenAIRE

    Guo, Peijun

    2011-01-01

    One-shot (one-time) decision problems concern the situations where a decision is experienced only once. Such one-shot decision problems are commonly encountered in business, economics and social systems. One-shot decision theory has been initially proposed by Guo [4]. The one-shot decision procedure comprises two steps. In the first step, a decision maker identifies which state of nature should be taken into account for each alternative amongst all available states of nature. These identified...

  1. FACTORS INFLUENCING DECISIONS FOR USING OUTSIDE FUNDS FOR FARM INVESTMENTS AND PROPRIETOR WITHDRAWALS BY SMALL-SCALE FARMERS IN ABIA STATE, NIGERIA

    Directory of Open Access Journals (Sweden)

    Chriso O. EMEROLE

    2013-08-01

    Full Text Available This study on factors influencing decisions for using outside funds for Farm investments and for proprietor withdrawals was carried out among rural small-scale farm households in Abia state, Nigeria. A cross-sectional survey of ninety (90 rural farm households of multi-type (varied enterprises was carried out using cluster random sampling technique in three communities, each chosen from one of the three agricultural zones of the state. Results indicated rural household level variables that positively influenced decisions to source farm investment fund to include level of education, gender, membership of cooperative society, interest charge, land acquisition method, and ease of getting loan. Other factors that negatively influenced decisions include farming as major occupation, household savings, household size, and distance of farmers’ home to source of credit. Proprietor withdrawal decisions were positively influenced by household level variables like taking farming as major occupation, payment of school fees for children of farmers, and amount of credit so far repaid by a farm household. Other factors namely household size, being member of cooperative society or savings group, interest charges on loan, off-farm income, and household savings had negative influences on proprietor withdrawal decisions. We recommended that small-scale farmers should not borrow their start-up capital from outside their households but as their farm businesses stabilize, they could decide to take loans from outside to cover their working capital and/or expand their farms and be prepared to repay such loans according to contractual agreements.

  2. Civil Remedies Division Administrative Law Judge Decisions

    Data.gov (United States)

    U.S. Department of Health & Human Services — Decisions issued by Administrative Law Judges of the Departmental Appeals Board's Civil Remedies Division concerning fraud and abuse determinations by the Office of...

  3. Factors Associated with Decision to Hospitalize Emergency Department Patients with Skin and Soft Tissue Infection

    Directory of Open Access Journals (Sweden)

    Talan, David A.

    2014-12-01

    Full Text Available Introduction: Emergency department (ED hospitalizations for skin and soft tissue infection (SSTI have increased, while concern for costs has grown and outpatient parenteral antibiotic options have expanded. To identify opportunities to reduce admissions, we explored factors that influence the decision to hospitalize an ED patient with a SSTI. Methods: We conducted a prospective study of adults presenting to 12 U.S. EDs with a SSTI in which physicians were surveyed as to reason(s for admission, and clinical characteristics were correlated with disposition. We employed chi-square binary recursive partitioning to assess independent predictors of admission. Serious adverse events were recorded. Results: Among 619 patients, median age was 38.7 years. The median duration of symptoms was 4.0 days, 96 (15.5% had a history of fever, and 46 (7.5% had failed treatment. Median maximal length of erythema was 4.0cm (IQR, 2.0-7.0. Upon presentation, 39 (6.3% had temperature >38oC, 81 (13.1% tachycardia, 35 (5.7%, tachypnea, and 5 (0.8% hypotension; at the time of the ED disposition decision, these findings were present in 9 (1.5%, 11 (1.8%, 7 (1.1%, and 3 (0.5% patients, respectively. Ninety-four patients (15.2% were admitted, 3 (0.5% to the intensive care unit (ICU. Common reasons for admission were need for intravenous antibiotics in 80 (85.1%; the only reason in 41.5%, surgery in 23 (24.5%, and underlying disease in 11 (11.7%. Hospitalization was significantly associated with the following factors in decreasing order of importance: history of fever (present in 43.6% of those admitted, and 10.5% discharged; maximal length of erythema >10cm (43.6%, 11.3%; history of failed treatment (16.1%, 6.0%; any co-morbidity (61.7%, 27.2%; and age >65 years (5.4%, 1.3%. Two patients required amputation and none had ICU transfer or died. Conclusion: ED SSTI patients with fever, larger lesions, and co-morbidities tend to be hospitalized, almost all to non-critical areas

  4. Risk-based decision-making: A reality at the INEL

    International Nuclear Information System (INIS)

    Halford, V.E.; Nitschke, R.L.; Hula, G.A.

    1994-01-01

    Risk Analysis and Risk Management are major components of the Idaho National Engineering Laboratory's (INEL's) environmental restoration and waste management program. These tools help define responsible and cost-effective approaches to address potential human health and environmental risks from past operational practices. These techniques along with stake holder involvement, play a key role in the decision-making process which involves the US Department of Energy Idaho Operations Office (DOE), the US Environmental Protection Agency Region 10 (EPA), and the State of Idaho Department of Health and Welfare (IDHW), hereafter referred to as the agencies. An example of how this process works is Pad A, an above-ground mixed waste disposal site composed mainly of transuranic-contaminated evaporation pond salts. The site was constructed in 1972 for the disposal of solid radioactive wastes. A Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) baseline risk assessment was conducted to determine the incremental cancer risk and potential for adverse health effects to the public and the impacts to the environment if no action was performed. The risk characterization indicated that the carcinogenic risk for current and future hypothetical scenarios was below or within the NCP acceptable risk range. There was a potential 10 year window for an adverse health effect to an infant from nitrate contamination of the groundwater in about 250 years. Based on these results, a responsible and sound decision was reached to maintain and recontour the existing soil cover and to perform monitoring to confirm modeling assumptions

  5. Decision process involved in preparing the Shippingport reactor pressure vessel for transport

    International Nuclear Information System (INIS)

    Murphie, W.E.

    1989-01-01

    The most significant part of the Shippingport Station Decommissioning Project was the one-piece removal and shipment of the reactor pressure vessel (RPV). Implicit in the RPV transport was the task of qualifying the RPV as a waste package acceptable for shipment. Soon after physical decommissioning began on September 1985, questions regarding the packaging certification and transport of the RPV from Shippingport, Pennsylvania to the US Department of Energy (DOE) Hanford Waste Burial Site necessitated reexamination of several planning assumptions. A complete reassessment of the regulatory requirements governing the RPV shipment resulted in a programmatic decision to obtain a type B(U) Certificate of Compliance and abandon the originally planned US Department of Transportation (DOT) low specific activity (LSA) shipment. The decision process resulting in this conclusion was extensive and involved many organizations and agencies. Incidental to this process, several subtle certification issues were identified that required resolution. Some of these issues involved the definition of LSA material for large packages; interpretation and compliance with DOE, DOT and US Nuclear Regulatory Commission (NRC) regulations for the transport of radioactive material; incorporation of the International Atomic Energy Agency (IAEA) regulations by the Panama Canal; and DOE policy requiring advance notification to states of radioactive waste shipments. 2 figs

  6. Decision process involved in preparing the Shippingport reactor pressure vessel for transport

    International Nuclear Information System (INIS)

    Murphie, W.E.

    1990-01-01

    The most significant part of the Shippingport Station Decommissioning Project was the one-piece removal and shipment of the reactor pressure vessel (RPV). Implicit in the RPV transport was the task of qualifying the RPV as a waste package acceptable for shipment. Soon after physical decommissioning began on September, 1985, questions regarding the packaging certification and transport of the RPV from Shippingport, Pennsylvania to the U.S. Department of Energy (DOE) Hanford waste burial site necessitated reexamination of several planning assumptions. A complete reassessment of the regulatory requirements governing the RPV shipment resulting in a programmatic decision to obtain a Type B(U) Certification of Compliance and abandon the originally planned U.S. Department of Transportation (DOT) low specific activity (LSA) shipment. The decision process resulting in this conclusion was extensive and involved many organizations and agencies. Incidental to this process, several subtle certification issues were identified that required resolution. Some of these issues involved the definition of LSA material for large packages; interpretation and compliance with DOE, DOT and U.S. Nuclear Regulatory Commission (NRC) regulations for the transport of radioactive material; incorporation of the International Atomic Energy Agency (IAEA) regulations by the Panama Canal; and DOE policy requiring advance notification to states of radioactive waste shipments

  7. Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: a sociotechnical analysis.

    Science.gov (United States)

    Sheehan, Barbara; Nigrovic, Lise E; Dayan, Peter S; Kuppermann, Nathan; Ballard, Dustin W; Alessandrini, Evaline; Bajaj, Lalit; Goldberg, Howard; Hoffman, Jeffrey; Offerman, Steven R; Mark, Dustin G; Swietlik, Marguerite; Tham, Eric; Tzimenatos, Leah; Vinson, David R; Jones, Grant S; Bakken, Suzanne

    2013-10-01

    Integration of clinical decision support services (CDSS) into electronic health records (EHRs) may be integral to widespread dissemination and use of clinical prediction rules in the emergency department (ED). However, the best way to design such services to maximize their usefulness in such a complex setting is poorly understood. We conducted a multi-site cross-sectional qualitative study whose aim was to describe the sociotechnical environment in the ED to inform the design of a CDSS intervention to implement the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules for children with minor blunt head trauma. Informed by a sociotechnical model consisting of eight dimensions, we conducted focus groups, individual interviews and workflow observations in 11 EDs, of which 5 were located in academic medical centers and 6 were in community hospitals. A total of 126 ED clinicians, information technology specialists, and administrators participated. We clustered data into 19 categories of sociotechnical factors through a process of thematic analysis and subsequently organized the categories into a sociotechnical matrix consisting of three high-level sociotechnical dimensions (workflow and communication, organizational factors, human factors) and three themes (interdisciplinary assessment processes, clinical practices related to prediction rules, EHR as a decision support tool). Design challenges that emerged from the analysis included the need to use structured data fields to support data capture and re-use while maintaining efficient care processes, supporting interdisciplinary communication, and facilitating family-clinician interaction for decision-making. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Final Scientifc Report - Hydrogen Education State Partnership Project

    Energy Technology Data Exchange (ETDEWEB)

    Leon, Warren

    2012-02-03

    Under the leadership of the Department of Energy Hydrogen and Fuel Cells program, Clean Energy States Alliance (CESA) educated and worked with state leaders to encourage wider deployment of fuel cell and hydrogen technologies. Through outreach to state policymakers, legislative leaders, clean energy funds, energy agencies, and public utility commissions, CESA worked to accomplish the following objectives of this project: 1. Provide information and technical assistance to state policy leaders and state renewable energy programs in the development of effective hydrogen fuel cell programs. 2. Identify and foster hydrogen program best practices. 3. Identify and promote strategic opportunities for states and the Department of Energy (DOE) to advance hydrogen technology deployment through partnerships, collaboration, and targeted activities. Over the three years of this project, CESA, with our partner National Conference of State Legislatures (NCSL), was able to provide credible information on fuel cell policies, finance, and technical assistance to hundreds of state officials and other stakeholders. CESA worked with its membership network to effectively educate state clean energy policymakers, program managers, and decision makers about fuel cell and hydrogen technologies and the efforts by states to advance those technologies. With the assistance of NCSL, CESA gained access to an effective forum for outreach and communication with state legislators from all 50 states on hydrogen issues and policies. This project worked to educate policymakers and stakeholders with the potential to develop and deploy stationary and portable fuel cell technologies.

  9. Capturing a Commander's decision making style

    Science.gov (United States)

    Santos, Eugene; Nguyen, Hien; Russell, Jacob; Kim, Keumjoo; Veenhuis, Luke; Boparai, Ramnjit; Stautland, Thomas Kristoffer

    2017-05-01

    A Commander's decision making style represents how he weighs his choices and evaluates possible solutions with regards to his goals. Specifically, in the naval warfare domain, it relates the way he processes a large amount of information in dynamic, uncertain environments, allocates resources, and chooses appropriate actions to pursue. In this paper, we describe an approach to capture a Commander's decision style by creating a cognitive model that captures his decisionmaking process and evaluate this model using a set of scenarios using an online naval warfare simulation game. In this model, we use the Commander's past behaviors and generalize Commander's actions across multiple problems and multiple decision making sequences in order to recommend actions to a Commander in a manner that he may have taken. Our approach builds upon the Double Transition Model to represent the Commander's focus and beliefs to estimate his cognitive state. Each cognitive state reflects a stage in a Commander's decision making process, each action reflects the tasks that he has taken to move himself closer to a final decision, and the reward reflects how close he is to achieving his goal. We then use inverse reinforcement learning to compute a reward for each of the Commander's actions. These rewards and cognitive states are used to compare between different styles of decision making. We construct a set of scenarios in the game where rational, intuitive and spontaneous decision making styles will be evaluated.

  10. Annual progress report of the Department of Solid State Physics

    International Nuclear Information System (INIS)

    Als-Nielsen, J.; Skov Pedersen, J.; Lebech, B.

    1992-01-01

    Research in the department covers the field of condensed matter physics. The principal activities of the department are presented in the Progress Report covering the period from 1 January to 31 December 1991. The condensed matter physics research is predominantly experimental utilizing diffraction of neutrons and X-rays. The research topics range from studies of two- and three-dimensional structures, magnetic ordering, heavy femions, high T c superconductivity, phase transitions in model systems to studies of precipitation phenomena and nano-scale structures in various materials. The major interest of the department is in basic research, but projects of more applied nature are often taken up, prompted by the applicability of the developed technique and expertise. (au) 2 tabs., 94 ills., 82 refs

  11. 76 FR 65710 - Decision and Order Amending Waivers Granted to Mitsubishi Electric & Electronics USA, Inc. From...

    Science.gov (United States)

    2011-10-24

    ... DEPARTMENT OF ENERGY Office of Energy Efficiency and Renewable Energy [Case No. CAC-037] Decision and Order Amending Waivers Granted to Mitsubishi Electric & Electronics USA, Inc. From the Department... Efficiency and Renewable Energy. Decision and Order In the Matter of: Mitsubishi Electric & Electronics USA...

  12. Strategic larval decision-making in a bivoltine butterfly.

    Science.gov (United States)

    Friberg, Magne; Dahlerus, Josefin; Wiklund, Christer

    2012-07-01

    In temperate areas, insect larvae must decide between entering winter diapause or developing directly and reproducing in the same season. Long daylength and high temperature promote direct development, which is generally associated with a higher growth rate. In this work, we investigated whether the larval pathway decision precedes the adjustment of growth rate (state-independent), or whether the pathway decision is conditional on the individual's growth rate (state-dependent), in the butterfly Pieris napi. This species typically makes the pathway decision in the penultimate instar. We measured growth rate throughout larval development under two daylengths: slightly shorter and slightly longer than the critical daylength. Results indicate that the pathway decision can be both state-independent and state-dependent; under the shorter daylength condition, most larvae entered diapause, and direct development was chosen exclusively by a small subset of larvae showing the highest growth rates already in the early instars; under the longer daylength condition, most larvae developed directly, and the diapause pathway was chosen exclusively by a small subset of slow-growing individuals. Among the remainder, the choice of pathway was independent of the early growth rate; larvae entering diapause under the short daylength grew as fast as or faster than the direct developers under the longer daylength in the early instars, whereas the direct developers grew faster than the diapausers only in the ultimate instar. Hence, the pathway decision was state-dependent in a subset with a very high or very low growth rate, whereas the decision was state-independent in the majority of the larvae, which made the growth rate adjustment downstream from the pathway decision.

  13. Datafication of Automated (Legal) Decisions

    DEFF Research Database (Denmark)

    Schaumburg-Müller, Sten

    Even though I maintain that it is a misconception to state that states are “no longer” the only actors, since they never were, indeed it makes sense to “shed light on the impact of (…) new tendencies on legal regulatory mechanisms (…)” One regulatory tendency is obviously the automation of (legal......) decisions which has implications for legal orders, legal actors and legal research, not to mention legal legitimacy as well as personal autonomy and democracy. On the one hand automation may facilitate better, faster, more predictable and more coherent decisions and leave cumbersome and time consuming...... a substantial part of the components of the decisions are prefabricated. With a risk of misplacing the responsibility, this may be called the “google syndrome”. The hidden algorithms may also constitute the basis for decisions concerning individuals (the passive aspect), the “profiling syndrome”. Based on big...

  14. Affective state influences perception by affecting decision parameters underlying bias and sensitivity.

    Science.gov (United States)

    Lynn, Spencer K; Zhang, Xuan; Barrett, Lisa Feldman

    2012-08-01

    Studies of the effect of affect on perception often show consistent directional effects of a person's affective state on perception. Unpleasant emotions have been associated with a "locally focused" style of stimulus evaluation, and positive emotions with a "globally focused" style. Typically, however, studies of affect and perception have not been conducted under the conditions of perceptual uncertainty and behavioral risk inherent to perceptual judgments outside the laboratory. We investigated the influence of perceivers' experienced affect (valence and arousal) on the utility of social threat perception by combining signal detection theory and behavioral economics. We compared 3 perceptual decision environments that systematically differed with respect to factors that underlie uncertainty and risk: the base rate of threat, the costs of incorrect identification threat, and the perceptual similarity of threats and nonthreats. We found that no single affective state yielded the best performance on the threat perception task across the 3 environments. Unpleasant valence promoted calibration of response bias to base rate and costs, high arousal promoted calibration of perceptual sensitivity to perceptual similarity, and low arousal was associated with an optimal adjustment of bias to sensitivity. However, the strength of these associations was conditional upon the difficulty of attaining optimal bias and high sensitivity, such that the effect of the perceiver's affective state on perception differed with the cause and/or level of uncertainty and risk.

  15. FORECASTING THE CHANGE IN THE TEACHER'S CONTRIBUTION TO THE WORK OF THE DEPARTMENT USING THE METHODS OF DATA MINING

    Directory of Open Access Journals (Sweden)

    Oleksandr Yu. Melnykov

    2018-02-01

    Full Text Available The existing forms and methods of assessing the work of teachers of higher educational institutions are described. The conclusion is made that the combination of indicators into groups (categories and the introduction of different weight factors depends on the specifics of the institution and the prevailing ideas about the priority of this or that type of activity. Practically all the considered methods do not take into account the change in the contribution share of each teacher in the integral indicator of the work of the whole department (department, faculty. The goal was to predict the change in the contribution of an individual teacher to the indicators of a higher education institution by means of mathematical modeling and intellectual decision-making. The prediction task is identified as a suitable data mining task. Methods for forecasting the assessment of the work of teachers - regression and neural network - were chosen. An object-oriented model of a projected computer system in the language of visual modeling of UML is described. Diagrams of use cases, classes and states are given. The program implementation of the intellectual decision-making system for evaluating the work of teachers of a higher education institution and an example of the system's operation based on real data are described. Conclusions are made about a possible change in the contribution share of each teacher in the indicators of the department.

  16. Decommissioning of nuclear facilities by the United States Department of Energy Oak Ridge Field Office

    International Nuclear Information System (INIS)

    DeLozier, M.F.P.

    1992-01-01

    The Oak Ridge Field Office of the United States Department of Energy is projecting one of the largest decommissioning efforts in the nation during the next ten to twenty years. The nuclear facilities are varied with respect to the types of contaminants and types of structures and equipment involved. The facilities planned for decommissioning include 26 ORNL facilities (e.g., OGR, HRE, MSRE), 70 facilities at Oak Ridge K25 site, and the Y-12 plant at Oak Ridge. Innovative technologies are required to decommission the facilities and dispose of the waste generated. (R.P.)

  17. To buy or not buy? A review of affective priming in purchase decision

    Directory of Open Access Journals (Sweden)

    Mograbi GJ

    2012-08-01

    Full Text Available Gabriel JC Mograbi,1 Daniel C Mograbi21Department of Philosophy, UFMT – Federal University of Mato Grosso, Mato Grosso, Brazil; 2Department of Psychology, Institute of Psychiatry, King's College London, London, UKAbstract: The current paradigm of neuroeconomics goes beyond merely axiomatic models and contemplates the influence of psychological factors on economic decisions. Under this framework, the main aim of the current review is to address the influence of affective priming in purchase decision. For this purpose, we first summarize the affective priming literature, followed by a section concentrating on purchase-decision studies that show that this phenomenon is value-driven, going beyond the emotionless calculation of traditional utility models in microeconomics. Finally, both themes are connected by reviewing the available experiments investigating affective priming effects on economic and purchase decision. We discuss these findings within a framework that considers that humans, as biological entities, attribute salience to hedonic information, highlighting the value-driven nature of decision-making, especially purchase decisions.Keywords: affective priming, decision-making, purchase decision, prospective theory

  18. On the impact of optimisation models in maintenance decision making: the state of the art

    International Nuclear Information System (INIS)

    Dekker, Rommert; Scarf, Philip A.

    1998-01-01

    In this paper we discuss the state of the art in applications of maintenance optimisation models. After giving a short introduction to the area, we consider several ways in which models may be used to optimise maintenance, such as case studies, operational and strategic decision support systems, and give examples of each of them. Next we discuss several areas where the models have been applied successfully. These include civil structure and aeroplane maintenance. From a comparative point of view, we discuss future prospects

  19. Processing Information in Quantum Decision Theory

    OpenAIRE

    Yukalov, V. I.; Sornette, D.

    2008-01-01

    A survey is given summarizing the state of the art of describing information processing in Quantum Decision Theory, which has been recently advanced as a novel variant of decision making, based on the mathematical theory of separable Hilbert spaces. This mathematical structure captures the effect of superposition of composite prospects, including many incorporated intended actions. The theory characterizes entangled decision making, non-commutativity of subsequent decisions, and intention int...

  20. THE TOMSK SCIENTIFIC SCHOOL OF NEUROLOGISTS. TO THE 120TH ANNIVERSARY OF THE DEPARTMENT OF NEUROLOGY AND NEUROSURGERY OF SIBERIAN STATE MEDICAL UNIVERSITY

    Directory of Open Access Journals (Sweden)

    V. M. Alifirova

    2013-01-01

    Full Text Available The history of the development of the Tomsk Scientific School Neurologists and the past and current events in the Department of Neurology and Neurosurgery of Siberian State Medical University are described. The Department of Neurology was established in 1881–1882. At a different times the department was headed by many great Russian physicians such as Michail G. Kurlov, Leonid I. Omorokov, Nikolay V. Schubin, Nikolay I. Komandenko. In addition to the academic work the department leads research in many fields of neurology, including movement disorders, cerebrovascular diseases, demyelinating and paroxysmal diseases. 

  1. United States rejoin ITER

    International Nuclear Information System (INIS)

    Roberts, M.

    2003-01-01

    Upon pressure from the United States Congress, the US Department of Energy had to withdraw from further American participation in the ITER Engineering Design Activities after the end of its commitment to the EDA in July 1998. In the years since that time, changes have taken place in both the ITER activity and the US fusion community's position on burning plasma physics. Reflecting the interest in the United States in pursuing burning plasma physics, the DOE's Office of Science commissioned three studies as part of its examination of the option of entering the Negotiations on the Agreement on the Establishment of the International Fusion Energy Organization for the Joint Implementation of the ITER Project. These were a National Academy Review Panel Report supporting the burning plasma mission; a Fusion Energy Sciences Advisory Committee (FESAC) report confirming the role of ITER in achieving fusion power production, and The Lehman Review of the ITER project costing and project management processes (for the latter one, see ITER CTA Newsletter, no. 15, December 2002). All three studies have endorsed the US return to the ITER activities. This historical decision was announced by DOE Secretary Abraham during his remarks to employees of the Department's Princeton Plasma Physics Laboratory. The United States will be working with the other Participants in the ITER Negotiations on the Agreement and is preparing to participate in the ITA

  2. 75 FR 64350 - Notice of Availability of Record of Decision for the NextLight Renewable Power, LLC, Silver State...

    Science.gov (United States)

    2010-10-19

    ...Light Renewable Power, LLC, Silver State Solar Project Environmental Impact Statement AGENCY: Bureau of... CONTACT: Gregory Helseth, Renewable Energy Project Manager, phone: (702) 515-5173; address: BLM Southern...) announces the availability of the Record of Decision (ROD) for the NextLight Renewable Power, LLC, Silver...

  3. Relationships among Career and Life Stress, Negative Career thoughts, and Career Decision State: A Cognitive Information Processing Perspective

    Science.gov (United States)

    Bullock-Yowell, Emily; Peterson, Gary W.; Reardon, Robert C.; Leierer, Stephen J.; Reed, Corey A.

    2011-01-01

    According to cognitive information processing theory, career thoughts mediate the relationship between career and life stress and the ensuing career decision state. Using a sample of 232 college students and structural equation modeling, this study found that an increase in career and life stress was associated with an increase in negative career…

  4. Aggregate assessments support improved operational decision making

    International Nuclear Information System (INIS)

    Bauer, R.

    2003-01-01

    At Darlington Nuclear aggregate assessment of plant conditions is carried out in support of Operational Decision Making. This paper discusses how aggregate assessments have been applied to Operator Workarounds leading to improved prioritisation and alignment of work programs in different departments. As well, aggregate assessment of plant and human performance factors has been carried out to identify criteria which support conservative decision making in the main control room during unit transients. (author)

  5. 75 FR 60093 - Record of Decision for the United States Marine Corps Basewide Utilities Infrastructure Project...

    Science.gov (United States)

    2010-09-29

    ... Basewide Utilities Infrastructure Project at Marine Corps Base Camp Pendleton, CA AGENCY: Department of the... Environmental Policy Act (NEPA) of 1969, 42 United States Code (U.S.C.) Section 4332(2)(c), the regulations of the Council on Environmental Quality (CEQ) for Implementing the Procedural Provisions of NEPA (40 Code...

  6. Self Inflicted Injuries among Children in United States - estimates from a nationwide emergency department sample.

    Directory of Open Access Journals (Sweden)

    Naseem Sulyman

    Full Text Available OBJECTIVE: The objectives of the current study are to provide nationally representative estimates of hospital based emergency department visits (ED attributed to self inflicted injuries and attempted suicides among children in United States; and to identify potential methods of such intentional self inflicted injuries and attempted suicides. METHODS: The Nationwide Emergency Department Sample (year 2007 was used. All ED visits occurring among children (aged ≤18 years with an External Cause of Injury for any of self inflicted injuries were selected. Outcomes examined include hospital ED charges and hospitalization charges. All estimates were projected to national levels. RESULTS: 77,420 visits to hospital based emergency departments were attributed to self inflicted injuries among children (26,045 males and 51,370 females. The average age of the ED visits was 15.7 years. 134 patients died in ED's (106 males and 28 females and 93 died in hospitals following in-patient admission (75 males and 18 females. A greater proportion of male ED visits were discharged routinely as opposed to female ED visits (51.1% versus 44%. A greater proportion of male ED visits also died in the emergency departments compared to female visits (0.4% versus 0.05%. 17,965 ED visits necessitated admission into same hospital. The mean charge for each ED visit was $1,874. Self inflicted injuries by poisoning were the most frequently reported sources accounting for close to 70% of all ED visits. CONCLUSIONS: Females comprise a greater proportion of ED visits attributed to self inflicted injuries. 227 children died either in the ED's or in hospitals. The current study results highlight the burden associated with such injuries among children.

  7. Forced Displacement and State Council. The Judge who Had a Wide Range of Arguments but not a Broad Extent of Decisions

    Directory of Open Access Journals (Sweden)

    Miguel Andrés López Martínez

    2014-07-01

    Full Text Available People in forced displacement can receive reparations through the State liability declarations by a judge. Judgment could involve some disadvantages but it is still probably to overcome them if the judge attends experts’ recommendations. Theorists were inspired in unconstitutional statu quo showed by Constitutional Court in T-025 case in 2004. We attempt to identify the proposals that influenced the State liability area and specifically the way in which they changed the frame of administrative judge’s decisions. First, we identified 18 theoretical scape lines, as alternatives to understand in a wider sense the damage, its imputation and reparation in a judicial landscape. Second, we attempt to establish if the State Council was influenced by the theorists’ suggestions, by studying four decisions published from 2004 until 2010. The evidence has shown that the administrative judge was far from the theorists’ proposals, although his attempts to offer better conditions to the victims.

  8. State Decision-Makers Guide for Hazardous Waste Management: Defining Hazardous Wastes, Problem Recognition, Land Use, Facility Operations, Conceptual Framework, Policy Issues, Transportation.

    Science.gov (United States)

    Corson, Alan; And Others

    Presented are key issues to be addressed by state, regional, and local governments and agencies in creating effective hazardous waste management programs. Eight chapters broadly frame the topics which state-level decision makers should consider. These chapters include: (1) definition of hazardous waste; (2) problem definition and recognition; (3)…

  9. Forecasting the Emergency Department Patients Flow.

    Science.gov (United States)

    Afilal, Mohamed; Yalaoui, Farouk; Dugardin, Frédéric; Amodeo, Lionel; Laplanche, David; Blua, Philippe

    2016-07-01

    Emergency department (ED) have become the patient's main point of entrance in modern hospitals causing it frequent overcrowding, thus hospital managers are increasingly paying attention to the ED in order to provide better quality service for patients. One of the key elements for a good management strategy is demand forecasting. In this case, forecasting patients flow, which will help decision makers to optimize human (doctors, nurses…) and material(beds, boxs…) resources allocation. The main interest of this research is forecasting daily attendance at an emergency department. The study was conducted on the Emergency Department of Troyes city hospital center, France, in which we propose a new practical ED patients classification that consolidate the CCMU and GEMSA categories into one category and innovative time-series based models to forecast long and short term daily attendance. The models we developed for this case study shows very good performances (up to 91,24 % for the annual Total flow forecast) and robustness to epidemic periods.

  10. Restructuring a State Nutrition Education and Obesity Prevention Program: Implications of a Local Health Department Model for SNAP-Ed.

    Science.gov (United States)

    Wu, Helen W; Backman, Desiree; Kizer, Kenneth W

    The US Department of Agriculture Supplemental Nutrition Assistance Program-Education (SNAP-Ed) funds state programs to improve nutrition and physical activity in low-income populations through its Nutrition Education and Obesity Prevention grants. States vary in how they manage and structure these programs. California substantially restructured its program in 2012 to universally position local health departments (LHDs) as the programmatic lead in all jurisdictions. This study sought to determine whether California's reorganization aligned with desirable attributes of decentralized public management. This study conducted 40 in person, semistructured interviews with 57 local, state, and federal SNAP-Ed stakeholders between October 2014 and March 2015. Local respondents represented 15 counties in all 7 of California's SNAP-Ed regions. We identified 3 common themes that outlined advantages or disadvantages of local public management, and we further defined subthemes within: (1) coordination and communication (within local jurisdictions, across regions, between local and state), (2) efficiency (administrative, fiscal, program), and (3) quality (innovation, skills). We conducted qualitative content analysis to evaluate how respondents characterized the California experience for each theme, identifying positive and negative experiences. California's LHD model offers some distinct advantages, but the model does not exhibit all the advantages of decentralized public management. Strategic planning, partnerships, subcontracting, and fiscal oversight are closer to communities than previously. However, administrative burden remains high and LHDs are limited in their ability to customize programs on the basis of community needs because of state and federal constraints. California's use of a universal LHD model for SNAP-Ed is novel. Recent federal SNAP-Ed changes present an opportunity for other states to consider this structure. Employing small-scale approaches initially (eg

  11. Sequential Probability Ratio Test for Collision Avoidance Maneuver Decisions Based on a Bank of Norm-Inequality-Constrained Epoch-State Filters

    Science.gov (United States)

    Carpenter, J. R.; Markley, F. L.; Alfriend, K. T.; Wright, C.; Arcido, J.

    2011-01-01

    Sequential probability ratio tests explicitly allow decision makers to incorporate false alarm and missed detection risks, and are potentially less sensitive to modeling errors than a procedure that relies solely on a probability of collision threshold. Recent work on constrained Kalman filtering has suggested an approach to formulating such a test for collision avoidance maneuver decisions: a filter bank with two norm-inequality-constrained epoch-state extended Kalman filters. One filter models 1he null hypothesis 1ha1 the miss distance is inside the combined hard body radius at the predicted time of closest approach, and one filter models the alternative hypothesis. The epoch-state filter developed for this method explicitly accounts for any process noise present in the system. The method appears to work well using a realistic example based on an upcoming highly-elliptical orbit formation flying mission.

  12. Energy Decision Science and Informatics | Integrated Energy Solutions |

    Science.gov (United States)

    NREL Decision Science and Informatics Energy Decision Science and Informatics NREL utilizes and advances state-of-the-art decision science and informatics to help partners make well-informed energy decisions backed by credible, objective data analysis and insights to maximize the impact of energy

  13. Corrective Action Decision Document/Closure Report for Corrective Action Unit 477: Area 12 N-Tunnel Muckpile, Nevada Test Site

    Energy Technology Data Exchange (ETDEWEB)

    NSTec Environmental Restoration

    2010-03-15

    This Corrective Action Decision Document (CADD)/Closure Report (CR) was prepared by the Defense Threat Reduction Agency (DTRA) for Corrective Action Unit (CAU) 477, N-Tunnel Muckpile. This CADD/CR is consistent with the requirements of the Federal Facility Agreement and Consent Order (FFACO) agreed to by the State of Nevada, the U.S. Department of Energy, and the U.S. Department of Defense. Corrective Action Unit 477 is comprised of one Corrective Action Site (CAS): • 12-06-03, Muckpile The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation for closure with no further action, by placing use restrictions on CAU 477.

  14. Corrective Action Decision Document/Closure Report for Corrective Action Unit 476: Area 12 T-Tunnel Muckpile, Nevada Test Site

    Energy Technology Data Exchange (ETDEWEB)

    NSTec Environmental Restoration

    2010-03-15

    This Corrective Action Decision Document (CADD)/Closure Report (CR) was prepared by the Defense Threat Reduction Agency (DTRA) for Corrective Action Unit (CAU) 476, Area 12 T-Tunnel Muckpile. This CADD/CR is consistent with the requirements of the Federal Facility Agreement and Consent Order (FFACO) agreed to by the State of Nevada, the U.S. Department of Energy, and the U.S. Department of Defense. Corrective Action Unit 476 is comprised of one Corrective Action Site (CAS): • 12-06-02, Muckpile The purpose of this CADD/CR is to provide justification and documentation supporting the recommendation for closure in place with use restrictions for CAU 476.

  15. Probabilistic Analysis in Management Decision Making

    DEFF Research Database (Denmark)

    Delmar, M. V.; Sørensen, John Dalsgaard

    1992-01-01

    The target group in this paper is people concerned with mathematical economic decision theory. It is shown how the numerically effective First Order Reliability Methods (FORM) can be used in rational management decision making, where some parameters in the applied decision basis are uncertainty...... quantities. The uncertainties are taken into account consistently and the decision analysis is based on the general decision theory in combination with reliability and optimization theory. Examples are shown where the described technique is used and some general conclusion are stated....

  16. 45 CFR 99.33 - Effective date of Assistant Secretary's decision.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Effective date of Assistant Secretary's decision. 99.33 Section 99.33 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROCEDURE FOR HEARINGS FOR THE CHILD CARE AND DEVELOPMENT FUND Posthearing Procedures, Decisions § 99.33...

  17. Artificial Intelligence at Advanced Information and Decision Systems

    OpenAIRE

    McCune, Brian P.

    1981-01-01

    Advanced Information and Decision Systems (AI-DS) is a relatively new, employee-owned company that does basic and applied research, product development, and consulting in the fields of artificial intelligence, computer science, decision analysis, operations research, control theory, estimation theory, and signal processing. AI&DS performs studies, analyses, systems design and evaluation, and software development for a variety of industrial clients and government agencies, including the Depart...

  18. Public/stakeholder involvement at two Department of Energy sites: Case studies

    International Nuclear Information System (INIS)

    Gray, R.H.

    1995-01-01

    Efforts to communicate the results of environmental studies and involve the public in environmental decisions have increased nationwide. Outreach efforts at two US Department of Energy sites (i.e., the Hanford Site in southeastern Washington State and the Pantex Plant in the Texas Panhandle) have used a broad spectrum of communications media, including technical articles (open literature and symposium publications, annual and topical reports); information brochures and fact sheets; video productions; interactive exhibits, presentations at scientific, technical, civic, and other public meetings; and proactive interactions with the news media and with local, state, federal, and other agencies. In addition, representatives of local communities now operate offsite environmental monitoring stations and Native Americans are involved in studying cultural resources, fisheries, and other issues at Hanford and a program to obtain environmental samples from neighbor's property is underway at the Pantex Plant. All major environmental programs, such as the multi-year effort to reconstruct past radiological doses to offsite human populations at Hanford, are now conducted with open public participation

  19. Public/stakeholder involvement at two Department of Energy sites: Case studies

    Energy Technology Data Exchange (ETDEWEB)

    Gray, R.H. [Battelle Pantex, Amarillo, TX (United States)

    1995-12-31

    Efforts to communicate the results of environmental studies and involve the public in environmental decisions have increased nationwide. Outreach efforts at two US Department of Energy sites (i.e., the Hanford Site in southeastern Washington State and the Pantex Plant in the Texas Panhandle) have used a broad spectrum of communications media, including technical articles (open literature and symposium publications, annual and topical reports); information brochures and fact sheets; video productions; interactive exhibits, presentations at scientific, technical, civic, and other public meetings; and proactive interactions with the news media and with local, state, federal, and other agencies. In addition, representatives of local communities now operate offsite environmental monitoring stations and Native Americans are involved in studying cultural resources, fisheries, and other issues at Hanford and a program to obtain environmental samples from neighbor`s property is underway at the Pantex Plant. All major environmental programs, such as the multi-year effort to reconstruct past radiological doses to offsite human populations at Hanford, are now conducted with open public participation.

  20. Public involvement in radioactive waste management decisions

    International Nuclear Information System (INIS)

    1994-04-01

    Current repository siting efforts focus on Yucca Mountain, Nevada, where DOE's Office of Civilian Radioactive Waste Management (OCRWM) is conducting exploratory studies to determine if the site is suitable. The state of Nevada has resisted these efforts: it has denied permits, brought suit against DOE, and publicly denounced the federal government's decision to study Yucca Mountain. The state's opposition reflects public opinion in Nevada, and has considerably slowed DOE's progress in studying the site. The Yucca Mountain controversy demonstrates the importance of understanding public attitudes and their potential influence as DOE develops a program to manage radioactive waste. The strength and nature of Nevada's opposition -- its ability to thwart if not outright derail DOE's activities -- indicate a need to develop alternative methods for making decisions that affect the public. This report analyzes public participation as a key component of this openness, one that provides a means of garnering acceptance of, or reducing public opposition to, DOE's radioactive waste management activities, including facility siting and transportation. The first section, Public Perceptions: Attitudes, Trust, and Theory, reviews the risk-perception literature to identify how the public perceives the risks associated with radioactivity. DOE and the Public discusses DOE's low level of credibility among the general public as the product, in part, of the department's past actions. This section looks at the three components of the radioactive waste management program -- disposal, storage, and transportation -- and the different ways DOE has approached the problem of public confidence in each case. Midwestern Radioactive Waste Management Histories focuses on selected Midwestern facility-siting and transportation activities involving radioactive materials

  1. Users' experiences of an emergency department patient admission predictive tool: A qualitative evaluation.

    Science.gov (United States)

    Jessup, Melanie; Crilly, Julia; Boyle, Justin; Wallis, Marianne; Lind, James; Green, David; Fitzgerald, Gerard

    2016-09-01

    Emergency department overcrowding is an increasing issue impacting patients, staff and quality of care, resulting in poor patient and system outcomes. In order to facilitate better management of emergency department resources, a patient admission predictive tool was developed and implemented. Evaluation of the tool's accuracy and efficacy was complemented with a qualitative component that explicated the experiences of users and its impact upon their management strategies, and is the focus of this article. Semi-structured interviews were conducted with 15 pertinent users, including bed managers, after-hours managers, specialty department heads, nurse unit managers and hospital executives. Analysis realised dynamics of accuracy, facilitating communication and enabling group decision-making Users generally welcomed the enhanced potential to predict and plan following the incorporation of the patient admission predictive tool into their daily and weekly decision-making processes. They offered astute feedback with regard to their responses when faced with issues of capacity and communication. Participants reported an growing confidence in making informed decisions in a cultural context that is continually moving from reactive to proactive. This information will inform further patient admission predictive tool development specifically and implementation processes generally. © The Author(s) 2015.

  2. 25 CFR 273.72 - Appeal from decision to cancel contract for cause.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Appeal from decision to cancel contract for cause. 273.72 Section 273.72 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR INDIAN SELF-DETERMINATION AND... decision to cancel contract for cause. A contractor may appeal the decision of a Bureau official to cancel...

  3. 43 CFR 4.1393 - Status of decision pending administrative review.

    Science.gov (United States)

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Status of decision pending administrative review. 4.1393 Section 4.1393 Public Lands: Interior Office of the Secretary of the Interior DEPARTMENT... Program; Federal Program for Indian Lands) § 4.1393 Status of decision pending administrative review. 43...

  4. Moab, Utah: Using Energy Data to Target Carbon Reductions from Building Energy Efficiency (City Energy: From Data to Decisions)

    Energy Technology Data Exchange (ETDEWEB)

    Strategic Priorities and Impact Analysis Team, Office of Strategic Programs

    2017-11-01

    This fact sheet "Moab, Utah: Using Energy Data to Target Carbon Reductions from Building Energy Efficiency" explains how the City of Moab used data from the U.S. Department of Energy's Cities Leading through Energy Analysis and Planning (Cities-LEAP) and the State and Local Energy Data (SLED) programs to inform its city energy planning. It is one of ten fact sheets in the "City Energy: From Data to Decisions" series.

  5. A history of wind erosion prediction models in the United States Department of Agriculture: The Wind Erosion Prediction System (WEPS)

    Science.gov (United States)

    Development of the Wind Erosion Prediction System (WEPS) was officially inaugurated in 1985 by United States Department of Agriculture-Agricultural Research Service (USDA-ARS) scientists in response to customer requests, particularly those coming from the USDA Soil Conservation Service (SCS), for im...

  6. Decision about buying a gamma camera

    International Nuclear Information System (INIS)

    Ganatra, R.D.

    1992-01-01

    A large part of the referral to a nuclear medicine department is usually for imaging studies. Sooner or later, the nuclear medicine specialist will be called upon to make a decision about when and what type of gamma camera to buy. There is no longer an option of choosing between a rectilinear scanner and a gamma camera as the former is virtually out of the market. The decision that one has to make is when to invest in a gamma camera, and then on what basis to select the gamma camera

  7. Decision about buying a gamma camera

    Energy Technology Data Exchange (ETDEWEB)

    Ganatra, R D

    1993-12-31

    A large part of the referral to a nuclear medicine department is usually for imaging studies. Sooner or later, the nuclear medicine specialist will be called upon to make a decision about when and what type of gamma camera to buy. There is no longer an option of choosing between a rectilinear scanner and a gamma camera as the former is virtually out of the market. The decision that one has to make is when to invest in a gamma camera, and then on what basis to select the gamma camera 1 tab., 1 fig

  8. Working at the intersection of context, culture, and technology: Provider perspectives on antimicrobial stewardship in the emergency department using electronic health record clinical decision support.

    Science.gov (United States)

    Chung, Phillip; Scandlyn, Jean; Dayan, Peter S; Mistry, Rakesh D

    2017-11-01

    Antibiotic stewardship programs (ASPs) have not been fully developed for the emergency department (ED), in part the result of the barriers characteristic of this setting. Electronic health record-based clinical decision support (EHR CDS) represents a promising strategy to implement ASPs in the ED. We aimed to determine the cultural beliefs and structural barriers and facilitators to implementation of antimicrobial stewardship in the pediatric ED using EHR CDS. Interviews and focus groups were conducted with hospital and ED leadership, attending ED physicians, nurse practitioners, physician assistants, and residents at a single health system in Colorado. We reviewed and coded the data using constant comparative analysis and framework analysis until a final set of themes emerged. Two dominant perceptions shaped providers' perspectives on ASPs in the ED and EHR CDS: (1) maintaining workflow efficiency and (2) constrained decision-making autonomy. Clinicians identified structural barriers to ASPs, such as pace of the ED, and various beliefs that shaped patterns of practice, including accommodating the prescribing decisions of other providers and managing parental expectations. Recommendations to enhance uptake focused on designing a simple yet flexible user interface, providing clinicians with performance data, and on-boarding clinicians to enhance buy-in. Developing a successful ED-based ASP using EHR CDS should attend to technologic needs, the institutional context, and the cultural beliefs of practice associated with providers' antibiotic prescribing. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  9. Socioeconomic assessment guidance report: Determining the effects of amenity characteristics on business location decisions

    International Nuclear Information System (INIS)

    Allison, T.

    1993-02-01

    Evaluating perception-based impacts of hazardous waste facilities has become an increasingly important part of socioeconomic impact assessments in recent years. One area of discussion has been the potential effect of risk perceptions on business location decision making. This report evaluates the importance of environmental amenities (broadly defined to include natural, cultural, and recreational features; environmental quality; and other indexes of quality of life) with respect to decisions on locating both manufacturing and business service activities. It discusses the major theoretical and empirical issues that arise in attempting to determine the effects of environmental amenities on the location choices for businesses and business activities. This discussion is followed by a survey of major findings from the academic literature and a review of research by the state of Nevada. A number of recommendations for further research are also provided to help the US Department of Energy's Office of Civilian Radioactive Waste Management better understand the importance of perception-based impacts in business location decision making and estimate the scale of socioeconomic impacts that would result from siting a high-level waste repository in Nevada

  10. Decision Making under Uncertainty: A Neural Model based on Partially Observable Markov Decision Processes

    Directory of Open Access Journals (Sweden)

    Rajesh P N Rao

    2010-11-01

    Full Text Available A fundamental problem faced by animals is learning to select actions based on noisy sensory information and incomplete knowledge of the world. It has been suggested that the brain engages in Bayesian inference during perception but how such probabilistic representations are used to select actions has remained unclear. Here we propose a neural model of action selection and decision making based on the theory of partially observable Markov decision processes (POMDPs. Actions are selected based not on a single optimal estimate of state but on the posterior distribution over states (the belief state. We show how such a model provides a unified framework for explaining experimental results in decision making that involve both information gathering and overt actions. The model utilizes temporal difference (TD learning for maximizing expected reward. The resulting neural architecture posits an active role for the neocortex in belief computation while ascribing a role to the basal ganglia in belief representation, value computation, and action selection. When applied to the random dots motion discrimination task, model neurons representing belief exhibit responses similar to those of LIP neurons in primate neocortex. The appropriate threshold for switching from information gathering to overt actions emerges naturally during reward maximization. Additionally, the time course of reward prediction error in the model shares similarities with dopaminergic responses in the basal ganglia during the random dots task. For tasks with a deadline, the model learns a decision making strategy that changes with elapsed time, predicting a collapsing decision threshold consistent with some experimental studies. The model provides a new framework for understanding neural decision making and suggests an important role for interactions between the neocortex and the basal ganglia in learning the mapping between probabilistic sensory representations and actions that maximize

  11. The Effect of a State Department of Education Teacher Mentor Initiative on Science Achievement

    Science.gov (United States)

    Pruitt, Stephen L.; Wallace, Carolyn S.

    2012-06-01

    This study investigated the effectiveness of a southern state's department of education program to improve science achievement through embedded professional development of science teachers in the lowest performing schools. The Science Mentor Program provided content and inquiry-based coaching by teacher leaders to science teachers in their own classrooms. The study analyzed the mean scale scores for the science portion of the state's high school graduation test for the years 2004 through 2007 to determine whether schools receiving the intervention scored significantly higher than comparison schools receiving no intervention. The results showed that all schools achieved significant improvement of scale scores between 2004 and 2007, but there were no significant performance differences between intervention and comparison schools, nor were there any significant differences between various subgroups in intervention and comparison schools. However, one subgroup, economically disadvantaged (ED) students, from high-level intervention schools closed the achievement gap with ED students from no-intervention schools across the period of the study. The study provides important information to guide future research on and design of large-scale professional development programs to foster inquiry-based science.

  12. Factors associated with closures of emergency departments in the United States.

    Science.gov (United States)

    Hsia, Renee Y; Kellermann, Arthur L; Shen, Yu-Chu

    2011-05-18

    Between 1998 and 2008, the number of hospital-based emergency departments (EDs) in the United States declined, while the number of ED visits increased, particularly visits by patients who were publicly insured and uninsured. Little is known about the hospital, community, and market factors associated with ED closures. Federal law requiring EDs to treat all in need regardless of a patient's ability to pay may make EDs more vulnerable to the market forces that govern US health care. To determine hospital, community, and market factors associated with ED closures. Emergency department and hospital organizational information from 1990 through 2009 was acquired from the American Hospital Association (AHA) Annual Surveys (annual response rates ranging from 84%-92%) and merged with hospital financial and payer mix information available through 2007 from Medicare hospital cost reports. We evaluated 3 sets of risk factors: hospital characteristics (safety net [as defined by hospitals caring for more than double their Medicaid share of discharges compared with other hospitals within a 15-mile radius], ownership, teaching status, system membership, ED size, case mix), county population demographics (race, poverty, uninsurance, elderly), and market factors (ownership mix, profit margin, location in a competitive market, presence of other EDs). All general, acute, nonrural, short-stay hospitals in the United States with an operating ED anytime from 1990-2009. Closure of an ED during the study period. From 1990 to 2009, the number of hospitals with EDs in nonrural areas declined from 2446 to 1779, with 1041 EDs closing and 374 hospitals opening EDs. Based on analysis of 2814 urban acute-care hospitals, constituting 36,335 hospital-year observations over an 18-year study interval (1990-2007), for-profit hospitals and those with low profit margins were more likely to close than their counterparts (cumulative hazard rate based on bivariate model, 26% vs 16%; hazard ratio [HR], 1

  13. Ambulatory Healthcare Utilization in the United States: A System Dynamics Approach

    Science.gov (United States)

    Diaz, Rafael; Behr, Joshua G.; Tulpule, Mandar

    2011-01-01

    Ambulatory health care needs within the United States are served by a wide range of hospitals, clinics, and private practices. The Emergency Department (ED) functions as an important point of supply for ambulatory healthcare services. Growth in our aging populations as well as changes stemming from broader healthcare reform are expected to continue trend in congestion and increasing demand for ED services. While congestion is, in part, a manifestation of unmatched demand, the state of the alignment between the demand for, and supply of, emergency department services affects quality of care and profitability. The central focus of this research is to provide an explanation of the salient factors at play within the dynamic demand-supply tensions within which ambulatory care is provided within an Emergency Department. A System Dynamics (SO) simulation model is used to capture the complexities among the intricate balance and conditional effects at play within the demand-supply emergency department environment. Conceptual clarification of the forces driving the elements within the system , quantifying these elements, and empirically capturing the interaction among these elements provides actionable knowledge for operational and strategic decision-making.

  14. United States Department of Energy/United States Environmental Protection Agency beneficial uses program for the use of cesium-137

    International Nuclear Information System (INIS)

    Krenz, D.L.; McMullen, W.H.; Yeager, J.G.; Sivinski, J.S.

    1982-03-01

    The goal of the United States Department of Energy (US DOE) Beneficial Uses Program for use of Cesium-137 is to identify and develop ways in which this isotope can be utilized to aid in the solution of major national and international problems. Gamma radiation from Cesium-137 has been shown to be effective in reducing pathogens in sewage sludge to levels where reuse of the material in public areas meets current regulatory criteria for safety. The first full-scale demonstration of this technology is being actively pursued in Albuquerque, New Mexico. Similar gamma treatment has also proved effective in ridding food commodities of destructive insects. This paper discusses program research and engineering history related to sludge irradiation, current activities and future plans for sludge irradiation and plans regarding food irradiation

  15. 29 CFR 500.269 - Stay pending decision of the Secretary.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Stay pending decision of the Secretary. 500.269 Section 500.269 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR... Vacation of Order of Administrative Law Judge § 500.269 Stay pending decision of the Secretary. (a) The...

  16. On developing a prospecting tool for wind industry and policy decision support

    International Nuclear Information System (INIS)

    McKeown, Charles; Adelaja, Adesoji; Calnin, Benjamin

    2011-01-01

    This paper presents the rudiments of a Wind Prospecting Tool designed to inform private and public decision makers involved in wind industry development in reducing transaction costs associated with identifying areas of mutual focus within a state. The multiple layer decision support framework has proven to be valuable to industry, state government and local decision makers. Information on wind resources, land availability, potential land costs, potential NIMBYism concerns and economic development potential were integrated to develop a framework for decision support. The paper also highlights implications for decision support research and the role of higher education in providing anticipatory science to enhance private and public choices in economic development. - Research Highlights: →In this paper we explore the building and value of a wind industry location decision support tool. →We examine the development process from the industry perspective. →We discuss the creation of a decision support tool that was designed for industry, state policy makers and local decision makers. →We build a model framework for wind prospecting decision support. →Finally we discuss the impact on local and state decision making as a result of being informed by science based decision support.

  17. 19 CFR 115.18 - Decision of Commissioner of Customs final.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Decision of Commissioner of Customs final. 115.18 Section 115.18 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY CARGO CONTAINER AND ROAD VEHICLE CERTIFICATION PURSUANT TO INTERNATIONAL CUSTOMS...

  18. Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Dirk T Ubbink

    2008-11-01

    Full Text Available Dirk T Ubbink1,2, Anouk M Knops1, Sjaak Molenaar1, Astrid Goossens11Department of Quality Assurance and Process Innovation and 2Department of Surgery, Academic Medical Center, Amsterdam, The NetherlandsObjective: To design, develop, and evaluate an evidence-based decision aid (DA for patients with an asymptomatic abdominal aortic aneurysm (AAA to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation and to help them make a shared decision.Methods: A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS. Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool.Results: A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients.Conclusion: This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values.Keywords: decision support techniques, research design, program development, abdominal aortic aneurysm, decision making

  19. 31 CFR 223.20 - Final decisions.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Final decisions. 223.20 Section 223.20 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE SURETY COMPANIES DOING BUSINESS WITH THE UNITED...

  20. The Department of Energy's Remedial Action Assessment System (RAAS): Decision support tools for performing streamlined feasibility studies

    International Nuclear Information System (INIS)

    White, M.K.

    1994-06-01

    The United States Department of Energy (DOE) faces the major task of cleaning up hundreds of waste sites across the nation, which will require completion of a large number of remedial investigation/feasibility studies (RI/FSs). The intent of each RI/FS is to characterize the waste problems and environmental conditions at the operable unit level, segment the remediation problem into manageable medium-specific and contaminant-specific pieces, define corresponding remediation objectives, and identify remedial response actions to satisfy those objectives. The RI/FS team can then identify combinations of remediation technologies that will meet the remediation objectives. Finally, the team must evaluate these remedial alternatives in terms of effectiveness, implementability, cost, and acceptability. The Remedial Action Assessment System (RAAS) is being developed by Pacific Northwest Laboratory (PNL) to support DOE in this effort

  1. Corrective Action Decision Document/Closure Report for Corrective Action Unit 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Matthews, Patrick [Navarro-Intera, LLC (N-I), Las Vegas, NV (United States)

    2013-11-01

    This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. This complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The purpose of the CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed.

  2. Emergency Department Sickle Cell Assessment of Needs and Strengths (ED-SCANS), a Focus Group and Decision Support Tool Development Project

    Science.gov (United States)

    Tanabe, Paula; Reddin, Christopher; Thornton, Victoria L.; Todd, Knox H.; Wun, Ted; Lyons, John S.

    2010-01-01

    Objectives A decision support tool may guide emergency clinicians in recognizing assessment, analgesic and overall management, and health service delivery needs for patients with sickle cell disease (SCD) in the emergency department (ED). We aimed to identify data and process elements important in making decisions regarding evaluation and management of adult patients in the ED with painful episodes of sickle cell disease. Methods Qualitative methods using a series of focus groups and grounded theory were used. Eligible participants included adult clients with SCD, and emergency physicians and nurses with a minimum of one year of experience providing care to patients with SCD in the ED. Patients were recruited in conjunction with annual SCD meetings, and providers included clinicians who were and were not affiliated with sickle cell centers. Groups were conducted until saturation was reached, and included a total of two patient groups, three physician groups, and two nurse groups. Focus groups were held in New York, Durham, Chicago, New Orleans, and Denver. Clinician participants were asked the following three questions to guide the discussion: 1) what information would be important to know about patients with SCD in the ED setting to effectively care for them and help you identify patient analgesic, treatment, and referral needs? 2) what treatment decisions would you make with this information? and 3) what characteristics would a decision support tool need to have to make it meaningful and useful? Client participants were asked the same questions with re-wording to reflect what they believed providers should know to provide the best care, and what they should do with the information. All focus groups were audio taped and transcribed. The constant comparative method was used to analyze the data. Two coders independently coded participant responses and identified focal themes based on the key questions. An investigator and assistant independently reviewed the

  3. Participation in the United States Department of Energy Reactor Sharing Program. Annual report, September 1981-August 1982

    International Nuclear Information System (INIS)

    Brenizer, J.S.; Benneche, P.E.

    1982-12-01

    The University of Virginia Reactor Facility is an integral part of the Department of Nuclear Engineering and Engineering Physics and is used to support educational programs in engineering and science at the University of Virginia and at other area colleges and universities. The University of Virginia Research Reactor (UVAR) is the highest power (two megawatts thermal power) and most utilized (total power production in 1981 and nearly 5000 megawatt-hours) research reactor in the mid-Atlantic States. In addition, a second, small (50 watt) reactor is also available for use in educational programs in the region. The University of Virginia has received support under the US Department of Energy (DOE) Reactor Sharing Program every year since 1978 to assist in meeting this objective. This report documents the major educational accomplishments under the Reactor Sharing Program for the period September 1981 through August 1982

  4. Opportunities for addressing laminated root rot caused by Phellinus sulphuracens in Washington's forests: A Report from the Washington State Academy of Sciences in cooperation with the Washington State Department of Natural Resources

    Science.gov (United States)

    R. James Cook; Robert L. Edmonds; Ned B. Klopfenstein; Willis Littke; Geral McDonald; Daniel Omdahl; Karen Ripley; Charles G. Shaw; Rona Sturrock; Paul Zambino

    2013-01-01

    This report from the Washington State Academy of Sciences (WSAS) is in response to a request from the Washington State Department of Natural Resources (DNR) to "identify approaches and opportunities ripe for research on understanding and managing root diseases of Douglas-fir." Similar to the process used by the National Research Council, the WSAS upon...

  5. Department of Energy (DOE) transportation system for nuclear materials and the role of state law enforcement agencies

    International Nuclear Information System (INIS)

    Jones, J.M.; Hoover, T.W.

    1978-01-01

    The Department of Energy has been assigned the responsibility for the safe and secure movement of strategic quantities of government-owned special nuclear material as well as classified material. To accomplish this mission, a transportation system has been developed which takes advantage of advanced technology and other features to reduce vulnerability to terrorists. The system consists of a careful balance of specially-trained personnel, procedures and sophisticated equipment. These, in combination, generally allow the system to be self-sufficient. However, should the need arise, DOE will request assistance from state law enforcement agencies. The primary contact for assistance is the state police or highway patrol. DOE, with the assistance of Sandia Laboratories, has surveyed state police agencies throughout the nation. A data base has been created which includes the results of these surveys and a numerical description of DOE transportation routes. This data base, along with a ''Response'' model developed by Sandia Laboratories, allows projections of officer availability to be made for all of DOE's routes. This paper will describe the DOE Transportation System, the role of state law enforcement agencies in support of the system, the nationwide state policy survey, and the operation of the response computer model

  6. How social cognition can inform social decision making

    Science.gov (United States)

    Lee, Victoria K.; Harris, Lasana T.

    2013-01-01

    Social decision-making is often complex, requiring the decision-maker to make inferences of others' mental states in addition to engaging traditional decision-making processes like valuation and reward processing. A growing body of research in neuroeconomics has examined decision-making involving social and non-social stimuli to explore activity in brain regions such as the striatum and prefrontal cortex, largely ignoring the power of the social context. Perhaps more complex processes may influence decision-making in social vs. non-social contexts. Years of social psychology and social neuroscience research have documented a multitude of processes (e.g., mental state inferences, impression formation, spontaneous trait inferences) that occur upon viewing another person. These processes rely on a network of brain regions including medial prefrontal cortex (MPFC), superior temporal sulcus (STS), temporal parietal junction, and precuneus among others. Undoubtedly, these social cognition processes affect social decision-making since mental state inferences occur spontaneously and automatically. Few studies have looked at how these social inference processes affect decision-making in a social context despite the capability of these inferences to serve as predictions that can guide future decision-making. Here we review and integrate the person perception and decision-making literatures to understand how social cognition can inform the study of social decision-making in a way that is consistent with both literatures. We identify gaps in both literatures—while behavioral economics largely ignores social processes that spontaneously occur upon viewing another person, social psychology has largely failed to talk about the implications of social cognition processes in an economic decision-making context—and examine the benefits of integrating social psychological theory with behavioral economic theory. PMID:24399928

  7. How social cognition can inform social decision making.

    Science.gov (United States)

    Lee, Victoria K; Harris, Lasana T

    2013-12-25

    Social decision-making is often complex, requiring the decision-maker to make inferences of others' mental states in addition to engaging traditional decision-making processes like valuation and reward processing. A growing body of research in neuroeconomics has examined decision-making involving social and non-social stimuli to explore activity in brain regions such as the striatum and prefrontal cortex, largely ignoring the power of the social context. Perhaps more complex processes may influence decision-making in social vs. non-social contexts. Years of social psychology and social neuroscience research have documented a multitude of processes (e.g., mental state inferences, impression formation, spontaneous trait inferences) that occur upon viewing another person. These processes rely on a network of brain regions including medial prefrontal cortex (MPFC), superior temporal sulcus (STS), temporal parietal junction, and precuneus among others. Undoubtedly, these social cognition processes affect social decision-making since mental state inferences occur spontaneously and automatically. Few studies have looked at how these social inference processes affect decision-making in a social context despite the capability of these inferences to serve as predictions that can guide future decision-making. Here we review and integrate the person perception and decision-making literatures to understand how social cognition can inform the study of social decision-making in a way that is consistent with both literatures. We identify gaps in both literatures-while behavioral economics largely ignores social processes that spontaneously occur upon viewing another person, social psychology has largely failed to talk about the implications of social cognition processes in an economic decision-making context-and examine the benefits of integrating social psychological theory with behavioral economic theory.

  8. How Social Cognition Can Inform Social Decision Making

    Directory of Open Access Journals (Sweden)

    Victoria eLee

    2013-12-01

    Full Text Available Social decision-making is often complex, requiring the decision-maker to make inferences of others’ mental states in addition to engaging traditional decision-making processes like valuation and reward processing. A growing body of research in neuroeconomics has examined decision- making involving social and nonsocial stimuli to explore activity in brain regions such as the striatum and prefrontal cortex, largely ignoring the power of the social context. Perhaps more complex processes may influence decision-making in social versus nonsocial contexts. Years of social psychology and social neuroscience research have documented a multitude of processes (e.g. mental state inferences, impression formation, spontaneous trait inferences that occur upon viewing another person. These processes rely on a network of brain regions including medial prefrontal cortex, superior temporal sulcus, temporal parietal junction, and precuneus among others. Undoubtedly, these social cognition processes affect social decision-making since mental state inferences occur spontaneously and automatically. Few studies have looked at how these social inference processes affect decision-making in a social context despite the capability of these inferences to serve as predictions that can guide future decision-making. Here we review and integrate the person perception and decision-making literatures to understand how social cognition can inform the study of social decision-making in a way that is consistent with both literatures. We identify gaps in both literatures—while behavioral economics largely ignores social processes that spontaneously occur upon viewing another person, social psychology has largely failed to talk about the implications of social cognition processes in an economic decision-making context—and examine the benefits of integrating social psychological theory with behavioral economic theory.

  9. Record of Decision for Amchitka Surface Closure, Alaska

    Energy Technology Data Exchange (ETDEWEB)

    None

    2008-08-01

    This Record of Decision has been prepared to document the remedial actions taken on Amchitka Island to stabilize contaminants associated with drilling mud pits generated as a result of nuclear testing operations conducted on the island. This document has been prepared in accordance with the recommended outline in the Alaska Department of Environmental Conservation guidance on decision documentation under the Site Cleanup Rules (18 AAC 75.325-18 AAC 75.390) (ADEC 1999). It also describes the decision-making process used to establish the remedial action plans and defines the associated human health and ecological risks for the remediation.

  10. United States Department of Energy Automated Transportation Management System

    International Nuclear Information System (INIS)

    Portsmouth, J.H.

    1992-01-01

    At the US Department of Energy (DOE) 80 transportation facilities, each contractor's transportation management operation has different internal and site specific procedures, and reports to a DOE regional Field Office Traffic Manager (FOTM). The DOE Transportation Management Program (TMP) has the responsibility to manage a transportation program for safe, efficient, and economical transportation of DOE-owned materials. The TMP develops and administers transportation/traffic operations management policies and programs for materials; including radioactive materials, other hazardous materials, hazardous substances, and hazardous wastes, pursuant to applicable federal regulations, such as the Code of Federal Register, Sections 40 and 49. Transportation management has become an increasingly critical primarily because of transportation issues regarding the shipment of radioactive materials and hazardous wastes that are frequently the focus of public concerns. A large shipments and requiring millions of business transactions necessitates the establishment of automated systems, programs, procedures, and controls to ensure that the transportation management process in being handled in a safe, efficient, and economical manner. As the mission of many DOE facilities changes from production of special nuclear materials for defense purposes to environmental restoration and waste management, the role of transportation management will become even more important to the safe and efficient movement of waste materials to prescribed locations. In support of this role, the Automated Transportation Management System (ATMS) was conceived to assist the DOE and its contractors in the performance of their day-to-day transportation management activities. The ATMS utilizes the latest in technology and will supply state-of-the-art automated transportation management for current and future DOE transportation requirements

  11. The Importance of Ethical Training for the Improvement of Ethical Decision-Making: Evidence from Germany and the United States

    Science.gov (United States)

    Rottig, Daniel; Heischmidt, Kenneth A.

    2007-01-01

    Based on three independent samples from Germany and the United States, this exploratory, cross-cultural study examines empirically the importance of ethical training for the improvement of ethical decision-making. The results of the study reveal a significant difference in the use of corporate codes of conduct and ethical training, as well as…

  12. Technical assistance from state health departments for communities engaged in policy, systems, and environmental change: the ACHIEVE Program.

    Science.gov (United States)

    Hefelfinger, Jenny; Patty, Alice; Ussery, Ann; Young, Walter

    2013-10-24

    This study assessed the value of technical assistance provided by state health department expert advisors and by the staff of the National Association of Chronic Disease Directors (NACDD) to community groups that participated in the Action Communities for Health, Innovation, and Environmental Change (ACHIEVE) Program, a CDC-funded health promotion program. We analyzed quantitative and qualitative data reported by community project coordinators to assess the nature and value of technical assistance provided by expert advisors and NACDD staff and the usefulness of ACHIEVE resources in the development and implementation of community action plans. A grounded theory approach was used to analyze and categorize phrases in text data provided by community coordinators. Open coding placed conceptual labels on text phrases. Frequency distributions of the quantitative data are described and discussed. The most valuable technical assistance and program support resources were those determined to be in the interpersonal domain (ie, interactions with state expert advisors, NACDD staff, and peer-to-peer support). The most valuable technical assistance events were action institutes, coaches' meetings, webinars, and technical assistance conference calls. This analysis suggests that ACHIEVE communities valued the management and training assistance provided by expert advisors and NACDD staff. State health department expert advisors provided technical guidance and support, including such skills or knowledge-based services as best-practice strategies, review and discussion of community assessment data, sustainability planning, and identification of possible funding opportunities. NACDD staff led development and implementation of technical assistance events.

  13. Family Communication about End-of-Life Decisions and the Enactment of the Decision-Maker Role

    Directory of Open Access Journals (Sweden)

    April R. Trees

    2017-06-01

    Full Text Available End-of-life (EOL decisions in families are complex and emotional sites of family interaction necessitating family members coordinate roles in the EOL decision-making process. How family members in the United States enact the decision-maker role in EOL decision situations was examined through in-depth interviews with 22 individuals who participated in EOL decision-making for a family member. A number of themes emerged from the data with regard to the enactment of the decision-maker role. Families varied in how decision makers enacted the role in relation to collective family input, with consulting, informing and collaborating as different patterns of behavior. Formal family roles along with gender- and age-based roles shaped who took on the decision-maker role. Additionally, both family members and medical professionals facilitated or undermined the decision-maker’s role enactment. Understanding the structure and enactment of the decision-maker role in family interaction provides insight into how individuals and/or family members perform the decision-making role within a cultural context that values autonomy and self-determination in combination with collective family action in EOL decision-making.

  14. Visualization of Decision Tree State for the Classification of Parkinson's Disease

    NARCIS (Netherlands)

    Valentijn, E

    2016-01-01

    Decision trees have been shown to be effective at classifying subjects with Parkinson’s disease when provided with features (subject scores) derived from FDG-PET data. Such subject scores have strong discriminative power but are not intuitive to understand. We therefore augment each decision node

  15. Decision analysis with cumulative prospect theory.

    Science.gov (United States)

    Bayoumi, A M; Redelmeier, D A

    2000-01-01

    Individuals sometimes express preferences that do not follow expected utility theory. Cumulative prospect theory adjusts for some phenomena by using decision weights rather than probabilities when analyzing a decision tree. The authors examined how probability transformations from cumulative prospect theory might alter a decision analysis of a prophylactic therapy in AIDS, eliciting utilities from patients with HIV infection (n = 75) and calculating expected outcomes using an established Markov model. They next focused on transformations of three sets of probabilities: 1) the probabilities used in calculating standard-gamble utility scores; 2) the probabilities of being in discrete Markov states; 3) the probabilities of transitioning between Markov states. The same prophylaxis strategy yielded the highest quality-adjusted survival under all transformations. For the average patient, prophylaxis appeared relatively less advantageous when standard-gamble utilities were transformed. Prophylaxis appeared relatively more advantageous when state probabilities were transformed and relatively less advantageous when transition probabilities were transformed. Transforming standard-gamble and transition probabilities simultaneously decreased the gain from prophylaxis by almost half. Sensitivity analysis indicated that even near-linear probability weighting transformations could substantially alter quality-adjusted survival estimates. The magnitude of benefit estimated in a decision-analytic model can change significantly after using cumulative prospect theory. Incorporating cumulative prospect theory into decision analysis can provide a form of sensitivity analysis and may help describe when people deviate from expected utility theory.

  16. 15 CFR 785.7 - Summary decision.

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false Summary decision. 785.7 Section 785.7 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE ADDITIONAL PROTOCOL REGULATIONS ENFORCEMENT § 785.7 Summary...

  17. Framework of Uncertainty in Medical Decision Making

    DEFF Research Database (Denmark)

    Austin, L; Brodersen, John; Reventlow, Susanne

    Historically, medical decisions have primarily involved diagnosis and treatment of symptomatic patients. Increasingly, medical decisions concern uncertain future health states in asymptomatic people. We construct a taxonomy of five medical decision situations that encompasses these wider...... possibilities. For each, we identify potential sources of uncertainty that should be considered when assessing the degree of belief that a person has, or will have, a condition. Decision trees illustrate the normative structure of each situation. The five decision situations involve: 1) assessing...

  18. 30 CFR 746.13 - Decision document and recommendation on mining plan.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Decision document and recommendation on mining plan. 746.13 Section 746.13 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR FEDERAL LANDS PROGRAM REVIEW AND APPROVAL OF MINING PLANS § 746.13 Decision...

  19. The effectiveness of international regimes in states with low internal capacity : a study of international refugee regime in Afghanistan, Iraq and Sudan

    OpenAIRE

    Güler, Arzu

    2013-01-01

    Ankara : The Department of International Relations, İhsan Doğramacı Bilkent University, 2013. Thesis (Ph. D.) -- Bilkent University, 2013. Includes bibliographical references. Nearly one out of the six states in the world is regarded with low internal capacity by the Failed State Index 2012. However, having a priori assumption on states’ internal capacity to take decisions and implement them within their own states, scholarly attention has been given to the factors that shap...

  20. Student loan burden and its impact on career decisions in dermatology.

    Science.gov (United States)

    Nguyen, Jannett; Song, Eingun; Liu, Michael A; Lee, Patrick K; Truong, Sam

    2017-12-01

    Dermatology departments in the United States face difficulties in recruiting dermatologists to academic positions, raising concerns for the future of dermatology education and research. This preliminary study aimed to explore the impact of student loan burden on career plans in dermatology and to determine if the Public Service Loan Forgiveness (PSLF) program can be used as a recruitment tool for academic positions in dermatology. Results from this electronic survey, which was distributed to dermatology residents and attending physicians, revealed that debt burden may influence career decisions in dermatology. Dermatologists may not be fully educated on loan repayment options. With increased awareness, the PSLF can potentially be used as a recruitment tool for academic positions in dermatology.